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Tanzania Menu Home Endnotes About Download the full report Maternal, neonatal, and child health in Tanzania February 5, 2015 May 7, 2015 17 minute read by Paul Franz Over the last 15 years, the world has made considerable progress on reducing the mortality of children under the age of five. In sub-Saharan Africa, many countries are on track to meet the international community’s child health goals. The United States has supported maternal, neonatal, and child health (MNCH) programs for several decades, and these efforts have had a considerable impact on the lives of children throughout the region. But making similar reductions in maternal and neonatal mortality has proven to be a much greater challenge. 1 What lessons can be learned from sub-Saharan Africa’s success in improving child health? What role can the United States play in building on those successes? What can be done to address the persistent challenges related to maternal and neonatal health in sub-Saharan Africa? The experience of the United Republic of Tanzania in addressing maternal, neonatal, and child health challenges offers important examples to consider in answering these questions. TANZANIA IN FOCUS The United Republic of Tanzania was formed in 1964 after the islands of Zanzibar gained independence from the United Kingdom and united politically with the mainland, Tanganyika. Tanzania is a low-income country with a population of more than 49 million. Over 70 percent of the country is rural. Dar es Salaam, Tanzania’s largest city, has a population of about 4.5 million. Enlarge Health in Tanzania In Tanzania, the Ministry of Health and Social Welfare (MOHSW) oversees public health policy and program implementation for the country’s population. The country is divided into 30 regions, each of which has some level of autonomy in managing hospitals and providing health services, although all must follow national health policy and report health data back to the MOHSW. 2 The point of entry for mothers and children into the public health system is the community-level dispensary, where patients can receive exams, seek advice from a clinical officer or nurse, and procure medicines, medical supplies, and immunization services. Some dispensaries are equipped for labor and delivery; many offer HIV treatment options and services for the prevention of mother-to-children transmission (PMTCT) of HIV. For more comprehensive services or to consult with a physician, however, mothers and their children must visit a health center, which may serve several communities and typically offers a broader range of services than the dispensary. Most people access health services at facilities without comprehensive treatment options. Patients who arrive at dispensaries or health centers with more complicated cases are sent to the district hospital or regional referral hospitals. Particularly challenging cases may be sent to one of a handful of specialized national referral hospitals in Dar es Salaam. Those patients who live closer to a referral facility than a dispensary, and those who prefer to visit a more distant health center or district hospital because they believe the services will be of higher quality, often bypass community-level facilities altogether. More than 70% of Tanzania’s population lives in rural areas. Accessing health services at the community level can be a challenge. In recent years, Tanzania has realized significant gains in child health and has already met its millennium development goal (MDG) target of reducing the mortality of children under the age of five by two-thirds since 1990. Particularly noteworthy achievements that contribute to this improvement include strong progress in extending vaccine coverage in all regions and successful activities to prevent and treat malaria among children. 3 However, newborns account for 40 percent of deaths among children under the age of five. And the maternal mortality ratio has fallen only slowly. 4 Enlarge A mother provides kangaroo care to their preterm neonates at the Sekou Toure Referral Regional Hospital in Mwanza. This 260-bed facility operates in a catchment area of 2.5 million people. Tanzania’s more modest achievements in reducing maternal and neonatal deaths are due in part to inadequate infrastructure, a lack of trained health workers in the most remote areas, and limited availability of necessary commodities, including supplies for facility-based childbirth and blood in the event of postpartum hemorrhage. Compounding these challenges are Tanzania’s relatively high total fertility rate of 5.3 and low national contraceptive prevalence rate of around 34 percent. 5 The government of Tanzania has articulated ambitious plans to improve the population’s access to health services. Its strategy includes aggressively training and deploying health workers and bolstering domestic financing for health through a national health insurance scheme. Enlarge Enlarge TANZANIA PRIORITIZES MNCH In part due to its failure to meet the MDG target of reducing maternal mortality by three-quarters by the end of 2015, the government of Tanzania has recently prioritized MNCH through the launch of two new government programs: the Sharpened One Plan and Big Results Now . It has outlined a three-pronged approach for ending preventable deaths of women, newborns, and children: providing voluntary family planning services, improving quality care at birth, and continuing progress on child health. 6 These efforts concentrate on serving regions that face the greatest challenges and are intended to focus the attention of national, regional, and district-level authorities on improving maternal, neonatal, and child health outcomes. (left) Health care workers attend to women in labor in the Mnazi Moja Health Center labor ward. The Mnazi Mmoja Health Center, located in Dar es Salaam, provides outpatient health services to the 634,924 citizens of the Ilala municipal region. This facility performs an estimated 300 to 360 deliveries per month. (right) Mother and child in the Magu District Hospital. This 150-bed facility operates in a catchment area of 299,759 million people. IN DETAIL: The Sharpened One Plan In April 2014, the Tanzanian government launched the Sharpened One Plan aimed at reducing maternal, newborn, and child mortality.7 The plan was developed following a 2013 review of the country’s 2008–2015 National Road Map Strategic Plan to Accelerate Reduction of Maternal, Newborn and Child Death, also known as the One Plan. The Sharpened One Plan emphasizes accelerating progress in Tanzania’s Lake and Western zones, where progress has been particularly slow. It focuses on strengthening health systems in rural and underserved urban areas to increase access to reproductive, maternal, and child health services for women and girls in the most vulnerable communities. Sharpened One is a costed plan covering the 500-day period until the 2015 MDG deadline to accelerate the reduction of maternal, neonatal, and child deaths. It focuses on five strategic areas: geographic vulnerability, high-burden populations, high-impact interventions, enabling environment, and accountability. Prioritized interventions aim to expand access to safe deliveries and increase family planning users in the Lake and Western zones; reduce stock-outs of maternal, neonatal, and child health commodities at the facility level; and improve accountability through the use of tools such as the Reproductive, Maternal, Newborn, and Child Health scorecard. Through this scorecard, regional commissioners (who are similar to state governors in the United States) are required to submit quarterly reports showing the percentage of women using contraceptives; the percentage of pregnant women attending antenatal clinics; and the percentage of women who deliver their babies in the presence of a skilled attendant. IN DETAIL: Big Results Now (BRN) In 2013, the government of Tanzania launched a multisector development...