Tanzania Under five Mortality Reduced by a Quarter: Why??

United Republic of Tanzania Ministry of Health

Cost per child managed correctly in Tanzania

London , 13-14 Dec 2005


Evidence for recent child survival gainsRufiji District Sentinel surveillance (RDSS)-48%-60%Source: MOH TEHIP / NSS

London , 13-14 Dec 2005

Rufiji DSS Mortality Trend

1411513.8108.213.212.1

113.212.511.673.210.29.3

102.111.710.866.19.58.7

109.512.211.167.69.78.7

72.910.19.145.78.17.2

Under-five

Infant

Mortality (nq0)

National DHS Mortality Trend

14192

136.45211.6811.6887.4719.3799.379

146.59318.15718.15799.13914.19214.192

11268

Under-five

Infant

Mortality (nq0)

Data

DHS Trends - Tanzania

Rates and 95% CI

1992199619992004

Under-five141136.452146.593112

+2SE11.6818.157

-2SE11.6818.157

Infant9287.47199.13968

+2SE9.37914.192

-2SE9.37914.192

DSS Trends - Rufiji

Rates and 95% CI

19992000200120022003

Under-five141113.2102.1109.572.9

+2SE1512.511.712.210.1

-2SE13.811.610.811.19.1

Infant108.273.266.167.645.7

+2SE13.210.29.59.78.1

-2SE12.19.38.78.77.2

Sheet2

Sheet3


Key message 3Better access to quality health services as a result of policies and investments supporting the Tanzanian Health System.

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Strong Investment in Rural Health Infrastructure & Primary Health careStructural adjustment and Debt CrisisHealth Sector ReformsEssential health interventions &Sector wide ApproachEvolution of health sector in Tanzania

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Aligning budgets with priorities

1996-97Before basket funding and planning tools..

2000-01After basket funding and planning tools..

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ChallengesSustaining the observed child health gains

Inadequate coverage of interventions and tools e.g District burden-of-disease planning tool & health budget mapping tools

HIV/AIDS pandemic threatening to reverse the gains

Co-ordination at national, district and community level

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ConclusionsTanzania has a comparative advantage for Child SurvivalGood access & utilization of health facilitiesHealth sector reform Poverty Reduction Strategy- PRSP II (NSGRP)Potential for achieving the child survival ;Mobilizing available resources for child health interventionsScaling up of and universal access to effective interventionsStrengthening Partnership at all levels e.g. Maternal, Newborn and Child Health Partnership

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Implications for universal coverageNational Health Sector Strategic plan and Development frameworks to support Child survivalIncreasing resource allocation for scaling up of child survival delivery interventions and strategiesDecentralization at district including;capacity building for planning and budgeting Use of data for decision making and resource allocation e.g. DHA, BOD,SHMPrioritization of essential interventions

Harmonization and convergence of partners through National Partnerships e.g. Maternal Newborn and Child Survival Partnership

London , 13-14 Dec 2005


Implications for Universal Coverage It is never too late to invest in developing sustainable health systems that provide evidence based, cost effective and high impact interventions with high coverage and quality.

London , 13-14 Dec 2005


Thank you

London , 13-14 Dec 2005

Gains in child survival were stagnant and sometimes worsening during the 1990s according to three consecutive DHS national child mortality surveys. But in the fourth and most recent 2004/2005 DHS survey, a substantial reduction in under-five and infant mortality has been seen.

Declines over the past 5 years were also seen in various districts running continuous mortality surveillance systems. One district, implementing health system reforms starting in 1997-8 is shown. Some of these reforms (e.g. basket funding) were extended to the rest of the country starting in 2002.

Some of the survival gain in MCE /TEHIP supported districts was shown to be due to IMCI (13% between 2000 and 2002).

[Note the current national DHS value is the estimate for the previous five years from the survey. We are attempting to get the data to parse out the year by year mortality estimates during this period. The 2002 census showed no mortality decline (U5M 153), so it is possible that much of this five year decline occurred since 2001. While Child and under five mortality show downward trend the neonatal mortality is still stagnant

The red solid line reflects The MDG target for Tanzania which is 48.4 per 1000 Live births is estimated from the 1990 U5mortality which was 145 per 1,000 Live births.

With the 24% reduction in U5M represents 39,200 child deaths prevented per year..With the current trends Tanzania is likely to attain the target even before 2015 Tanzania has experienced increased effort to scaling interventions which have proven to be effective for reducing child mortality.These interventions has been prioritized in the national Essential Interventions Package for Health services and all the districts are directed to include these interventions into their comprehensive district health plans. They include; (next slide)

These are some of the interventions.IMCI was introduced in Tanzania in 1996 starting with 7 districts, the review which was conducted in 1998 recommended scaling up of IMCI to all districts s in a phased up manner.As shown in 1999 IMCI was in 20 out of 114 districts, we currently in 107 out of 114 (93.8%).. But all districts have included IMCI in their plans. The rapid expansion was observed in the last 2 years as a result of results from Multi country evaluation of IMCI that IMCI works and cost more money as it was originally thoughtImmunizations coverage has equally improved as a result of strengthening both routine and supplementary campaigns and surveillance systemVitamin Coverage varies from source. TDHS reports a lower rate of 46%. However the figure from the Population Based Assessment on Vit A supplementation coverage, conducted in Sept 2004 was 85%

RBM Monitoring for ITN 2005 survey conducted in August found out ITN use in U5 was 30%Access to anti malarial treatment within first 24 hours 58% (TDHS 2004-2005)

Exclusive breast feeding rate is estimated to be 41% While skilled attendants at birth is still very low 47% despite very high ANC attendance of >90% for 4 visits Key messages from MCE have facilitated to change the mind set of people who did not believe in IMCI and resources have been increased to support IMCI implementation at all levels

IMCI was also associated with high quality of care of children who were correctly managed as compared to non IMCI districtsThe cost of the child correctly managed is extremely lower in IMCI districts as compared to non IMCI districts..Declines over the past 5 years were also seen in various districts running continuous mortality surveillance systems. One district, implementing health system reforms starting in 1997-8 is shown. Some of these reforms (e.g. basket funding) were extended to the rest of the country starting in 2002.If we could be able to implement as in this rural district through out the country we could be able to attain the MD target.The other components included Capacity building for management, BOD and DHA tool, Integrated mangement cascade for supportive supervision Phase 1: 1960- 1970s: Primary health Care, strong investment in rural health infrastructure, health human resources, and health systems which formed a basis for improved health status

Phase II: 1970- 1990: Structural adjustments, debt crisis, escalating costs which was subsequently followed by poor quality of services and increase in mortality

Phase III: 1990-todate: Health Sector reform with decentralization, Essential interventions package e.e IMCI, Immunization, Nutrition, Sector wide approaches, health strategic plan, PRSP I & IIResulting in improved quality of services and decline in mortality.

Use of Planning tools in Morogoro Rural. Among the tools which were used included; DHA, BOD and Health management has helped the districts to allocated resources to interventions with high burden e.g. 1997 more resources to EPI, TB DOTs proportionately the picture changed in 2001, now more resources are allocated to interventions with high burden e.g. Malaria and IMCI

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Tanzania Under five Mortality Reduced by a Quarter: Why??