Insights

Since 1987, Amref Health Africa in Tanzania (Amref Tanzania) has been among the major supporters of the Government of the United Republic Tanzania’s health care initiatives, particularly with the Ministry of Health. In operation since the 1960s, they have over 15 active projects across different regions in Tanzania in the areas of reproductive, maternal, newborn child and adolescent health; disease control and prevention in HIV/AIDS, tuberculosis (TB), malaria, and water, sanitation, and hygiene, laboratory services, and obstetric fistula.

Amref Tanzania employs an innovative, evidence-based, person-centered approach to improve access to high-quality, community-based family planning (FP) and TB services,. This approach builds upon their framework of delivering a comprehensive set of interventions needed to achieve Global End TB targets and bring the TB epidemic into the elimination phase. Amref Tanzania has been successfully been implementing Global Fund projects and is currently the Principal Recipient representing non-state actors for the Global Fund New Funding Mechanism (2021-2023) in Tanzania. In addition to Global Fund, Amref Tanzania also receives funds from the US Centers for Disease Control (CDC) and the United States A gency for International Development (USAID).

NPI EXPAND collaborates with Amref Tanzania in support of USAID’s Afya Shirikishi Activity. Afya Shirikishi Activity is a five-year, community-based intervention that aims to expand and strengthen community TB and FP services in nine regions of mainland Tanzania and Zanzibar. In collaboration with several stakeholders, including the Ministry of Health and other local implementing partners, Afya Shirikishi strengthens access to and use of quality FP and TB services at the community level.

Under this activity, Amref Tanzania expects to strengthen its organizational and technical capacity by addressing capacity gaps in human resources policies, succession planning, virtual data storage and management, and grants management. The technical focus area for capacity strengthening is improving FP-related social and behavior change communication (SBCC) as well as strengthening the capacity of their sub-grantee to engage in family planning service delivery.

In addition to improving FP technical skills, Amref Tanzania is focusing on the reduction of gender-based violence in the communitities where they are engaged. Amref Tanzania is employing a SASA! strategy in efforts to curb Gender-based Violence (GBV). SASA! is a Kiswahili word that means Now! and is also an acronym for the four phases of community mobilization: Start, Awareness, Support, Action. The approach aims to inspire and enable communities to rethink and reshape social and gender norms that make women vulnerable to social, health and economic inequities.

SASA! has the following objectives:

• Improve community mobilization interventions that seek to prevent GBV, reduce TB-related risk behaviors, and promote sexual reproductive health at the community level;
• Empower community health workers (CHWs) on how to use the SASA! approach in community mobilization interventions;
• Strengthen ability of CHWs to identify GBV, FP, and/or TB related cases and reporting.

Afya Shirikishi customized the SASA! community mobilization approach to inspire and enable communities to rethink and reshape social and gender norms to address gender inequalities and encourage the communities to access and utilize the available community-based FP and TB health services.

During the reporting period of October through December 2021, a total of 46,830 beneficiaries were reached with GBV education using the SASA! approach. Out of those reached, 376 (1%) reported experiencing some form of gender and rights violations in accessing FP/TB services. For example, there were cases where a husband was physically violent with his wife if she used FP secretly without informing her husband, or sometimes husbands forced women to go back to the health facility and remove the FP method. A total of 344 (91%) out of the 376 were referred to a nearby health facility to receive necessary support such as counselling, FP education, social welfare support, and clinical management of GBV. 283 (82%) out of 344 reported to Community Health Workers received the necessary support at a health facility.

These findings have shown a tremendous increase in the number of FP/TB clients that reported experiencing some form of gender and/or rights violations in accessing FP/TB services; from seven cases from April to June 2021 before introducing SASA Approach, to 344 from October to December 2021.

A voice from the community:

“Now after getting the knowledge about Gender-based Violence from CHWs, we will be the frontline advocates for equal rights among men and women in our communities” Community Member, from Nkasi Dc.

The approach has proven to be an effective and innovative approach to community mobilization and engaging, which might be adopted in other Amref projects in the future.

EXPAND is happy to be supporting Amref and helping them to become a more sustainable organization and further increasing their health impact.

For more information on Amref Tanzania, please visit https://amref.org/tanzania or contact the Director of Communications and Fund Raising, Eliminatha Paschal at Eliminatha.Paschal@Amref.org