A Maternal and Reproductive Health Program initiated by Bloomberg Philanthropies and H&B Agerup helped prevent the deaths of 2,200 mothers in the Kigoma region, one of the riskiest places in Tanzania for women to give birth. The Global Health Advocacy Incubator supported local partners to advocate for the regional government and the local community to take ownership of the program.

The Challenge

GHAI’s Role

In 2016, Bloomberg Philanthropies brought in GHAI to ensure the program’s long-term sustainability. GHAI’s role would be to support local partners to advocate for the government to assume management and funding of many of the program’s services in 2019.

The first step was to map the budget process and identify key decision makers who could influence budget decisions. With this analysis in hand, GHAI convened experts and implementing partners to develop a three-year sustainability plan to advocate for human and financial resources that would align with existing government priorities and enable the continuation of lifesaving services. The plan called for Tanzanian organizations to lead the advocacy campaign and enlist the community at large in support.

GHAI supported implementing partners to recruit and train advocates, strengthen and transfer skills and knowledge to locals, identify and lobby key decision makers and legislators, demonstrate impact, create local ownership and demand for continuity, and document political commitments for desired action. GHAI’s locally-led team was embedded with implementing partners, working side-by-side to transfer key advocacy skills.

Thanks to advocacy by health workers and the communities they serve, this progress can be maintained. In 2019, the implementing partners signed a transition document with the Regional Administrative Secretary office to ensure the continuation of vital maternal and reproductive health services. The document promised additional skilled health workers for Kigoma, the retention of health workers who have already been trained, and ongoing budgetary support for the health facilities.

The results will help ensure that accessible, quality, lifesaving care continues:

  • Tanzania’s Minister of Health deployed an additional 369 health providers to Kigoma Region, the highest total ever.
  • Local councils approved additional budget allocations for essential maternal and reproductive health services, and medical officers were formally instructed to provide budgets to ensure essential health services reach the community.
  • A signed transition document committed the Government of Tanzania to continue the program and laid out maternal health funding priorities for Kigoma.
  • High-profile public closeout events featured speeches from committed legislators and policy champions ready to support ongoing funding for years to come, including the Vice President of Tanzania.

Lessons Learned

  • Sustainability planning should start during project design and be integrated throughout implementation.
  • Agreement on end goals, processes and roles should be established at the outset.
  • Government engagement and ownership is key to achieving financial sustainability.
  • Systematic transfer of capacity, knowledge and skills is crucial.
  • Reaching the right policymakers and understanding their priorities is key to finding champions.
  • Embed media advocacy and communications throughout project planning and execution.
  • Advocacy doesn’t stop once bills or agreements are signed—government budgeting is an annual process.

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