The Delivery Diaries

How m-mama is revolutionizing emergency referrals to life-saving health care for expectant mothers and their newborns experiencing complications in Tanzania

After 18 hours of labor, Miza Juma Juma’s labor was not progressing, and the doctor in charge of the facility decided to call the m-mama hotline to help transport her to a referral facility. The m-mama dispatcher confirmed with the referral hospital that they could manage Miza’s condition and then quickly coordinated a boat driver to get her from Tumbatu to the mainland and a community driver to transport her from the port to the referral hospital. / Amy Cotter Fowler for USAID

When an emergency happens, every second counts. This is particularly true for women in labor and newborns.

Enter Fatma, a nurse dispatcher for the m-mama referral system — a hotline staffed by nurses who can seamlessly connect pregnant women or new moms experiencing complications with local transportation. These moms may be in need of an ambulance or community driver to transport them as efficiently as possible to a precise health facility equipped to provide them with vital and often lifesaving health services.

Tumbatu is a rural island off of Unguja, which means Miza will need to be transported by a boat driver and a community driver. / Amy Cotter Fowler for USAID

In Tanzania, USAID is part of the innovative m-mama partnership, led by the Government of Tanzania, which brings together the expertise of Vodafone, Touch Foundation, and Pathfinder, to ensure expectant mothers and their newborns experiencing complications are referred and transported to the correct health facility as quickly as possible.

In the rural island of Tumbatu, this is not easy, but for new mom Miza Juma Juma, it made all of the difference.

Dispatchers at the m-mama Unguja Dispatch Center, in Zanzibar, receive a phone call from a facility with a mother in labor. An app will help determine if the patient is an emergency, in which case, m-mama transport will be arranged and dispatched to move the patient to a higher level facility. The dispatchers are all trained nurses, supported by the Government of Zanzibar, so they can use their experience to mentor and counsel facility staff with less experience. / Amy Cotter Fowler for USAID

When Miza went into labor at home, she knew something wasn’t right. She walked 15 minutes to reach the Tumbatu Primary Health Care Unit. But because it was night time, there was only one nurse on duty. The facility does not have an ultrasound machine, so the nurse monitored Miza briefly, and then decided to call m-mama (*115).

Fatma (pictured in first image and left in second image), the dispatch supervisor at the m-mama Unguja Dispatch Center, in Zanzibar, receives a phone call about a mother in labor with a potential emergency. After confirming the call is an emergency, Fatma will arrange and dispatch m-mama transport to move the patient to a higher level facility. / Amy Cotter Fowler for USAID

When a call is made to the m-mama toll-free number *115 in Tanzania, it immediately connects to a nurse like Fatma at the dispatch center in Stone Town, the capital of Zanzibar’s main island. Fatma is a trained government nurse who can no longer work at the hospital due to injury, but has become an m-mama dispatcher.

She receives calls from the hotline, uses the m-mama app to triage the calls and if there are complications she identifies the appropriate facility who can manage the complication and she organizes transport for the women to get to the facility.

Haji Ali Haji is a boat driver with m-mama. When women in his community on the island of Tumbatu need to be transported to the mainland for delivery, m-mama calls him and he safely gets them to higher level care and is paid through mobile money. / Amy Cotter Fowler for USAID

Fatma quickly calls Haji Ali Haji, a boat driver based in Tumbatu. Tumbatu is a rural island off of Unguja, which means Miza will need to be transported by boat to Zanzibar. Haji confirms with Fatma via SMS that he has delivered Miza to the mainland, which will trigger the process for his payment. Upon her arrival at the main land port, she is greeted by a community driver who will directly drive her the rest of the way from the port to the referral hospital.

Haji transports women a few times per month, and he recalls that when Miza was in labor, the water level was particularly low. He could not get his boat into the dock.

The solution: Miza’s family walked with her along the shoreline until she could get close enough to wade through knee-high water to the boat. Haji grew up on Tumbatu and knows the waters, so even at night he can navigate without an issue, making him the perfect boat driver for m-mama.

“When growing up, I saw mothers having difficulty, so when I got this boat, I decided to use it not just for passengers but for emergencies,” Haji said.

Haji Ali Haji and Suleiman Juma Khamis work together to ensure mothers from Tumbatu island can safely reach referral facilities on the main island of Unguja. / Amy Cotter Fowler for USAID

As soon as Haji, Miza, the nurse, and Miza’s sister got to the port of the main island, Unguja, Suleiman Juma Khamis was waiting for them. He had gotten the call from Fatma at midnight, and he quickly drove the 30 minutes to the port to make sure he was there when they arrived. Like his friend Haji, Suleiman is motivated to help the women of his community.

“I love the program and am fully committed. I want to continue supporting mothers and babies, and I will answer when the dispatcher calls,” Suleiman said.

The final call Fatma made that night was to Kivunge District Hospital to alert them that Miza was coming. She told them that Miza had been in labor for hours and was not progressing, so the team there prepared for her arrival.

Kivunge District Hospital is a referral facility, so it can handle complicated deliveries. Staff at Kivunge have been trained by USAID to identify emergencies, provide quality labor and delivery, and care for babies who can’t breathe at birth.

When Miza arrived, her bed was ready and staff were prepped, and the on-call doctor had been alerted that he may need to assist with a high-risk delivery.

Under the close supervision and support of head nurse Mwuanamvua Said, Miza delivered her baby, Umulayman Mwadini Hossan, soon after arriving at Kivunge. Umulayman means “mother of faith,” as Miza and her family needed unwavering faith that Umulayman would be delivered okay.

“I expect my baby to be a teacher in the future, so she can teach people about lessons,” Miza said.

After 18 hours of labor, Miza’s labor was not progressing, and the doctor in charge decided to call m-mama to help transport her to a referral facility. The m-mama nurse dispatcher quickly identified a facility who could manage the complication, then coordinated a boat driver to get Miza from Tumbatu to the mainland, with the support of a nurse from the health post, and a community driver to transport her from the port to the referral hospital. / Amy Cotter Fowler for USAID

Later, nurse Fatma would call the hospital to make sure everything worked out well, and to coordinate payment for Haji and Sulaiman. Previously, there was insufficient data on the causes of maternal emergencies, so m-mama is helping to show the scope of emergency maternal health needs to ensure continued prioritization.

“We love this job a lot. Saving lives is a big deal!” Fatma said.

Since it was created, m-mama has transported over 28,000 women and newborns, resulting in a 38% reduction in maternal mortality in the Shinyanga region of Tanzania from 2016–2020. Additionally, m-mama is estimated to have saved over 900 lives with USAID’s support. M-mama recently launched in Kenya, and plans to expand to Malawi and other countries.

About the Author

USAID’s Office of Maternal and Child Health and Nutrition, which works to ensure that all women and children have the same chance of a healthy life, regardless of where they live or are born.