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- W305521898 abstract "Introduction Although fostering sustainability is a desired goal of many programs, there is seldom an opportunity to examine whether this goal is actually reached, often because of limited time frames or failure to include sustainability in the project planning phase. The existing literature has described various dimensions of sustainability, including independent functioning of the program beyond the funding cycle, institutionalization of a program that might have been adopted during implementation, and continued relevance. (1-8) Sustainability is viewed as an outcome of a set of activities after project implementation, (4) and it is important because of the large investments involved in developing and implementing a program. The Community-Based Reproductive Health Project (CBRHP) initiated through CARE-Tanzania in collaboration with that country's Ministry of Health and Social Welfare (MOHSW) and used community-based approaches to promote demand for maternal health services. (9-11) The CBRHP activities took place during 1998-2000, with a focus on increasing demand for- and supply of maternal health services, including emergency obstetric care (EMOC). (8-10) One component of the community mobilization approach focused on building capacity to address EMOC through the development/implementation of affordable community-supported emergency transport systems, which was identified by the communities as a critical need. (9-11) The purpose of our study was to examine the extent to which the community-supported transport systems for medical/EMOC emergencies were integrated into the village operations and to assess their operational status. Using the conceptual basis of the sustainability planning model (4) and literature on program institutionalization, (1,12) we assessed the status of transport options in the communities (Figure 1). We followed up villages with different end-of-project status as documented in the 2001 evaluation of the CBRHP (11) in order to examine independent movement among villages that participated in CBRHP. Context and Description of CBRHP Activities The estimated maternal mortality ratio (MMR) in sub-Saharan Africa is particularly high--900 deaths per 100,000 live births, (13) and it was 578 deaths per 100,000 live births in Tanzania according to the 2004-2005 Demographic and Health Survey (http://www.measuredhs.com/pubs/pdf/FR173/FR 173-TZ04-05.pdf) Three major types of delays contribute to maternal mortality: delay in (1) patients deciding to seek care, (2) reaching a health facility, and (3) receiving appropriate care once at the health facility. (13-21) Although most obstetrical complications cannot be predicted, timely response, such as those offered by affordable transport to a functioning health facility can reduce maternal morbidity and mortality. (22-27) The two districts where the CBRHP activities were implemented were in Northwestern Tanzania. Combined, these two rural districts house a population of 500,000 people with a crude birth rate of 39.65 per 1,000, and an estimated [greater than or equal to]20,000 births per year (Personal communication-MOHSW-Reproductive Health Coordinator, 2006). Four district-level hospitals, four health centers, and 58 dispensaries serve the districts. The CBRHP consisted of strengthening community-level prevention services by mobilizing the community and building capacity to address maternal health, training village health workers, and improving the quality of EMOC services offered at the health facilities. The maternal-and- newborn component of the project was designed to increase demand for (and access to) prenatal care, to improve basic obstetric services at dispensaries/health centers, and to improve both the availability and quality of comprehensive obstetrical services at the district hospitals. At the community level the emphases were on early initiation of prenatal care, increasing recognition of pregnancy-related danger signs, increasing referrals, pregnancy planning, and availability of affordable transport to health facilities. …" @default.
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- W305521898 date "2012-01-01" @default.
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- W305521898 title "Post-Project Assessment of Community-Supported Emergency Transport Systems for Health Care Services in Tanzania" @default.
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