The Conflict of Outsiders in Community Development on Maternal Child Health in Rorya, Tanzania

In the past two years, Mama Maisha, also known as Mother Life in Swahili, began to promote maternal child health in the Rorya District of Tanzania through the efforts of Maternal Health Workers (MHWs). Mama Maisha was started by Dr. Reta and Jeff Graham, medical doctors from the USA, and Leisha Otieno, a retired American missionary. The western led program has been guided by Village Life Outreach Project (VLOP), also a western led organization, and Shirati Health, Education, & Development Foundation (SHEDF). SHEDF is led partially by westerns, but predominately, the Kawira Family who has lived in the Rorya District for hundreds of years directs it. Without VLOP and SHEDF, Mama Maisha would not have the foundation to exist.

Mama Maisha expects their trained MHWs to provide advice on safe delivery, health pregnancy, and family planning for 30 percent of the women in their designated communities. However, the MHWs are reaching fewer people than their expectations, and surveys show that their advice is not nearly as socially desirable as anticipated. The directors of Mama Maisha blame poor performance on the MHWs, and are attempting to fix the issue by increased financial incentives and longer, more intense trainings. Regardless of such adjustments, the MHWs still perform below expectations in terms of client uptake for advice on safe pregnancy, family planning, and HIV prevention.

Mama Maisha is ineffective because the establishment of maternal health workers was initially communicated and integrated inadequately with SHEDF and the target communities. The western directors of Mama Maisha have been too absorbed with their blind determination for outcomes without concerning the process of implementation that they have failed to recognize the required relationships and networks they must build before implementation. From the start, Mama Maisha has distanced its efforts from SHEDF. They believe their association with the complicated history and politics of SHEDF will burden their progress, but they forget they are outsiders without SHEDF. Years ago, the directors of SHEDF stopped reasoning with donors and outsiders. Now, they wait for outsiders to fail, and then give advice when asked. Thus, SHEDF has let Mama Maisha push forward with their ignorance inevitably bound to waste time and resources. Mama Maisha has conducted surveys in its target communities as a means to simultaneously gauge interests and advertise for the new program, but they did them without approval from the community leaders, thus the surveys only gauged interests from a few women and did not act as a means of advertisement for the new advice service provided by MHWs.