title: Sustainability of community-capacity to promote safer motherhood in northwestern Tanzania: what remains?
abstract: OBJECTIVE
  To examine the remains of the Community-Based Reproductive Health Project (CBRHP) implemented by CARE-Tanzania to address high maternal mortality in two rural districts.
  
  
  METHODS
  In early 2007, data were collected from 29 villages and used to assess sustainability of emergency transport systems, retention of village health workers (VHWs), and their potential impact on maternal health. Surveillance data from the Ministry of Health were reviewed to assess changes in prenatal and service use indicators.
  
  
  RESULTS
  From 2001 through 2006, the CBRHP-trained VHWs have continued to provide education and referrals to women in their communities including prenatal and emergency obstetric care; six villages with emergency transport systems have continued for more than 5 years providing free or low-cost transport to health facilities. Selected maternal and infant health indicators, such as early prenatal care, identification of pregnancy-related danger signs, and data on maternal and infant outcomes, improved in the two targeted districts over time.
  
  
  CONCLUSIONS
  The two components of CBRHP, work of VHWs and community-financing for emergency transport systems in six villages, have continued. Both of these promote maternal health and linkages with the health delivery systems. Surveillance data show changes in maternal health indicators that were targeted by the district-wide CBRHP interventions. Programs such as CBRHP, with focus on capacity-building and empowerment, can assist in mobilizing the formal and informal systems in communities, components of which may be sustained over time.
authors.affiliation: Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA. Iahluwalia@cdc.gov
authors.forename: Indu B
authors.initials: IB
authors.lastname: Ahluwalia
authors.forename: Dorcas
authors.initials: D
authors.lastname: Robinson
authors.forename: Lisa
authors.initials: L
authors.lastname: Vallely
authors.forename: Karen E
authors.initials: KE
authors.lastname: Gieseker
authors.forename: Alfreda
authors.initials: A
authors.lastname: Kabakama
mesh_terms: D003150:Community Health Workers; D004632:Emergency Medical Services; D005260:Female; D006266:Health Education; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008427:Maternal Health Services / Q000458:organization & administration*; D011159:Population Surveillance; D011247:Pregnancy; D015397:Program Evaluation; D012017:Referral and Consultation; D013636:Tanzania