Public and Private Maternal Health Service Capacity and Patient Flows in Southern Tanzania: Using a Geographic Information System to Link Hospital and National Census data.

Background : Strategies to improve maternal health in low-income countries are increasingly embracing partnership approaches between public and private stakeholders in health. In Tanzania, such partnerships are a declared policy goal. However, implementation remains challenging as unfamiliarity between partners and insufficient recognition of private health providers prevail. This hinders cooperation and reflects the need to improve the evidence base of private sector contribution. Objective : To map and analyse the capacities of public and private hospitals to provide maternal health care in southern Tanzania and the population reached with these services. Design : A hospital questionnaire was applied in all 16 hospitals (public n=10; private faith-based n=6) in 12 districts of southern Tanzania. Areas of inquiry included selected maternal health service indicators (human resources, maternity/delivery beds), provider-fees for obstetric services and patient turnover (antenatal care, births). Spatial information was linked to the 2002 Population Census dataset and a geographic information system to map patient flows and socio-geographic characteristics of service recipients. Results : The contribution of faith-based organizations (FBOs) to hospital maternal health services is substantial. FBO hospitals are primarily located in rural areas and their patient composition places a higher emphasis on rural populations. Also, maternal health service capacity was more favourable in FBO hospitals. We approximated that 19.9% of deliveries in the study area were performed in hospitals and that the proportion of c-sections was 2.7%. Mapping of patient flows demonstrated that women often travelled far to seek hospital care and where catchment areas of public and FBO hospitals overlap. Conclusions : We conclude that the important contribution of FBOs to maternal health services and capacity as well as their emphasis on serving rural populations makes them promising partners in health programming. Inclusive partnerships could increase integration of FBOs into the public health care system and improve coordination and use of scarce resources

Experience from a community-based education program in Burkina Faso: The Tostan program

This study describes a project that tested the feasibility and effectiveness of replicating the village empowerment program (VEP) developed by the Senegalese NGO, TOSTAN, in Burkina Faso. Although originally developed for empowering women, the program implemented in Burkina Faso also involved men because of their key role in such decisions. Frontiers in Reproductive Health, with funding from USAID and the GTZ Supra Regional Project for the Elimination of FGC, supported the adaptation, implementation, and evaluation of the VEP model in 23 villages in the province of Bazega/Zoundwéogo. In the existing social climate among the Burkinabé, where there is widespread awareness of the law forbidding FGC, the education program has contributed to strengthening the existing measures and to a significant improvement in the level of awareness of human rights and reproductive health

The Tostan program: Evaluation of a community based education program in Senegal

This operations research project evaluated the effect and impact of a basic education program, developed by TOSTAN, a nongovernmental organization based at Thiès, Senegal. The basic education program consisted of four modules: hygiene, problem-solving, women’s health, and human rights. Through these four themes, emphasis was placed on enabling the participants, who were mostly women, to analyze their own situation more effectively and thus find the best solutions for themselves. The GTZ Supra Regional Project for the Elimination of Female Genital Cutting funded implementation of the program in 90 villages in Kolda Region, and the Population Council’s Frontiers in Reproductive Health Program, with funding from USAID, used this opportunity to evaluate the program in 20 villages. The program was able to bring about a social change within the community and to mobilize the villagers for better environmental hygiene, and respect for human rights and improvement of health, as well as specifically reducing support for and practice of FGC

Arterial remodeling and plasma volume expansion in caveolin-1 deficient mice.

Caveolin- 1 ( Cav- 1) is essential for the morphology of membrane caveolae and exerts a negative influence on a number of signaling systems, including nitric oxide ( NO) production and activity of the MAP kinase cascade. In the vascular system, ablation of caveolin- 1 may thus be expected to cause arterial dilatation and increased vessel wall mass ( remodeling). This was tested in Cav- 1 knockout ( KO) mice by a detailed morphometric and functional analysis of mesenteric resistance arteries, shown to lack caveolae. Quantitative morphometry revealed increased media thickness and media- to- lumen ratio in KO. Pressure- induced myogenic tone and flow- induced dilatation were decreased in KO arteries, but both were increased toward wild- type ( WT) levels following NO synthase ( NOS) inhibition. Isometric force recordings following NOS inhibition showed rightward shifts of passive and active length- force relationships in KO, and the force response to alpha 1- adrenergic stimulation was increased. In contrast, media thickness and force response of the aorta were unaltered in KO vs. WT, whereas lumen diameter was increased. Mean arterial blood pressure during isoflurane anesthesia was not different in KO vs. WT, but greater fluctuation in blood pressure over time was noted. Following NOS inhibition, fluctuations disappeared and pressure increased twice as much in KO ( 38 +/- 6%) compared with WT ( 17 +/- 3%). Tracer- dilution experiments showed increased plasma volume in KO. We conclude that NO affects blood pressure more in Cav- 1 KO than in WT mice and that restructuring of resistance vessels and an increased responsiveness to adrenergic stimulation compensate for a decreased tone in Cav- 1 KO mice