By Florence Temu
As October approaches, all roads will lead to Zanzibar, the Indian Ocean archipelago, for the 11th Tanzania Health Summit. A thousand-plus health stakeholders from across 20 countries, including Tanzania will convene to discuss “Igniting progress: joining efforts for quality healthcare through public-private partnerships.”
This critical conversation comes at a time when governments worldwide are grappling with the pressing challenges of climate change. The World Health Organization (WHO) estimates that between 2030 and 2050, climate change will cause approximately 250,000 additional deaths per year from undernutrition, malaria, diarrhea, and heat stress alone. The direct damage costs to health are projected to be between US$2–4 billion per year by 2030.
During the summit, we will set the conversation on the urgent issue of climate change and its impact on including water security, food supply, and to the spread of vector-borne diseases in Tanzania, through a forum, titled: ” Strengthening Primary Health Facilities and Community Systems in Preparedness and Adaptation to Climate Change”.
In this forum, a team of experts and partners (from Amref, UNICEF, USAID, and Ministry of Health) will discuss in detail the preparedness and adaption processes in globally and in country as we strive to build climate resilient communities as well as their respective primary health care systems. By raising awareness, fostering collaboration, and promoting innovative solutions, we can work towards a healthier and more sustainable future for our country. Why?
Tanzania, including many African nations, are disproportionately affected by climate change despite contributing less than 10 percent of global greenhouse gas emissions. The Intergovernmental Panel on Climate Change (IPCC) confirms that climate-related illnesses, premature deaths, malnutrition, and threats to mental health are on the rise. Human activities have caused significant damage to ecosystems, leading to increased temperatures and extreme weather events such as droughts, floods, and hurricanes.
These occurrences have negatively impacted air, food, water, shelter, and social infrastructure, jeopardizing our health and existence.
The Sixth Assessment Report (AR6) of the IPCC highlights that in East Africa, malaria has spread to higher altitudes, while warmer temperatures are increasing infection rates. Rising temperatures are also contributing to spikes in cholera cases, particularly following tropical cyclones. Human mobility, water management, and sanitation practices further influence the transmission of vector-borne and waterborne diseases.
The frequent and intensified droughts and floods experienced in most parts of Africa are driving infections to new heights.
Heat-related deaths are also on the increase, with tens of millions of Africans exposed to extreme heat. For instance, the report finds that in South Africa, about 43.8% of heat-related deaths from 1991 to 2018 were attributable to climate change.
Additionally, climate change impacts agriculture through droughts and floods, leading to reduced food security and its cascading effects on nutrition. This has long-term consequences for child development, educational achievements, and pregnancy outcomes.
A worldwide study of 51 countries affected by the El Niño Southern Oscillation, most of which were in Africa, found that about 5.9 million additional children became underweight in 2015–2016. Africa is at risk of increased cases of malaria, waterborne diseases, malnutrition, and heat stress-related conditions. Extreme weather events can also cause serious damage to healthcare infrastructure, particularly in rural and peri-urban areas.
There are documented cases of floods and cyclones destroying health posts in affected communities. According to WHO, at least 56% of the 2121 public health events recorded between 2001 and 2021 were climate-related.
Floods can also damage other essential infrastructure at health facilities, compromising water treatment, sanitation facilities, and leading to disease outbreaks. The rate of temperature increase in Africa has accelerated in recent decades, making extreme weather events and climate hazards more severe.
The IPCC highlights that these impacts are unevenly distributed across and within societies and will continue to be experienced inequitably due to differences in exposure and vulnerability. Africa’s limited capacity to cope with cascading and compounding risks exacerbates this vulnerability.
Despite the dire situation, financing for climate adaptation remains insufficient. This scenario has made Africa one of the most vulnerable continents. With increased disease burden due to climate change, many African governments are stretched for resources, diverting funds from critical healthcare services to address climate change disasters.
Some countries are already spending as much as 9 percent of their Gross Domestic Products (GDPs) on climate adaptation support.
Climate change also disproportionately impacts the health of women and girls in marginalized communities, particularly in sub-Saharan Africa. Worsening climatic changes negatively affect gender inequalities, widening the g gap through socioeconomic, cultural, and physiological factors.
Several African countries are investing in climate-resilient health systems, such as renewable energy for health facilities, capacity building, and strengthening early warning systems.
The international community must continue to call for deep, rapid, and sustained reductions in greenhouse gas emissions (mitigation).
They must also commit to strengthening climate finance, technology transfer, and capacity building policies to maximize health gains from mitigation and adaptation actions. Close partnerships with indigenous peoples, local communities, women and girls, children and youth, healthcare workers, and vulnerable populations are essential.
Amref Health Africa Tanzania is implementing a strategic, integrated approach to combat climate-induced health challenges. At a broader picture, this strategy is addressing climate-related effects being major contributors of social determinants of health.
With emphasis on primary health care, on health systems and services delivery, while targeting infectious diseases, non-communicable diseases, diseases outbreaks, one-healthh, undernutrition, and gender disparities, to mention some, we are emphasizing on WASH interventions including infrastructures as we promote community resilience with deliberate adaptation interventions.
Through collective action with stakeholders on climate and health, we aim to drive more investments, bolster coordination, and propel evidence-based interventions. This will amplify our efforts in climate change mitigation and adaptation, ultimately fostering enduring health advancements.
The author is the Country Director for Amref Health Africa in Tanzania. The opinions expressed here are the author’s and don’t necessarily reflect the editorial position of The Citizen.
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Inside Tanzania’s Life-Saving Birthcare Model
Tanzania is winning the battle against maternal and newborn deaths, as the latest numbers reveal a significant decline.
“Tanzania is committed to reducing maternal and newborn mortality and ensuring safe deliveries as part of the national development plan. The Safer Births Bundle of Care is one of the key strategies supporting this effort,” said Dr. Benjamin Kamala, the Senior Research Scientist at Haydom Lutheran Hospital and Principal Investigator for the program, leading its implementation across five regions in Tanzania.
A groundbreaking study published in the New England Journal of Medicine shows that the innovative health program in Tanzania – centered on regular, on-the-job training for healthcare workers – reduced maternal deaths by 75% and early newborn deaths by 40%. The three-year study, conducted across 30 high-burden healthcare facilities in Tanzania, tracked approximately 300,000 mother-baby pairs under the Safer Births Bundle of Care (SBBC) programme. The programme focuses on improving care for mothers and babies during the day of birth, the critical time when a woman goes into labor and delivers her baby.
Maternal health is a key focus of the United Nations Sustainable Development Goals (SDGs), specifically Target 3.1, which aims to reduce the global maternal mortality ratio to fewer than 70 deaths per 100,000 live births by 2030.
Tanzania’s program combines continuous, simulation-based training for frontline healthcare workers alongside innovative clinical tools to improve labour monitoring (fetal heart rate monitoring) and newborn resuscitation.It also uses data to drive ongoing improvements, ensuring that healthcare workers have the skills, confidence, and competence to manage birth-related complications for both mothers and newborns.
“We work closely with healthcare workers, equipping them with the necessary tools to improve the quality of care, ensuring they can effectively manage both mothers and babies during and after childbirth,” Dr. Kamala said, which helps them build on over a decade of innovative research and collaboration to improve care during childbirth.
“To give you a sense of the scale of the burden of maternal and newborn mortality in Tanzania when the Safer Births Bundles of Care program was in early development in 2015/16, there were around 556 maternal deaths per 100,000 live births and 25 neonatal deaths per 1,000 live births,” he said.
The published study demonstrates the “transformative impact” of the Safer Births Bundle of Care program conducted across 30 hospitals in five high-burden regions of Tanzania, where there were about 300,000 mother-baby pairs.
Maternal deaths at the start of the program were recorded at 240 per 100,000 live births, with postpartum hemorrhage and hypertensive disorders being the leading causes of death, he said. Over the 24-month study period, this number dropped to approximately 60 per 100,000 live births, representing a 75% reduction. The number of newborn deaths – which are primarily due to breathing difficulties and complications related to prematurity – declined by 40% – from 7 deaths per 1,000 live births to 4 deaths per 1,000 live births.
“These results are remarkable,” Dr. Kamala said.
According to Dr. Kamala, the 75% reduction in maternal deaths was not expected, and a key lesson was the important role of the in-situ team simulations – including for postpartum bleeding – with reflective debriefings that trained facilitators led.
“This seems to be a major part of the success of the program,” he said. “We are delighted by these results and hope that other countries adopt and scale the Safer Births Bundle of Care program… Beyond the numbers, the Safer Births Bundle of Care program has fostered a dramatic culture shift in our healthcare system,” he said. “Healthcare workers are now more confident and better equipped to handle birth-related complications for both mothers and babies.”
Maternal death drop
Dr. Kamala attributed the 60-70% reduction in newborn deaths in Geita and Manyara to several factors.
“Firstly, Manyara was the first site for implementation, giving the region more time to adapt and experience the impact of the program. Most importantly, both regions had a high burden of stillbirths and neonatal deaths, making them ideal targets for focused intervention. As a result, newborn deaths decreased by 60-70%, showcasing a clear positive impact on newborn survival,” he said.
Dr. Kamala said another possible explanation is the differences in the culture of practices, where some health facilities reported inaccurate data due to the fear of blame and shame. However, with the project’s implementation, reporting became more accurate after mplementation. Some regions, such as Tabora, reported an increase in the number of referrals to the study hospitals from other care centers after the program was implemented. These were more likely to be late admissions, which increase the likelihood of poor health outcomes, he said.
After the implementation of the program, there was a 40% decrease in newborn deaths within the first 24 hours after birth, according to the study.
Dr. Kamala said Tanzania’s remarkable progress in reducing maternal mortality by 80% is driven by strategic investments and innovative programs focused on improving maternal and child survival rates.
“Over 2,000 new healthcare facilities have been developed, free health services are being provided to expectant mothers and children under the age of five, and emergency obstetric care – including better transport to hospitals in rural areas are helping to ensure timely, life-saving interventions.
“Most importantly, the Ministry of Health works in collaboration with healthcare workers, hospitals, and development partners to strengthen the skills of frontline healthcare workers, which has been a key factor in driving this progress.
“Political leadership, alongside strategic partnerships and financing, has been crucial in driving progress in maternal and newborn health,” he said.
The program was made possible by the support of the Global Financing Facility for Women, Children, and Adolescents, Norad, UNICEF, and Laerdal Global Health, as well as the Ministry of Health and Haydom Lutheran Hospital. Their partnership and investment enabled the scaling of the Safer Births Bundle of Care to 30 hospitals and supported the research. “The government has now scaled the program to over 150 sites, and there are plans for further expansion to three regions this year and then nationally,” he said.
Dr. Kamala outlined key policy recommendations for other governments can adopt to prioritize maternal health.
“Firstly, it focuses on cost-effective and relatively simple interventions that are essential to preventing maternal and newborn deaths. For example, stronger primary healthcare that is delivered in the community and a well-trained healthcare workforce are also critical. Additionally, working in close collaboration with national, regional, and local health authorities is key.”
He said Tanzania’s approach, where the Safer Births Bundle of Care program was successfully scaled and sustained by aligning the initiative with national guidelines for obstetrical and newborn care. In addition, the creation of mentorship programs and regular supervision has helped to sustain the results.
Looking ahead
Tanzania now plans to expand to three new regions in 2025, followed by a nationwide rollout.
The success of the program has attracted interest from other countries, with Botswana, Ethiopia, Lesotho, and Namibia expressing interest in adapting the program to their healthcare system. In Nigeria, the program has already been launched in two states, Gombe and Borno, marking a significant step in its scaling.
Source: allafrica.com
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