Notes from the Field: Meet Dorcas

Case Study

Dorcas is part of our Maternal Health Capacity Building Team, which works to strengthen health systems in Dar es Salaam by expanding the knowledge of clinicians and quality of care. In April 2019, Dorcas (pictured) visited Tegeta dispensary, a clinic in Dar es Salaam that provides antenatal care for expectant mothers. There, she met a 17-year-old pregnant girl, Jane, who was brought to the clinic by her mother. Jane’s mother explained that they had been to the clinic before, but had been told by the clinic that Jane either needed a male partner with her to receive services or a letter from her “ten-cell” leader, a government-employed local community leader in charge of a block of ten houses. Without a male partner after she moved to Dar es Salaam to be with her mother during her pregnancy, Jane had sought out a letter from her ten-cell leader authorizing her to receive antenatal care. “I told Jane and her mother that nothing like that is needed to get services,” remembers Dorcas. “Even when their partners are not around, women should still be able to access the care they need.”

Later that day, Dorcas met another couple, and quickly realized the man was withholding information. When Dorcas investigated, she discovered that the man in the clinic was not actually the baby’s father. Because the real father had left the baby’s mother after discovering she was pregnant, the mother had brought along her friend to pose as the father. In her two prior visits to Tegeta Dispensary, the mother had been told that she needed a male partner or a letter from her ten-cell leader to access care, just as Jane had. Dorcas realized what was happening: the clinic had misinterpreted best practice knowledge advising that male partners are encouraged to join antenatal visits to receive information on how to best support mother and child. However, male partners are by no means necessary for a woman to receive antenatal care. “The fathers are encouraged to come to antenatal visits, so that they get all the information necessary about how to help make the right decisions, and how to care for the whole family,” says Dorcas. “Women who need services don’t have to come to the clinic with a false partner.”

Dorcas knew she had to fix the situation. She quickly informed regional and district authorities and gave the correct information to the Regional Nursing Officer and the in-charges in her network, who are taking action to remedy the incorrect rule. While requesting male partner engagement was well-intentioned, Dorcas says that “the enforcement was misguided, and further stigmatizes the vulnerable, such as teenagers and single mothers. We should be empowering them instead.” Dorcas emphasizes how this situation proves the efficacy and necessity of CCBRT’s MHCB Program. The miscommunication underscores how health education messages need to be standardized and written to ensure quality and compliance, an action point in strategy. “This challenge was only discovered working alongside the providers on the frontline. Health education messages can get modified without direct observation and quality control,” explains Dorcas. “That’s why CCBRT’s Capacity Building Program is so important – on-site coaching and practice facilitation has proven to be the best practice for behavior change, so that every mother in need can access the best care.”