HAWA Seleman was counting days until she delivers her twin babies she has been carrying for nine months. The married woman decided to move from her home located at Viwege Street to her mother’s residence at Rada Street within Majohe Ward, Ilala District of Dar es Salaam, Tanzania's commercial City.
According to the mother of four, the main reason for her move was to cut short the distance to Nguvukazi Health Centre in the next ward since in their locality, there was no such facility capacitated to conduct operations when necessary. Theirs is merely a dispensary.
The 33-year-old mother stayed at Rada until April 16, 2020, when she recognized the first signs of labour approaching.
“As I was packing my bag, my mother went to the neighbor to ask for a transport. We were lucky we got it…but the journey terrible, because the dilapidated road had a lot of potholes,” she says as she holds one of her twins.
The Good Samaritan who volunteered his vehicle drove carefully on the bumpy and dusty road towards the health centre, but she felt that she was not going to make it.
“I felt unbearable pains….I felt tired. The driver was forced to stop the car….My mother and her neighbors took me out and immediately laid me down and helped me to deliver my baby boy in the car,” she says.
Her mother, Mwana Milanzi says she and her neighbours had never helped someone to deliver a baby before. “It was my first time and it was a challenge to all of us. We managed to help her to deliver one of the twins, but she lost a lot of blood,” Mwana who is in her early 60s, says.
After delivering one of the twins, they drove all the way to Nguvukazi Health Centre located at a neighbouring ward. At this time, Hawa was not conscious due to the unbearable pain and bleeding, her mother recalls.
“Health staff at the facility told us that we were lucky since Hawa would have been at a higher risk if they had delayed further.”
Not only Hawa
After giving birth to another baby, this time a baby girl, Hawa continued to stay at the facility for health staff to monitor her development. “I recognized another woman from Viwege, where I live, being attended by Nguvukazi Health Centre staff. She also delivered while on her way to the facility,”
Hawa says as she cites unmaintained roads and long distance from Majohe to Nguvumali as among factors that force expecting mothers to deliver before arriving at the health centre. Ruth Kiwia, a Rada Resident at Majohe Ward in Ilala district, Dar es Salaam says she has been supporting a number of expecting mothers to give birth at Nguvukazi Health Centre using her private vehicle.
Since the road is full of potholes and too bumpy and they have to travel long distances for medical attention, she says most expecting mothers are being forced to deliver before arriving at the facility, something experienced midwife and general nurse, Frida Kimaro says might put lives of new born babies and mothers at risk.
Frida, who is currently working with St Bakita Mission as a trainer at Namanyere in Rukwa Region, says if an expecting mother delays going to hospital after experiencing first signs of labour, there is a possibility of delivering before arriving at a health facility. According to the trainer, the lives of a mother and newly born baby can be at risk if not well attended.
“For instance, if a baby is exposed to a cold weather, it might develop health problems,” she says.
While she suggests expecting mothers should go to health facilities early since some may require delivery by operation commonly known as cesarean section (c—section), Hawa and other women from Majohe have a different view.
To Hawa, an unmaintained road to a health facility, which is not available at Majohe Ward, is the main reason for some of the women to deliver before arriving at the hospital. She and fellow residents of Majohe ward, just 20 kilometers from the City Centre of Dar es Salaam, ask the government to work on two major issues; ward health centre and a paved road.
Just 20km from City Centre
Straight from the Dar es Salaam City Centre’s Askari Monument, Majohe ward is located approximately 20km away. It is among six wards of Ilala, an oldest and richest municipal council in the country in terms of revenues.
According to then Minister in the President’s Office responsible for Regional Administration and Local Government (PO-RALG), Seleman Jafo, in 2019, Ilala trailed other municipal councils in the country after collecting gross revenue of 58 bn/.
Despite the achievement, residents living in the periphery of the municipality like Majohe have no health centre and accessible roads. Tabling the 2020/21 budget estimates in Parliament, the then Minister of Finance, Dr Philip Mpango said in the final year of the implementation of the National Five-Year Development Plan 2016/17 – 2020/21, the government was compelled to allocate more resources to rehabilitate roads, bridges, railways and other infrastructure damaged by floods.
Furthermore, Dr Mpango, who is currently Tanzania's Vice President, told the lawmakers that the government will continue to improve access to health services through universal health coverage by implementing various projects, including construction of regional and zonal referral hospitals, district hospitals, health centres and dispensaries.
As the 2020/21 FY ends in June 30 this year, residents of Majohe still demand for a health centre and roads.
End of the tunnel?
Augustino Nyambuya, the chairman of Rada local government says Majohe is the only ward in Ukonga Constituency which has poor roads compared to other wards. During the rainy season, the chairman says, the situation becomes even worse, and important social services such as transport are not accessible.
He admits to being aware that some expecting mothers in Rada and Majohe at large are being forced to give birth before their arrival at the health centre due to poor infrastructure.
“Some delay to go to health facilities, but it’s true some women deliver while on the way to hospital due to poor roads,” the chairman says as he explains that he has been making a follow up at Tanzania Rural and Urban Roads Authority (TARURA) in Ilala, but the answer was always the same, “budget is limited.”
Mr Nyambuya is optimistic that in the next fiscal year (FY), Majohe residents will have a reason to smile since the budget estimates plan that is set to be approved by the Members of Parliament in Dodoma at the end of June, 2021 will address the aforementioned challenges.
Despite the challenges she encountered, Hawa and her one-year-old twins are alive. She and her twins were at risk only because of poor roads and lack of health services in Majohe Ward. As Tanzania strives to 'score' Sustainable Development Goals SDG 5 by 2030, which focuses on reducing global maternal mortality ratio to less than 70 per 100,000 live births, another Rada resident in Majohe ward, Ruth Kiwia advises the government to speed up the infrastructure programme in the marginalized areas like Majohe.
The SDGs, unanimously adopted by the UN’s 193 Member States at a historic summit in September 2015, insists on the needs of people in both developed and developing countries, emphasizing that “no one should be left behind,” including Majohe residents.