Ministry of Health and Social WelfareReproductive and Child Health Section

Tanzania Provides Over 900,000 Implants in Last Six Years

International FP ConferenceAddis Ababa, November 14, 2013

Presenter: Richard Killian, (EngenderHealth, Tanzania [EHT]): Co-Authors: Mwanga, F (EHT); Hiza, M, (Ministry of Health and Social Welfare-Tanzania); Kanama, J (EHT)

Current FP situation in Tanzania

Total population: 44.9 million (2012)

Population growth rate: 2.7% (2012)

Three in four Tanzanians reside in rural areas

Total Fertility rate (TFR): 5.4

Modern CPR: 27% (20% in 2004-05)

LARC/PM CPR: 6%

Implants CPR: 2.3% (2010 DHS):

265% increase from 2004 (0.5%)

Unmet need for FP: 25%

Data Sources: Tanzania Census 2012; Tanzania DHS 2010

FP Programme Objectives and Action Areas (from National FP Strategy)

Contraceptive Security

Capacity Building

Service Delivery

Advocacy and Demand Generation

Management, Monitoring and Evaluation

(2008 National FP goal: 60% total CPR by 2015)

USAID support to Tanzania’s public sector FP program

“Flagship” USAID projects, managed by EngenderHealth, 2007-present, for comprehensive technical assistance to Tanzania’s public sector FP program

– Follows EngenderHealth’s holistic SEED Programming Model

– Country-wide coverage / national scale, district focus:

> All 30 regions;110 of 169 districts

> > 3,700 public sector health care facilities

> > 9,000 service providers trained

> ~2,200 service providers trained in implant insertion & removal

– Capacity-building / system strengthening approach, to build public-sector capacity and increase delivery of FP/RH services

– Direct support for public sector mobile outreach to serve hard-to-reach and under-served individuals and communities

Tanzania’s LARC/PM service delivery achievements

Selected LARC/PM Results, 2007/08 to 2012/13 (70% in public sector; 50-60% of total via mobile services)

Annual LARC/PM clients Nearly tripled, from 157,107 to 424,761Cumulative total of 1,671,067 clients in 2007-2013

IUD clients Six-fold increase, 16,429 (2007-08) to 99,552 (2012-13), cumulative total of 350,242 IUDs provided

Implants clients More than tripled, with a 265% increase, from 78,687 (2007-08) to 247,620 (2012/13) cumulative total of 900,045 implants provided

Minilap clients(Female sterilization)

419,863 clients chose and received minilap (female sterilization) from 2007-2013

Source: National HMIS (MTHUA), 2007/08-2012/13

Rising trends in total numbers of LARC/PM clients being served, and rising number of implants users

Factors in the increase in implants acceptors

The clinical method most preferred by clients and providers

More trained providers are available for implants than other LARC/PMs

Less provider bias than for other LARCs/PMs

Mobile outreach services are bringing providers to lower-level health facilities for services, including implants

Good supplies of implants generally available (except for 2009-2010)

Approval and stocking of Jadelle by the MOHSW, so there are choices of two implants

Price reductions in 2012-2013 by manufacturers of Jadelle and Implanon

A client receiving implant services at a public facility

Current use of implants in Tanzania (TDHS 2010)

3.7%3.7%

0.3%

2.1%1.5%

2.2.5%

Urban

2.5% of urban women

2.2% of rural women currently using implant for FP

3.6%

3.6%

A majority of married women age 15-49 currently using implants live in rural areas

LARC/PM provision according to service modality

Total LARC/PM

OUTREACH

SERVICE DAY

ROUTINE

Conclusions: Good progress has been made in Tanzania in increasing LARC/PM availability

FP service delivery and system strengthening

˗ Number of government hospitals, health centres and dispensaries able to provide at least one LARC/PM has doubled since 2007 and is continuing to rise

˗ The popularity and availability of implants continues to increase

˗ The public sector and its partners are reaching underserved people and communities through mobile outreach

˗ Mobile services also are providing the opportunity for practical skills development, with associated supervision and QA

The Way Forward: Further increase access and choice by building on the strong foundation

Continue to build public sector capacity

Enhance public-private partnership and coordination

Fine tune approaches to reduce unmet need, reach underserved populations and increase equity, and offer a full range of methods

Mobilize resources for FP, including FP2020 commitments, several of which specify implants

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