Alumni Report: Improving childbirth services in rural Tanzania

London School of Hygiene & Tropical Medicine alumni Dr Manuela Straneo (MSc Public Health 2011, Distance Learning) and Dr Piera Fogliati (MSc Epidemiology 2009, Distance Learning), are currently in Tanzania working for Doctors with Africa, the largest Italian non-governmental organisation for the promotion and safeguarding of the health of African populations.

Manuela and Piera’s work focuses on improving childbirth services for the rural poor. The pair recently published two papers on this topic, both of which are now available online. Below, Manuela describes her and Piera’s experience of working in Tanzania and how their time at the School influenced their research opportunities and career choices.

Dear London School of Hygiene & Tropical Medicine Alumni!

It feels appropriate to discuss our work on childbirth services in this forum, as the tools we needed to carry out our work came from studying at the School – with some of you as fellow students.

Support to Dispensaries - Mahuninga Labour roomCan childbirth care for the rural poor in Africa be improved?

Achieving coverage of facility delivery is an essential first step, but it may not be enough to reduce maternal and newborn deaths. As in education, to learn, children must not only access school but also receive a high enough standard of education. Quality of care in facilities is essential to save lives at birth. Front-line quality is particularly important for the poorest, who bear the burden of mothers’ and newborns’ deaths.

Our work has shown that in rural Africa, even in areas where nine out of 10 women deliver in health facilities, the poorest remain disadvantaged. Women from the lowest socio-economic quintiles tend to access primary level services where quality is limited. Low quality cannot be attributed only to gaps in infrastructure, equipment or training. Poor staffing levels and limited delivery caseload at peripheral level are upstream challenges that must be addressed (“Where Do the Rural Poor Deliver When High Coverage of Health Facility Delivery Is Achieved? Findings from a Community and Hospital Survey in Tanzania”, Straneo et al).

GIS modelling has contributed to suggesting a solution. Concentrating delivery sites into fewer facilities in a high coverage context is feasible, without compromising women’s access. A re-organisation of childbirth services would allow the concentration of limited resources into fewer, better staffed facilities, with caseloads adequate for staff to maintain skills. (“How Can Childbirth Care for the Rural Poor Be Improved? A Contribution from Spatial Modelling in Rural Tanzania”, Fogliati et al).

Manuela 3The research described in these two manuscripts was part of our development work in Tanzania with Doctors with Africa-CUAMM, a non-governmental organisation. Our  NGO’s overarching strategy is to strengthen health services, an essential component of the right to health. It has been enormously supportive to operative research as part of development work, and for this we are very thankful.

How has the School influenced our work?

This research would not have been possible if we had not studied at the School. I completed my MSc in Public Health in 2011, and Piera completed an MSc in Epidemiology in 2009.

MANUELA 5We both started our postgraduate degrees after more than 10 years’ work in health, with experience in sub-Saharan Africa and Europe. The School’s Distance Learning programme was the chance to put theory behind what had been learnt in the field. Our knowledge in epidemiology and public health improved enormously, adding quality to our work in development. Studying on-campus for a year at the School would have ensured more direct contacts with faculty and students, but the flexibility of distant learning matched our needs and allowed us to fit our Master’s degrees around other commitments.

We agree that our studies at the School were the best learning experience we have had, out of the many years’ training we have received from medical school and postgraduate specialisation.

Main photo credit: S. Van Vechgel 

Inset photo 1: A delivery room in a dispensary in Iringa, Tanzania 

Inset photo 2: Dr Manuela Straneo

Inset photo 3: Dr Piera Fogliati


  1. Bertha Maegga

    This is great news, I really appreciate such uplifting news even when other social and economic aspects in the Tanzanian rural life are not so rosy– life must go on. Congratulations to the two London School Alumni, and please keep up the good work.!!

  2. Anna Plateroti

    I work voluntarily on Zanzibar. I was v. sad at 2 cases of post natal maternal mortality, no one seemed to know the reason. I also found a newborn being fed casava water, the mother had no milk. Wet nursing is not practised there.