Tushikamane means: “We stick together”, and implies “Sticking together, we are empowered”. Its aim is to reduce maternal and child mortality in the small rural hamlets in Tunguli and Msamvu, by developing community participation, beginning with women’s groups. The women’s groups began to be set up early in 2016, and began by identifying root causes of tragic death, and key issues to address. These issues will include challenges as diverse as poverty; access to education; clean water; sanitation; nutrition; family planning; safe childbirth; immunisation; emergency transport; as well as prevention and early treatment of malaria. Etc etc.
How bad are the problems?
In the UK, one mother in 10,000 dies in relation to giving birth. In rural Tanzania, by contrast, nearly 1 in every 100 women dies in childbirth, and up to 10% of children do not reach their fifth birthday. In this vast but peaceful country, the reasons are many and interconnected: lack of access to health care; social inequality; lack of education; chronic disease; malnutrition; long distances to travel when sick; poor family planning; and poor transport.
Underlying it all, 90% of the population live on $2/day or less.
Where is Tushikamane active?
Tunguli and Msamvu together have a population of about 5000+, about one sixth of which are under 5's. The single health centre, hours from the nearest hospital and inaccessible in the rain, sees more than 100 child deaths per year
Why do we need women’s groups?
Why not just go in and fix the problems? The answer is simply this: it does not produce sustainable development. Time after time, experience in Africa has shown that doing things to people; and doing things for people; ends up with effort fizzling out: Things break and don’t get fixed. Money and equipment disappear. The wrong priorities are addressed. The elders make all the decisions. Tradition stifles progress. And so on. The World Health Organisation is now quite clear about how we should be tackling the awful death maternal rates in rural sub-Saharan Africa: we need to engage with the mothers themselves, and give them a voice. Once the wives and mothers have really begun to understand the issues, and once the myths and prejudices have been stripped away, an energy is unleashed from within the community that produces a lasting impetus for progress.
Not only does that mean that things happen, and are owned, but it also means that the entire community begins to engage more with health services, and with those governmental and non-governmental agencies who can help them make a real difference to their problems.
What is the Number One priority of ‘Tushikamane’?
There is so much to do, it would be difficult for outsiders to know where to start. However, the number one priority expressed in each of the women’s groups was water. Women and girls spend much of the day travelling long distances five times a day to fetch dirty water.
Sanitation is a linked problem – the majority of people in these rural hamlets have never used a toilet in their lives. When they catch dysentery or cholera, they still have to go to the water hole to fetch water, and then the water itself gets infected. Diarrhoeal disease is a major killer, especially of babies.
How will water and sanitation issues be addressed?
The community themselves do not have the know-how or the money to fix the problem, and Mission Morogoro cannot just ‘airdrop’ solutions and hope that they will be long-lasting. The key that unlocks exciting answers to this impasse is partnership. SAWA (Sanitation And Water Action) is a ‘Non-Profit Organisation’ staffed by talented, dedicated and charismatic staff, who understand the challenges at a very deep level. Their interventions demand not just community engagement, but also both active work and education. This insistence on community involvement and commitment – achieved through Tushikamane – means that pumps are maintained, and that people understand, for instance, how dirty water conveys disease and death. Furthermore, now that communities are undertaking much of the hard work themselves – digging, building, and the like - costs are tiny compared to costs of an NGO coming in, doing the work, and then leaving. The Kwibomba pump, for instance, cost MM only £500:
What other projects are the communities now trying to tackle under the banner of ‘Tushikamane’?
In addition, in each hamlet, small, feasible, appropriate projects are needed, especially to address the immediate needs of poverty and malnutrition. They include: toilets; chickens; eggs; goats; gardens; irrigation; malaria prevention; brick or other commodity production; sewing or other skill development; etc, etc. Many such projects will need start-up funds, for which sustainable microfinancing is necessary. Additionally, the eleven hamlets within Tushikamane need to come together to begin to address the big issues: health care provision in the local clinic; health-care outreach to the hamlets; immunisation; family planning; clean water consumption, and water for crops; improving access to complex emergency obstetric care when things go wrong; new roles for traditional birth attendants; improving access to education for the next generation; etc.
Is it working?
Giving young women a voice seems to have produced a profound unleashing of energy, and challenge of traditional attitudes: FGM is disappearing; children are immunised; and women and children are starting to use the health centre not just for delivery, but for antenatal, family planning, growth charts, immunisation and primary care. Although children with infectious and diarrhoeal diseases are still dying in frightening numbers, many are now being brought to the clinic at times before they are terminal. Suddenly there is an awareness of possibility.
How does Mission Morogoro help?
Once the communities have begun themselves to undertake developments, they find that they have needs – not just for water, but for advice, expertise, friendship, encouragement, and for help tackling the inevitable problems which emerge: a broken pump; a roll of chicken wire; raw materials; buildings and repairs – an endless list of needs, perhaps, but MM’s support is about empowerment. More partnerships are envisaged, with NPOs that support, for instance, microfinancing and agricultural developments. Such partnership also includes working with the Governmental District Office team, such that we produce synergy between governmental and non-governmental development.
How can you help?
You can be part of this inspiring development by donating – however small an amount, it goes a long, long way in rural Tanzania:
Every single penny that MM raises goes into its work in rural Tanzania, with zero administration cost.
Where can I find out more?
Laurence Wood is an ex-obstetrician who went to Berega in 2013 to try to help address the awful maternal mortality problem. Having realised that most of the deaths occurred in the community, he began to explore how tragedy might be addressed at source.
You can read about how this thought translated into the setting up of women’s groups through almost 100 blog postings, both from Laurence and other partners in Tushikamane:
‘Tushikamane: Sticking together, we are empowered’.