Sustainability of the Uturo community-based maternal and child health model in Mbarali District, Tanzania

Tanzania is striving to reduce the maternal mortality rate to 70 per 100,000 live births by 2030, in line with the Sustainable Development Goals (SDGs), through diverse initiatives. The Uturo model is one of the initiatives implemented for over two decades, since 2000, in Mbarali District, Mbeya Region, and has shown significant impacts in reducing maternal deaths. Given that many other initiatives did not persist beyond five years, there is a need to explore the key factors that contributed to its sustainability with a view to informing other health interventions. A qualitative case study design was employed involving 69 participants, whereby 41 were consulted through in-depth interviews, and 28 participated in four (4) Focus Group Discussions. The participants included 10 female champions, 8 female champion leaders, 6 community health workers, 7 local community leaders, 5 healthcare workers, and 5 district health managers. Thematic analysis was used to analyse the collected data. The sustainability of the Uturo model hinges on being a homegrown initiative that relies entirely on local community resources and active community participation. It is also reinforced by a strong sense of female champions who implement the designed strategy with utmost dedication while promoting clients’ confidentiality and enhancing community ownership of the strategies. Additionally, the model benefits from the support and integration of the decentralised health system. The Uturo model owes its success to the amplification of diverse sustainability measures emerging from the local level, especially from female champions. For resource-constrained countries like Tanzania, there is a need to foster homegrown initiatives that have the potential to attain long-lasting achievements in MCH services. Again, it is imperative to strengthen health systems in areas where local initiatives are implemented to improve MCH outcomes and ensure the sustainability of the interventions.