United Republic of Tanzania Ministry of Health and Social ... · 2ii When a woman undertakes her biological role of becoming pregnant and undergoing childbirth, the society has an

The National Road Map Strategic Plan -2008 - 2015 i

United Republic of Tanzania

Ministry of Health and Social Welfare

The National Road Map Strategic PlanTo Accelerate Reduction of Maternal, Newborn

and Child Deaths in Tanzania

2008 - 2015

April 2008

2ii

When a woman

undertakes her biological

role of becoming

pregnant and undergoing

childbirth, the society has

an obligation to fulfil her

basic human rights,

which include the right to

life, liberty social

security, maternity

protection and non

discrimination.

The National Road Map Strategic Plan -2008 - 2015 iii

TABLE OF CONTENTS

Abbreviations ............................................................................................................................................ ivForeword.................................................................................................................................................... viiAcknowledgements ................................................................................................................................... viii

Chapter 1:Overview ................................................................................................................................................... 1

1.1 Introduction ..................................................................................................................................... 11.2 Initiatives to Improve Maternal, Newborn and Child Health in Tanzania ...................................... 11.3 Rationale for the Strategic Plan to Accelerate Reduction of Maternal,

Newborn and Child Deaths in Tanzania.......................................................................................... 2

Chapter 2:SituationAL Analysis of maternal, newborn and child health in tanzania ................................................ 3

2.1 Maternal Health............................................................................................................................... 32.2 Newborn Health .............................................................................................................................. 62.3 Child Health ................................................................................................................................... 82.4 Cross Cutting Issues ....................................................................................................................... 11

Chapter 3:Strategic FRAMEWORK.......................................................................................................................... 15

Chapter 4:Implementation Framework ...................................................................................................................... 18

Chapter 5:Strategic plan and activities – 2008-2015 ................................................................................................ 24

Chapter 6:MONITORING FRAMEWORK ............................................................................................................. 47

ANNEXES

SWOT Analysis ......................................................................................................................................... 57Inputs for Improving MNCH at All Levels ............................................................................................... 71Relevant Policy Documents ...................................................................................................................... 42Most Cost Effective Interventions Based on Evidence to Date for Reduction of Perinatal and Neonatal Mortality............................................................................................................... 83Evidence-Based Interventions that Influence Child Health ...................................................................... 84Evidence-Based Interventions for MNCH ................................................................................................ 85Where Does Tanzania Stand in Terms of MNCH Service Delivery?........................................................ 88Essential MNCH Medicines, Equipment and Supplies ............................................................................. 90Glossary ..................................................................................................................................................... 92

REFERENCES .......................................................................................................................................... 93

ABBREVIATIONS

ADDOS Accredited Drug Dispensing Outlets

AIDS Acquired Immuno Deficiency Syndrome

ALu Artemether Lumefantrine

AMO Assistant Medical Officer

ANC Antenatal Care

ARH Adolescent Reproductive Health

ARI Acute Respiratory Tract Infection

BCC Behaviour Change Communication

BEmOC Basic Emergency Obstetric Care

BFHI Baby Friendly Hospital Initiative

BMI Body Mass Index

CBD Community Based Distributor

CBIMS Community Based Information Management System

CBO Community Based Organization

CCHP Comprehensive Council Health Plan

CEmOC Comprehensive Emergency Obstetric Care

CHMT Council Health Management Team

c-IMCI Community Integrated Management of Childhood Illness

CPR Contraceptive Prevalence Rate

CSO Civil Society Organization

DHR Director Human Resources

DPS Director Preventive Services

EmOC Emergency Obstetric Care

ENC Essential Newborn Care

EPI Expanded Programme on Immunization

FANC Focused Antenatal Care

FBO Faith Based Organization

FP Family Planning

HIV Human Immuno Deficiency Virus

HMIS Health Management Information System

HPV Human Papilloma Virus

HSSP Health Sector Support Programme

ICPD International Conference on Population and Development

IDWE Infectious Disease Week Ending report

IEC Information Education and Communication

IMCI Integrated Management of Childhood Illness

IMR Infant Mortality Rate

IPT Intermittent Preventive Treatment

ITN Insecticide Treated Net

IYCF Infant Young Child Feeding

iv The National Road Map Strategic Plan -2008 - 2015

The National Road Map Strategic Plan -2008 - 2015 v

KMC Kangaroo Mother Care

LLINs Long Lasting Insecticide Treated Nets

LSS Life Saving Skills

MDGs Millennium Development Goals

MKUKUTA Mkakati wa Kukuza Uchumi na Kupunguza Umaskini Tanzania (The National Strategy for

Growth and Reduction of Poverty)

MMAM Mpango wa Maendeleo wa Afya ya Msingi (The Primary Health Services Development

Programme)

MMR Maternal Mortality Ratio

MNCH Maternal, Newborn and Child Health

MNT Maternal and Newborn Tetanus

MoAFSC Ministry of Agriculture, Food Security and Cooperatives

MoCDGC Ministry of Community Development, Gender and Children

MoEVT Ministry of Education and Vocational Training

MoFEA Ministry of Finance and Economic Affairs

MoHSW Ministry of Health and Social Welfare

MoICS Ministry of Information, Culture and Sports

MoID Ministry of Infrastructure Development

MoLEYD Ministry of Labour, Employment and Youth Development

MVA Manual Vacuum Aspiration

NACP National AIDS Control Programme

NBS National Bureau of Statistics

NGOs Non Governmental Organization

NMCP National Malaria Control Programme

NMW Nurse Midwife

NORAD Norwegian Development Cooperation

NPEHI National Package of Essential Health Interventions

NPERCHI National Package of Essential Reproductive and Child

Health Interventions

ORS Oral Rehydration Solution

ORT Oral Rehydration Therapy

PAC Post Abortion Care

PHAST Participatory Hygiene and Sanitation Transformation

PHC Primary Health Care

PHSDP Primary Health Services Development Programme

PMNCH Partnership for Maternal, Newborn and Child Health

PMO-RALG Prime Minister’s Office, Regional Administration and Local Government

PMTCT Prevention of Mother to Child Transmission

POPSM President’s Office – Public Service Management

QIRI Quality Improvement and Recognition Initiative

RED Reaching Every District

REC Reaching Every Child

RCH Reproductive and Child Health

RCHS Reproductive and Child Health Section

RHMT Regional Health Management Team

RTI Reproductive Tract Infection

SM Safe Motherhood

SMI Safe Motherhood Initiative

SNL Saving Newborn Lives

SRH Sexual and Reproductive Health

STI Sexually Transmitted Infection

SWOT Strengths, Weaknesses, Opportunities and Threats

TAMWA Tanzania Media Women Association

TASAF Tanzanian Social Action Fund

TBA Traditional Birth Attendant

THIS Tanzania HIV/AIDS Indicator Survey

TDHS Tanzania Demographic and Health Survey

TFNC Tanzania Food and Nutrition Centre

TFR Total Fertility Rate

TGNP Tanzania Gender Networking Group

TPMNCH Tanzanian Partnership for Maternal, Newborn and Child Health

TRCHS Tanzania Reproductive and Child Health Survey

TSPA Tanzania Service Provision Assessment

TT Tetanus Toxoid

UNFPA United Nations Population Fund

UNICEF United Nations Children Fund

VVF Vesico Vaginal Fistula

WB World Bank

WHO World Health Organization

WRATZ White Ribbon Alliance Tanzania

ZRCH Zonal Reproductive and Child Health

vi The National Road Map Strategic Plan -2008 - 2015

The National Road Map Strategic Plan -2008 - 2015 vii

FOREWORD

Reduction of maternal, newborn and child deaths is a high priority for all, given the persistently high maternal,newborn and child morbidity and mortality rates over the past two decades in African countries, Tanzaniaincluded. It is one of the major concerns addressed by various global and national commitments, as reflectedin the targets of the Millennium Development Goals, Tanzania Vision 2025, the National Strategy for Growthand Reduction of Poverty (NSGRP-MKUKUTA), and the Primary Health Services Development Program(PHSDP-MMAM), among others.

Maternal deaths are caused by factors attributable to pregnancy, childbirth and poor quality of health services.Newborn deaths are related to the same issues and occur mostly during the first week of life. Child healthdepends heavily on availability of and access to immunizations, quality management of childhood illnessesand proper nutrition. Improving access to quality health services for the mother, newborn and child requiresevidence-based and goal-oriented health and social policies and interventions that are informed by best practices.

Development of this plan for reducing maternal, newborn and child mortality is in line with the tenets of theNew Delhi Declaration 2005. Tanzania and other countries committed to develop one national MNCH plan foraccelerating the reduction of maternal, newborn and child deaths, in order to improve coordination, alignresources and standardize monitoring. Further support for incorporating child health interventions into this planwas voiced by various stakeholders and development partners following the April 2007 launch of the TanzaniaPartnership for Maternal, Newborn and Child Health (TPMNCH). The National Road Map Strategic Plan toAccelerate Reduction of Maternal, Newborn and Child Deaths in Tanzania (2008 – 2015) was subsequentlydeveloped as Tanzania’s national response to the renewed commitment to improve maternal, newborn and childcare. The Reproductive and Child Health Section (RCHS) of the Ministry of Health and Social Welfare(MoHSW), in collaboration with a number of different stakeholders, has developed this strategic plan to guideimplementation of all maternal, newborn and child health interventions in Tanzania.

The National Road Map Strategic Plan stipulates various strategies to guide stakeholders for Maternal, Newbornand Child Health (MNCH), these include the Government, development partners, non-governmentalorganizations, civil society organizations, private health sector, faith-based organizations and communities, inworking together towards attainment of the Millennium Development Goals (MDGs) as well as other regionaland national commitments and targets related to maternal, newborn and child health

It is the expectation of the Government, particularly the MoHSW, that all stakeholders will make optimal useof this strategic framework to support the implementation of maternal, newborn and child health interventions,as this is in line with the National Health Policy and existing MNCH standards, guidelines and protocols.

The Government highly values your partnership in working towards realization of the objectives of the NationalRoad Map Strategic Plan to Accelerate Reduction of Maternal, Newborn and Child Deaths. Together, we canimprove the health of Tanzanian mothers, babies and children, and build a stronger and more prosperous nation.

Professor David Homeli Mwakyusa (MP),Minister for Health and Social Welfare

viii The National Road Map Strategic Plan -2008 - 2015

ACKNOWLEDGEMENTS

The MoHSW wishes to express its gratitude to the many individuals and development partners who worked withthe Ministry in the development of “The National Road Map Strategic Plan to Accelerate Reduction of Maternal,Newborn and Child Deaths in Tanzania, 2008 – 2015”. The completion of the document is a result of extensiveconsultations and collaboration with various stakeholders including the RCHS of the MoHSW, developmentpartners, interested organizations as well as committed individuals.

The MoHSW would like to acknowledge all those stakeholders who contributed in one way or another to thesuccessful development of the document. The Ministry particularly wishes to acknowledge the invaluablecontribution of the PMNCH Country Support Working Group: Dr. Nancy Terreri (UNICEF HQ); Dr. CiroFranco (BASICS, USA); and Dr. Koki Agarwal (ACCESS/Jhpiego, USA). The MoHSW also acknowledgesthe contribution of the technical group members: Dr. Theresa Nduku Nzomo (WHO/AFRO Harare); Dr. SamMuziki (WHO/AFRO Harare); Dr. Thierry Lambrechts (WHO/HQ); and local Consultants led by Dr. Ali Mzigeand Dr. Rosemary Kigadye. Other national technical experts who contributed in the development include: Dr.Catherine Sanga (RCHS, MoHSW), Dr. Neema Rusibamayila (IMCI, MoHSW), Dr. Georgina Msemo(IMCI/SNL, MoHSW), Dr. Mary Kitambi (EPI, MoHSW); Ms. Lena Mfalila (RCHS/SMI, MoHSW); Dr.Elizabeth Mapella (ARH, MoHSW); Ms. Hilda Missano (TFNC); Dr. Rutasha Dadi and Dr. Chilanga Asmani(UNFPA); Dr. Theopista John, Dr. Josephine Obel and Dr. Iriya Nemes (WHO Tanzania); Dr. Asia Hussein(UNICEF, Tanzania); and Maryjane Lacoste (ACCESS/Jhpiego, Tanzania).

The Ministry would also like to acknowledge Ms. Hassara Maulid (MoHSW) for her secretarial work with theinitial drafts of this document.

Lastly, the Ministry would like to acknowledge technical and financial support provided by EC, WHO, UNFPA,UNICEF and One UN Fund for the development and printing of the MNCH strategic plan.

Wilson C. MukamaPermanent Secretary, MoHSW

The National Road Map Strategic Plan -2008 - 2015 1

CHAPTER 1:OVERVIEW

Purpose of the documentThis document has been conceived for various purposes. The health of the mother is closely linked to the healthand survival of the child. In addition, the socio-economic level of the mother and the maternal health status(HIV/AIDS, malaria, nutrition) has an impact on the survival of the child. Thus the primary purpose of “OneIntegrated Maternal Newborn and Child Health Strategic Plan” is to ensure improved coordination ofinterventions and delivery of services across the continuum of care. Another purpose of the document is toguide implementation across operational levels of the system so that policy drawn at national level will becarried out at the district and community levels, with support from the regional level. It is anticipated that a jointstrategy will contribute to more integrated implementation, improved services, and ultimately a significantreduction in morbidity and mortality of Tanzanian women and children.

1.1 Introduction

The total population of Mainland Tanzania is estimated to be 39,384,223 (as of July 2007)1. Most of thepopulation (75%) resides in the rural area. The annual growth rate is 2.9% with life expectancy at birth being54 years for males and 56 years for females2.

The total fertility rate in Tanzania has been consistently high over the past ten years and currently stands at 5.7children per woman. There are regional variations with urban-rural disparities, where rural women have higherfertility rates than their urban counterparts3.

The Maternal Mortality Ratio (MMR) has remained high for the last 10 years4 without showing any decline andis currently estimated to be 578 per 100,000 live births5. While significant progress has been made to reducechild mortality in Tanzania, the neonatal mortality rate remains high at 32 per 1,000 live births, and accountsfor 47% of the infant mortality rate which is estimated at 68 per 1,000 live births.

The critical challenges in reducing maternal, newborn and child morbidity and mortality comprise twocategories:

(a) Health system factors - inadequate implementation of pro-poor policies, weak health infrastructure, limitedaccess to quality health services, inadequate human resource, shortage of skilled health providers, weak referralsystems, low utilization of modern family planning services, lack of equipment and supplies, weak healthmanagement at all levels and inadequate coordination between public and private facilities.

(b) Non health system factors- inadequate community involvement and participation in planning,implementation, monitoring and evaluation of health services, some social cultural beliefs and practices, genderinequality, weak educational sector and poor health seeking behaviour.

1.2 Initiatives to improve maternal, newborn and child health in Tanzania

Maternal and child health services were established in Tanzania in 1974. In 1975 the Expanded Programme ofImmunization (EPI) was initiated to strengthen immunization services for vaccine preventable childhooddiseases. Tanzania adopted the Safe Motherhood Initiative (SMI) in 1989, following the official launch of theGlobal Safe Motherhood Initiative in 1987 in Nairobi, Kenya. Subsequently, the 1994 International Conferencefor Population and Development (ICPD) emphasized access to comprehensive reproductive health services andrights. In response to the ICPD Plan of Action, Tanzania established the Reproductive and Child Health Section(RCHS) within the Ministry of Health and developed a National Reproductive and Child Health Strategy.

1 CIA World Fact Book, March 20082 Census, 20023 TDHS 2004/05

4 Maternal Mortality ratio was 529/100,000 live births in TDHS 19965 TDHS 2004/05

In 1996 Tanzania adopted the Integrated Management of Childhood Illness (IMCI) approach for reductionof childhood morbidity and mortality. Various nutrition interventions have also been adopted including theBaby Friendly Hospital Initiative (BFHI) in 1992, the Code of Marketing Breast Milk Substitutes in 1994

and Vitamin A Supplementation in 1997. Tanzania developed its National Strategy on Infant and Young ChildFeeding and Nutrition in 2005.

In Tanzania, specific attempts have been made to address maternal, newborn and child health (MNCH)challenges through the National Health Policy (revised in 2003), the Health Sector Reforms and the HealthSector Strategic Plan (2003-2007). Furthermore, the Reproductive and Child Health Strategy (2005-2010) andthe National Road Map Strategic Plan to Accelerate the Reduction of Maternal and Newborn Mortality (2006-2010) were also formulated to respond to these challenges.

Improving MNCH is also a major priority area in the National Strategy for Growth and Poverty Reduction(NSGPR/MKUKUTA) 2005-2010 which has three major interlinked clusters6. One of the goals clearly outlinedin the second cluster of the strategy is to improve the survival, health and well being of all children and womenand of especially vulnerable groups. Under this goal, there are four operational targets related to maternal andchild health for monitoring progress towards achieving MDGs 4 and 5.

The Health Sector Support Programme III (2008 – 2012) will incorporate and address MNCH issues in termsof alignment with Government policies, resource mobilization and donor harmonization. The newly initiatedPrimary Health Service Development Programme, (PHSDP/MMAM) 2007 – 2017, will address the deliveryof health services to ensure fair, equitable and quality services to the community and is envisioned to be thespringboard for achieving good health for Tanzanians.

The Tanzania MNCH Partnership was officially launched in April 2007 to re-focus the strategies for reducingthe persistently high maternal, newborn and child mortality rates, through adopting the One Plan and settingclear targets for improved MNCH.

1.3 Rationale for the Strategic Plan to accelerate reduction of maternal, newborn and childdeaths in Tanzania

Annually, it is estimated that 536,000 women7 worldwide die from pregnancy- and childbirth-related conditions,as do 11,000,000 under-fives, of which 4.4 million are newborns. Most of these deaths occur in Sub SaharanAfrica. Tanzania is one of the ten countries contributing to 61% and 66% of the global total of maternal andnewborn deaths, respectively. In Tanzania, the estimated annual number of maternal deaths is 13,000, theestimate for under-fives is 157,000, and newborn deaths are estimated at 45,0008. In committing to MDGs 4and 5, the Government of Tanzania agreed to reduce the under-five mortality rate by two-thirds and reduce thematernal mortality ration by three-quarters, by 2015.

Maternal, newborn and child outcomes are interdependent; maternal morbidity and mortality impacts neonataland under-five survival, growth and development. Thus service demand and provision for mothers, newbornsand children are closely interlinked. Integration of MNCH services demands reorganization and reorientationof components of the health systems to ensure delivery of a set of essential interventions for women, newbornsand children. A focus on the continuum of care replaces competing calls for mother or child, with a focus onhigh coverage of effective interventions and integrated MNCH service packages as well as other keyprogrammes such as Safe Motherhood (SM), Family Planning (FP), Prevention of Mother to Child Transmission(PMTCT) of HIV, Malaria, EPI, IMCI, Adolescent Health and Nutrition. Sustained investment and systematicphased scale up of essential MNCH interventions integrated in the continuum of care are required.

2 The National Road Map Strategic Plan -2008 - 2015

6 Cluster 1: Growth and Reduction of Income Poverty; Cluster 2: Improvedquality of life and social well being; Cluster 3: Good governance andaccountability.

7 Maternal Mortality Estimates 2005, WHO, UNICEF, UNFPA, World Bank8 Opportunities for Africa’s Newborns 2006, the Partnership for MNCH


CHAPTER 2:SITUATIONAL ANALYSIS OF MATERNAL, NEWBORN

AND CHILD HEALTH IN TANZANIA

Introduction

Maternal, newborn and child health care is one of the key components of the National Package of EssentialReproductive and Child Health Interventions (NPERCHI) focusing on improving the quality of life forwomen, adolescents and children. The major components of the package include:• antenatal care; • care during childbirth; • care of obstetric emergencies; • newborn care; • postpartum care; • post abortion care; • family planning; • diagnosis and management of HIV/AIDS including PMTCT,

other sexually transmitted infections and • reproductive tractinfections (STI/RTI);

• prevention and management of infertility; • prevention and management of cancer; • prevention and management of childhood illness; • prevention and management of immunisable diseases; • nutrition care.

In spite of the good coverage of health facilities, not all components of the services are of good quality andprovided to scale; hence, maternal, newborn and child mortalities remain a major public health challenge inTanzania.

2.1 Maternal Health

• Antenatal care

According to TDHS (2004/05), 94% of pregnant women make at least one antenatal care (ANC) visitand 62% of women have four or more ANC visits. The number of pregnant mothers in Tanzania makingfour or more ANC visits appears to have declined slightly from 70% in 19999. However, the quality ofantenatal care provided is inadequate. About 65% of the women have their blood pressure measured and54% have blood samples taken for haemoglobin estimation and syphilis screening. About 41% haveurine analysis done and only 47% are informed of the danger signs in pregnancy.

Approximately 80% of pregnant women received at least 1 dose of tetanus toxoid (TT), and 56% of womenreceived two or more TT doses10. Younger mothers, women in their first pregnancy, women of the highereducation and wealth strata and urban women are more likely to receive two or more doses of TT.

Despite high ANC attendance, only 14% of pregnant women start ANC during the first trimester as per thenational guidelines. The median number of months that women are pregnant at their first visit is 5.4. One-third of women do not seek ANC until their sixth month or later11. However, early booking has an advantagefor proper pregnancy information sharing and pregnancy monitoring.

9 TRCHS 199910 TDHS 2004/0511 TDHS 2004/05

When a woman

undertakes her biological

role of becoming

pregnant and undergoing

childbirth, the society

has obligation to fulfil

her basic human rights

and that of her child.

• Malaria in pregnancy

Pregnancy alters a woman’s immune response to malaria, particularly in the first malaria-exposedpregnancy, resulting in more episodes of severe infection and anaemia, all of which contribute to ahigher risk of death. Malaria is estimated to cause up to 15 % of maternal anaemia, which is morefrequent and severe in first pregnancies. Malaria is a significant cause of low birth weight which is themost important risk factor for newborn death and is also a risk factor for stillbirth.

Efforts to combat malaria among pregnant mothers are being scaled up. Pregnant women are supposed toreceive two doses of SP for intermittent preventive treatment (IPT) of malaria during routine antenatal carevisits. However, according to TDHS (2004/05), only 22% of pregnant women attending the ANC clinicreceive the complete course of IPT, and only 16% use Insecticide Treated Nets (ITNs). Recent data fromthe National Malaria Control Programme (NMCP) indicate that the proportion of pregnant women sleepingunder ITNs has increased to 28%12.

• Intrapartum care

Only 47% of all births in Tanzania occur at health facilities and 46% of all births are assisted by a skilledhealth worker. Out of the 53% of births which take place at home, 31% are assisted by relatives, 19% bytraditional birth attendants (TBAs) and 3% are conducted without assistance. As expected, births to womenin the highest wealth quintile are more likely to be assisted by a skilled birth attendant (87%) than womenin the lowest quintile (31%)13.

Emergency obstetric care services are crucial for handling complicated deliveries. Findings from TDHS(2004/05) revealed that only 3% of all babies were delivered by caesarean section – this figure is belowthe WHO-recommended standard of 5-15%, and is partially due delay in timely referral, lack of skilledattendance and functioning blood banks at most hospitals and health centres. About 64.5% of publichospitals provide Comprehensive Emergency Obstetric Care (CEmOC), whereas only 5.5% of public healthcentres are providing Basic Emergency Obstetric Care (BEmOC)14. Furthermore, the referral system hasserious challenges including limited number of ambulances; unreliable logistics and communicationsystems; and inadequate community-based facilitated referral systems.

• Postnatal care

Postnatal care is an important component of good maternal and baby health care is not very well utilizedin Tanzania. Eighty-three percent of women who delivered a live baby outside the health facility did notreceive a postnatal check-up, and only 13% were examined within two days of giving birth asrecommended. Women in the highest income quintiles were more likely to receive a timely postnatal check-up compared to those in the lowest quintiles15.

Prevention of Mother-to- Child Transmission of HIV

The key to ensuring an HIV-free start in life is prevention of HIV transmission to children by preventingHIV in mothers. PMTCT interventions include testing and counselling for HIV, antiretroviral prophylaxisfor HIV-infected pregnant women and their exposed children, treatment of eligible women, counselling andsupport for infant feeding, safer obstetric practices and family planning to prevent unintended pregnanciesin HIV-infected women. By September 2007, there were about 1,311 PMTCT sites established withinreproductive and child health (RCH) clinics throughout the country16. Additional sites need to be establishedto provide services as close to the community as possible. The goal, objectives and strategies to scale upquality PMTCT services are stipulated in the Health Sector Strategy for HIV/AIDS (2008-2012).


12 NMCP-MoHSW 200713 TDHS 2004/0514 MoHSW, 2006. Situation Analysis of Emergency Obstetric Care for Safe

Motherhood in Public Health Facilities in Tanzania 15 TDHS 2004/0516 NACP 2007


Integration of PMTCT interventions in ANC, nutrition programmes, IMCI and other HIV/AIDSservices enhances opportunities for reducing paediatric HIV and its associated deaths.

• Nutrition

Maternal nutrition during the pre- and postnatal periods is extremely important for the outcome ofpregnancy as well as infant feeding. A good and adequate balanced diet, as well as vitamin and mineralsupplementation, improves birth outcome and maternal well-being.

Underweight status contributes to poor maternal health and birth outcomes. Overall, 10% of Tanzanianwomen of reproductive age (15–49 years) are considered to be undernourished, having a Body Mass Index(BMI) of less than 18.5. Women living in rural areas are more affected compared to those living in urbanareas17.

Maternal under-nutrition, is often reflected in the proportion of children born with low birth weight (below2.5 kg). Representative data on the prevalence of low birth weight babies is not readily available butestimates from UNICEF suggest that 10 % of Tanzanian newborns are low birth weight18.

Pregnant women are particularly vulnerable to anaemia due to increased requirements for iron and folicacid. According to TDHS (2004/05), 48% of women aged 15-49 years were found to be anaemic, whereas58% of pregnant women and 48% of breast-feeding mothers were anaemic. Ten percent of pregnant womentook iron tablets for at least 90 days, while about half (52%) took iron tablets for less than 60 days, and 38%did not take iron tablets at all. Haemorrhage is the most frequent cause of maternal deaths, and pregnantwomen who are anaemic are more vulnerable to postpartum haemorrhage.

• Family planning

Spacing the intervals between pregnancies can prevent 20 to 35% of all maternal deaths19. However, familyplanning services continue to face challenges in meeting clients’ expectations and needs. Despite havinghigh knowledge of contraceptives (90%), only 26 % of married women use any method of contraception,with only 20% using a modern method. The most commonly used methods are injectables (8%), pills (6%)and traditional methods (6%)20. Current usage of any modern method is higher among sexually activeunmarried women than among married women (41% and 26%, respectively). To be noted is the fact thatthe percentage of married women using any method of contraception has changed little from the 1999TRCHS. The total demand for FP among married women is 50%, while 22% have an unmet need for FP21.

Factors contributing to low contraceptive prevalence include low acceptance of modern FP methods, erraticsupplies of contraceptives with limited range of choices, limited knowledge/skills of providers andprovider’s bias affecting informed choice. The situation is worsened by limited spousal communication,inadequate male involvement and lack of adolescent-friendly health services and misconceptions aboutmodern family planning methods. In an attempt to improve access to family planning services, community-based programmes are being implemented in 46 mainland districts; however, this represents less than halfof all districts in the country.

• Challenges in accessing quality careData from TDHS (2004/05) revealed that the major barriers perceived by women in accessing deliveryhealth services include lack of money (40%), long distance to health facility (38%), lack of transport (37%),and unfriendly services (14%). The high rate of home deliveries is also attributable to a malfunctioningreferral system, inadequate capacity of health facilities in terms of available space, skilled attendants andcommodities, and other socio-cultural aspects affecting the pregnant women. Additional factors includegender inequalities in decision-making and access to resources at household-level.

17 TDHS 2004/0518 State of the World’s Children Report, 200819 Singh S. et al. 2004. Adding it Up: The Benefits of Investing in Sexual andReproductive Health Care. Washington D.C. and New York: The Alan Guttmacher

Institute and UNFPA.20 TDHS 2004/0521 TDHS 2004/05

• Maternal morbidity and mortalityAccording to TDHS (2004/05), the maternal mortality ratio is estimated at 578/100,000 live births.Major direct causes of maternal mortality include obstetric haemorrhage, obstructed labour, pregnancyinduced hypertension, sepsis and abortion complications.

It is estimated that abortion complications contribute to about 20% of maternal deaths worldwide22. InTanzania, induced abortion is illegal hence the actual magnitude of the problem is not known. However,several attempts have been made to document the severity of the issue – in Hai District, for example, it wasreported that nearly a third of maternal deaths are related to unsafe abortion (Mswia et al, 200323). Postabortion care (PAC) services can significantly reduce maternal mortality due to unsafe abortions; however,only 5% of health facilities in Tanzania currently provide this service24.

Indirect causes leading to poor maternal health outcomes are malaria, anaemia, and HIV/AIDS. Withspecific regard to HIV, prevalence in Tanzania is estimated to be 7% in adults aged 15-49 years, withprevalence among women being higher (8%), compared to 6% among men25.

2.2 Newborn Health

• Newborn morbidity and mortalityTanzania is among those countries that have had success in reducing child mortality, but there has been nomeasurable progress in reducing neonatal deaths. The neonatal mortality rate was 40.4 per 1,000 live birthsin 1999 and 32 per 1,000 live births in 2004/05. Up to 50% of neonatal deaths occur in the first 24 hoursof life, with over 75% of them arising in the first week of life. Newborn mortality is a sensitive indicatorof the quality of care provided during the antenatal period, delivery and immediate postnatal period.

According to modelled estimates for Tanzania, 79% of newborn deaths are due to three main causes:infections including sepsis/pneumonia (29%), birth asphyxia (27%); and complications of preterm birth(23%) (Figure 2). Sepsis was the most common cause of death noted in a study conducted in Mbulu and


Figure 1: Direct Causes of Maternal Deaths

Source: The World Health Report, 2005

22 The World Health Report, 200523 Mswia et al, 2003. Community Based Monitoring of Safe Motherhood in UnitedRepublic of Tanzania

24 TDHS 2004/0525 THIS, 2003/04


Hanang districts of rural northern Tanzania26. Many of these conditions are preventable and closelylinked to the absence of skilled birth attendance at delivery. Eighty-six percent (86%) of neonataldeaths in Tanzania are also low birth weight, many of whom are preterm. On average in Tanzania, newborn deaths are 67% higher in the poorest families as compared to the wealthier families, and themajority of deaths occur in rural areas27.

Low birth weight (birth weight less than2500 grams) and preterm birth (less than36 completed weeks of gestation) togethercontribute to 28% of neonatal deathsglobally28. The recent Tanzania DHS(2004/05) asked mothers to estimatewhether their infant was “very small,small, average, or large”. They were alsoasked to report the actual birth weight, if itwas known. The TDHS data cite aneonatal mortality of 86% in the five-yearperiod prior to the survey among“small/very small” newborns. However,other all-cause mortality estimates indicatea mortality rate of 23% for preterm infants(who are most likely also of low birthweight.).

• Continuum of careIt is important to address the coverage of interventions along the continuum of care from pregnancy,neonatal period, infancy and childhood. It is critical to note that the coverage of essential interventions islowest at the time when needed most: that is, during child birth and the early neonatal period whenmore than 50% of maternal and newborn deaths occur (Figure 3).

Source: 2004/5 TDHS

Figure 2: Estimated Causes of Neonatal Deaths

Figure 3: Coverage of Interventions along the Continuum of Care in Tanzania

Source: Opportunities for Africa’s Newborns, Lawn JE, et al 2006

26 Hinderraker et al, 200327 TDHS, 2004/0528 Lancet Neonatal Survival Series, 2005

• Other challenges

Furthermore, quality newborn and child care faces other challenges including poor health infrastructureand referral for neonatal care, child care and poor skills of service providers related to inadequateincorporation of neonatal content in pre- and in-service training curricula. A recent study conducted in Dares Salaam in 2005 showed that none of the primary and secondary level health facilities was providingbasic/essential newborn care.

2.3 Child Health

• Immunization

The Expanded Programme of Immunization (EPI) has performed well over thepast decade with immunization coverage of 71% for all vaccines for children 12-23 months (TDHS, 2004/05). Currently the policy is to provide each child withone dose of BCG, four doses of OPV, three doses of DTP-HB and one dose ofmeasles vaccine. As expected, children born to mothers in the lowest wealthquintile are less likely to be fully immunized than those born to mothers in thehighest wealth quintile.

Pneumonia is one of the major contributors towards under five mortality and it accounted for 21.1% ofunder five deaths in 2006. The Lancet series on child survival identifies Hib vaccine as an intervention thatcould reduce under five mortality due to pneumonia by 20%. Plans are under way to consider introductionof Hib and pneumococcal vaccines in the national policy.

Measles outbreaks are still happening despite high measles routine immunization coverage (above 80% inalmost all districts). Tanzania has been implementing the Reaching Every District (RED) strategy toimprove immunization coverage for all antigens including measles but also conducting periodic measlessupplementation immunization campaigns after every three years.

The achievement of TT and polio vaccines is evident by the significant reduction in neonatal tetanus deathsand polio cases. The last polio case in the country was identified in 1996; however, there is a high risk ofwild polio virus importation from polio-endemic countries. In this regard polio eradication initiatives needto be sustained until polio is eradicated.Tanzania is close to achieving Maternal Neonatal Tetanus (MNT) elimination; however, there are still

some pockets in high risk districts. Implementation of MNT elimination strategies will focus more in highrisk districts.

• Integrated Management of Childhood Illness

Case management of common childhood illness is a key step to reducing child mortality. Appropriatemanagement of malaria, pneumonia, diarrhoea and dysentery can reduce under five mortality by 5, 6, 15and 3% respectively. The IMCI strategy has been implemented at scale in Tanzania from 1996 with alldistricts implementing at different levels of coverage. Tanzania was part of an IMCI inter-country evaluationand the results were encouraging, but issues around quality of care and supervision were noted29.

IMCI has been found to be an effective delivery strategy for various child survival interventions and hascontributed to a 13% mortality reduction over a two-year period in those districts in Tanzania where it hasbeen implemented30. Management of diarrhoeal disease has been improved to include low osmolarity oralrehydration solution (ORS) and zinc supplementation. The IMCI clinical guidelines have been updatedaccordingly and have also included the newborn, HIV/AIDS and strengthened nutrition.


29 MCE Report, 200530 MCE Report, 2005

Only 20% of women

receive Vitamin A

supplementation

within 2months

after childbirth.


• Prevention and management of malaria

Malaria contributes to 23% percent of under five mortality in Tanzania31. Use of ITNs contributes to7 percent reduction of overall deaths among under-fives 32. Only 47% of under fives in Tanzania sleepunder ITNs33. ITNs are distributed through the health system by vouchers, as well as by free distribution oflong lasting insecticide treated nets (LLINs) through catch up campaigns and replacement campaigns toreplace worn out ITNs in the period 2008 – 2012 when appropriate.

Malaria management has been improved using the combination therapy of Artemether and Lumefantrine(ALu). The MoHSW is training district focal persons for both IMCI and malaria and regional focalpersons for coordination of malaria and IMCI interventions. Since a good proportion of caretakers seektreatment outside of the health facility, the MoHSW is also training the private sellers to dispense basicessential drugs to the community through Accredited Drug Dispensing Outlets (ADDOs).

• Care seeking

Care seeking for sick children needs to be improved. The TDHS 2004/05 showed that among children withsymptoms prior to the survey, half of the children (57%) with symptoms of Acute Respiratory Infection(ARI) or fever and 47% of children with diarrhoea were taken to a health facility. Those in urban areas weremore likely than rural children to be taken to the health facility. However, a vast majority of the childrenwith diarrhoea (70%) were also given some form of ORT and 54% were given a solution prepared fromORS.

In Tanzania, although access to health services is good, many people seek care when it is too late or notat all. Attention should be paid to the fact that only 57% of under-fives receive anti- malarial treatmentwithin 24 hours of developing symptoms. In this perspective the MoHSW has always prioritizedcommunity IMCI (c-IMCI) as a way of identifying danger signs among under-fives and when to seekcare.

• Nutrition

Nutrition indicators for under-fives have shown some improvement over the years but undernutrition is stillwidely prevalent in Tanzania. Stunting, underweight status and wasting among children aged 0-59 monthshave reduced from 44%, 29% and 5% in 1999 to 38%, 22% and 3% respectively34 . Anaemia is also highlyprevalent among under-fives with 72% of all 6-59 months children being anaemic. The main causes ofanaemia are nutritional deficiency, intestinal worms and malaria.

Optimal breastfeeding can reduce under-five mortality by up to 13%35. The majority of Tanzanian babiesare breastfed, for a median duration of 21 months. Fifty-four percent (54%) are breastfed up to two years.However, initiation of breastfeeding within one hour of birth is only 59% and the exclusive breastfeedingrate (0-5 months of age) is estimated to be 41%36 . Early complementary feeding is common with 39% ofinfants below 3 months already introduced to complementary foods37. About 12% of infants are notcomplemented at the age of 6-7 months. Furthermore feeding frequency during complementation is too low(about 2-3 feeds a day), nutrient density is low and the preparation and feeding practices are often unsafe38.Children 2 – 5 years old are fed family foods; however, feeding frequency and nutrient density are alsoinadequate in this group.

Coverage of health workers trained on infant and young child feeding is low and only 68 have beenaccredited as baby friendly39. Training on Essential Nutrition Actions (Vitamin A supplementation, exclusivebreastfeeding, complementary feeding, iodine) is in the early stages of implementation. Coverage of

31 Country Health System Fact Sheet 2006, WHO32 Lancet Child Survival Series, 200333 TNVS Survey, 2007

34 TDHS, 2004/0535 Lancet Child Survival Series, 200336 TDHS, 2004/05

37 TDHS, 2004/0538 TDHS, 2004/0539 Communication with TFNC, April 2008

appropriate facility management of severe malnutrition is still low and community management ofsevere malnutrition has not been implemented.

Vitamin A deficiency is the leading cause of preventable blindness in children and raises the risk of diseaseand death from severe infections. Vitamin A supplementation twice a year has been estimated by the WorldBank (1993) to be one of the most cost-effective health interventions, yet in Tanzania the coverage is only20%40. Currently the biannual Vitamin A supplementation campaign is the main strategy to combat vitaminA deficiency and it is estimated that the coverage is 85%41.

Iodine deficiency during pregnancy has a great impact on physical and mental development of the foetusand is related to poor educational outcomes and productivity. In Tanzania the prevalence of goitre amongschool children is estimated at 7%42. Salt iodation is the most effective strategy for the control of iodinedeficiency. However, currently only 75% of households consume iodated salt43.

• Child morbidity and mortality

Although the most recent Demographic Health Survey (TDHS, 2004/5) has shown decline in under-fiveand infant mortality by 24% and 31% respectively to 112 and 68 per 1,000 live births, the infant and under-five mortality rates in Tanzania are still unacceptably high. Every year about 154,000 children die beforereaching their fifth birthday. In addition, as expected, the mortality rates are highest in the lowest, secondand middle wealth quintiles (137, 156 and 147, respectively) as compared to the highest wealth quintile(93).

Although under-fives constitute about 16% of the population, they account for 50% of the total mortalityburden for all ages. Most of these deaths are due to preventable diseases. Malaria, pneumonia, diarrhoea,HIV/AIDS and neonatal conditions account for over 80% of deaths. Malnutrition is a contributory factorto about fifty percent of all deaths.

The under-five mortality rate for children whose mothers were less than 20 years of age when they gavebirth is 157/1,000, versus 120/1,000 for children whose mothers were in their twenties. Children whose birthorder is seven or higher have a mortality rate of 151/1000, compared with 121/1,000 for those born secondor third.


40 TDHS, 2004/0541 Helen Keller International, 2004/05

42 TFNC, 2004/0543 NBS and TDHS 2004/05


• Adolescents

Adolescents constitute a significant proportion of the population, at about 31% 44. A high percentage ofadolescents are sexually active and practice unsafe sex. Consequently, the majority of them are highlyvulnerable to SRH problems that include adolescent pregnancy and early child bearing, the complicationsarising from unsafe abortion, and STIs including HIV/AIDS45. In Tanzania, more than half of young womenunder the age of 19 are pregnant or already mothers, and the perinatal mortality rate is significantly higherfor young women under the age of 20 (at 56 per 1,000 pregnancies) than it is for women aged 20-29 (at 39per 1,000 pregnancies), and older women aged 30-39 (32 per 1,000 pregnancies). Obtaining permission toaccess services is a greater obstacle for young women age 15-19 than for their older counterparts. Youngwomen age 15-19 also cited not knowing where to go as a barrier to accessing services46. Hence the needto invest in adolescent sexual reproductive health (SRH) services, including HIV/AIDS is paramount giventhe fact that SRH needs are not only basic human rights but that adolescents forma significant section of the population and bear a disproportionate burden ofdisease with regards to reproductive ill-health and HIV prevalence

2.4 Cross-Cutting Issues

• National Policies and GuidelinesTanzania has mainstreamed maternal, newborn and child survival into its nationalhealth policy. The services for maternal, newborn and child health are exemptedfrom cost sharing. However, the exemption policy faces difficulties in itsimplementation at lower level due to lack of clarity on how to effect theexemption mechanisms.

Several national policy documents have been developed targeting improvement of reproductive and childhealth services, which include maternal and newborn health. However, certain professional regulationsand legislations contribute to compromised implementation of the policies.

The MoHSW and partners have developed several clinical national protocols; however, there is need to havean integrated protocol. Although training on RCH interventions has been ongoing nationally through theMoHSW, district councils and NGOs, the quality of the trainings, transfer skill to practice and follow up

Figure 4: Causes of Deaths for Children Aged less than Five Years,in the Year 2006*

Source: WHO, 2006

44 Census, 200245 National Adolescent Health and Development Strategy, 2004-2008

46 TDHS, 2004/05

Good governance is

participatory,

consensus-oriented,

accountable,

transparent,

equitable, and

follows the rule of

law.

supervision are still challenges that need to be addressed. National capacity development is alsocompromised by poor working environment; low geographical coverage; weak integration of gender and

human rights issues.

• Community Mobilization and ParticipationCommunity-based maternal, newborn and child health interventions are crucial in complementing servicesat the health facility level. Since the Alma Ata Declaration on Primary Health Care (PHC) in 1978 and thesubsequent health sector reforms initiated in 2000, there has been increased focus on communityparticipation in the delivery of health services. Community participation has been strengthened further bylocal Government reforms, which interface the health sector within the overall Government policy ofdecentralization by devolution. In Tanzania communities play an increasingly important role in thedevelopment of the Comprehensive Council Health Plans (CCHPs) through the decentralised districtplanning framework. Further community participation has been strengthened through communityrepresentation on the Council Health Service Boards and Health Facility Governing Committees.

Though a few districts have been successful in involving communities in the process of planning,monitoring and evaluation of health services, their participation is still compromised by the low capacityof health boards and health facility governing committees and inadequate outreach activities.

Other challenges include weak partnership between clients and service providers, which is compoundedby low awareness of clients’ and service providers’ rights and obligations; low public awareness ofreproductive health matters such as management of pregnancy, newborn care and child care and relatedcomplications, socio-cultural barriers; gender inequalities, low women empowerment; and myths andmisconceptions of various health-related issues.

• Water, Sanitation and HygieneThe proper sanitation, hygiene and use of safe water are vital in containing the spread of water borne andwater related diseases. The TDHS (2004/0) also showed that during the two weeks that preceded the survey13% of children under-five had diarrhoea. The rate was highest among children 6-11 months old (25%).

Less than half of all households are within 15 minutes of their drinking water supply. Nineteen percent ofurban households have water piped into their compound and 33% from neighbours’ taps while ruralhouseholds primarily rely on public wells both open and protected (43%) and rivers and streams (18%) fortheir drinking water. About a half of households (47%) have improved toilets.

Improved household water, sanitation and promotion of key hygiene behaviour changes will be critical tocomplement and strengthen the essential health package. Various community-based interventions are beingimplemented to improve hygiene and sanitation such as Participatory Hygiene and SanitationTransformation (PHAST) and c-IMCI.

• Human ResourcesHuman resources for health is a crisis in the country with only one-third of posts filled. The situation isworse especially for the lower-level health facilities, where dispensaries and health centres haveshortages of 65.6% and 71.6% respectively47. This has a major impact on maternal, newborn andchildcare, most significantly recognizable in the lack of skilled attendants during childbirth. Efforts arebeing made by MoHSW to recruit additional skilled health providers but challenges remain such as poorskills mix; non-attractive incentive and salary packages; poor motivation; inadequate performanceassessment; rewarding systems; retention of staff especially in remote and hard to reach areas;.

• Monitoring and Evaluation


47 MoHSW, 2006


Monitoring and evaluation play a critical management function by assessing whether implementationof programmes proceeds according to plan and leads to the desired outcomes. Monitoring of maternal,newborn and childhood health in Tanzania has been implemented through HMIS, annual RCH reports,TDHS, Tanzania Service Provision Assessment (TSPA), maternal and perinatal death review reports,Infectious Disease Week Ending Report (IDWE) and other health facility and household surveys. Some ofthe limitations in reporting maternal, newborn and child deaths are the problem of incorrect and incompleterecording, proper case definition, data management, source of information (i.e. facility versus community-based data) and methods of estimation. Further, the use of process indicators is critical for evaluation ofimplementation. However, process indicators are not widely used at all levels. In order to achieve coherentand useful data for monitoring and evaluation of maternal, newborn and child health in Tanzania it is crucialto strengthen the current health information system to address the information gaps for maternal, newbornand child care.

• Advocacy and Resource MobilizationAlthough there has been advocacy and commitment at different levels in addressing maternal, newborn andchild health issues, the meagre budget allocation to the health sector has been a hindrance to effectiveimplementation of the Essential RCH Package. During FY 2005/06, the health budget allocation was Tsh.453.2 billion, which is 10.1% of the total Government budget, below the recommended Abuja target of15%. Due to other competing health priorities such as malaria, HIV/AIDS and tuberculosis, the budgetallocation for reproductive and child health is still limited.

Opportunities and synergies for addressing maternal, newborn and child health include introduction andscaling up of the TASAF II initiative, which will enable communities to address their infrastructuredevelopment needs, logistics and human capacity gaps, in order to provide appropriate maternal, newbornand child care interventions and services. The existence of the Joint Rehabilitation Fund, District DemandDriven Initiative, GAVI and Global Fund for AIDS, TB and Malaria, also provide opportunities for thedistricts to strengthen maternal, newborn and child health interventions.

• Partnerships and CoordinationMaternal, newborn and child health interventions need to be addressed in the context of a multi-sectoralapproach. Partnerships, resources and more effective and coordinated programmes at all levels areincreasingly needed to reach the MDGs.

Due to other competing health priorities such as

Malaria, HIV/AIDS and Tuberculosis, Reproductive

and Child Health budget is still limited. This has

affected implementation of comprehensive

interventions on maternal, family planning and

newborn care.


Strategic Plan


CHAPTER 3: STRATEGIC FRAMEWORK

Maternal, Newborn and Child Health Strategic Plan

The development of the MNCH Strategic Plan to Accelerate Reduction of Maternal, Newborn and Child Deathsis a response to the New Delhi Declaration (April 2005) which urged all countries to develop strategies toreducing the persistently high rates of maternal, newborn and child deaths in order to reach MDG 4 and 5. Thisplan is expected to contribute to the achievement of MKUKUTA and MMAM goals and targets, as well asobjectives and targets of other existing national programmes, interventions and strategies, which focus onimproving MNCH.

This strategic plan aims to address maternal, newborn and child health and accelerate mortality reduction in anintegrated manner addressing the continuum of care. The rationale for taking the integrated approach relies ona number of factors:

1. Specific interventions delivered in a specific time frame have multiple benefits.

2. Linking interventions in packages can reduce costs, facilitate greater efficiency in training, monitoring andsupervision, and strengthen supply systems.

3. Integration of services increases uptake and promotes continuation of positive behaviours

4. Integration maximizes programme achievements

3.1. VisionA healthy and well-informed Tanzanian population with access to quality MNCH services, which areaffordable, sustainable and accessible through an effectively functioning health system.

3.2. MissionTo promote, facilitate and support in an integrated manner, the provision of comprehensive, high impactand cost-effective MNCH services, in order to accelerate reduction of maternal, newborn and childmorbidity and mortality.

3.3. GoalTo accelerate the reduction of maternal, newborn and childhood morbidity and mortality, in line withMDGs 4 and 5, by 2015.

3.4. ObjectivesThe following are the objectives for the MNCH Strategic Plan, which should be met by the end of the year2015.

3.4.1. To reduce maternal mortality from 578 to 193 per 100,000 live births.

3.4.2. To reduce neonatal mortality from 32 to 19 per 1000 live births

3.4.3. To reduce under-five mortality from 112 to 54 per 1000 live births

3.5 Operational targets to be achieved by 2015

1. Increased coverage of births attended by skilled attendants from 46% to 80%.

2. Increased immunization coverage of DTP-HB 3 and Measles vaccine to above 90% in 90% of thedistricts.

3. New EPI vaccines introduced (Hib, Pneumoccocal, Human Papilloma Virus (HPV) and Rota Virus

vaccines).

4. Reduced stunting and underweight status among under-fives from38% and 22% to 22% and 14%,respectively.

5. Increased exclusive breast feeding coverage from 41% to 80 %

6. PMTCT services provided to at least 80% of pregnant women, their babies and families.

7. 90% of sick children seeking care at health facilities appropriately managed.

8. Increased coverage of under-fives sleeping under ITNs from 47% to 80%.

9. 75% of villages have community health workers offering MNCH services at community level.

10. Increased modern contraceptive prevalence rate from 20% to 60%

11. Increased coverage of CEmOC from 64% of hospitals to 100% and of BEmOC from 5% of healthcentres and dispensaries to 70%

12. Increased proportion of health facilities offering Essential Newborn Care to 75%.

13. Increased antenatal care attendance for at least 4 visits from 64% to 90%

14. Increased number of health facilities providing Adolescent friendly reproductive health services to80%

3.6.Strategies

3.6.1. Advocacy and resource mobilization for MNCH goals and agenda in order to promote, implement, andscale up evidence-based and cost-effective interventions, and allocate sufficient resources to achievenational and international goals and targets;

3.6.2. Health System strengthening and capacity development at all levels of the health sector and ensuringquality service delivery to achieve high population coverage of MNCH interventions in an integratedmanner;

3.6.3. Community mobilization and participation to improve key maternal, newborn and child care practices,generate demand for services and increase access to services within the community;

3.6.4. Fostering partnership to implement promising interventions among Government (as lead), donors,NGOs, the private sector and other stakeholders engaged in joint programming and co-funding of activitiesand technical reviews;

3.6.5.Information, education and communication /behavioural change communication (IEC/BCC).Promotion of appropriate reproductive health behaviours is critical in accelerating reduction of maternal,newborn and child deaths. With implementation of the MNCH Strategic Plan, the use of IEC/BCCapproaches for positive behaviour adoption and create demand for quality maternal, newborn and child care.

3.7.Guiding Principles

The following principles will guide the planning and implementation of the MNCH Strategic Plan in orderto ensure effectiveness, ownership and sustainability of the initiative in Tanzania:

• Continuum of Care: Ensuring provision of the continuum of care from pregnancy, childbirth andneonatal period through childhood and across all services levels from family/household, community,and primary facility to referral care.

• Integration: All efforts will be made to implement the proposed priority interventions at various levels



of the health system in a coherent and effective manner that is responsive to the needs of themother, the newborn and the child.

• Evidence-based approach: ensuring that the interventions promoted through the plan are basedon priority needs, up-to-date evidence, and are cost-effective.

• Complementarities: Building on existing programmes by taking into account the comparativeadvantages of different stakeholders in the planning, implementation and evaluation of MNCHprogrammes.

• Partnership: Promoting partnership, coordination and joint programming among stakeholdersincluding the regional secretariat, district councils, private sector, faith-based sector, academia,professional organizations, civil society organizations, as well as communities, in order to improvecollaboration and maximize on the available limited resources by avoiding duplication of effort

• Addressing underlying causes of high mortality: Taking a multi-sectoral and partnership approachto address the underlying causes of maternal, newborn and child death such as, transport, nutrition, foodsecurity, water and sanitation, education, gender equality and women empowerment to ensuresustainability.

• Shared responsibility: The family/household is the primary institution for supporting holistic growth,development and protection of children. The community has the obligation and the duty to ensure thesurvival and health of mothers and children and ensuring that every child grows to its full potential.The state, on the other hand, has the responsibility for developing a conducive legislation and publicservice provision for survival, growth and development.

• Division of labour for increased synergy: Defining roles and responsibilities of all players andpartners in the implementation, monitoring and evaluation of the activities for increased synergy.

• Appropriateness and relevance: Interventions must rely on a clear understanding of the status andlocal perceptions of MNCH in the country.

• Transparency and accountability: Promoting a sense of stewardship, accountability and transparencyon the part of the Government as well as stakeholders for enhanced sustainability.

• Equity and accessibility: Supporting scaling-up of cost-effectiveinterventions that promote equitable access to quality healthservices with greater attention to the youth, poor and mostvulnerable children and groups, especially in rural and underservedareas.

• Phased planning, and implementation: Promotingimplementation in clear phases with timelines and benchmarks thatenable re-planning for better results. Building and strengtheningexisting health infrastructures will be a priority.

• Human rights and gender in health: The right to life is a basichuman right. Mainstreaming gender throughout the programmeand adopting a human rights approach as the basis of planning andimplementation is important. It is also critical to understand thatchildren’s rights are important human rights and therefore need tobe respected at all times in order to uphold the dignity that enableschild development and participation.

For majority of women,

especially the poor and

disadvantaged groups,

the pathway to safe

motherhood is blocked

by the underlying

factors that lead to

delays in accessing

appropriate care.

CHAPTER 4: IMPLEMENTATION FRAMEWORK

4.1 Introduction

The MNCH Strategic Plan has been designed to accelerate the reduction of maternal newborn and child deathswith the aim of attaining MDGs 4 and 5 by 2015. It should be implemented jointly by all stakeholders as a multi-sectoral strategy for comprehensive reproductive and child health care.

Good governance is a critical element for successful implementation of the strategic plan, right from central levelto the grass root level. Good governance is participatory, consensus-oriented, accountable, transparent, equitable,and follows the rule of law. It assures that corruption is minimised, and voices of the most vulnerable in societyare heard in decision making.

The MNCH Strategic Plan will be implemented in collaboration with relevant stakeholders, which includerelated Ministries and agencies, development partners, the civil society, community based organisations,professional associations, faith-based organisations, voluntary agencies, and the private sector, among others.

4.2. Specific Roles and Responsibilities of Different Levels

4.2.1 Ministry of Health and Social Welfare (National Level)

The MoHSW will mobilise resources and advocate for reduction of maternal, newborn and child deaths. It willalso be responsible for the overall technical leadership, guidance and advice on the implementation andmonitoring of the strategic plan. The following will be the specific roles and responsibilities of the variousDirectorates of the MoHSW.

i) Directorate of Policy and Planning will ensure adequate budget allocation for MNCH and mainstreamingof MNCH indicators into policy frameworks. The HMIS Unit will facilitate the monitoring of all indicatorsfrom routine data collection systems including community-based data through Community BasedManagement Information System (CBMIS).

ii) Directorate of Hospital Services will ensure availability of essential drugs, supplies, equipment anddiagnostics by facilitating efficient procurement and distribution to all levels of service delivery.

iii) Directorate of Human Resource and Development. The training department will be responsible to reviewand update pre- and in-service curricula to ensure relevant issues for MNCH are adequately addressed.The department will also promote accelerated training of mid-level cadres in order to increase the availablenumber of skilled health workers, and will facilitate effective development, recruitment and deploymentof skilled health workers at health units to address the human resource crisis48. This will be done incollaboration with the Prime Minister’s Office - Regional Administration and Local Government(PMORALG) , the President’s Office - Public Service Management (POPSM) and Ministry of Financeand Economic Affairs..

iv) Directorate of Preventive Services will supervise and coordinate all activities with respect to allsections under its charge for the realisation of the strategic plan objectives. It will particularly undertakethe following activities:• Advocate for the implementation of the MNCH Strategic Plan by • Coordinate the implementation, monitoring of MNCH activities• Involve and collaborate with various stakeholders at all levels for planning and implementation of the

MNCH Strategic Plan


48 MMAM


• Facilitate capacity development at national, zonal, regional and district levels by developingprotocols and training packages for MNCH

• Design and develop IEC/BCC materials with stakeholders and disseminate them to the intendedusers

• In collaboration with the procurement unit, facilitate procurement of communication equipment andits installation at hospital, health centres and selected dispensaries

• Identify and propose disaggregated indicators and update monitoring data collection tools to includeprocess indicators for EmOC, newborn care, nutrition, postnatal care, child care and Adolescent healthincluding functioning monitoring and evaluation systems and userfirendly data base

• Review and harmonize existing CBMIS, in collaboration with the district councils• Facilitate integration of nutrition actions in maternal, newborn and child care programmes.• Promote research on MNCH including FP and nutrition• Capacity developemnt for the implementation of maternal, newborn, child and Adolescent health

4.2.2 Zonal Level• Disseminate the MNCH Strategic Plan to their respective districts• Support capacity development in MNCH in the districts• Zonal Training Centres and ZRCH coordinator maintain effective partnership with key stakeholders

(MoHSW- RCHS, RHMTs, CHMTs, NGOs, CBOs etc)• Conduct and build research capacity in the regions and districts

4.2.3 Regional Level• Provide technical support for effective planning and implementation of the integrated MNCH activities in

the CCHPs.• Coordinate, monitor and supervise MNCH activities in the region• Technical support for training and ensuring quality in service provision• Support districts in analysis and utilization of MNCH data and disseminate/report to the national level

4.2.4 District Level• Disseminate MNCH Strategic Plan to all stakeholders in the District Council including NGOs, FBOs and

other private sector partners.• Incorporate MNCH activities into the CCHPs• Coordinate and supervise all MNCH activities planned and implemented by all stakeholders in the district• Provide technical support for quality MNCH services• Capacity development for facility and community MNCH interventions• Follow up maternal, perinatal, neonatal and child death reviews at health facility (dispensaries, health

centres, district hospitals, regional hospitals, as well as voluntary agencies and private hospitals) andcommunity levels

• Council Management Teams and District Health Boards to ensure adequate resource allocation forimplementation and monitoring of the MNCH interventions

4.2.5 Health Facility (Dispensary, Health Centre and Hospital)• Incorporate MNCH activities into facility health plans• Provide quality MNCH services• Implement quality improvement approaches such as Quality Improvement and Recognition Initiative

(QIRI), Pay for Performance, Integrated Management Cascade and Collaborative Approach• Ensure timely availablity of essential equipment, supplies and drugs for service MNCH provision• Conduct maternal, perinatal, neonatal and child death reviews, involving the community• Health facility committees to monitor and ensure quality MNCH service provision• Provide technical and supportive supervision to community interventions

4.2.6 CommunityThe Village Government and Ward Development Committee through the Primary Health Care (PHC)

committee and health facility governing committee will be responsible for supervision and implementationof MNCH activities in their areas. Other responsibilities include:

• Facilitate development and monitoring of community MNCH action plans• Mobilize the community to participate in community interventions• Establish and/or strengthen CBMIS• Leverage community resources for the implementation of MNCH interventions

4.2.7 Roles and Responsibilities of other Ministries Key Ministries should be involved to ensure that the reduction of maternal, newborn and child mortality ishigh on their agenda. These include Ministry of Finance and Economic Affairs (MoFEA), PMORALG,Ministry of Community Development Gender and Children (MoCDGC), Ministry of Education andVocational Training (MoEVT), Ministry of Agriculture, Food Security and Cooperatives (MoAFSC),Ministry of Labour, Employment and Youth Development (MoLEYD), Ministry of InfrastructureDevelopment (MoID), Ministry of Communication, Science and Technology (MoCST), and Ministry ofInformation, Culture and Sports (MoICS).

i) Ministry of Finance and Economic Affairs• Give priority to health, especially MNCH, in budget guidelines for allocation of resources• Increase financial resources for health and especially implementation of MNCH activities as guided by the

MNCH Strategic Plan

ii) Prime Minister’s Office Regional Administration and Local Government• Provide technical support to regions and councils for planning and implementation of CCHPs• Mobilize funds to support implementation of CCHPs including CBMIS• Support infrastructural development, rehabilitation and maintenance to improve access for MNCH services• Include maternal, perinatal, newborn and child health indicators in the national health sector monitoring

and evaluation framework.

iii) Ministry of Education and Vocational Training• Promote universal access to education, especially education for girls and women• Review and update components of MNCH and SRH in various school and pre-service curricula in

collaboration with MoHSW particluarly on provision of adolescent friendly services

iv) Ministry of Agriculture, Food Security and Cooperation• Promote food security at household, community, district and national levels

v) Ministry of Community Development, Gender and Children• Support community development extension workers to supervise and identify problems and derive solutions

for MNCH in the local context• Facilitate the establishment of community mechanisms to support emergency transportation for MNCH

services• Advocate for gender issues to improve MNCH decision-making at all levels• Support and promote rights-based approach to programming for MNCH • Advocate for revision of laws, legislations and policies to improve MNCH• Promote parental support for adolescents to access information and health services

vi) Ministry of Infrastructure Development• Improve road networks to facilitate access to services at primary and referral levels, especially in rural

areas where the majority of Tanzanians live



vii) Ministry of Labour, Employment and Youth Development• In collaboration with the MoHSW and the MoCDGC, develop a Youth Communication Strategy• Develop capacity for life skills and livelihood young people• Advocate for adoption of maternity protection conventions (ILO, convention 183)

viii) Ministry of Communication, Science and Technology• Promote the development, availability of and access to appropriate technology to support MNCH service

provision

ix) Ministry of Information, Culture and Sports• Promote positive RH behaviours including early health care seeking for MNCH services.• Disseminate information aimed at promoting early care seeking behaviour for MNCH and use of

preventive care services

4.2.8 Roles and Responsibilities of Development Partners• Provide technical and financial support for the coordination, planning, implementation, capacity

developemnt and monitoring and evaluation of MNCH services• Advocate for increased global and national commitment to the reduction of maternal, newborn and child

morbidity and mortality• Mobilise and allocate resources for the implementation of MNCH interventions

4.2.9 Roles and Responsibilities of Civil Society Organisations (NGOs, FBOs, CBOs, ProfessionalAssociations)

• Advocate for the rights of women and children.• Forge partnership with different stakeholders including political leaders to promote MNCH• Implement community based strategies to promote healthy behaviours during pregnancy, child birth, post

partum period, childhood and adolescence• Complement governement efforts in the provision of quality MNCH services• Disseminate the MNCH Strategic Plan to accelerate the reduction of maternal, newborn and child morbidity

and mortality• Mobilize and allocate resources for implementation of the MNCH Strategic Plan

4.2.9 Roles and Responsibilities of Private Sector• Complement Government efforts in the provision of quality MNCH services• Invest in commodites and supplies for MNCH interventions

4.2.10 Role of Training and Research Institutions• Undertake relevant MNCH research to provide evidence for policy directions and implementation guidance• Review and update curricula to ensure relevant MNCH issues are adequately addressed• Provide technical advice and updates on current developments on MNCH and SRH to policy makers

4.3.Key Strategies to be Implemented

4.3.1. Advocacy and Resource MobilizationIn advocating for improved MNCH, the following issues will be emphasized:

• Increased budget allocation for MNCH interventions including FP and nutrition. The target is to mobilizeresources from internal and external sources in order to complement the Government’s efforts towardsreducing maternal, newborn and childhood deaths

• Revision of laws, legislations and policies that hinder effective provision of maternal, newborn andchildcare services

• Improved production, employment, deployment and retention of a skilled health work force at all levels

4.3.2. Health Systems Strengthening and Capacity Development

Health system strengthening for MNCH involves improving; service delivery; health workforce;information; medical products , vaccines and technologies; financing; and leadership/ governance as well asmanaging interactions among them, so that more equitable and sustained improvements across services andhealth outcomes will be achieved.

4.3.2.1 Capacity development

• The strategy aims to increase the number of skilled health work force required, as well as the knowledgeand skills of existing service providers and supervisors so that quality care is provided.

• User friendly protocols will be developed/reviewed and the mechanisms for making essential commoditiesfor MNCH, including FP, available will be strengthened

• Basic and comprehensive EmOC as well as essential newborn services will be strengthened at dispensaries,health centres and hopsitals

• Skills for planning and management of MNCH services, including FP and Nutrition, will be imparted tothe CHMTs.

• Necessary infrastructure, logistics and equipment support will be provided for the effective delivery of thecomprehensive MNCH packages.

4. 3. 2.2 Referral systems

• Referral systems will be improved to ensure equitable access to quality MNCH services through makingappropriate means of transportation available and improve linkages between community and referralfacilities

• Communications equipment (e.g., radio calls and mobile phones) will be installed in hospitals, healthcentres and selected dispensaries.

• Community emergency committees will be established and oriented to emergency preparedness andresponse.

• Maternity waiting homes will be established where appropriate.

4.3.2.3 Research, Monitoring and Evaluation

• Capacity building for conducting operational research will be strengthened at all levels. Districts will beencouraged to identify research priority areas according to their needs.

Essential monitoring tools and indicators will be developed and mainstreamed into the HMIS. Data will begenerated periodically to monitor the milestones and improvement of services provided at health facilities.

• Periodic reviews and reporting will be carried out every two years to assess progress. A mid-term reviewwill be conducted between 2010 – 2011, and an end of term review will be conducted in 2015 to report onthe attainment of the MDGs.

4.3.3. Community Mobilization

• Communities will be mobilised to participate fully in initiatives aimed at improving maternal, newborn andchild care by:

• Educating and sensitising them on community-based MNCH interventions

• Mobilizing resources at the village level for MNCH including emergency referral as well as building and



strengthening health facilities.

• Orienting the facility governing committees to the MNCH Strategic Plan to ensure effectiveimplementation of the plan at the health facility and community levels

• Re-institutionalizing quarterly village health days

4.3.4: Information Education and Communication (IEC)/Behaviour Change Communication (BCC)

• Use of IEC/BCC approaches will be intensified towards adoption of positive behaviours for quality MNCHincluding nutrition and adolescent sexual reproductive health.

• The IEC/BCC activities will target community-based initiatives particularly in addressing birthpreparedness, with an emphasis on birth planning for individual couples, transport in case of emergency,and promotion of key MNCH practises at the household and community levels.

4.3.5: Fostering Partnership and Accountability

Effective implementation of the MNCH Strategic Plan will entail fostering and establishing strategicpartnerships to improve coordination and collaboration between communities, partners and among programmesas well as galvanizing resources for long term sustainable actions for MNCH.

• Coordinate regular planning, implementation, monitoring and evaluation of MNCH activities to assessprogress towards attainment of the MDGs

The goal of this National

Strategic Plan is to accelerate

the reduction of maternal,

newborn and child mortality and

morbidity, and the atteinment of

the MDGs 4 and 5 in Tanzania.

Tim

efra

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ivit

ies

0809

1011

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1415

Pro

cess

In

dica

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R

esp

onsi

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Per

son

R

esou

rces

N

eed

ed in

U

S d

olla

rs

5.1

Ad

voca

cy a

nd

Res

ourc

e M

obil

isat

ion

5.1.

1.1C

ost t

he p

acka

ge fo

r m

ater

nal,

new

born

and

chi

ld

hea

lth

incl

ud

ing

FP a

nd n

utr

itio

n b

y es

tabl

ishi

ng:

•

Un

it c

ost p

er in

terv

enti

on p

er

area

; •

Op

erat

iona

l cos

ts;

•R

ecu

rren

t cos

ts.

X

X

X

T

he

pac

kage

for

mat

erna

l, ne

wbo

rn a

nd

child

hea

lth

incl

ud

ing

FP a

nd n

utr

itio

n co

sted

an

d in

pla

ce.

MoH

SW

(RC

HS,

Pol

icy

and

P

lan

nin

g)

Dev

elop

men

t Par

tner

s

Res

earc

h In

stit

utio

ns

80,0

00

5.1.

1.2.

Con

du

ct A

dvo

cacy

for

m

ater

nal n

ewbo

rn a

nd c

hild

car

e th

rou

gh D

eliv

er N

ow f

or

Wom

en a

nd

Chi

ldre

n ca

mp

aign

5.1.

1.3

Dev

elop

an

advo

cacy

p

acka

ge ta

rget

ing

the

follo

win

g:

MoH

SW, P

MO

-RA

LG

, MoF

EA

an

d o

ther

rel

evan

t lin

e m

inis

trie

s,

par

tner

s, p

arlia

men

tari

ans

(usi

ng

RE

DU

CE

/A

LIV

E an

d ot

her

mat

eria

ls) t

o m

obil

ise

hum

an a

nd

fina

ncia

l res

ourc

es fr

om

Gov

ern

men

t, po

litic

al a

nd

com

mu

nit

y le

ader

s.

X X

X X

XX

X

X

X

X

X

X

Nu

mbe

r of

ad

voca

cy

even

ts c

ond

ucte

d an

nual

ly

Ad

voca

cy p

acka

ge

dev

elop

ed a

nd

dis

sem

inat

ed.

MoH

SW

(RC

HS,

HE

U)

Dev

elop

men

t Par

tner

s

CSO

s P

rofe

ssio

nal

Ass

ocia

tions

Aca

dem

ic

and

Res

earc

h In

stit

utio

ns

Med

ia

200,

000

5.1.

1 B

ud

get a

lloc

atio

n fo

r h

ealt

h,

par

ticu

larl

y fo

r m

ater

nal

, n

ewb

orn

& c

hild

h

ealt

h in

clu

din

g FP

an

d n

utri

tion

in

crea

sed

at a

ll

leve

ls.

Stra

tegi

c O

utp

ut

Ind

icat

or:

Bud

get f

or

mat

erna

l, ne

wbo

rn

and

child

hea

lth

incl

udin

g FP

and

n

utri

tion

incr

ease

d by

50%

by

2015

.

5.1.

1.4

Iden

tify

foca

l per

sons

am

ong

mem

bers

of p

arlia

men

t an

d o

ther

infl

uen

tial

lead

ers

to

advo

cate

for

mat

erna

l, ne

wbo

rn

and

chi

ld h

ealt

h.

5.1.

1.5

Pro

vid

e su

ppo

rt to

MN

CH

ch

amp

ion

and

oth

er fo

cal p

erso

ns.

X

XX

X XX

XX

XX

Num

bers

of i

nflu

enti

al

lead

ers

advo

cati

ng

for

mat

erna

l, ne

wbo

rn a

nd

child

hea

lth

iden

tifi

ed.

MoH

SW (R

CH

S)

Dev

elop

men

t Par

tner

s C

SOs

-

24T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

CH

AP

TE

R 5

: S

TR

AT

EG

IC P

LA

N A

ND

AC

TIV

ITIE

S: 2

008

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5

Tim

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me

Stra

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c O

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Act

ivit

ies

0809

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Pro

cess

In

dica

tors

R

esp

onsi

ble

Per

son

R

esou

rces

N

eed

ed in

U

S d

olla

rs

5.1.

1.6

Con

duc

t ad

voca

cy m

eeti

ngs

to

pol

icy/

dec

isio

n - m

aker

s on

the

MN

CH

Str

ateg

ic P

lan,

to s

up

port

im

ple

men

tati

on o

f the

str

ateg

y at

the

cent

ral,

regi

onal

and

dis

tric

t lev

els.

5.1.

1.7

Lobb

y w

ith

the

gove

rnm

ent f

or

subs

idy

on IT

Ns

in o

rder

to e

nsu

re

equ

itab

le a

cces

s to

the

mat

eria

ls b

y al

l vu

lner

able

gro

up

s.

X X

X X

X X

X X

X X

X X

X X

X X

Nu

mbe

r of

ad

voca

cy

mee

tin

gs c

ond

ucte

d

Subs

idy

pol

icy

on IT

N fo

r al

l vu

lner

able

gro

up

in p

lace

MoH

SW (R

CH

S)

CSO

s P

rofe

ssio

nal A

ssoc

iatio

ns

Dev

elop

men

t Par

tner

s

680,

000

5.1.

1.8

Esta

blis

h an

d c

ond

uct M

othe

r-B

aby

Day

/ W

eek,

ann

ual

ly a

t all

leve

ls th

rou

gh:

•P

ubl

ic a

war

enes

s ca

mp

aign

s (m

edia

/ra

llie

s/d

ebat

es).

•P

rogr

amm

e co

mm

uni

catio

n d

evel

opm

ent.

X

X

X

X

X

X

X

X

Mot

her-

Bab

y D

ay/

Wee

k co

mm

emor

ated

M

oHSW

, Min

iste

rial

D

epar

tmen

t Age

ncie

s (M

DA

s)

Med

ia

Dev

elop

men

t Par

tner

s

CH

MT

s

Pro

fess

iona

l Ass

ocia

tions

C

SOs

400

,000

5.1.

1.9

Ad

voca

te fo

r bi

-ann

ual

Chi

ld

and

vil

lage

hea

lth

day

s at

all

leve

ls

thro

ugh

: •

Pu

blic

aw

aren

ess

cam

pai

gns

•P

rogr

amm

e C

omm

un

icat

ion

dev

elop

men

t

5.1.

1.10

Sen

siti

ze R

HM

Ts a

nd C

HM

Ts

of th

e im

por

tanc

e of

incl

udin

g ch

ild

and

vil

lage

hea

lth

day

s in

the

CC

HPs

5.1.

1.11

Tra

in, e

stab

lish

and

su

ppo

rt

Med

ia G

rou

ps

to r

epor

t on

MN

CH

X X X

X X X

X X X

X X X

X X X

X X X

X X X

X X X

Pro

port

ion

of v

illag

es

cond

ucti

ng

sem

i ann

ual

ch

ild h

ealt

h d

ay

Pro

port

ion

of C

CH

Ps

wit

h bu

dge

t allo

cati

on fo

r Vill

age

Hea

lth

Day

s

Nu

mbe

r of

est

ablis

hed

m

edia

gro

up

s

MoH

SW, M

DA

s M

edia

R

HM

Ts

CH

MT

s N

GO

s,

Pro

fess

iona

l Ass

ocia

tions

V

illag

e G

over

nm

ents

D

evel

opm

ent

Par

tner

s

600,

000

100,

000

25T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

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Tim

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Act

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0809

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Pro

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In

dica

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R

esp

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Per

son

R

esou

rces

Nee

ded

in

US

dol

lars

5.1.

2.1

Rev

iew

reg

ula

tion

s an

d le

gisl

atio

ns r

elat

ed to

the

pro

visi

on o

f m

ater

nal,

new

born

an

d c

hild

car

e.

X

X

X

N

um

ber

of

regu

lati

ons,

law

s an

d

pol

icie

s to

su

ppo

rt

effe

ctiv

e p

rovi

sion

of

qual

ity

mat

erna

l, n

ewbo

rn a

nd c

hild

ca

re r

evie

wed

.

MoH

SW (R

CH

S)

Pro

fess

iona

l A

ssoc

iatio

ns

Dev

elop

men

t Par

tner

s M

edic

al C

ounc

il N

urs

es &

Mid

wiv

es

Cou

ncil

CSO

s

60,0

00

5.1.

2 R

egu

lati

ons,

law

s an

d p

olic

ies

to

sup

por

t eff

ecti

ve

impl

emen

tati

on o

f m

ater

nal

, new

bor

n

and

Chi

ld h

ealt

h re

view

ed.

Stra

tegi

c O

utp

ut

Ind

icat

or:

Nu

mbe

r of

reg

ulat

ions

ap

prov

ed b

y re

gula

tory

bo

dies

.

Nu

mbe

r of

law

s ap

prov

ed b

y re

gula

tory

bo

dies

. 5.

1.2.

2 A

dvo

cate

for

revi

ew a

nd

adop

tion

of la

ws

such

as

the

Mar

riag

e A

ct o

f 197

0, a

nd th

e Se

xual

Off

ence

Sp

ecia

l Pro

visi

on

Act

(SO

SPA

) of 1

998

that

in

flu

ence

mat

erna

l, ne

wbo

rn a

nd

child

hea

lth.

X

X

Law

s af

fect

ing

mat

erna

l and

n

ewbo

rn h

ealt

h re

view

ed a

nd

adop

ted.

MoH

SW,

Min

istr

y of

Just

ice

and

Con

stit

utio

nal A

ffai

rs

MC

DG

C, M

DA

s,

Dev

elop

men

t Par

tner

s,

Pro

fess

iona

l A

ssoc

iatio

ns

CSO

s

120,

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atio

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Str

ateg

ic P

lan

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STR

AT

EG

IC P

LA

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AC

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ivit

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cess

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dica

tors

R

esp

onsi

ble

Per

son

R

esou

rces

N

eed

ed in

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S d

olla

rs

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3

Imp

lem

enta

tion

of

the

exem

pti

on

pol

icy

for

mat

ern

al

and

chil

d h

ealt

h st

ren

gth

ened

.

Stra

tegi

c O

utp

ut

Ind

icat

or:

Exe

mpt

ion

polic

y ef

fect

ivel

y im

plem

ente

d.

5.1.

3.1

Ad

voca

te fo

r ex

emp

tion

pol

icy

on M

NC

H to

be

effe

cted

in v

olu

ntar

y an

d p

ubl

ic h

ealt

h fa

cilit

ies

( Ser

vice

Agr

eem

ent)

XX

Pro

port

ion

of p

ubl

ic

and

vol

unt

ary

hea

lth

faci

litie

s im

ple

men

tin

g th

e E

xem

pti

on P

olic

y.

MoH

SW (R

CH

S &

Pol

icy

and

Pla

nnin

g)

Hea

lth

pro

fess

iona

l as

soci

atio

ns

Pri

vate

sec

tor

CSO

s

25,0

00

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atio

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Tim

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dica

tors

R

esp

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Per

son

R

esou

rces

N

eed

ed in

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S d

olla

rs

5.1.

4.1

Ad

voca

te fo

r re

view

of t

he

1999

Hu

man

Res

ourc

es

Est

abli

shm

ent (

and

2006

pro

pose

d re

visi

on) i

n lin

e w

ith

skil

led

at

tend

ance

req

uir

emen

ts fo

r m

ater

nal,

new

born

and

chi

ld c

are.

X

X

Hu

man

Res

ourc

e E

stab

lish

men

t of

MoH

SW (1

999)

re

view

ed.

MoH

SW (D

HR

, DA

P)

PMO

-RA

LG

P

O- P

ubl

ic S

ervi

ce

Man

agem

ent

MoF

EA

H

ealt

h p

rofe

ssio

nal

asso

ciat

ions

, CSO

s

Dev

elop

men

t Par

tner

s

62,0

00

5.1.

4.2

Ad

voca

te fo

r re

cru

itm

ent a

nd

dep

loym

ent o

f ski

lled

hea

lth

wor

kers

at a

ll le

vels

of c

are.

X

X

X

X

X

X

X

X

Pro

port

ion

of

dis

tric

ts w

ith

app

rop

riat

e nu

mbe

r of

ski

lled

h

ealt

h w

orke

rs.

MoH

SW

PMO

-RA

LG

H

ealt

h p

rofe

ssio

nal

asso

ciat

ions

D

evel

opm

ent P

artn

ers

CSO

s

37,0

00

5.1.

4

Em

plo

ymen

t, d

eplo

ym

ent a

nd

rete

ntio

n of

ski

lled

h

ealt

h w

ork

ers

at a

ll

leve

ls o

f ca

re

imp

rove

d.

Stra

tegi

c O

utp

ut

Ind

icat

or:

Nu

mbe

r of

ski

lled

heal

th w

orke

rs

incr

ease

d to

100

% o

f es

tabl

ishe

d ne

ed b

y

2015

5.1.

4.3

Ad

voca

te to

the

Gov

ern

men

t to

mot

ivat

e sk

ille

d h

ealt

h w

orke

rs

by

pro

vid

ing

a p

acka

ge o

f inc

enti

ves

in o

rder

to e

nsu

re o

ptim

um

p

erfo

rman

ce.

X

X

X

X

X

X

X

X

Typ

es o

f Inc

enti

ve

pac

kage

pro

vid

ed

by

the

Gov

ern

men

t at a

ll le

vels

.

Pro

port

ion

of

dis

tric

ts p

rovi

din

g in

cent

ive

pac

kage

s

MoH

SW (D

HR

, DA

P,

Pol

icy

& P

lan

nin

g)

PMO

-RA

LG

P

O-P

ubl

ic S

ervi

ce

Man

agem

ent

MoF

EA

H

ealt

h p

rofe

ssio

nal

asso

ciat

ions

C

SOs

66,0

00

28T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

STR

AT

EG

IC P

LA

N A

ND

AC

TIV

ITIE

S: 2

008

-201

5

Tim

efra

me

Stra

tegi

c O

bjec

tive

/ O

utp

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Act

ivit

ies

0809

1011

1213

1415

Pro

cess

In

dica

tors

R

esp

onsi

ble

Per

son

R

esou

rces

Nee

ded

in

US

dol

lars

5.2.

Hea

lth

Sys

tem

s St

ren

gth

enin

g an

d C

apac

ity

Dev

elop

men

t5.

2.1

K

now

led

ge a

nd

skil

ls o

f su

perv

isor

s an

d se

rvic

e p

rovi

der

s on

mat

ern

al,

new

bor

n a

nd

chil

d ca

re

incl

udi

ng

FP a

nd

nut

riti

on

incr

ease

d.

Stra

tegi

c O

utp

ut

Ind

icat

or:

Mat

erna

l, ne

wbo

rn

and

child

hea

lth

serv

ice

prov

ided

ac

cord

ing

to

stan

dard

s.

5.2.

1.1

Rev

iew

/d

evel

op u

ser-

frie

ndly

p

roto

cols

for a

nten

atal

car

e, p

ostn

atal

ca

re, n

ewbo

rn a

nd c

hild

car

e, E

mO

C,

FP a

nd n

utr

itio

n. S

pec

ific

act

ivit

ies

incl

ude:

•

Dev

elop

/ad

apt/

revi

ew a

nd

dis

sem

inat

e C

omm

un

ity

Mat

erna

l, N

ewbo

rn a

nd C

hild

C

are

pac

kage

s •

Dev

elop

/ad

apt/

revi

ew

stan

dar

ds

job

aid

es a

nd to

ols f

or

MN

CH

ser

vice

pro

visi

on

•D

evel

op/

adap

t/re

view

and

d

isse

min

ate

Nu

trit

ion

Pac

kage

s in

clu

din

g E

NA

, SA

M, I

YC

F/B

FHI

•R

evie

w E

PI g

uid

elin

es fo

r in

clus

ion

of n

ew v

acci

nes

•

Ad

apta

tion

of E

ssen

tial

New

born

C

are

(EN

C) a

nd K

anga

roo

Mot

her

care

gu

idel

ines

(KM

C)

•A

dap

tati

on a

nd a

dop

tion

of th

e n

ew c

hild

gro

wth

sta

ndar

ds

and

ch

arts

X

X

X

X

Pro

toco

ls o

n an

tena

tal c

are,

E

mO

C, n

ewbo

rn

care

, sev

ere

mal

nutr

itio

n,

grow

th m

onit

orin

g,

child

car

e an

d p

ostn

atal

car

e d

evel

oped

and

ad

opte

d by

the

MoH

SW.

MoH

SW (R

CH

S,

DH

S H

EU

) D

evel

opm

ent

Par

tner

s H

ealt

h p

rofe

ssio

nal

asso

ciat

ions

C

SOs

147,

000

29T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

Tim

efra

me

Stra

tegi

c O

bjec

tive

/ O

utp

ut

Act

ivit

ies

0809

1011

1213

1415

Pro

cess

In

dica

tors

R

esp

onsi

ble

Per

son

R

esou

rces

Nee

ded

in

US

dol

lars

5.2.

1.2

Sup

port

pre

-ser

vice

trai

nin

g in

stit

uti

ons

to p

rovi

de

up

dat

ed a

nd

com

pet

ency

-bas

ed te

achi

ng

on

mat

erna

l, ne

wbo

rn a

nd c

hild

car

e in

clud

ing

FP a

nd n

utri

tion

(LSS

-E

mO

C, E

NC

, KM

C F

AN

C, P

AC

, FP

, n

ewbo

rn c

are,

nu

trit

ion,

BFH

I, IY

CF,

SA

M, P

MT

CT

, IM

CI,

ET

AT

, Ref

erra

l C

are

Pac

kage

, Im

mu

niz

atio

n) b

y:

•U

pd

atin

g p

re-s

ervi

ce c

urr

icu

la to

ad

dre

ss c

urr

ent c

han

ges

in

mat

erna

l, ne

wbo

rn a

nd c

hild

ca

re in

clu

din

g FP

and

nu

trit

ion

•D

evel

opin

g an

d p

rovi

din

g an

or

ient

atio

n p

acka

ge a

nd o

ther

ed

uca

tiona

l mat

eria

ls to

tuto

rs a

nd

clin

ical

pre

cep

tors

. •

Up

dat

e an

d s

tand

ard

ize

know

led

ge, c

linic

al a

nd te

achi

ng

skil

ls o

f tu

tors

and

clin

ical

p

rece

pto

rs a

t med

ical

, nu

rsin

g an

d

par

amed

ical

sch

ools

. •

Pro

vid

e sc

hool

s an

d c

linic

al

pra

ctic

e si

tes

wit

h ne

cess

ary

teac

hin

g an

d c

linic

al p

ract

ice

mat

eria

ls a

nd e

quip

men

t

X

X

X

X

X

X

X

X

1000

tuto

rs/c

linic

al

pre

cep

tors

from

va

riou

s in

stit

utio

ns

up

dat

ed o

n m

ater

nal a

nd

new

born

car

e in

clud

ing

FP a

nd

nutr

itio

n.

All

pre

serv

ice

MN

CH

cu

rric

ula

r co

mp

onen

ts

up

dat

ed

All

pre

serv

ice

inst

itu

tion

s p

rovi

ded

wit

h n

eces

sary

teac

hin

g m

ater

ials

, eq

uip

men

t and

su

pp

lies

MoH

SW (R

CH

S,

PMT

CT,

TFN

C)

Hu

man

Res

ourc

e D

evel

opm

ent

and

Tra

inin

g H

ealt

h T

rain

ing

Inst

itut

ions

R

egu

lato

ry

bod

ies

Pri

vate

in

stit

uti

ons

CSO

s D

evel

opm

ent

Par

tner

s

680,

000

5.2.

1.3

Up

dat

e kn

owle

dge

and

ski

lls

of s

up

ervi

sors

on

mat

erna

l, ne

wbo

rn

and

chi

ld c

are

incl

ud

ing

FP, n

utr

itio

n an

d s

up

ervi

sory

ski

lls (L

SS-E

mO

C,

EN

C, K

MC

, FA

NC

, PA

C, F

P,

new

born

car

e, n

utr

itio

n, B

FHI,

IYC

F,

PMT

CT

, IM

CI,

ET

AT

, Ref

erra

l Car

e P

acka

ge, i

mm

un

izat

ion)

X

X

X

X

X

X

X

X

910

CH

MT

mem

bers

(130

C

ounc

ils),

and

147

Z

onal

and

RH

MT

mem

bers

, all

up

dat

ed in

su

per

viso

ry s

kills

.

MoH

SW (R

CH

S,

DR

H)

Dev

elop

men

t P

artn

ers

CSO

s

1,52

5,00

0

30T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

STR

AT

EG

IC P

LA

N A

ND

AC

TIV

ITIE

S: 2

008

-201

5

Tim

efra

me

Stra

tegi

c O

bjec

tive

/ O

utp

ut

Act

ivit

ies

0809

1011

1213

1415

Pro

cess

In

dica

tors

R

esp

onsi

ble

Per

son

R

esou

rces

Nee

ded

in

US

dol

lars

5.2.

1.4

Up

dat

e kn

owle

dge

and

ski

lls

of s

ervi

ce p

rovi

der

s on

mat

erna

l, n

ewbo

rn a

nd c

hild

car

e in

clu

din

g FP

and

nu

trit

ion

(LSS

-Em

OC

, EN

C,

KM

C, F

AN

C, P

AC

, PN

C, F

P, E

NA

, IM

CI,

ET

AT

, BFH

I, IY

CF,

PM

TC

T,

SAM

, im

mu

niza

tion

) and

lin

k th

e in

terv

enti

ons

to m

alar

ia, H

IV/

AID

s,

and

STIs

con

trol

pro

gram

mes

.

X

X

X

X

X

X

X

X

Nu

mbe

r of

ser

vice

p

rovi

der

s tr

ain

ed in

M

NC

H s

ervi

ce

del

iver

y

MoH

SW (R

CH

S),

Dis

tric

t Cou

ncils

, an

d D

evel

opm

ent

Par

tner

s.

CSO

s P

riva

te in

stit

uti

ons

Hea

lth

pP

rofe

ssio

nal

asso

ciat

ions

7,00

0,00

0

5.2.

1.5

Rev

iew

mat

erna

l, p

erin

atal

an

d c

hild

dea

ths

at a

ll le

vels

(fac

ility

&

com

mu

nit

y).

•T

rain

ser

vice

pro

vid

er o

n m

ater

nal,

per

inat

al a

nd c

hild

d

eath

rev

iew

s

•D

evel

op a

sys

tem

to r

evie

w c

hild

d

eath

s •

Em

plo

y/tr

ain

the

com

mu

nity

h

ealt

h w

orke

rs to

con

duc

t ver

bal

auto

psi

es

Pro

duc

e w

eekl

y, m

onth

ly, q

uar

terl

y an

d a

nnu

al s

um

mar

y re

por

ts o

f m

ater

nal,

per

inat

al a

nd c

hild

dea

th

revi

ews

X

X

X

X

X

X

X

X

Pro

port

ion

of h

ealt

h fa

cilit

ies

wit

h m

ater

nal,

per

inat

al

and

chi

ld d

eath

s re

view

rep

orts

.

Pro

port

ion

of

faci

litie

s w

ith

heal

th

wor

kers

trai

ned

in

mat

erna

l, p

erin

atal

an

d c

hild

dea

th

revi

ew

MoH

SW (R

CH

S)

PMO

RA

LG

M

oCD

GC

R

HM

Ts

CH

MT

s C

MTs

700,

000

The

Nat

iona

l Roa

d M

ap S

trat

egic

Pla

n -2

008

- 20

15

Tim

efra

me

Stra

tegi

c O

bjec

tive

/ O

utp

ut

Act

ivit

ies

0809

1011

1213

1415

Pro

cess

In

dic

ator

s

Res

pon

sibl

e P

erso

n

Res

ourc

es

Nee

ded

in

US

dol

lars

5.2.

2 Pl

anni

ng

and

man

agem

ent

cap

acit

y fo

r m

ater

nal

an

d n

ewb

orn

car

e in

clu

din

g FP

an

d n

utri

tion

st

ren

gth

ened

.

Stra

tegi

c O

utp

ut

Ind

icat

or:

Rel

evan

t sec

tor

(Min

istr

y of

Fin

ance

, M

oHSW

) allo

cati

ng

15%

of t

he H

ealt

h bu

dget

for

mat

erna

l an

d ne

wbo

rn c

are.

5.2.

2.1

Tra

in C

HM

T/

RH

MT

s on

ev

iden

ce-b

ased

pla

nn

ing

1in

ord

er to

en

sure

that

str

ateg

ic in

terv

enti

ons

on

mat

erna

l new

born

and

chi

ld c

are

incl

ud

ing

FP a

nd n

utr

itio

n ar

e in

corp

orat

ed in

the

CC

HP

and

imp

lem

ente

d.

X

X

X

X

X

X

X

X

Pro

port

ion

of

CH

MT

s an

d R

HM

T’s

trai

ned

on

pla

nnin

g fo

r M

NC

H

Pro

port

ion

of

dis

tric

ts w

ith

incr

ease

d b

ud

get

allo

catio

n fo

r m

ater

nal

new

born

and

ch

ild h

ealt

h in

terv

enti

ons

in

CC

HP

s.

MoH

SW

(RC

HS,

P

olic

y an

d

Pla

nn

ing

Un

it) D

istr

ict

Cou

ncils

D

evel

opm

ent

Par

tner

s.

290,

000

1 Exa

mpl

es o

f to

ols

to b

e us

ed in

clud

e P

lan

Rep

, cos

tin

g to

ols

and

othe

r re

leva

nt s

ourc

es o

f inf

orm

atio

n

32T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

STR

AT

EG

IC P

LA

N A

ND

AC

TIV

ITIE

S: 2

008

-201

5

Tim

efra

me

Str

ateg

ic O

bje

ctiv

e/

Ou

tpu

t A

ctiv

itie

s

08

09

10

11

12

13

14

15

Pro

cess

In

dic

ato

rs

Res

po

nsi

ble

P

erso

n

Res

ourc

es

Nee

ded

in

U

S d

olla

rs

X

X

X

X

X

X

X

X

Pro

port

ion

of

heal

th fa

cili

ties

p

rovi

din

g B

asic

E

mO

C in

the

MoH

SW

(Dir

ecto

rate

s of

Pre

vent

ive

80,8

00,0

00

X

X

X

X

X

X

X

X

Pro

port

ion

of

heal

th fa

cili

ties

p

rovi

din

g

MoH

SW

(Dir

ecto

rate

s of

Pre

vent

ive

and

H

osp

ital

Se

rvic

es),

48,4

00,0

00

5. 2

.3

Bas

ic (B

Em

OC

) an

d

Com

pre

hen

sive

E

mO

C

(CE

mO

C)a

nd

n

ewb

orn

ser

vice

s at

al

l lev

els

stre

ngt

hen

ed.

Str

ateg

ic O

utp

ut

Ind

icat

or:

%

of h

ealt

h fa

cili

ties

pr

ovid

ing

BE

mO

C

and

CE

mO

C a

nd

Ess

enti

al N

ewbo

rn

care

and

P

MO

-RA

LG

. A

PHT

A

PRIN

MA

T

Dev

elop

men

t P

artn

er a

nd

U

N A

genc

ies

esse

ntia

l new

born

ca

re

Com

pre

hens

ive

Em

OC

an

d

esse

ntia

l new

born

ca

re

Nu

mbe

r of

AM

Os

trai

ned

usi

ng

tail

or m

ade

curr

icu

lar

and

Hos

pit

al

Serv

ices

) P

MO

-RA

LG

, C

SOs

Pri

vate

sec

tor

4E

ver

y p

opu

lati

on o

f 50

0,00

0, a

t lea

st 4

Bas

ic E

mO

C a

re n

eed

ed (S

ee G

loss

ary

for

com

pon

ents

of

Bas

ic a

nd

Com

pre

hen

siv

e E

mO

C)

5E

ver

y p

opu

lati

on o

f 50

0,00

0, a

t lea

st 1

com

pre

hen

sive

Em

OC

is n

eed

ed (S

ee G

loss

ary

for

com

pon

ents

of

Bas

ic a

nd C

omp

reh

ensi

ve E

mO

C)

5.2.

3.1

Stre

ngth

en th

e ca

paci

ty o

f all

dis

pens

arie

s an

d a

ll he

alth

cen

tres

to

prov

ide

BE

mO

C, e

ssen

tial

new

born

car

e an

d K

MC

thro

ugh:

•

Dep

loym

ent o

f ski

lled

hea

lth

wor

kers

(Nur

se m

idw

ives

, Clin

ical

Off

icer

s,

la

bora

tory

ass

ista

nts)

•

Prov

isio

n of

ess

enti

al e

quip

men

t and

supp

lies.

•

Infr

astr

uctu

ral i

mpr

ovem

ent f

or

se

rvic

e d

eliv

ery

(Del

iver

y ro

om,

po

stna

tal r

oom

, lab

orat

ory)

5.2.

3.2

Stre

ngth

en th

e ca

paci

ty o

f all

ho

spit

als

and

upg

rad

e 50

% o

f hea

lth

cent

res

to p

rovi

de

CE

mO

C a

nd

es

sent

ial n

ewbo

rn c

are

thro

ugh:

•

D

eplo

ymen

t of s

kille

d h

ealt

h w

orke

rs

(N

urse

mid

wiv

es, M

O, A

MO

s,

A

naes

thet

ists

, Lab

orat

ory

tech

nici

ans)

•

Pr

ovis

ion

of e

ssen

tial

equ

ipm

ent a

nd

su

pplie

s.•

In

fras

truc

tura

l im

prov

emen

t for

serv

ice

del

iver

y (O

pera

ting

thea

tres

,

Lab

our

war

d, B

lood

sto

rage

faci

litie

s,

in

cine

rato

rs)

•

Est

ablis

h ne

onat

al a

nd K

MC

uni

ts

5.2.

3.3

Dev

elop

and

con

duc

t tai

lor

mad

e

trai

ning

for

AM

Os

and

Nur

ses

to

pr

ovid

e C

Em

OC

, Ess

enti

al N

ewbo

rn

an

d c

hild

hea

lth

serv

ices

33T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

Tim

efra

me

Stra

tegi

c O

bjec

tive

/ O

utp

ut

Act

ivit

ies

0809

1011

1213

1415

Pro

cess

In

dic

ator

s

Res

pon

sibl

e P

erso

n

Res

ourc

es

Nee

ded

in

US

dol

lars

5.2.

4.1

Fore

cast

dem

and

, pro

cure

and

su

pp

ly e

ssen

tial

com

mod

itie

s an

d su

pp

lies

for

mat

erna

l, ne

wbo

rn a

nd

child

car

e6 in

clu

din

g co

ntra

cep

tive

s.

Em

pha

sis

to b

e p

ut o

n:

•E

ssen

tial

obs

tetr

ic s

up

plie

s a

nd

med

icin

es fo

r A

NC

, del

iver

y an

d

pos

tpar

tum

. •

New

born

res

usc

itat

ion

kits

, su

pp

lies

and

dru

gs.

•C

ontr

acep

tive

s (p

ills,

IUC

D,

imp

lant

s, in

ject

able

s an

d co

ndom

s).

•V

acci

nes

•

Lab

orat

ory

reag

ents

. •

Pae

dia

tric

em

erge

ncy

equ

ipm

ent

(oxy

gen

conc

entr

ator

, glu

com

eter

s,

ambu

bag

s, s

uctio

n, in

fusi

on p

um

ps)

an

d IM

CI d

rugs

and

su

pp

lies

•Su

pp

lies

for t

hera

peu

tic

feed

ing

for

man

agem

ent o

f sev

ere

acu

te

mal

nutr

itio

n

X

X

X

X

X

X

X

X

Per

cent

age

of

hea

lth

faci

litie

s w

ith

stoc

k-ou

ts o

f es

sent

ial

com

mod

itie

s,

sup

plie

s an

d

med

icin

es f

or

mat

erna

l, n

ewbo

rn a

nd

child

car

e in

clu

din

g co

ntra

cep

tive

s.

MoH

SW

(Dir

ecto

rate

of

Hos

pit

al S

ervi

ces,

R

CH

S an

d M

SD)

Dis

tric

t Cou

ncils

, D

evel

opm

ent

Par

tner

s

CSO

s P

riva

te s

ecto

r

400,

000,

000

5.2.

4 M

ech

anis

ms

for

avai

labi

lity

of

esse

ntia

l co

mm

odit

ies,

su

ppl

ies

and

med

icin

es f

or

mat

ern

al,

new

bor

n

and

chil

d h

ealt

h in

clu

din

g fa

mil

y pl

anni

ng

st

ren

gth

ened

.

Stra

tegi

c O

utp

ut

Ind

icat

or:

Ess

enti

al

com

mod

itie

s, s

uppl

ies

and

med

icin

es fo

r m

ater

nal,

new

born

an

d ch

ild c

are

avai

labl

e al

l the

tim

e at

eve

ry h

ealth

faci

lity

5.2.

4.2

Rev

ive

and

/or

est

abli

sh

mai

nten

ance

uni

ts fo

r va

riou

s eq

uip

men

t at

the

hosp

ital

leve

l.

XX

X

X

X

X

X

X

P

ropo

rtio

n of

ho

spit

als

wit

h fu

nctio

nin

g eq

uip

men

t m

aint

enan

ce

uni

ts.

MoH

SW (R

CH

S,

Dir

ecto

rate

of H

S)

RH

MT

s

Dis

tric

t Cou

ncils

100,

000,

000

6 Ess

enti

al N

ewbo

rn e

quip

men

t an

d s

uppl

ies

(See

An

nex

8)

34T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

STR

AT

EG

IC P

LA

N A

ND

AC

TIV

ITIE

S: 2

008

-201

5

Tim

efra

me

Stra

tegi

c O

bjec

tive

/ O

utp

ut

Act

ivit

ies

0809

1011

1213

1415

Pro

cess

In

dic

ator

s

Res

pon

sibl

e P

erso

n

Res

ourc

es

Nee

ded

in

US

dol

lars

5.2.

5.1

Pro

cure

and

inst

all c

omm

un

icat

ion

equ

ipm

ent (

Two

way

rad

io

com

mu

nic

atio

n, p

hone

s) in

dis

tric

t ho

spit

als,

sel

ecte

d he

alth

cen

tres

and

d

isp

ensa

ries

.

X

X

X

X

X

X

X

X

Pro

port

ion

of

hea

lth

uni

ts w

ith

2way

Rad

io

com

mu

nic

atio

n eq

uip

men

t

MoH

SW/

R

CH

S D

istr

ict

Cou

ncils

D

evel

opm

ent

Par

tner

s C

SOs

Pri

vate

sec

tor

2,80

0,00

0

5.2.

5.2

Pro

cure

and

uti

lise

ambu

lanc

es fo

r re

ferr

al p

urp

oses

, at l

east

one

per

dis

tric

t ho

spit

al a

nd o

ne p

er h

ealt

h ce

ntre

and

se

lect

ed d

isp

ensa

ries

.

5.2.

5.3

Pro

cure

mot

orbi

ke A

mbu

lanc

e fo

r H

ealt

h C

entr

e /

dis

pen

sari

es w

here

ap

plic

able

5.2.

5.4

Pro

vid

e su

ffic

ient

fuel

for

ve

hic

les/

mot

orbi

kes

5.2.

5.5

Con

duc

t mai

nten

ance

ser

vice

s fo

r co

mm

un

icat

ion

equ

ipm

ents

and

ve

hic

les/

mot

orbi

kes

X

X

X

X

X

X

X

X

Pro

port

ion

of

hea

lth

faci

litie

s w

ith

func

tion

ing

ambu

lanc

es a

nd

mot

orbi

kes

for

refe

rral

.

MoH

SW

RC

HS

PMO

RA

LG

M

oID

D

istr

ict

Cou

ncils

D

evel

opm

ent

Par

tner

s C

SOs

Pri

vate

sec

tor

6,00

0,00

0

5.2.

5 R

efer

ral s

yste

m a

t al

l lev

els

stre

ngt

hen

ed.

Stra

tegi

c O

utp

ut

Ind

icat

or:

Fu

ncti

onal

ref

erra

l sy

stem

s in

pla

ce a

t all

leve

ls

5.2.

5.6

Ori

ent r

egio

nal a

nd d

istr

ict h

ealt

h co

mm

itte

es o

n ob

stet

ric,

new

born

and

ch

ild e

mer

genc

y p

rep

ared

nes

s

X

X

X

X

X

X

X

X

Pro

port

ion

of

regi

onal

/d

istr

ict

hea

lth

com

mit

tees

or

ient

ed o

n em

erge

ncy

pre

par

edn

ess.

MoH

SW/

R

CH

S Z

TC

s R

HM

Ts

CH

MT

s

Dev

elop

men

t P

artn

ers

CSO

s

1,00

0,00

0

35T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

Tim

efra

me

Pro

cess

In

dic

ator

s

Res

pon

sibl

e P

erso

n

Res

ourc

es

Nee

ded

in

US

dol

lars

Stra

tegi

c O

bjec

tive

/ O

utp

ut

Act

ivit

ies

0809

1011

1213

1415

5.

2.5.

7 O

rien

t oth

er s

up

port

sta

ff

(com

mu

nity

hea

lth

wor

kers

, am

bula

nce

dri

vers

and

att

end

ants

) on

emer

genc

y an

d r

esp

onse

p

rep

ared

nes

s.

X

X

X

X

X

X

X

X

Nu

mbe

r of

hea

lth

faci

litie

s w

ith

sup

port

sta

ff

orie

nted

on

emer

genc

y an

d

resp

onse

p

rep

ared

nes

s.

MoH

SW/

R

CH

S Z

TC

s,

RH

MT

s C

HM

Ts,

Dev

elop

men

t Par

tner

s C

SOs

1,00

0,00

0

5.2.

5.8

Esta

blis

h/re

vive

com

mu

nity

em

erge

ncy

com

mit

tee

in e

very

vi

llage

to m

obil

ise

com

mu

nit

y re

sou

rce

for

emer

genc

y tr

ansp

ort a

nd

for

bloo

d do

nors

.

X

X

X

X

X

X

X

X

Pro

port

ion

of

villa

ges

wit

h fu

nctio

nin

g em

erge

ncy

com

mit

tees

for

MN

CH

PMO

RA

LG

M

oCD

GC

M

oHSW

/ R

CH

S,

Dis

tric

t C

ounc

ils

CH

MT

V

illag

e G

over

nm

ent

Dev

elop

men

t Par

tner

s C

SOs

300,

000

5.2.

5.9

Esta

blis

h m

ater

nity

wai

tin

g ho

mes

whe

re a

pp

licab

le.

X

X

X

X

X

X

X

X

Pro

port

ion

of

hea

lth

faci

litie

s (w

here

ap

plic

able

) li

nke

d to

fu

nctio

nin

g m

ater

nit

y w

aiti

ng

hom

es.

MoH

SW/

RC

HS

Dis

tric

t C

ounc

ils

CH

MT

s V

illag

e G

over

nm

ent

Dev

elop

men

t Par

tner

s C

SOs

Pri

vate

sec

tor

500,

000

36T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

STR

AT

EG

IC P

LA

N A

ND

AC

TIV

ITIE

S: 2

008

-201

5

Tim

efra

me

Stra

tegi

c O

bjec

tive

/ O

utp

ut

Act

ivit

ies

0809

1011

1213

1415

Pro

cess

In

dic

ator

s

Res

pon

sibl

e P

erso

n

Res

ourc

es

Nee

ded

in

US

dol

lars

Res

earc

h, M

onit

orin

g an

d E

valu

atio

n5.

2.6.

1 D

evel

op a

nd u

pd

ate

mon

itor

ing

and

eva

luat

ion

fram

ewor

k fo

r MN

CH

5.2.

6.2

Up

dat

e m

onit

orin

g d

ata

colle

ctio

n to

ols

to in

clud

e E

mO

C

pro

cess

ind

icat

ors

and

othe

r m

issi

ng

info

rmat

ion

on n

utr

itio

n, p

ost a

bort

al

care

, pos

tnat

al c

are,

new

born

and

ch

ild c

are

and

refe

rral

form

s, r

egis

ter

for

refe

rral

, l

og-b

ooks

.

X X

X X

X

X

Mon

itori

ng

and

ev

alu

atio

n fr

amew

ork

for

MN

CH

in p

lace

Mon

itori

ng

dat

a co

llect

ion

tool

s u

pd

ated

MoH

SW (H

MIS

U

nit

) N

BS (P

over

ty

Mon

itori

ng

Un

it)

CH

MT

and

Dev

elop

men

t P

artn

ers

45,0

00

5.2.

6

HM

IS c

apac

ity

to

capt

ure

info

rmat

ion

on

mat

ern

al, n

eon

atal

an

d ch

ild

indi

cato

rs

incl

udi

ng

FP a

nd

nut

riti

on im

pro

ved

.

Stra

tegi

c O

utp

ut

Ind

icat

or :

Key

Mat

erna

l, ne

wbo

rn

and

child

hea

lth

indi

cato

rs r

epor

ted

an

nua

lly th

roug

h H

MIS

5.2.

6.3

Pro

duc

e, d

isse

min

ate

,dis

trib

ute

up

dat

ed d

ata

colle

ctio

n to

ols

at a

ll le

vels

.

X

X

X

P

ropo

rtio

n of

fa

cilit

ies

usi

ng

up

dat

ed d

ata

colle

ctio

n to

ols

MO

HSW

(R

CH

S, H

IS)

MSD

C

HM

Ts

CSO

s P

riva

te s

ecto

r

500,

000

37T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

Tim

efra

me

Stra

tegi

c O

bjec

tive

/ O

utp

ut

Act

ivit

ies

0809

1011

1213

1415

Pro

cess

In

dic

ator

s

Res

pon

sibl

e P

erso

n

Res

ourc

es

Nee

ded

in

US

dol

lars

5.2.

7.1

Ori

ent h

ealt

h se

rvic

e p

rovi

der

s/su

per

viso

rs o

n M

NC

H

mon

itor

ing

and

eva

luat

ion

fram

ewor

k an

d e

ffec

tive

dat

a m

anag

emen

t (da

ta c

olle

ctio

n, a

naly

sis

and

uti

lizat

ion.

)

X

X

X

X

X

X

X

X

Nu

mbe

r of

hea

lth

serv

ice

pro

vid

ers/

su

per

viso

rs

orie

nted

on

data

m

anag

emen

t.

MoH

SW (H

MIS

U

nit

) R

HM

Ts

CH

MT

s

1,00

0,00

0

5.2.

7.2.

Con

du

ct s

up

port

ive

sup

ervi

sion

for M

NC

H in

bot

h p

ubl

ic

and

pri

vate

hea

lth

faci

litie

s.

5.2.

7.3

Con

duc

t fol

low

up

of h

ealt

h w

orke

rs a

fter

trai

nin

g on

MN

CH

p

acka

ges.

X X

X X

X X

X X

X X

X X

X X

X X

Pro

port

ion

of

hea

lth

faci

litie

s re

ceiv

ing

qu

arte

rly

sup

port

ive

sup

ervi

sion

.

Pro

port

ion

of

hea

lth

wor

kers

th

at r

ecei

ved

fo

llow

up

afte

r tr

ain

ing

on

MN

CH

pac

kage

s ye

arly

MoH

SW

(Ins

pec

tora

te

Un

it, R

CH

S)

RH

MT

s C

HM

Ts

C

SOs

.

850

,000

5.2.

7

Mon

itor

ing

and

eval

uat

ion

fram

ewor

k

for

MN

CH

st

ren

gth

ened

an

d im

plem

ente

d.

Stra

tegi

c O

utp

ut

Ind

icat

or :

Pro

gres

s on

Mat

erna

l, ne

wbo

rn a

nd c

hild

hea

lth

stat

us/t

rend

s r

epor

ted.

5.2.

7.4

Con

duc

t per

iod

ic s

urv

eys

on

qual

ity

of c

are,

clie

nt s

atis

fact

ion

and

ca

re s

eeki

ng

beha

viou

r in

sel

ecte

d d

istr

icts

and

fact

ors

faci

litat

ing

or

hind

erin

g ac

cess

for

mat

erna

l, n

ewbo

rn a

nd c

hild

car

e.

5.2.

7.5

Con

duc

t Bie

nn

ial R

evie

w

mee

tin

gs to

ass

ess

pro

gres

s on

the

imp

lem

enta

tion

.

X

X

X

X

X

X

X

N

um

ber

of

surv

eys

cond

ucte

d on

qu

alit

y as

sura

nce

of s

ervi

ce

del

iver

ed.

Nu

mbe

r of

re

view

mee

tin

gs

cond

ucte

d

MoH

SW

PMO

RA

LG

D

evel

opm

ent

Par

tner

s R

esea

rch

inst

itu

tion

s

NBS

A

cad

emic

in

stit

uti

ons,

H

ealt

h p

rofe

ssio

nal

asso

ciat

ions

C

SOs

38T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

STR

AT

EG

IC P

LA

N A

ND

AC

TIV

ITIE

S: 2

008

-201

5

Tim

efra

me

Stra

tegi

c O

bjec

tive

/ O

utp

ut

Act

ivit

ies

0809

1011

1213

1415

Pro

cess

In

dic

ator

s

Res

pon

sibl

e P

erso

n

Res

ourc

es

Nee

ded

in

US

dol

lars

5.2.

7.6

Doc

um

ent a

nd s

hare

bes

t p

ract

ices

on

mat

erna

l, ne

wbo

rn a

nd

child

hea

lth.

X

X

X

X

X

X

X

X

Nu

mbe

r of

bes

t p

ract

ices

d

ocu

men

ted

and

sc

aled

up.

MoH

SW/

RC

HS

CSO

s D

evel

opm

ent

Par

tner

s

Pri

vate

sec

tor

100,

000

5.2.

7.7

Inst

itu

tiona

lize

mat

erna

l, n

ewbo

rn a

nd c

hild

mor

talit

y re

view

ap

pro

ache

s at

all

leve

ls

•V

ital

reg

istr

atio

n sy

stem

(b

irth

and

dea

th)

•C

onfi

den

tial

en

quir

y •

Nea

r m

iss

surv

eys

•M

orta

lity

surv

eys

•V

erba

l au

top

sy

•O

ther

ap

pro

pri

ate

revi

ew

mec

hani

sms

X

X

X

X

X

X

X

X

Nu

mbe

r an

d ty

pe

of M

NC

H

mor

talit

y re

view

re

por

ts.

MoH

SW/

RC

HS

RH

MT

s,

CH

MT

s Fa

cilit

ies

Vill

age

Gov

ern

men

ts

RIT

A

NBS

R

esea

rch

and

acad

emic

in

stit

uti

ons

Dev

elop

men

t P

artn

ers

CSO

s

200,

000

39T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

Tim

efra

me

Stra

tegi

c O

bjec

tive

/ O

utp

ut

Act

ivit

ies

0809

1011

1213

1415

Pro

cess

In

dic

ator

s

Res

pon

sibl

e P

erso

n

Res

ourc

es

Nee

ded

in

US

dol

lars

5.

2.8.

1 R

evie

w a

nd h

arm

oniz

e ex

isti

ng

com

mu

nit

y ba

sed

man

agem

ent

info

rmat

ion

tool

s.

X

X

X

H

arm

oniz

ed

com

mu

nit

y ba

sed

m

anag

emen

t in

form

atio

n to

ols

in p

lace

RC

HS

HM

IS

PMO

-RA

LG

, R

HM

Ts

C

HM

Ts

Dev

elop

men

t P

artn

ers

C

SOs,

V

illag

e G

over

nm

ents

18,

000

5.2.

.8.2

Ori

ent v

illa

ge G

over

nm

ents

on

the

com

mu

nit

y ba

sed

man

agem

ent

info

rmat

ion

tool

s.

X

X

X

X

X

X

X

X

Pro

port

ion

of

villa

ge

Gov

ern

men

t m

embe

rs

orie

nted

on

com

mu

nit

y ba

sed

d

ata

man

agem

ent.

RC

HS

HM

IS

PMO

-RA

LG

R

HM

Ts

CH

MT

s D

evel

opm

ent

Par

tner

s

CSO

s V

illag

e G

over

nm

ents

600

,000

5.2.

8 C

omm

un

ity

bas

ed

man

agem

ent

info

rmat

ion

sys

tem

st

ren

gth

ened

.

Stra

tegi

c O

utp

ut

Ind

icat

or:

Com

mu

nit

y ba

sed

data

effe

ctiv

ely

colle

cted

and

use

d in

pl

anni

ng

5.2.

8.3

Tra

in c

omm

un

ity

hea

lth

wor

kers

an

d o

ther

ser

vice

pro

vid

ers

on

com

mu

nit

y ba

sed

info

rmat

ion

man

agem

ent.

X

X

X

X

Pro

port

ion

of

com

mu

nit

y h

ealt

h w

orke

rs

and

ser

vice

p

rovi

der

s tr

ain

ed

on d

ata

man

agem

ent.

RC

HS

HM

IS

PMO

-RA

LG

R

HM

Ts

C

HM

Ts

Vill

age

Gov

ern

men

ts, D

evel

opm

ent

Par

tner

s

CSO

s

900,

000

40T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

STR

AT

EG

IC P

LA

N A

ND

AC

TIV

ITIE

S: 2

008

-201

5

Tim

efra

me

Stra

tegi

c O

bjec

tive

/ O

utp

ut

Act

ivit

ies

0809

1011

1213

1415

Pro

cess

In

dic

ator

s

Res

pon

sibl

e P

erso

n

Res

ourc

es

Nee

ded

in

US

dol

lars

5.

2.9

Cap

acit

y fo

r co

nd

uct

ing

MN

CH

op

erat

ion

al

rese

arch

st

ren

gth

ened

Stra

tegi

c ou

tput

in

dica

tor:

E

vide

nce

on M

NC

H

avai

labl

e fo

r pl

ann

ing

and

prog

ram

me

deve

lopm

ent

5.2.

9.1

Iden

tify

MN

CH

op

erat

iona

l re

sear

ch p

rior

itie

s

5.2.

9.2

Con

duc

t MN

CH

op

erat

iona

l re

sear

ch a

nd d

ocu

men

t and

dis

sem

inat

e re

sult

s

X X

X XX

XX

XX

X

Nu

mbe

r of

M

NC

H

oper

atio

nal

rese

arch

es

cond

ucte

d

MoH

SW-

RH

CS,

R

esea

rch

and

acad

emic

in

stit

uti

ons

1,00

0,00

0

41T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

Tim

efra

me

Stra

tegi

c O

bjec

tive

/ O

utp

ut

Act

ivit

ies

0809

1011

1213

1415

Pro

cess

In

dica

tors

R

esp

onsi

ble

Per

son

R

esou

rces

N

eed

ed in

U

S d

olla

rs

5.2.

10.1

Ad

apt q

ual

ity

assu

ranc

e ap

pro

ache

s fo

r MN

CH

(QIR

I, PI

A, C

OP

E,

Col

labo

rati

ve)

X

X

Nu

mbe

r of

qu

alit

y as

sura

nce

app

roac

hes

adap

ted

MoH

SW

(RC

HS,

In

spec

tora

te

uni

t) R

HM

Ts

Dis

tric

t C

ounc

ils

CH

MT

s D

evel

opm

ent

Par

tner

s C

SOs

50,0

00

5.2.

10

Qu

alit

y as

sura

nce

and

man

agem

ent

(su

per

visi

on, c

lien

t sa

tisf

acti

on,

per

form

ance

as

sess

men

t)

stre

ngt

hen

ed.

Stra

tegi

c O

utp

ut

Ind

icat

or:

Pro

port

ion

of h

ealt

h fa

cilit

ies

deliv

erin

g M

NC

H s

ervi

ces

acco

rdin

g to

na

tion

ally

def

ined

se

rvic

e st

anda

rds

5.2.

10.2

Ori

ent s

up

ervi

sors

and

ser

vice

p

rovi

der

s on

qu

alit

y as

sura

nce

met

hod

s fo

r MN

CH

ser

vice

s.

5.2.

.10.

3 O

rien

t ser

vice

pro

vid

ers

on th

e C

lien

t Hea

lth

Cha

rter

as

tool

to im

pro

ve

rela

tion

ship

wit

h cl

ient

.

5.2.

10.4

Up

dat

e co

de

of c

ond

uct a

nd jo

b d

escr

ipti

on.

5.2.

10.5

Ori

ent h

ealt

h fa

cilit

y co

mm

itte

es

and

dis

tric

t hea

lth

boar

ds

on C

lient

Se

rvic

e C

hart

er to

ens

ure

sat

isfa

ctor

y cl

ient

-ser

vice

rel

atio

nsh

ip.

X X X X

X X X X

X X X

X X X

X X X

X X X

X X X

X X X

Nu

mbe

r of

su

per

viso

rs a

nd

serv

ice

pro

vid

ers

orie

nted

on

qual

ity

assu

ranc

e ap

pro

ache

s.

Pro

port

ion

of h

ealt

h se

rvic

e p

rovi

der

s or

ient

ed o

n C

lient

Se

rvic

e C

hart

er a

t al

l lev

els.

Cod

e of

con

duc

t and

jo

b d

escr

ipti

on

up

dat

ed.

Pro

port

ion

of h

ealt

h fa

cilit

y co

mm

itte

es

and

dis

tric

t hea

lth

boar

ds

orie

nted

on

clie

nt-s

ervi

ce

rela

tion

ship

at a

ll le

vels

.

MoH

SW(R

CH

S,

Insp

ecto

rate

u

nit)

RH

MTs

D

istr

ict

Cou

ncils

C

HM

Ts,

D

evel

opm

ent

Par

tner

s C

SOs

400,

000

42T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

STR

AT

EG

IC P

LA

N A

ND

AC

TIV

ITIE

S: 2

008

-201

5

Tim

efra

me

Stra

tegi

c O

bjec

tive

/ O

utp

ut

Act

ivit

ies

0809

1011

1213

1415

Pro

cess

In

dica

tors

R

esp

onsi

ble

Per

son

R

esou

rces

N

eed

ed in

U

S d

olla

rs

5.3

Com

mu

nit

y M

obil

isat

ion

5.

3.1

Com

mu

nit

y b

ased

m

ater

nal

, ne

wb

orn

an

d ch

ild

hea

lth

care

incl

udi

ng

FP

and

nut

riti

on

stre

ngt

hen

ed

Stra

tegi

c O

utp

ut

Ind

icat

or:

Mat

erna

l, n

ewbo

rn

and

child

hea

lth c

are

serv

ices

pro

vide

d at

co

mm

uni

ty le

vel

5.3.

1.1

Tra

in c

omm

un

ity

base

d h

ealt

h w

orke

rs o

n M

NC

car

e in

clu

din

g

com

mu

nit

y IM

CI.

5.3.

1.2

Tra

in E

mp

loye

d C

HW

on

Com

pre

hen

sive

Mat

erna

l, N

eona

tal a

nd

child

Pac

kage

.

5.3.

1.3

Re-

inst

uti

onal

ize

quar

terl

y vi

llage

h

ealt

h d

ays

5.3.

1.4

Con

du

ct m

onth

ly o

utre

ach

and

mob

ile

clin

ic s

ervi

ces

for M

NC

H.

5.3.

1.5

Pro

vid

e co

mm

uni

ty h

ealt

h w

orke

rs w

ith

nece

ssar

y eq

uip

men

t, co

mm

odit

ies,

su

pp

lies

and

tran

spor

t.

5.3.

1.6

Dev

elop

and

imp

lem

ent

ince

ntiv

e m

echa

nism

for

com

mu

nit

y h

ealt

h w

orke

rs

X

X

X

X

X

X

X

X

Pro

port

ion

of

villa

ges

wit

h co

mm

un

ity

hea

lth

wor

kers

7,

trai

ned

on

mat

erna

l, n

eona

tal a

nd c

hild

h

ealt

h is

sues

in

clu

din

g nu

trit

ion

and

FP

.

Pro

port

ion

of

villa

ges

cond

ucti

ng

villa

ge h

ealt

h d

ays.

Pro

port

ion

of

dis

pen

sari

es a

nd

hea

lth

cent

res

cond

ucti

ng

mon

thly

ou

trea

ch

and

mob

ile

clin

ic

serv

ices

.

Pro

port

ion

of

villa

ges

wit

h in

cent

ive

mec

hani

sm fo

r co

mm

un

ity

hea

lth

wor

kers

.

MoH

SW/

RC

HS

, MoC

DG

C

PMO

RA

LG

R

HM

Ts,

D

istr

ict

Cou

ncils

C

HM

Ts,

V

illag

e G

over

nm

ents

, D

evel

opm

ent

Par

tner

s C

SOs

2,80

0,00

0

7 Req

uire

d ra

tio 1

/30

hous

ehol

ds

43T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

Stra

tegi

c O

bjec

tive

/ A

ctiv

itie

s

Tim

efra

me

Pro

cess

R

esp

onsi

ble

Res

ourc

es

Out

put

08

0910

1112

1314

15In

dic

ator

s

Per

son

N

eed

ed in

U

S d

olla

rs

5.3.

2.1

Sens

itiz

e co

mm

un

ity

lead

ers

and

com

mu

niti

es o

n p

arti

cip

ator

y p

lan

nin

g ,

imp

lem

enta

tion

and

mon

itor

ing

of c

omm

un

ity

base

d M

NC

H

inte

rven

tion

s.

X

X

X

X

X

X

Pro

port

ion

of

villa

ges

wit

h co

mm

un

ity

lead

ers

and

m

embe

rs

sens

itis

ed o

n m

ater

nal,

new

born

and

ch

ild h

ealt

h is

sues

.

Pro

port

ion

of

villa

ges

pla

ns

wit

h M

NC

H

acti

viti

es.

MoH

SW/

RC

HS,

M

oCD

GC

PM

OR

AL

G

Dis

tric

t C

ounc

ils

CH

MT

s, C

omm

uni

ties

C

SOs

Dev

elop

men

t P

artn

ers

2, 5

00,0

00

5.3.

2

Com

mu

nit

y p

arti

cipa

tion

in

mat

ern

al n

ewb

orn

an

d ch

ild

hea

lth

care

incr

ease

d.

Stra

tegi

c O

utp

ut

Ind

icat

ors

Com

mu

nit

y le

ader

s an

d m

embe

rs

part

icip

atin

g ac

tive

ly

in M

NC

H is

sues

5.3.

2.2

Ori

ent h

ealt

h fa

cilit

y co

mm

itte

es

and

dis

tric

t hea

lth

boar

ds

on

Cli

ent S

ervi

ce C

hart

er to

ens

ure

sa

tisf

acto

ry c

lient

-ser

vice

re

lati

onsh

ip

X

X

X

X

X

X

X

X

Pro

port

ion

of

hea

lth

faci

lity

com

mit

tees

and

d

istr

ict h

ealt

h bo

ard

s or

ient

ed

on c

lient

-se

rvic

e re

lati

onsh

ip a

t al

l lev

els.

MoH

SW,

Dis

tric

t C

ounc

ils

500,

000

44T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

STR

AT

EG

IC P

LA

N A

ND

AC

TIV

ITIE

S: 2

008

-201

5

Tim

efra

me

Stra

tegi

c O

bjec

tive

/ O

utp

ut

Act

ivit

ies

0809

1011

1213

1415

Pro

cess

In

dica

tors

R

esp

onsi

ble

Per

son

R

esou

rces

N

eed

ed in

U

S d

olla

rs

5.4

Beh

avio

ur

Ch

ange

5.

4.1

Key

com

mu

nit

y an

d h

ouse

hol

d p

ract

ises

for

m

ater

nal

, ne

wb

orn

an

d ch

ild

care

im

pro

ved

.

Stra

tegi

c O

utp

ut

Ind

icat

or:

Impr

oved

pra

ctis

es

for

mat

erna

l, ne

wbo

rn a

nd c

hild

he

alth

car

e at a

ll le

vels

.

5.4.

1.1

Des

ign,

dev

elop

IEC

/B

CC

m

essa

ges

and

mat

eria

ls fo

r com

mu

nit

y m

embe

rs (m

en, w

omen

and

ado

lesc

ents

) fo

r sp

ecif

ic m

ater

nal

new

born

and

chi

ld

issu

es, w

ith e

mp

hasi

s on

: •

Pos

tnat

al a

nd N

ewbo

rn c

are;

•

Ad

vant

ages

of e

arly

att

end

ance

to

hea

lth

faci

litie

s (A

NC

); •

Bir

th p

rep

ared

nes

s;

•E

ssen

tial

nut

riti

onal

pra

ctic

es a

nd

actio

ns fo

r m

ater

nal

new

born

and

ch

ild;

•C

ause

s of

mat

erna

l, ne

wbo

rn a

nd

child

dea

ths

and

iden

tifi

catio

n of

D

ange

r si

gns;

•

Ear

ly C

are

seek

ing

and

com

plia

nce

•H

ome

man

agem

ent o

f com

mon

ch

ildho

od il

lnes

s •

Dis

ease

pre

vent

ion

(IT

N’s

, im

mu

niz

atio

n, h

ygie

ne

and

sa

nita

tion

) •

Inte

rven

tion

s to

pre

vent

HIV

and

M

othe

r to

Chi

ld tr

ansm

issi

on o

f HIV

•

Rep

osit

ioni

ng

fam

ily

pla

nn

ing

•P

reve

nti

on o

n ea

rly

and

unw

ante

d

pre

gnan

cies

•

Rol

e of

men

in M

ater

nal n

ewbo

rn

and

chi

ld h

ealt

h ca

re

X

X

X

XX

IEC

/B

CC

mes

sage

s an

d m

ater

ials

ad

dre

ssin

g sp

ecif

ic

mat

erna

l and

n

ewbo

rn is

sues

d

evel

oped

for

com

mu

nit

y m

embe

rs.

MoH

SW,

PMO

RA

LG

, M

oCD

GC

, M

oEV

T, M

oISC

D

istr

ict

Cou

ncils

, C

HM

T’s

, V

illag

e G

over

nm

ent,

Dev

elop

men

t P

artn

ers

, M

edia

, C

SOs,

100,

000

45T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

Tim

efra

me

Stra

tegi

c O

bjec

tive

/ O

utp

ut

Act

ivit

ies

0809

1011

1213

1415

Pro

cess

In

dica

tors

R

esp

onsi

ble

Per

son

R

esou

rces

N

eed

ed in

U

S d

olla

rs

5.4.

1.2

Dis

sem

inat

e an

d d

istr

ibu

te

IEC

/B

CC

mes

sage

s an

d m

ater

ials

for

com

mu

nit

y m

embe

rs th

rou

gh d

iffer

ent

med

ia.

5.4.

1.3

Dev

elop

the

cap

acit

y of

co

mm

un

ity

thea

tre

grou

ps

to

dis

sem

inat

e M

NC

H m

essa

ges

Pro

port

ion

of IE

C/

BC

C

mat

eria

ls d

isse

min

ated

th

rou

gh d

iffer

ent m

edia

(R

oad

show

s, T

V, R

adio

et

c).

Nu

mbe

r of

com

mu

nity

th

eatr

e gr

oup

s es

tabl

ish

ed to

dis

sem

inat

e M

NC

H m

essa

ges

MoH

SW ,

PMO

RA

LG

M

oCD

GC

M

oEV

T, M

oISC

D

istr

ict C

ounc

ils

CH

MT

s, V

illag

e G

over

nm

ents

, D

evel

opm

ent

Par

tner

s , M

edia

C

SOs.

4,00

0,00

0

350,

000

5.5

Fost

erin

g P

artn

ersh

ip 5.5.

1.1

Ori

ent p

artn

ers

on O

ne

MN

CH

St

rate

gic

Pla

n

5.5.

1.2

Con

duc

t joi

nt p

lann

ing

and

co

ord

inat

ion

mee

tin

gs w

ith

stak

ehol

der

s/p

artn

ers

for

mat

erna

l, n

ewbo

rn a

nd c

hild

car

e at

all

leve

ls

5.5.

1.3

Con

duc

t qu

arte

rly

PM

NC

H

com

mit

tee

mee

tin

gs

5.5.

1.4

Con

duc

t bi-

annu

al P

MN

CH

fo

rum

X X X X

X X X X

X X X

X X X

X X X

X X X

X X X

X X X

Num

ber

of o

rien

tati

on

sess

ions

on

One

MN

CH

St

rate

gic

Pla

n c

ond

ucte

d

Nu

mbe

r of

join

t pla

nnin

g an

d c

oord

inat

ion

mee

tin

gs c

ond

ucte

d

Nu

mbe

r of

PM

NC

H

com

mit

tee

mee

tin

gs h

eld

an

nual

ly

Nu

mbe

r of

PM

NC

H f

ora

hel

d

MoH

SW/

RC

HS

MO

CD

GC

, PM

OR

AL

G

Reg

iona

l Se

cret

aria

t D

istr

ict C

ounc

ils

Dev

elop

men

t P

artn

ers

Hea

lth

pro

fess

iona

l as

soci

atio

ns

CSO

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65,0

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5.5.

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artn

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ip a

nd

coor

din

atio

n f

or

MN

CH

act

ivit

ies

at

all l

evel

s im

pro

ved

.

Stra

tegi

c O

utp

ut

Ind

icat

or:

Coo

rdin

ated

res

pons

e an

d le

vera

ging

of

reso

urce

s fo

r M

NC

H

acti

viti

es.

5.5.

1.4

Pro

vid

e su

ppo

rt to

the

PMN

CH

se

cret

aria

t for

Par

tner

ship

co-

ordi

nati

on

X

X

X

X

X

X

X

X

Func

tiona

l sec

reta

riat

for

par

tner

ship

in p

lace

M

oHSW

D

evel

opm

ent

Par

tner

s H

ealt

h p

rofe

ssio

nal

asso

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ions

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-

GR

AN

D T

OT

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$674

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46T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

STR

AT

EG

IC P

LA

N A

ND

AC

TIV

ITIE

S: 2

008

-201

5


CHAPTER 6MONITORING FRAMEWORK

Maternal, newborn and child care programmes will be evaluated based on an agreed set of indicators, bothqualitative and quantitative. Routine health information systems currently track outputs such as number ofadmissions, management of childhood illnesses, immunization, antenatal care, births, and caesarean sections.There is little information on quality of maternal and newborn care, such as intrapartum care, stillbirth rate,babies receiving resuscitation and outcome, and percentage of newborns receiving essential newborn care.

List of indicators to assess MNCH Progress

a) Indicators at National level:Sources of data will be a combination of HMIS, District Health Surveys, Household surveys, Health Facilitysurveys, Demographic Health Surveys (DHS), Tanzania Service Provision Assessment surveys (TSPA),Roll back Malaria M&E surveys and financial records. Collected data will be grouped according to gender,age groups, income/wealth quintiles, geographical location (rural and urban) as well as ethnic groups.

.b) Community Indicators:

• Proportion of communities that have set up functional emergency preparedness committees and plansfor MNCH including FP and nutrition

• Proportion of pregnant women that have birth preparedness plans

• Proportion of women and children who needed referral who went for referral

• Proportion of women with knowledge of danger signs of obstetric, neonatal and child healthcomplications

• Proportion of district management task forces and committees with representation from communities

• Proportion of facilities with a designated staff responsible for community health services

• Proportion of villages conducting quarterly village health days

• Proportion of villages with community health workers implementing MNCH interventions

• Coverage of access to potable water (improved drinking water source)

• Coverage of improved latrines

• Use of solid fuels for cooking

• Households’ care-seeking rate for diarrhoea, malaria and pneumonia• ITN use in under-fives and pregnant women

c) Neonatal Indicators

• Neonatal mortality rate

• Prevalence of low birth weight

• Early initiation of breast feeding (within the first hour)

• Proportion of district hospitals that have functional newborn resuscitation facilities in the deliveryroom

• Number of perinatal deaths (still births, deaths within the first seven days of life)

• Postnatal care attendance rate

• Proportion of district hospitals implementing Kangaroo Mother Care for management of Low BirthWeight

• Proportion of district hospitals that are accredited baby friendly

• Postnatal vitamin A coverage


d) Family Planning Indicators

• Contraceptive prevalence rate by method, by age group, by socio economic quintiles

• Met need for FP by age group.

• Total fertility rate.

• Age specific fertility rates

• Number of individuals accepting contraceptives new acceptors

• Number of FP service delivery points per 500,000 population offering full range of contraceptiveinformation counselling and supplies.

e) Maternal Health Indicators:

• Maternal mortality ratio

• Proportion of deliveries taking place in a health facility

• Proportion of births assisted by a skilled attendant

• Proportion of facilities offering BEmOC services and CEmOC services

• Coverage of met need for obstetric complications (coverage of women with obstetric complications thathave received EmOC out of all women with obstetric complications)

• Caesarean sections as a percentage of all live births

• Case Fatality Rate for obstetric complications

• Proportion of first level facilities (PHC) with two or more skilled attendants

• Percentage of pregnant women attended at least once by skilled personnel; percentage attended byskilled personnel at least four times

• Proportion of HIV positive women provided with ARV’s during pregnancy

• Proportion of pregnant women with access to PMTCT services

• Prevalence of positive syphilis serology in pregnant women

• Percentage of pregnant women tested and treated for syphyllis

• Percentage of pregnant women receiving two doses of SP

• Percentage of service delivery points providing youth friendly services

f) Child Health Indicators

• Under-five mortality rate

• Exclusive breastfeeding rate <4 and <6 months

• Continued breastfeeding rate 6-23 months

• Timely complementary feeding rate

• Under-weight prevalence

• Stunting prevalence

• Wasting prevalence

• Vitamin A supplementation coverage (under-fives)

• Anti-malarial treatment in under-fives (within 24 hours of onset of fever, appropriateness)

• Antibiotic treatment for pneumonia and dysentery

• ORS and zinc treatment in management of diarrhoea

• Proportion of health facilities with 60% of health workers trained on IMCI


• Measles immunization coverage

• DTP- HB3 immunization coverage (Hib coverage after introduction)

• Proportion of HIV positive children accessing ARV

• Proportion of HIV exposed infants accessing ARV prophylaxis

g) Increased Political Will and Commitment Indicators:

• Proportion of Government budget allocated to health

• Proportion of MoHSW/ district budget allocated to MNCH and FP

• Availability of policies addressing increased coverage for skilled care

• Development plans integrating MNCH (Development Vision 2025, MKUKUTA, MMAM,HSSP)

h) Indicators for Measuring Progress of the MNCH Strategic Plan

• Existence of Partnership for Maternal Newborn and Child Health (Partnership)

• Total resources mobilized for MNCH Strategic Plan

• Biennial implementation report tracking progress on indicators listed above

Tab

le 2

: R

esul

ts b

ased

Mat

rix

MK

UK

UT

A b

road

out

com

es:

•Im

prov

ed q

ualit

y of

life

and

soc

ial w

ell-

bein

g, w

ith

part

icul

ar fo

cus

on th

e po

ores

t an

d m

ost v

ulne

rabl

e gr

oups

. •

Red

uced

ineq

ualit

ies

in o

utco

mes

(e.g

. edu

cati

on, s

urvi

val,

heal

th)

acro

ss g

eogr

aphi

c, in

com

e, a

ge, g

ende

r an

d ot

her

grou

ps.

MK

UK

UT

A (G

oal 2

.2):

To

impr

ove

surv

ival

and

wel

l-be

ing

of a

ll c

hild

ren

and

wom

en a

nd o

f esp

ecia

lly

vuln

erab

le g

rou

ps.

MK

UK

UT

A (G

oal 2

.5):

To

ensu

re e

ffec

tive

sys

tem

s to

per

mit

uni

vers

al a

cces

s to

qua

lity

an

d af

ford

able

pub

lic

serv

ices

.

Roa

dmap

Ope

rati

on t

arg

ets:

1.

Incr

ease

d co

vera

ge o

f bir

ths

atte

nded

by

skil

led

atte

ndan

ts fr

om 4

6% in

200

4/5

to 8

0%.

2.In

crea

sed

imm

uniz

atio

n co

vera

ge o

f DT

P-H

B 3

and

Mea

sles

vac

cine

to a

bove

90%

in 9

0% o

f the

dis

tric

ts.

3.In

trod

uced

new

vac

cine

s to

EP

I (H

ib, P

neum

occo

cal,

Hum

an p

apil

oma

(HP

V)

and

rota

vir

us v

acci

ne)

. 4.

Red

uced

stu

ntin

g an

d un

derw

eigh

t am

ong

unde

r-fi

ves

from

_38

% a

nd 2

2% to

22%

and

14%

res

pect

ivel

y.

5.In

crea

sed

excl

usiv

e br

east

feed

ing

cove

rage

from

41%

to 8

0 %

6.

PM

TC

T s

ervi

ces

prov

ided

to a

t lea

st 8

0% o

f pre

gnan

t wom

en, t

heir

bab

ies

and

fam

ilie

s.

7.90

% o

f sic

k ch

ildr

en s

eeki

ng c

are

at h

ealt

h fa

cili

ties

app

ropr

iate

ly m

anag

ed.

8.In

crea

sed

cove

rage

und

er-f

ives

sle

epin

g un

der

ITN

’s fr

om 1

6% to

80%

.

9.75

% o

f vill

ages

hav

e co

mm

unity

hea

lth w

orke

rs o

fferi

ng M

NC

H s

ervi

ces

at c

omm

unity

leve

l. 10

.In

crea

sed

mod

ern

cont

race

ptiv

e pr

eval

ence

rat

e fr

om 2

0% t

o 6

0%

11.

Incr

ease

d co

vera

ge o

f com

preh

ensi

ve E

MO

C fr

om 6

4% o

f hos

pita

ls to

100

% a

nd b

asic

EM

OC

from

5%

of H

ealth

cen

tres

and

Dis

pens

arie

s to

70%

12

.In

crea

se th

e nu

mbe

r of

hea

lth fa

cili

ties

off

erin

g E

ssen

tial N

ewbo

rn C

are

to 7

5%.

13.

Incr

ease

d an

tena

tal c

are

atte

ndan

ce fo

r at

leas

t fou

r vi

sits

from

64%

to 9

0%

Foc

us

Are

a In

dic

ator

s of

Res

ults

M

ean

s of

Ver

ific

atio

n

Ass

um

pti

ons

6.1

Ad

voca

cy a

nd

Res

ourc

e M

obil

isat

ion

Incr

ease

d b

udge

t all

ocat

ion

for

heal

th

espe

cial

ly fo

r m

ater

nal

an

d n

ewbo

rn

serv

ices

at a

ll le

vels

.

•15

% o

f Gov

ernm

ent b

udge

t al

loca

ted

to h

ealt

h

•%

Hea

lth

bud

get

avai

labl

e to

ca

ter

for

mat

ern

al, n

ewbo

rn a

nd

ch

ild

hea

lth

serv

ices

at

all l

evel

s

•B

ud

get

for

mat

erna

l, n

ewbo

rn a

nd

ch

ild

hea

lth

incl

ud

ing

FP a

nd

n

utr

itio

n in

crea

sed

by

50%

by

2015

.

•M

ediu

m T

erm

Exp

end

itu

re

Fram

ewor

k (M

TE

F) c

ash

flow

at

cent

ral l

evel

. •

Com

preh

ensi

ve C

ounc

il H

ealt

h Pl

an c

ash

flow

at d

istr

ict l

evel

. •

Cas

h an

d r

ecei

pt a

t all

leve

ls.

•Pu

blic

Exp

end

itur

e R

evie

w

repo

rts

•H

IPC

fund

s al

loca

ted

to h

ealt

h.

•St

able

eco

nom

ic g

row

th.

•B

aske

t fun

d a

vai

labl

e •

Com

mit

men

t by

don

ors/

par

tner

s

50T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

Tabl

e 2:

Res

ults

bas

ed M

atri

x

Foc

us

Are

a In

dic

ator

s of

Res

ults

M

ean

s of

Ver

ific

atio

n

Ass

um

pti

ons

Reg

ulat

ions

/ la

ws/

poli

cies

that

hi

nder

eff

ecti

ve im

plem

enta

tion

of

mat

ern

al a

nd

new

born

car

e by

re

leva

nt r

egul

ator

y bo

die

s re

view

ed.

•N

umbe

r of

reg

ulat

ions

an

d l

aws

appr

oved

by

regu

lato

ry b

odie

s •

Poli

cy d

ocum

ents

av

aila

ble

for

impl

emen

tati

on.

•W

illi

ngne

ss o

f reg

ulat

ory

bod

ies

to

revi

ew a

nd

end

orse

pol

icy

doc

umen

ts.

Imp

lem

enta

tion

of

the

exem

pti

on p

olic

y fo

r m

ater

nal

an

d c

hil

d h

ealt

h

stre

ngt

hen

ed.

.

•E

xem

ptio

n po

licy

eff

ecti

vely

im

plem

ente

d•

Exe

mpt

ion

poli

cy g

uid

elin

es i

n pl

ace

at a

ll f

acil

ity

leve

ls.

•Su

rvey

fin

din

gs.

•E

xem

ptio

n m

ech

anis

ms

impl

emen

ted

ac

cord

ing

to p

olic

y.

Em

plo

ymen

t, d

eplo

ymen

t an

d r

eten

tion

of

sk

ille

d h

ealt

h w

ork

ers

at a

ll l

evel

s of

ca

re i

mp

rove

d.

Num

ber

of s

kill

ed h

ealt

h w

orke

rs

incr

ease

d to

100

% b

y 2

015

•

•H

uman

res

ourc

e su

rvey

•

Hea

lth

Stat

isti

cs A

bstr

act

•

6.2

Hea

lth

Sys

tem

s S

tren

gth

enin

g an

d C

apac

ity

Dev

elop

men

t K

now

led

ge a

nd

sk

ills

of

sup

ervi

sors

an

d

serv

ice

pro

vid

ers

on m

ater

nal

, n

ewb

orn

an

d c

hil

d c

are

incl

ud

ing

FP a

nd

n

utr

itio

n i

ncr

ease

d.

•Pr

opor

tion

of h

ealt

h fa

cili

ties

pr

ovid

ing

qual

ity

mat

ern

al a

nd

ne

wbo

rn c

are.

•

Mat

ern

al, n

ewbo

rn a

nd

chi

ld

heal

th s

ervi

ce p

rovi

ded

ac

cord

ing

to s

tan

dar

ds.

•

Prop

orti

on

of

und

er-f

ives

re

ceiv

ing

corr

ect

anti

-mal

aria

l tr

eatm

ent.

•Pr

opor

tion

of

un

der

-fiv

es

rece

ivin

g ap

prop

riat

e an

ti-b

ioti

c tr

eatm

ent

for

pneu

mon

ia

and

d

ysen

tery

. •

Prop

orti

on

of

und

er-f

ives

re

ceiv

ing

OR

S an

d z

inc

trea

tmen

t in

man

agem

ent o

f dia

rrh

oea

•Pe

rcen

tage

of

pr

egn

ant

wom

en

rece

ivin

g to

dos

es o

f SP

•Pe

rcen

tage

of

pr

egn

ant

wom

en

test

ed a

nd

tre

ated

for

syph

ilis

•T

rain

ing

and

foll

ow u

p re

port

s •

Hea

lth

faci

lity

sur

vey

•Se

rvic

es s

tati

stic

s •

Tan

zan

ia S

ervi

ce P

rovi

sion

A

sses

smen

t (T

SPA

), •

Serv

ice

Ava

ilab

ilit

y M

appi

ng

(SA

M)

•R

oll b

ack

mal

aria

(RB

M) s

urve

y

•R

esou

rces

for

upd

atin

g kn

owle

dge

an

d

skil

ls a

vail

able

. •

Ava

ilab

ilit

y of

per

sonn

el to

be

trai

ned

.

51T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

Foc

us

Are

a In

dic

ator

s of

Res

ults

M

ean

s of

Ver

ific

atio

n

Ass

um

pti

ons

•R

elev

ant s

ecto

rs (

Min

istr

y of

Fi

nan

ce, M

oHSW

) all

ocat

ing

at

leas

t 15%

of G

over

nmen

t bud

get

for

.hea

lth

• M

oHSW

all

ocat

ing

15%

of t

he

Hea

lth

budg

et f

or m

ater

nal a

nd

new

born

car

e

•T

rain

ing

repo

rts

MT

EF

cash

fl

ow a

t al

l lev

els.

•

CC

HP

cash

flow

at d

istr

ict l

evel

. •

Cas

h an

d r

ecei

pt a

t all

leve

ls.

•Pu

blic

Exp

end

itur

e R

evie

w

repo

rts

•Pl

anni

ng a

nd

man

agem

ent t

ools

av

aila

ble.

•

Stab

le e

cono

mic

gro

wth

. •

Bas

ket f

und

av

aila

ble

•C

omm

itm

ent b

y d

onor

s/ p

artn

ers

•E

vid

ence

-bas

ed m

ater

nal

an

d

new

born

car

e pl

anni

ng a

t RC

HS

and

CH

MT

•Pl

anni

ng d

ocum

ents

. •

CC

HPs

•

MT

EF

•Pe

rson

nel a

vai

labl

e.

Pla

nn

ing

and

man

agem

ent

cap

acit

y fo

r m

ater

nal

an

d n

ewb

orn

car

e in

clu

din

g FP

an

d n

utr

itio

n s

tren

gth

ened

.

•Pr

opor

tion

of d

istr

icts

wit

h in

crea

sed

bu

dge

t allo

cati

on f

or m

ater

nal

new

born

an

d c

hild

hea

lth

in

terv

enti

ons

in C

CH

P

•C

CH

P ca

sh fl

ow

•St

able

eco

nom

ic g

row

th.

•B

aske

t fun

d a

vai

labl

e

•%

of

hea

lth

fac

iliti

es p

rovi

din

g B

asic

an

d c

omp

reh

ensi

ve

Em

OC

an

d

Ess

enti

al N

ewbo

rn c

are

•H

ealt

h fa

cili

ty s

urve

y •

serv

ice

stat

isti

cs (T

SPA

, SA

M)

•C

HM

T a

nd

HF

man

ager

s tr

aine

d o

n ho

w

to m

easu

re/

use

the

ind

icat

ors.

•

Ava

ilab

ilit

y of

fund

s

•A

vail

abil

ity

of s

kill

ed a

tten

dan

ts

•P

ropo

rtio

n of

bi

rths

as

sist

ed

by

a sk

ille

d at

tend

ant

•D

emog

raph

ic H

ealt

h Su

rvey

, H

ouse

hold

su

rvey

s •

Ava

ilab

ilit

y of

ski

lled

att

end

ants

•Pr

opor

tion

of c

aesa

rean

sec

tion

s as

a p

erce

ntag

e of

live

bir

ths.

•

Serv

ice

stat

isti

cs

•A

vail

abil

ity

of s

kill

ed a

tten

dan

ts

•C

ase

fata

lity

rat

e d

ue to

obs

tetr

ic

com

plic

atio

ns.

•Se

rvic

e st

atis

tics

•

Ava

ilab

ilit

y of

ski

lled

att

end

ants

Bas

ic a

nd

Com

pre

hen

sive

Em

OC

an

d

new

born

ser

vice

s at

all

leve

ls

stre

ngth

ened

.

•E

ssen

tial

com

mod

itie

s, s

up

pli

es

and

med

icin

es f

or m

ater

nal

, n

ewb

orn

an

d c

hil

d c

are

avai

lab

le

all

the

tim

e at

eve

ry h

ealt

h f

acil

ity

•In

vent

ory

repo

rts

•H

ealt

h fa

cili

ty s

urve

ys (T

SPA

) •

Ann

ual C

ontr

acep

tive

Pr

ocur

emen

t Tab

les

(CPT

s)

•M

onth

ly c

ontr

acep

tive

sto

ck

stat

us r

epor

ts fr

om M

SD

•A

deq

uat

e re

sour

ce a

vail

able

•

Poli

tica

l wil

l an

d c

omm

itm

ent

52T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

Res

ults

bas

ed M

atri

x

Foc

us

Are

a In

dic

ator

s of

Res

ults

M

ean

s of

Ver

ific

atio

n

Ass

um

pti

ons

Mec

han

ism

s fo

r av

aila

bil

ity

of e

ssen

tial

co

mm

odit

ies,

su

pp

lies

an

d m

edic

ines

fo

r m

ater

nal

, n

ewb

orn

an

d c

hil

d h

ealt

h

incl

ud

ing

fam

ily

pla

nn

ing

st

ren

gth

ened

.

•E

ssen

tial

com

mod

itie

s, s

up

pli

es

and

med

icin

es f

or m

ater

nal

, n

ewb

orn

an

d c

hil

d c

are

avai

lab

le

all

the

tim

e at

eve

ry h

ealt

h f

acil

ity

•In

vent

ory

repo

rts

•H

ealt

h fa

cili

ty s

urve

ys (T

SPA

) •

Ann

ual C

ontr

acep

tive

Pr

ocur

emen

t Tab

les

(CPT

s)

•M

onth

ly c

ontr

acep

tive

sto

ck

stat

us r

epor

ts fr

om M

SD

•A

deq

uat

e re

sour

ce a

vail

able

•

Poli

tica

l wil

l an

d c

omm

itm

ent

Ref

erra

l Sys

tem

Ref

erra

l sy

stem

at a

ll l

evel

s st

ren

gth

ened

. •

Fun

ctio

nal

ref

erra

l sys

tem

s in

p

lace

at

all l

evel

s•

Perc

enta

ge o

f all

wom

en w

ith

maj

or o

bste

tric

com

pli

cati

ons

trea

ted

in E

mO

C fa

cili

ties

(met

ob

stet

ric

need

) •

Perc

enta

ge o

f ref

erre

d u

nder

-fi

ves

who

act

ual

ly g

o fo

r re

ferr

al

•Sp

ecia

l Su

rvey

•

Serv

ice

stat

isti

cs r

epor

ts

•A

vail

abil

ity

of f

und

s to

impr

ove

refe

rral

sy

stem

•

Wil

ling

ness

of c

omm

unit

y m

embe

rs to

p

arti

cip

ate

in e

mer

genc

y pr

epar

edne

ss

Res

earc

h, M

onit

orin

g an

d E

valu

atio

n

HM

IS c

apac

ity

to c

aptu

re i

nfo

rmat

ion

on

m

ater

nal

, neo

nat

al a

nd

ch

ild

in

dic

ator

s in

clu

din

g FP

an

d n

utr

itio

n i

mp

rove

d.

•K

ey M

ater

nal,

new

born

and

chi

ld

heal

th i

ndic

ator

s re

port

ed a

nnua

lly

thro

ugh

HM

IS

•H

ealt

h st

atis

tics

rep

orts

•

Hea

lth

Stat

isti

cs A

bstr

act

•H

MIS

rev

iew

ed to

inco

rpor

ate

mat

ern

al

and

new

born

hea

lth

ind

icat

ors

53T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

Foc

us

Are

a In

dic

ator

s of

Res

ults

M

ean

s of

Ver

ific

atio

n

Ass

um

pti

ons

Mon

itor

ing

and

eva

luat

ion

fra

mew

ork

for

M

NC

H s

tren

gth

ened

an

d i

mp

lem

ente

d.

•Pr

ogre

ss o

n M

ater

nal,

new

born

an

d

chil

d h

ealt

h st

atus

/tr

end

s r

epor

ted

. o

Mat

ern

al m

orta

lity

rat

e o

Un

der

-fiv

e m

orta

lity

rat

e o

Infa

nt m

orta

lity

rat

e o

Neo

nat

al m

orta

lity

rat

e o

Con

trac

epti

ve

pre

vale

nce

ra

te

by

met

hod

, by

ag

e gr

oup

, by

so

cio

econ

omic

qu

inti

les

oU

nd

er w

eigh

t, s

tun

ting

ra

te

oE

xclu

sive

Bre

ast F

eed

ing

ra

te

oM

easl

es

imm

uni

zati

on

cov

erag

e o

DT

P-H

B3

imm

uni

zati

on

cov

erag

e

•Pr

opor

tion

of

hea

lth

fac

iliti

es

rece

ivin

g qu

arte

rly

sup

por

tiv

e su

per

visi

on.

•Pr

opor

tion

of

hea

lth

wor

kers

tha

t re

ceiv

ed f

ollo

w u

p a

fter

tra

inin

g on

M

NC

H p

acka

ges

year

ly

•N

um

ber

of s

urv

eys

con

du

cted

on

qual

ity

assu

ran

ce o

f ser

vice

del

iver

ed.

•N

um

ber

and

typ

e of

MN

CH

m

orta

lity

revi

ew r

epor

ts.

Bir

th r

egis

trat

ion

rate

•Sp

ecia

l rep

orts

/sur

veys

•

Serv

ice

stat

isti

cs r

epor

ts

•Su

perv

isio

n re

port

s •

Mor

tali

ty r

evie

w a

nd

no

tifi

cati

on r

epor

ts

•D

emog

raph

ic h

ealt

h su

rvey

, •

Cen

sus

•V

ital

sta

tist

ics

•A

deq

uat

e re

sour

ces

to c

ond

uct

Ope

rati

onal

Res

earc

h •

Cap

acit

y to

con

duc

t res

earc

h

Com

mu

nit

y b

ased

man

agem

ent

info

rmat

ion

sys

tem

str

engt

hen

ed.

•C

omm

un

ity

bas

ed d

ata

effe

ctiv

ely

coll

ecte

d a

nd

use

d i

n p

lann

ing.

•

Com

mun

ity

dev

elop

men

t pla

ns.

•

CB

MIS

dat

a av

aila

ble

•A

deq

uat

e re

sour

ces

to fa

cili

tate

pla

nnin

g at

com

mun

ity

leve

l. •

Cap

acit

y an

d c

apab

ilit

y of

the

com

mun

ity

mem

bers

to u

se e

vid

ence

bas

ed

info

rmat

ion

for

plan

ning

. Q

ual

ity

assu

ran

ce a

nd

man

agem

ent

(su

per

visi

on, c

lien

t sa

tisf

acti

on,

per

form

ance

ass

essm

ent)

str

engt

hen

ed.

•Pr

opor

tion

of

hea

lth

fac

iliti

es

del

iver

ing

MN

CH

ser

vice

s ac

cord

ing

to n

atio

nally

def

ined

ser

vice

st

and

ard

s

•Pr

opor

tion

of c

lien

ts s

atis

fied

w

ith

mat

ern

al a

nd

new

born

se

rvic

es

•H

ealt

h fa

cili

ty a

nd

hou

seho

ld

Surv

eys

•Se

rvic

e st

atis

tics

•

Supe

rvis

ion

repo

rts

•St

and

ard

s fo

r qu

alit

y im

prov

emen

t wil

l be

impl

emen

ted

.

54T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

Res

ults

bas

ed M

atri

x

Foc

us

Are

a In

dic

ator

s of

Res

ults

M

ean

s of

Ver

ific

atio

n

Ass

um

pti

ons

to h

ealt

h fa

cili

ty f

or c

are

sick

/ po

stn

atal

•P

erce

nta

ge

of

pre

gnan

t w

omen

at

ten

ded

at

le

ast

once

by

sk

illed

p

erso

nn

el;

per

cen

tage

at

ten

ded

by

sk

illed

per

son

nel

at

leas

t fo

ur

tim

es•

Hou

seho

lds

care

se

ekin

g ra

te

for

diar

rhoe

a,

mal

aria

, pn

eum

onia

an

d ne

onat

al c

ondi

tion

s

The

Nat

iona

l Roa

d M

ap S

trat

egic

Pla

n -2

008

- 20

1555



ANNEX 1 SWOT ANALYSIS

(A) M

ater

nal

Car

e

ST

RE

NG

TH

S

WE

AK

NE

SS

ES

O

PP

OR

TU

NIT

IES

T

HR

EA

TS

(i)

Pol

icy

Issu

es

••E

xist

ence

of n

atio

nal

pol

icie

s w

hic

h ad

dre

ss m

ater

nal

hea

lth

such

as

the

Nat

ion

al H

ealt

h Po

licy

, Rep

rod

ucti

ve a

nd

Chi

ld

Hea

lth

Poli

cy, M

KU

KU

TA

,M

MA

Met

c.

•T

he N

atio

nal

Hea

lth

Poli

cy a

nd

th

e R

epro

du

ctiv

e an

d C

hild

H

ealt

h Po

licy

em

phas

ise

a m

ulti

sect

oral

app

roac

h to

re

prod

ucti

ve h

ealt

h is

sues

, wh

ich

incl

ud

e m

ale

invo

lvem

ent.

•T

he N

atio

nal

Hea

lth

Poli

cy

prom

otes

the

righ

t of a

ll w

omen

to

acc

ess

qual

ity

repr

oduc

tive

he

alth

ser

vice

s.

•E

xist

ence

of v

ario

us to

ols

such

as

the

RC

H S

trat

egy,

RC

H E

ssen

tial

P

ack

age

and

pol

icy

guid

elin

es

wh

ich

add

ress

mat

ern

al h

ealt

h.

•M

ater

nal

hea

lth

is r

efle

cted

in

the

Dis

tric

t Pla

nnin

g G

uid

elin

e as

one

of t

he k

ey r

epro

duc

tive

an

d c

hild

hea

lth

inte

rven

tion

s.

•E

xist

ence

of e

stab

lish

men

t/

man

ning

leve

l (19

99) o

f hea

lth

staf

f for

hea

lth

del

iver

y ti

ers

•So

me

exis

ting

hea

lth

cad

res

hav

e be

en r

evie

wed

(MC

HA

, R

MA

/CA

upg

rad

ing)

•M

inim

al b

ud

get a

lloc

atio

n to

hea

lth

sect

or

espe

cial

ly m

ater

nal

hea

lth

(at a

ll le

vels

) •

Wea

k m

ulti

sect

oral

link

ages

at a

ll le

vels

in

add

ress

ing

mat

ern

al h

ealt

h •

The

RC

H s

trat

egy

hav

e no

t bee

n ab

le to

pr

iori

tise

key

inte

rven

tion

s to

red

ucin

g m

ater

nal

dea

th

•In

adeq

uat

e d

isse

min

atio

n an

d in

terp

reta

tion

to

use

r-fr

iend

ly fo

rmat

s of

RC

H p

olic

ies,

st

rate

gy a

nd

gui

del

ines

.

•So

me

man

ager

s an

d s

uper

viso

rs a

t al

l lev

els

ar

e no

t fam

ilia

r w

ith

poli

cies

an

d g

uid

elin

es

rela

ted

to R

CH

•

CC

HP

do

not c

ompr

ehen

sive

ly a

dd

ress

ing

RH

/mat

ern

al a

nd

chi

ld h

ealt

h in

terv

enti

ons

•R

CH

Coo

rdin

ator

not

full

mem

ber

of C

HM

T

but m

ore

of c

o-op

ted

mem

ber

(in

som

e d

istr

icts

) as

such

not

abl

e to

infl

uenc

e d

istr

ict

heal

th p

lans

•

Man

ning

leve

l not

imp

lem

ente

d a

ccor

din

gly

due

to in

suff

icie

nt li

nkag

es a

nd

mix

ed r

oles

of

HS

and

LG

. •

Est

abli

shm

ent/

man

ning

leve

l of s

taff

has

not

be

en r

evie

wed

acc

ord

ing

to r

ecen

t d

evel

opm

ents

in R

CH

car

e (P

MT

CT

, VC

T,

AR

H/Y

FS)

•C

urre

nt d

eplo

ymen

t sys

tem

doe

sn’t

foll

ow th

e m

anni

ng le

vel g

uid

elin

es.

•D

evel

opm

ent p

artn

ers

and

G

over

nmen

t ali

gnin

g to

jo

int s

uppo

rt a

ccor

din

g to

Jo

int A

ssis

tan

ce S

trat

egy.

•

Exi

sten

ce o

f Hea

lth

bask

et

fund

s to

sup

port

dis

tric

t he

alth

ser

vice

s •

Est

abli

shm

ent o

f MN

C

par

tner

ship

at c

entr

al le

vel

•E

xist

ence

of G

over

nmen

t le

d S

WA

Ps, M

OH

Tec

hnic

al

com

mit

tee

and

su

bcom

mit

tee

that

can

be

used

to p

ush

Mat

ern

al a

nd

N

ewbo

rn h

ealt

h is

sues

•

Exi

stin

g A

nnua

l Hea

lth

Sect

or R

evie

ws

hav

e ta

ken

into

con

sid

erat

ion

RH

/Mat

ern

al h

ealt

h is

sues

•

Poli

tica

l wil

l an

d

com

mit

men

t is

show

ing

posi

tive

sig

ns to

war

ds

add

ress

ing

mat

ern

al h

ealt

h (D

HA

tool

) •

Exi

sten

ce o

f Hea

lth

SWA

PS

•Z

onal

RC

H r

evie

ws

Car

e an

d T

reat

men

t Pla

n gi

ves

oppo

rtun

ity

to m

ains

trea

m

mat

ern

al h

ealt

h ca

re

•M

ore

focu

s on

HIV

/AID

S th

an

RH

/Mat

ern

al h

ealt

h •

Shor

t tim

e to

war

ds

atta

inm

ent o

f MD

Gs

•B

igge

r pr

opor

tion

of h

ealt

h se

ctor

bu

dge

t is

don

or

dep

end

ant.

•D

onor

dri

ven

init

iati

ves

•R

epro

duc

tive

hea

lth

conc

ept

may

be

over

rid

den

by

mat

ern

al h

ealt

h (t

hrea

t of

retu

rnin

g to

old

MC

H c

once

pt)

•C

ompe

ting

pri

orit

y pr

ogra

mm

es

•H

IV/A

IDS

•H

uman

res

ourc

es

• L

ogis

tic

Man

agem

ent

cap

acit

y •

TB

A p

olic

y re

view

an

d p

art o

f th

e A

nnu

al H

ealt

h Se

ctor

R

evie

w m

iles

tone

58T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

AN

NE

X 1

: SW

OT

AN

ALY

SIS

ST

RE

NG

TH

S

WE

AK

NE

SS

ES

O

PP

OR

TU

NIT

IES

T

HR

EA

TS

••E

xem

ptio

n po

licy

for

del

iver

ies

and

all

RC

H s

ervi

ces

•D

ecen

tral

isat

ion

of h

ealt

h se

rvic

es to

dis

tric

t lev

el (a

dv

ance

he

alth

sec

tor

refo

rms)

•

Exi

sten

ce o

f var

ious

fin

anci

al

reso

urce

s to

hea

lth

sect

or a

t the

d

istr

ict l

evel

(Bas

ket,

Blo

ck,

Dis

tric

t ow

n so

urc

e, c

ost s

har

ing,

N

HIF

, CH

F et

c)

•E

xist

ence

of P

aram

edic

al,

Med

ical

an

d N

ursi

ng

Inst

itut

ions

for

pre

-ser

vice

tr

ain

ing

•E

xist

ence

of t

rain

ing

guid

elin

es

on P

AC

, LSS

, FP,

PM

TC

T+,

ST

I, FA

NC

•

Ava

ilab

ilit

y of

com

mit

ted

D

evel

opm

ent P

artn

ers

supp

orti

ng R

H/m

ater

nal

hea

lth

•

MT

EF

allo

cate

d fu

nds

for

proc

urem

ent o

f con

trac

epti

ves

•M

ater

nal

nut

riti

on li

nked

wit

h ch

ild

nut

riti

on in

the

RC

H

pac

kag

e •

Com

mun

ity

base

d R

CH

gu

idel

ines

, str

ateg

ic p

lan

(dra

ft)

avai

labl

e •

Infr

astr

uct

ure

at a

ll le

vels

ov

erse

eing

hea

lth

serv

ices

- n

atio

nal

, reg

ion

al, d

istr

ict

and

co

mm

unit

y

•In

adeq

uat

e nu

mbe

r of

ski

lled

ser

vice

pr

ovid

ers

that

can

be

trai

ned

an

d c

aptu

re th

e kn

owle

dge

req

uire

d o

n sp

ecif

ic s

kill

s.

•So

me

skil

led

pro

vid

ers

are

not a

llow

ed to

do

life

sav

ing

skil

ls p

roce

dur

es d

ue to

sta

tuto

ry

regu

lati

ons

e.g.

IV d

rip

givi

ng, m

anu

al

rem

oval

of r

etai

ned

pla

cent

a, M

VA

usa

ge.

•T

here

's n

o m

echa

nis

m to

ass

ess

pre-

qual

ific

atio

n of

ser

vice

pro

vid

ers

in te

rms

of

atti

tud

e an

d p

sych

olog

ical

beh

avio

ur

befo

re

join

ing

nurs

ing

and

med

ical

sch

ools

. •

Wea

k in

cent

ive

pac

kage

to s

ervi

ce p

rovi

der

s •

Poor

mot

ivat

ion

and

inad

equ

ate

perf

orm

ance

as

sess

men

t and

rew

ard

ing

of s

ervi

ce

prov

ider

s •

Inco

nsis

tenc

y of

Ski

lled

att

end

ance

def

init

ion

and

how

do

we

atta

in S

kill

ed a

tten

dan

ce in

ou

r se

ttin

gs

•In

adeq

uat

e Pl

ans

for

hum

an r

esou

rce

dev

elop

men

t inc

lud

ing

cont

inui

ng e

duc

atio

n on

mat

ern

al h

ealt

h is

sues

•

Lac

k of

con

tinu

ing

educ

atio

n am

ong

tuto

rs a

t pr

e-se

rvic

e an

d r

egio

nal

inst

itut

ions

. •

Poor

inte

rpre

tati

on a

nd

impl

emen

tati

on o

f ex

empt

ion

poli

cy fo

r m

ater

nal

hea

lth

•In

form

al p

aym

ents

hin

der

s im

ple

men

tati

on o

f ex

empt

ion

poli

cy

•D

ue to

min

imal

all

ocat

ion

to R

CH

ser

vice

s,

wom

en a

re a

sked

to p

urch

ase

or c

ome

wit

h es

sent

ial s

uppl

ies/

dru

gs fo

r d

eliv

ery

sinc

e th

ey a

re fr

eque

ntly

out

of s

tock

•E

xist

ence

of A

nnu

al R

MO

s,

DM

Os

and

RC

H M

eeti

ngs

as f

ora

to d

iscu

ss

RH

/mat

ern

al a

nd

new

born

is

sues

•

Incr

easi

ng G

over

nmen

t an

d D

Ps a

tten

tion

on

add

ress

ing

Hum

an

reso

urce

cri

sis

•Pr

esen

ce o

f gui

del

ines

from

FC

I on

cari

ng b

ehav

iou

rs

amon

g se

rvic

e pr

ovid

ers

•O

ngoi

ng r

evie

w o

n in

cent

ive

pac

kage

for

heal

th

care

pro

vid

ers

•In

trod

uct

ion

of O

PRA

at a

ll

leve

ls.

•M

KU

KU

TA

•

Exi

stin

g pl

ans

of

stre

ngth

enin

g an

d

exp

and

ing

ZT

C fo

r in

-se

rvic

e tr

ain

ings

.

•O

vers

tret

chin

g of

hea

lth

syst

em a

s pe

r cu

rren

t d

evel

opm

ent w

hic

h is

alr

ead

y co

mpr

omis

ed.

59T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

ST

RE

NG

TH

S

WE

AK

NE

SS

ES

O

PP

OR

TU

NIT

IES

T

HR

EA

TS

••L

ack

of c

oste

d R

CH

pac

kage

incl

ud

ing

mat

ern

al h

ealt

h th

at c

an ju

stif

y ho

w m

uch

is b

eing

exe

mpt

ed

• •A

t all

leve

ls th

ere

has

bee

n sl

ow fo

llow

up

and

sca

ling

up

of in

terv

enti

ons

rela

ted

to

mat

ern

al h

ealt

h • •

Inad

equ

ate

doc

umen

tati

on o

f evi

den

ce

base

d in

terv

enti

on fo

cusi

ng o

n m

ater

nal

he

alth

• •

Unt

imel

y/Ir

regu

lar

revi

ew o

f Pre

-Ser

vice

tr

ain

ing

curr

icu

lum

to in

clu

de

curr

ent

mat

ern

al h

ealt

h d

evel

opm

ents

. • •

Lac

k of

pos

tnat

al g

uid

es

• •Po

licy

not

all

owin

g M

VA

kit

to b

e m

ade

avai

labl

e ex

cept

whe

n th

ere'

s pr

esen

ce o

f sk

ille

d a

tten

dan

t an

d a

fter

bei

ng tr

aine

d.

• •

Poor

coo

rdin

atio

n an

d li

nkag

es b

etw

een

dif

fere

nt a

ctor

s fr

om c

entr

al t

o lo

cal l

evel

.

• •E

xist

ence

of v

erti

cal p

rogr

amm

e/pr

ojec

ts

supp

ort t

o R

H (i

nclu

din

g FP

/mat

ern

al

heal

th)

• •W

eak

link

ages

bet

wee

n D

irec

tora

tes

of

Prev

enti

ve, H

ospi

tal

and

Tra

inin

g at

MO

H

••PM

NC

H p

rom

otes

nee

d

for

MN

CH

Str

ateg

ic P

lan

whe

re a

ll p

artn

ers

buy

in

• •E

xist

ence

of R

epro

du

ctiv

e H

ealt

h C

omm

odit

y Se

curi

ty c

omm

itte

e un

der

G

ovt l

ead

ersh

ip

• •E

xist

ence

of I

YC

F st

rate

gy

• •M

ater

nal

nut

riti

on

aspe

cts

inte

grat

ed in

to

Infa

nt a

nd

you

ng c

hild

fe

edin

g st

rate

gy

• •E

xist

ence

of H

ealt

h in

sura

nce

(NH

IF) a

nd

som

e co

min

g up

• •

Bir

th a

nd

dea

th

regi

stra

tion

(vit

al

stat

isti

cs) i

n pl

ace

in fe

w

vill

ages

wh

ich

can

be

adop

ted

in th

e re

st o

f the

co

untr

y.

• •E

xist

ing

heal

th M

CH

st

ruct

ure

from

co

mm

unit

y to

hos

pita

l le

vel

• •U

se o

f alt

ern

ativ

e se

rvic

e pr

ovid

ers

to s

uppo

rt

heal

th s

yste

m s

uch

as

reti

red

hea

lth

skil

led

st

aff,

perf

orm

ance

co

ntra

ct a

nd

Ret

enti

on

sche

mes

in M

KU

KU

TA

••In

adeq

uat

e li

nkag

es a

nd

col

labo

rati

on

betw

een

RC

H S

ecti

on w

ith

TFN

C a

nd

PM

TC

T U

nit

60T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

ST

RE

NG

TH

S

WE

AK

NE

SS

ES

O

PP

OR

TU

NIT

IES

T

HR

EA

TS

••R

ole

of T

BA

in p

reve

ntio

n of

mat

ern

al

mor

tali

ty is

unc

lear

. (R

ole

rem

ains

unc

lear

in

the

stra

tegi

es. W

eakn

esse

s in

SW

OT

sh

ould

gui

de

stra

tegi

es

•C

HF

exis

t in

mos

t are

as b

ut w

ith

lim

ited

us

e of

the

fund

s fo

r m

ater

nal

hea

lth

care

•

Few

dis

tric

ts h

ave

impl

emen

ted

com

mun

ity

base

d R

CH

pro

gram

•

Vil

lage

hea

lth

com

mit

tee

not l

egal

ly

reco

gnis

ed.

•Sh

orta

ge o

f Ski

lled

att

end

ance

(mor

e pr

onou

nced

in r

ural

are

as)

•U

nat

trac

tive

wor

king

con

dit

ion

espe

cial

ly in

ru

ral

area

s

(ii)

Hea

lth

Sys

tem

s•

Pres

ence

of Z

RC

HC

O, R

RC

H C

o an

d D

RC

HC

o •

Serv

ice

del

iver

y po

ints

wel

l d

istr

ibut

ed to

con

sult

ant,

regi

onal

an

d d

istr

ict h

ospi

tals

fo

llow

ed b

y he

alth

cen

tres

an

d

dis

pens

arie

s.

•In

den

t sys

tem

for

obta

inin

g es

sent

ial d

rugs

an

d s

uppl

ies

•In

tegr

atio

n of

FP

and

HIV

/AID

S co

nd

om s

uppl

y/re

ques

t at

dis

tric

t lev

el

•H

ealt

h se

rvic

es in

clu

din

g m

ater

nal

car

e no

t op

erat

ing

for

24 h

ours

•

Low

kno

wle

dge

on

SRH

am

ong

serv

ice

prov

ider

s •

Des

pite

trai

nin

g on

Foc

used

AN

C, t

here

's s

till

pr

oble

m in

its

imp

lem

enta

tion

due

to a

ttit

ud

e an

d lo

w e

duc

atio

nal

bac

kgro

und

of

prov

ider

s w

ho c

anno

t cap

ture

the

skil

ls;

inad

equ

ate

supp

lies

suc

h as

Hb,

RPR

, co

ntra

cept

ives

etc

. •

Lim

ited

trai

nin

g of

Ser

vice

pro

vid

ers

on P

AC

, FP

, LSS

•

RH

ser

vice

s no

t you

th fr

iend

ly

•In

adeq

uat

e/in

appr

opri

ate

Em

OC

(bas

ic a

nd

co

mpr

ehen

sive

ser

vice

s) a

t fac

ilit

y le

vel

•E

xist

ence

of b

oth

priv

ate

and

pub

lic

heal

th fa

cili

ties

th

at p

rovi

de

mat

ern

al

heal

th s

ervi

ces.

•

Plan

to s

tren

gthe

n Z

TC

•

Exi

sten

ce o

f goo

d p

ract

ices

on

you

th fr

iend

ly s

ervi

ces

(AY

A, U

MA

TI,

UN

ICE

F su

ppor

ted

inte

rven

tion

s)

•E

xist

ence

of g

ood

pr

acti

ces/

rese

arch

on

mat

ern

al c

are

imp

rove

men

t (t

houg

h a

few

)- F

CI,

WD

P,

Car

e, T

EH

IP, Q

IRI

•O

verw

helm

ing

the

ZT

C

cap

acit

y •

Cul

tura

l bar

rier

s

61T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

ST

RE

NG

TH

S

WE

AK

NE

SS

ES

O

PP

OR

TU

NIT

IES

T

HR

EA

TS

••L

ocal

Gov

ernm

ent a

utho

riti

es

refo

rms

are

supp

orti

ng

impl

emen

tati

on o

f HSR

• •

Pres

ence

of r

efer

ral s

truc

ture

w

ith

in th

e he

alth

del

iver

y sy

stem

• •

Mos

t of e

ssen

tial

RC

H s

ervi

ces

are

in p

lace

(AN

C, I

ntra

par

tum

/ ob

stet

ric,

FP,

ST

I, Im

mun

izat

ion,

PM

TC

T, P

ost p

artu

m) I

MC

I at

all

le

vels

.

••L

ack

of fu

ncti

onin

g of

blo

od b

anks

at h

ospi

tal

and

hea

lth

cent

re le

vel

• •In

adeq

uat

e co

vera

ge o

f PA

C s

ervi

ces

• •E

ssen

tial

equ

ipm

ent,

supp

lies

and

dru

gs o

n m

ater

nal

car

e in

clu

din

g FP

not

rea

dil

y av

aila

ble

• •B

ottl

enec

ks i

n pr

ocur

emen

t of d

rugs

, sup

plie

s an

d e

quip

men

t (bo

th w

ays

dis

tric

t lev

el a

nd

M

SD)

• •Fr

agm

ente

d p

rogr

am s

uppo

rt in

pro

visi

on o

f es

sent

ial s

uppl

ies

e.g.

syp

hili

s sc

reen

ing

reag

ents

• •

Faci

lity

bu

ild

ings

an

d p

rovi

der

s’ a

ttit

ude

not

acco

mm

odat

ing

mal

e an

d y

outh

frie

ndly

se

rvic

es• •

Pres

ence

of v

ast G

eogr

aphi

cal a

rea

wit

h po

or

tran

spor

t/ro

ads,

inad

equ

ate

heal

th fa

cili

ties

an

d th

eref

ore

poor

geo

grap

hic

al a

cces

sibi

lity

to

EM

OC

• •

Inad

equ

ate

ambu

lanc

es w

ith

in th

e co

untr

y

• •M

any

heal

th u

nits

do

not h

ave

reli

able

co

mm

unic

atio

n sy

stem

(rad

io c

all,

mob

ile)

• •

Lac

k of

pro

toco

ls o

n sp

ecif

ic m

ater

nal

he

alth

/obs

tetr

ic c

are

• •

Cou

nsel

ling

ski

lls

on F

P, P

AC

, PM

TC

T a

nd

m

ater

nal

nut

riti

on n

ot a

deq

uat

ely

prov

ided

by

ser

vice

pro

vid

ers

• •L

imit

ed p

ostn

atal

car

e d

ue to

lack

of g

uid

elin

es

••B

lood

saf

ety

prog

ram

me

• •E

xist

ence

of R

HM

T a

nd

C

HM

T w

hic

h co

ord

inat

es

dis

tric

t hea

lth

acti

viti

es

incl

ud

ing

mat

ern

al h

ealt

h ca

re

• •C

urre

ntly

Join

t R

ehab

ilit

atio

n Pr

ogra

mm

e h

as b

een

init

iate

d a

t dis

tric

t le

vel w

hich

can

be

used

to

acco

mm

odat

e st

ruct

ure

impr

ovem

ent f

or m

ater

nal

an

d n

ewbo

rn c

are

• •E

xist

ence

of m

obil

e co

mm

unic

atio

n ne

twor

k in

ru

ral

area

s • •

Pres

ence

of j

ob a

id fo

r E

MO

C

(iii

) S

up

por

t S

yste

ms

•E

xist

ence

of C

omm

unit

y d

evel

opm

ent o

ffic

ers

at d

istr

ict

and

war

d le

vel.

•Pr

emis

es o

f mos

t hea

lth

faci

liti

es a

re

inad

equ

ate

and

non

-use

r fr

iend

ly (p

riv

acy,

sp

ace)

•

Inad

equ

ate

awar

enes

s an

d a

dvo

cacy

on

mat

ern

al c

omp

lica

tion

s/ca

re a

t all

leve

ls

incl

ud

ing

heal

th fa

cili

ties

sup

port

sta

ff

62T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

ST

RE

NG

TH

S

WE

AK

NE

SS

ES

O

PP

OR

TU

NIT

IES

T

HR

EA

TS

(iv)

Pla

nn

ing,

Mon

itor

ing

and

Ev

alu

atio

n•

Plan

ning

dec

entr

alis

ed to

d

istr

ict l

evel

•

Mon

itor

ing

of M

ater

nal

dea

th

don

e th

roug

h w

eek

end

ing

repo

rtin

g, H

MIS

, DH

S an

d

Ann

ual Z

RC

H C

o re

port

s •

Pres

ence

of H

MIS

in a

ll h

ealt

h d

eliv

ery

syst

ems

•Su

perv

isio

n sy

stem

in p

lace

•

Pres

ence

of h

ealt

h fa

cili

ty

com

mit

tee

and

dis

tric

t boa

rds

in

maj

orit

y of

dis

tric

ts

•Pr

esen

ce o

f CH

MT

in a

ll d

istr

icts

•Po

or m

ain

stre

amin

g of

mat

ern

al h

ealt

h in

terv

enti

on in

to C

CH

P an

d th

erea

fter

into

O

vera

ll C

ounc

il P

lan

s as

suc

h in

terv

enti

on is

no

t ad

dre

ssed

Mu

ltis

ecto

ral.

•C

entr

aliz

atio

n of

ser

vice

s/he

alth

pla

ns a

t C

HM

T le

vel a

nd

less

on

low

er le

vel

•D

istr

ict H

ealt

h pl

ann

ing

proc

ess

rare

ly t

ake

into

con

sid

erat

ion

incl

usio

n of

oth

er r

elev

ant

mul

ti s

ecto

ral o

ffic

ers

(Ed

uca

tion

, A

gric

ultu

re, E

ngin

eer,

Com

mun

ity

dev

elop

men

t) in

ad

dre

ssin

g m

ater

nal

hea

lth

issu

es.

•In

adeq

uat

e ca

pac

ity

of C

HM

T t

o pl

an fo

r R

CH

ac

tivi

ties

incl

ud

ing

mat

ern

al h

ealt

h •

Poor

rec

ord

kee

ping

and

ther

efor

e pl

anni

ng is

no

t evi

den

ce b

ased

•

Mos

t CH

MT

s s

till

see

RC

H in

clu

din

g m

ater

nal

hea

lth

inte

rven

tion

s as

d

onor

/pro

ject

sup

port

ed a

nd

not

re

spon

sibi

lity

of d

istr

ict b

ud

gets

•

Fam

ily

Plan

ning

giv

en le

ss p

rior

ity

in

plan

ning

at d

istr

ict l

evel

(CC

HP)

. •

Con

flic

ting

pri

orit

ies

du

ring

join

t sup

ervi

sion

•D

istr

ict h

ealt

h bo

ard

s an

d

heal

th fa

cili

ty c

omm

itte

es

pres

ent a

ccor

din

g to

set

gu

idel

ines

•

Exi

sten

ce o

f TE

HIP

tool

th

ough

has

lim

itat

ion

on

RC

H in

terv

enti

on p

ack

age

•Pr

opos

al f

or r

ecor

ds

man

agem

ent i

mpr

ovem

ent

has

bee

n m

ade

to M

oHSW

•

Proc

ess

and

imp

act

ind

icat

ors

hav

e be

en

iden

tifi

ed a

nd

def

ined

in

rece

ntly

rel

ease

d R

CH

st

rate

gy

•E

xist

ence

Nat

ion

al E

MO

C

surv

ey d

ocum

ent w

ill

prov

ide

benc

hmar

k of

E

MO

C s

itu

atio

n co

untr

ywid

e.

•In

suff

icie

nt in

volv

emen

t of o

ther

sta

keho

lder

s in

the

dis

tric

t du

ring

pla

nnin

g pr

oces

s,

mon

itor

ing

and

eva

luat

ion

•V

illa

ge a

nd

war

d p

lan

s no

t cap

turi

ng

mat

ern

al a

nd

new

born

inte

rven

tion

s/is

sues

•

Mat

ern

al h

ealt

h in

dic

ator

s us

ed a

re m

ain

ly

imp

act a

nd

less

/non

e on

pro

cess

ind

icat

ors

•So

me

EM

OC

pro

cess

ind

icat

ors

are

dif

ficu

lt

to c

alcu

late

sin

ce s

ome

dat

a is

not

cap

ture

d in

th

e ro

utin

e H

MIS

/fac

ilit

y ba

sed

dat

a re

cord

s.

•In

adeq

uat

e ut

ilis

atio

n of

dat

a/in

dic

ator

s fo

r pl

anni

ng p

urpo

se a

nd

pri

orit

isat

ion

at a

ll

•In

trod

uct

ion

of m

ater

nal

an

d p

erin

atal

dea

th

revi

ews

•E

xist

ence

of v

ario

us

nat

ion

al s

urve

ys (C

ensu

s,

DH

S, T

HIS

) th

at c

an g

ive

pict

ure

on

RC

H s

itu

atio

n •

Cur

rent

ther

e's

dem

and

d

rive

n ca

pac

ity

buil

din

g in

itia

tive

(pil

oted

in la

ke

zone

reg

ions

) th

at r

equi

res

dis

tric

t to

dem

and

for

63T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

ST

RE

NG

TH

S

WE

AK

NE

SS

ES

O

PP

OR

TU

NIT

IES

T

HR

EA

TS

leve

ls.

•In

adeq

uat

e fu

ncti

onin

g of

HM

IS

•L

ack

of d

isag

greg

ated

dat

a by

sex

an

d a

ge

spec

ific

•

Insu

ffic

ient

ly c

aptu

ring

dat

a fr

om p

riv

ate

heal

th fa

cili

ties

•

Wea

k/ab

senc

e of

Com

mun

ity

Bas

ed

Man

agem

ent I

nfor

mat

ion

Syst

em

•Po

or d

ocum

enta

tion

of c

lien

ts n

otes

incl

udin

g tr

eatm

ent p

lan,

ref

erra

l not

es a

t fac

ilit

y le

vel

•L

ow c

over

age

of s

uper

visi

on

•L

ack

of c

omp

rehe

nsiv

e an

d in

tegr

ated

Su

perv

isio

n to

ol a

nd

pro

cess

•

Inad

equ

ate

acco

unta

bili

ty a

mon

g se

rvic

e pr

ovid

ers

and

man

ager

s/su

perv

isor

s

•W

eak

syst

em fo

r m

onit

orin

g an

d a

dd

ress

ing

clie

nts

com

pla

ints

/sug

gest

ions

•

Poor

sup

port

ive

supe

rvis

ion

due

to

inad

equ

ate

skil

ls, c

omm

itm

ent a

nd

att

itu

de.

trai

nin

gs (u

nder

DA

NID

A

supp

ort)

•

Qu

alit

y of

Car

e fr

amew

ork

to c

onso

lid

ate

supe

rvis

ory

tool

s

•Pr

esen

ce o

f Cli

ent h

ealt

h se

rvic

e ch

arte

r an

d

Gui

del

ines

on

role

s an

d

resp

onsi

bili

ties

of H

F co

mm

itte

es/d

istr

ict

boar

ds.

(v)

Com

mu

nit

y•

Pres

ence

of P

rim

ary

Hea

lth

Com

mit

tee/

Vil

lage

hea

lth

com

mit

tees

that

dis

cuss

issu

es o

n m

ater

nal

hea

lth.

•

Pres

ence

of c

-IM

CI c

orps

•

Pres

ence

of C

omm

unit

y B

ased

R

CH

Str

ateg

ic p

lan,

gui

del

ines

•

Com

mun

ity

reco

gnis

ed a

s ke

y st

akeh

old

ers

in b

oth

Loc

al G

ovt

and

hea

lth

sect

or r

efor

ms.

•

Loc

al G

over

nmen

t ref

orm

s h

ave

a st

ruct

ure/

link

dow

n to

the

vill

age

leve

l.

•W

eak

impl

emen

tati

on o

f dis

tric

t gui

de

of

invo

lvin

g co

mm

unit

y •

Low

pop

ulat

ion

cove

rage

•

Lim

ited

mal

e in

volv

emen

t on

issu

es r

elat

ed to

m

ater

nal

hea

lth

•O

bste

tric

em

erge

ncie

s ar

e no

t con

sid

ered

by

the

Com

mun

ity

emer

genc

y co

mm

itte

e

•C

omm

unit

y pl

ans

not i

ncor

pora

ted

into

the

CC

HP.

•

Wea

k ca

pac

ity

of h

ealt

h fa

cili

ty c

omm

itte

es

and

dis

tric

t boa

rds

•

The

pro

cess

of d

evel

opin

g by

law

s an

d th

e ti

me

it t

akes

to b

e ef

fect

ed.

•In

adeq

uat

e ou

trea

ch s

ervi

ces

due

to p

oor

plan

ning

, in

adeq

uat

e re

sou

rces

. •

Inad

equ

atel

y fu

ncti

onin

g vi

llag

e he

alth

co

mm

itte

es s

ince

they

're

not f

acil

itat

ed.

•Pr

esen

ce o

f O&

OD

pl

anni

ng p

roce

ss

•A

lloc

atio

n of

10%

of C

CH

P fu

nds

to c

omm

unit

y in

terv

enti

ons.

•

Pres

ence

of T

ASA

F II

that

pr

ovid

es fi

nan

cial

sup

port

fo

r co

mm

unit

y ba

sed

soc

ial

serv

ice

del

iver

y.

•Pr

esen

ce o

f com

mun

ity

mob

iliz

atio

n an

d

empo

wer

men

t ini

tiat

ives

on

repr

oduc

tive

hea

lth.

•

Exi

sten

ce o

f the

CB

D

prog

ram

me

•H

ealt

h fa

cili

ties

com

mit

tees

an

d d

istr

ict h

ealt

h bo

ard

s

•Pr

esen

ce o

f har

mfu

l tr

adit

ion

al p

ract

ices

that

can

ad

vers

ely

affe

ct m

ater

nal

an

d

new

born

e.g

. tak

ing

herb

s th

at

hav

e ox

ytox

ic e

ffec

ts c

an le

ad

to r

uptu

red

ute

rus.

64T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

ST

RE

NG

TH

S

WE

AK

NE

SS

ES

O

PP

OR

TU

NIT

IES

T

HR

EA

TS

•K

now

led

ge o

n B

irth

pre

par

edne

ss is

poo

r am

ong

com

mun

itie

s

•C

omm

unit

y no

t aw

are

of th

eir

righ

ts a

nd

ob

lig

atio

ns

in im

pro

ving

mat

ern

al h

ealt

h ca

re

•G

end

er in

equ

alit

ies

exis

ting

in th

e co

mm

unit

y co

ntri

bute

s to

poo

r m

ater

nal

hea

lth

outc

omes

•

Low

aw

aren

ess

on r

epro

duc

tive

sys

tem

fu

ncti

ons

and

pre

gnan

cy r

elat

ed is

sues

suc

h as

dan

ger

sign

s/co

mpl

icat

ion

s

reco

gnis

ed le

gall

y •

Abi

lity

of c

omm

unit

ies

to

dev

ise

by-l

aws

to a

dd

ress

is

sues

rel

ated

to m

ater

nal

he

alth

suc

h as

vio

lenc

e,

del

iver

y at

hom

es, e

tc.

•E

xist

ence

of C

omm

unit

y ba

sed

mat

ern

al h

ealt

h ca

re

syst

em in

som

e ar

eas

•E

xist

ence

of c

lien

t hea

lth

serv

ice

char

ter

•E

xist

ence

of C

SOs/

NG

Os

(vi)

Pu

bli

c-P

riv

ate

Par

tner

ship

•O

ne o

f com

pone

nts

of H

SR

stra

tegy

•

Pres

ence

of a

ctiv

e A

ssoc

iati

on o

f Pr

ivat

e H

ospi

tals

in T

anza

nia

an

d P

RIN

MA

T

•N

on-f

or p

rofi

t sec

tor

(FB

Os)

pr

ovid

ing

mat

ern

al c

are

espe

cial

ly in

ru

ral a

reas

. •

•In

adeq

uat

e co

ord

inat

ion

in p

lann

ing

and

im

plem

enta

tion

am

ong

par

tner

s at

cen

tral

an

d d

istr

ict l

evel

•

Par

tner

ship

pol

icy

guid

elin

es p

rese

nt b

ut

mor

e vi

sibl

e/kn

own

at c

entr

al le

vel a

nd

less

at

dis

tric

t lev

el.

•So

me

Priv

ate

heal

th fa

cili

ties

/CSO

s no

t su

bmit

ting

dat

a to

dis

tric

t/ce

ntra

l lev

el

•M

ajor

ity

of P

riv

ate

for

Prof

it p

rovi

de

serv

ices

on

oth

er h

ealt

h is

sues

an

d le

ss o

n m

ater

nal

he

alth

car

e •

Fait

h ba

sed

org

aniz

atio

ns

prov

idin

g li

mit

ed

mat

ern

al s

ervi

ces

(no

FP s

ervi

ce p

rovi

ded

) •

Som

e C

SOs

that

are

pro

-lif

e pr

ovid

e ne

gati

ve

info

rmat

ion

on c

ontr

acep

tive

s.

•E

xist

ence

of P

rofe

ssio

nal

as

soci

atio

ns (A

GO

TA

, T

AM

A)

•E

xist

ence

of a

dvo

cacy

gr

oups

that

are

non

-hea

lth

prof

essi

onal

s (T

AM

WA

, T

GN

P, T

AW

LA

, Pri

vat

e m

edia

com

pan

ies,

WR

A)

•C

ompe

titi

on fo

r re

cogn

itio

n an

d r

esou

rces

bet

wee

n pu

blic

an

d p

riv

ate

sect

or.

65T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

(B) N

ewb

orn

Car

e S

TR

EN

GT

HS

W

EA

KN

ES

SE

S

OP

PO

RT

UN

ITIE

S

TH

RE

AT

S

(i)

Pol

icy

Issu

es

•N

atio

nal

hea

lth

poli

cy in

clu

des

ch

ild

hea

lth

•

Nat

ion

al s

trat

egy

on In

fant

an

d

Chi

ld N

utri

tion

an

d p

lan

of a

ctio

n in

pla

ce

•Po

licy

gui

del

ine

on R

CH

av

aila

ble

and

ref

lect

ing

neon

atal

hea

lth

care

•

Ava

ilab

ilit

y of

PM

TC

T a

nd

HIV

C

are

and

trea

tmen

t gui

des

that

in

tegr

ates

neo

nat

al c

are

•E

xem

ptio

n po

licy

for

und

er-f

ives

in

clu

des

neo

nat

al h

ealt

h se

rvic

es/c

are

•In

stit

utio

nal

isat

ion

of IM

CI w

ithi

n th

e M

oHSW

str

uctu

re/R

CH

S •

IMC

I dea

ls w

ith

neon

ate

from

8th

day

of l

ife

•C

-IM

CI p

rom

otes

com

mun

ity

mat

ern

al c

are

and

lac

tati

on

•E

stab

lish

ed p

ostn

atal

foll

ow u

p fi

rst w

eek

of li

fe

•E

stab

lish

men

t of b

aby

frie

ndly

ho

spit

al s

ervi

ces

wit

hin

som

e ho

spit

als

•R

evie

wed

LSS

man

ual

in

corp

orat

ed N

ewbo

rn c

are

acco

rdin

g to

WH

O g

uid

elin

es

•A

vail

abil

ity

of c

omm

itte

d

dev

elop

men

t par

tner

s su

ppor

ting

ne

wbo

rn h

ealt

h

•N

eona

tal c

are

obta

inin

g li

mit

ed

bud

get a

lloc

atio

n w

ith

in th

e he

alth

se

ctor

/RC

H s

ervi

ces

•N

ursi

ng tr

ain

ing

not c

ompr

ehen

sive

ly

add

ress

ing

neon

atal

car

e •

Age

spe

cifi

c in

terv

enti

ons

for

0-1

mon

ths

are

not w

ell s

pelt

out

in p

olic

y gu

ides

on

RC

H

•Po

licy

gui

del

ine

to m

anag

e ne

wbo

rn

care

is l

acki

ng

•R

outi

ne h

ealt

h d

ata

lack

s ne

onat

al

heal

th p

rogr

ess

incl

ud

ing

com

mun

ity-

base

d d

ata.

•

Lac

k of

und

erst

and

ing

on th

e m

agni

tud

e of

neo

nat

al h

ealt

h pr

oble

ms

•IM

CI d

oes

not a

dd

ress

firs

t wee

k of

li

fe

•Fa

cili

ty IM

CI d

oes

not i

nclu

de

hom

e ca

re a

nd

car

e se

ekin

g fo

r ne

wbo

rns

•L

ack

of c

once

ntra

tion

on

mat

ern

al

care

an

d im

mun

izat

ion

and

abs

ence

of

a g

uid

e •

Inad

equ

ate

avai

labi

lity

of

pae

dia

tric

ian

s an

d n

eon

atal

nur

ses

•L

ack

of c

osti

ng o

f Neo

nata

l car

e p

ack

age

•L

ack

of p

ostn

atal

gui

de

thus

not

in

corp

orat

ing

new

born

car

e

•D

ecen

tral

isat

ion

of h

ealt

h se

rvic

es to

dis

tric

t le

vel (

adva

nce

hea

lth

sect

or r

efor

ms)

can

ac

com

mod

ate

new

born

car

e •

Fin

anci

al r

esou

rce

allo

cati

on to

the

dis

tric

t le

vel (

from

var

iou

s so

urce

s)

•E

stab

lish

men

t of M

NC

par

tner

ship

at c

entr

al

leve

l•

On

goin

g re

view

s of

MoH

SW in

ad

dre

ssin

g hu

man

res

ourc

e cr

isis

•

Exi

sten

ce o

f ZT

C, N

ursi

ng a

nd M

edic

al

scho

ols

•H

IV C

are

and

Tre

atm

ent P

lan

give

op

port

unit

y to

mai

nstr

eam

new

born

car

e.

•C

over

age

of IM

CI c

ase

man

agem

ent H

igh

add

ing

firs

t wee

k co

uld

rap

idly

incr

ease

co

vera

ge

•D

onor

s, p

artn

ers

inte

rest

ed to

sup

port

in

corp

orat

ion

of n

ewbo

rn c

are

•Po

licy

gui

de

on In

fant

an

d e

arly

feed

ing

for

new

born

intr

oduc

ed

•E

xist

ence

of H

ealt

h ba

sket

fund

s to

sup

port

d

istr

ict h

ealt

h se

rvic

es

•E

xist

ence

of G

ovt l

ed S

WA

Ps, M

oHSW

T

echn

ical

com

mit

tee

and

sub

com

mit

tee

that

ca

n be

use

d to

pus

h M

ater

nal

an

d N

B h

ealt

h is

sues

•

Exi

sten

ce o

f Ann

ual

RM

Os,

DM

Os

and

RC

H

Mee

ting

s a

foru

m to

dis

cuss

RH

/mat

ern

al

and

new

born

issu

es

•Sh

ort t

ime

tow

ard

s at

tain

men

t of M

DG

s •

For

mot

her

not a

war

e of

thei

r H

IV s

ero-

stat

us

•M

ult

ipli

city

of

guid

elin

es

over

whe

lms

serv

ice

prov

ider

s •

HIV

pre

gnan

t mot

hers

fa

ce s

tigm

a/d

ilem

ma

in in

fan

t fee

din

g op

tion

s •

Big

ger

prop

orti

on o

f he

alth

sec

tor

bud

get i

s d

onor

dep

end

ant

•D

onor

dri

ven

init

iati

ves?

? •

Har

mfu

l pra

ctis

es

and

bel

iefs

•

Wom

en n

ot

empo

wer

ed

•T

rad

itio

nal

pra

ctis

es

hind

erin

g po

stn

atal

at

tend

ance

66T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

ST

RE

NG

TH

S

WE

AK

NE

SS

ES

O

PP

OR

TU

NIT

IES

T

HR

EA

TS

(ii)

Hea

lth

Sys

tem

s•

Infr

astr

uct

ure

at a

ll le

vels

ov

erse

eing

hea

lth

serv

ices

- n

atio

nal

, reg

ion

al, d

istr

ict

and

co

mm

unit

y •

Pres

ence

of Z

RC

HC

O, R

RC

H C

o an

d D

RC

HC

o •

Serv

ice

del

iver

y po

ints

wel

l d

istr

ibut

ed to

con

sult

ant,

regi

onal

an

d d

istr

ict h

ospi

tals

foll

owed

by

heal

th c

entr

es a

nd

dis

pens

arie

s.

•L

ack

of a

ppro

pri

ate

resu

scit

atio

n eq

uipm

ent a

nd

sup

plie

s e.

g. in

fusi

on

pum

ps, i

njec

tabl

es p

heno

barb

iton

e et

c •

Un

attr

acti

ve w

orki

ng c

ond

itio

n es

peci

ally

in r

ura

l are

as

•H

ealt

h se

rvic

es in

clu

din

g ne

onat

al

care

not

ope

rati

ng fo

r 24

hou

rs

•H

MT

are

un

awar

e in

ad

dre

ssin

g ne

onat

al h

ealt

h is

sues

•

Lim

ited

trai

nin

g of

Ser

vice

pro

vid

ers

on L

SS w

hic

h h

as a

com

pone

nt o

f ne

onat

al c

are

•In

adeq

uat

e/in

appr

opri

ate

EM

OC

(b

asic

an

d c

omp

rehe

nsiv

e se

rvic

es) a

t fa

cili

ty le

vel

•So

me

neon

atal

sup

plie

s/ e

quip

men

ts

are

not m

ade

avai

labl

e at

MSD

•

Poor

sup

ply

plan

at s

ervi

ce d

eliv

ery

poin

t/d

istr

icts

•

Neo

nata

l ser

vice

s ar

e no

t ad

equ

atel

y pr

ovid

ed b

y m

ajor

ity

for

publ

ic a

nd

pr

ivat

e he

alth

faci

liti

es

•Fa

cili

ty b

uil

din

gs n

ot s

uita

ble

prov

idin

g ne

onat

al s

ervi

ces

•K

anga

roo

met

hod

for

low

bir

th

wei

ght b

abie

s in

res

ourc

e po

or

coun

trie

s h

as n

ot b

een

adop

ted

. •

Und

er-f

ives

car

e d

oes

not f

ocus

age

sp

ecif

ic w

ith

spec

ial n

eed

s, a

s a

resu

lt

neon

atal

are

not

take

n in

to

cons

ider

atio

n, e

spec

iall

y th

e 1st

wee

k

•E

xist

ence

of P

aed

iatr

ic A

ssoc

iati

on o

f T

anza

nia

(PA

T) a

nd

oth

er h

ealt

h pr

ofes

sion

al a

ssoc

iati

ons.

•

The

ong

oing

Join

t Reh

abil

itat

ion

Fund

s w

ith

in d

istr

icts

can

fac

ilit

ate

impr

ovin

g bu

ild

ings

to p

rovi

de

neon

atal

car

e •

Pres

ence

of D

istr

ict N

ursi

ng O

ffic

er a

nd

H

ospi

tal m

atro

n th

at c

an fo

cus

on n

eon

atal

ca

re

•Pr

esen

ce o

f Ind

ent s

yste

m fo

r ob

tain

ing

esse

ntia

l dru

gs a

nd

sup

plie

s •

Plan

to s

tren

gthe

n Z

TC

•

Exi

sten

ce o

f RH

MT

an

d C

HM

T w

hic

h co

ord

inat

es d

istr

ict h

ealt

h ac

tivi

ties

in

clu

din

g m

ater

nal

& n

ewbo

rn c

are

•R

ehab

ilit

atio

n of

hea

lth

faci

liti

es

•P

artn

ers

read

y to

sup

port

•O

verw

helm

ing

the

ZT

C

cap

acit

y

(ii)

Sys

tem

s S

up

por

t •

Loc

al G

over

nmen

t aut

hori

ties

re

form

s ar

e su

ppor

ting

im

plem

enta

tion

of H

SR

•T

here

's v

ast G

eogr

aphi

cal

area

wit

h po

or tr

ansp

ort/

road

s, in

adeq

uat

e he

alth

faci

liti

es a

nd

ther

efor

e po

or

geog

raph

ical

acc

essi

bili

ty to

EM

OC

•C

urre

ntly

Join

t Reh

abil

itat

ion

Prog

ram

me

has

bee

n in

itia

ted

at d

istr

ict l

evel

whi

ch c

an

be u

sed

to a

ccom

mod

ate

stru

ctur

e im

prov

emen

t for

mat

ern

al a

nd

new

born

car

e

67T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

ST

RE

NG

TH

S

WE

AK

NE

SS

ES

O

PP

OR

TU

NIT

IES

T

HR

EA

TS

•Pr

esen

ce o

f ref

erra

l str

uctu

re

wit

hin

the

heal

th d

eliv

ery

syst

em

•In

adeq

uat

e am

bula

nces

wit

hin

the

coun

try

•

Man

y he

alth

uni

ts d

o no

t hav

e re

liab

le c

omm

unic

atio

n sy

stem

(r

adio

cal

l, m

obil

e)

•In

adeq

uat

e aw

aren

ess

and

ad

voca

cy

on N

eona

tal c

are

at a

ll le

vels

in

clu

din

g he

alth

faci

liti

es s

uppo

rt

staf

f

•E

xist

ence

of m

obil

e co

mm

unic

atio

n ne

twor

k un

til r

ura

l are

as

(iv)

Pla

nn

ing,

Mon

itor

ing

and

Ev

alu

atio

n•

Plan

ning

dec

entr

alis

ed to

dis

tric

t le

vel

•Po

or m

ain

stre

amin

g of

neo

nat

al

heal

th in

terv

enti

on in

to C

CH

P

•C

entr

aliz

atio

n of

ser

vice

s/he

alth

pl

ans

at C

HM

T le

vel a

nd

less

on

low

er le

vel

•In

adeq

uat

e ca

pac

ity

of C

HM

T t

o pl

an

for

RC

H a

ctiv

itie

s in

clu

din

g ne

onat

al

heal

th

•Po

or r

ecor

d k

eepi

ng a

nd th

eref

ore

plan

ning

is n

ot e

vid

ence

bas

ed

•D

istr

ict h

ealt

h bo

ard

s an

d h

ealt

h fa

cili

ty

com

mit

tees

pre

sent

acc

ord

ing

to s

et

guid

elin

es

•Pr

opos

al f

or r

ecor

ds

man

agem

ent

impr

ovem

ent h

as b

een

mad

e to

MoH

SW

•In

trod

uct

ion

of m

ater

nal

an

d p

erin

atal

dea

th

revi

ews

(v)

Com

mu

nit

y

•Pr

esen

ce o

f HM

IS in

all

hea

lth

del

iver

y sy

stem

s •

Supe

rvis

ion

syst

em in

pla

ce

•Pr

esen

ce o

f hea

lth

faci

lity

co

mm

itte

e an

d d

istr

ict b

oard

s in

m

ajor

ity

of d

istr

icts

•

Pres

ence

of C

HM

T in

all

dis

tric

ts

• •

•In

adeq

uat

e fu

ncti

onin

g of

HM

IS

•L

ack

of d

isag

greg

ated

dat

a by

sex

an

d a

ge s

peci

fic

•W

eak/

abse

nce

of C

omm

unit

y B

ased

M

anag

emen

t Inf

orm

atio

n Sy

stem

•

Supe

rvis

ion

und

erta

ken

is n

ot

com

preh

ensi

ve a

nd

doe

s no

t cap

ture

ne

onat

al c

are

•W

eak

impl

emen

tati

on o

f dis

tric

t gu

ide

of in

volv

ing

com

mun

ity

•Q

ual

ity

of C

are

fram

ewor

k to

con

soli

dat

e su

perv

isor

y to

ols

•

Pres

ence

of C

lien

t hea

lth

serv

ice

char

ter

and

G

uid

elin

es o

n ro

les

and

res

pons

ibil

itie

s of

HF

com

mit

tees

/dis

tric

t boa

rds.

•

Pres

ence

of O

& O

D p

lann

ing

proc

ess

wh

ich

invo

lves

the

com

mun

ity

•A

ccor

din

g to

dis

tric

t hea

lth

plan

ning

gui

des

th

ere'

s 10

% fu

nds

allo

cate

d fo

r co

mm

unit

y in

terv

enti

on

•C

onfl

icti

ng p

rior

itie

s d

uri

ng jo

int

supe

rvis

ion

•Pr

esen

ce o

f har

mfu

l tr

adit

ion

al p

ract

ices

th

at c

an a

dve

rsel

y af

fect

mat

ern

al a

nd

ne

wbo

rn

68T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015

69T

he N

atio

nal R

oad

Map

Str

ateg

ic P

lan

-200

8 -

2015



ANNEX 2

INPUTS FOR IMPROVINGMATERNAL, NEWBORN AND

CHILD HEALTH AT ALLLEVELS

AN

TE

NA

TA

L C

AR

E

TR

AIN

ED

HE

AL

TH

CA

RE

P

RO

VID

ER

CO

MM

UN

ITY

D

ISP

EN

SAR

Y

HE

AL

TH

CE

NT

RE

H

OSP

ITA

L

SUG

GE

STE

D I

NP

UT

S

Pro

vide

IE

C, h

ealth

edu

catio

n an

d co

unse

lling

to w

omen

, men

, fa

mili

es a

nd c

omm

uniti

es a

bout

: •

The

nee

ds o

f pr

egna

nt w

omen

•

Dan

ger

sign

s an

d ap

prop

riat

e ac

tion

•B

irth

pre

pare

dnes

s, in

clud

ing

loca

l tra

nspo

rtat

ion

for

emer

genc

ies

•W

ork,

res

t and

nut

ritio

n •

HIV

/ST

D p

reve

ntio

n •

The

impo

rtan

ce o

f so

cial

su

ppor

t

Invo

lve

the

husb

and/

part

ner

in I

EC

an

d co

unse

lling

ses

sion

s

Pla

nnin

g fo

r bi

rth

and

emer

genc

ies

Ado

lesc

ent g

irls

enc

oura

ged

to

cont

inue

to g

o to

sch

ool

Pro

mot

e be

nefi

cial

trad

ition

al

prac

tice

s an

d ad

vise

aga

inst

ha

rmfu

l one

s

Pro

mot

e IT

Ns

Iden

tify

preg

nant

wom

en a

nd r

efer

ea

rly

to a

nten

atal

clin

ic

Pro

vide

fol

low

up

care

and

sup

port

be

twee

n sc

hedu

led

ante

nata

l clin

ic

visi

ts

Iden

tify

prob

lem

s an

d co

mpl

icat

ion

and

refe

r

Rec

ord

com

mun

ity-b

ased

hea

lth

info

rmat

ion

(e.g

. num

ber

of

wom

en r

efer

ral f

or a

nten

atal

car

e)

As

at c

omm

unity

leve

l, pl

us:

Obt

ain

targ

eted

his

tory

and

pe

rfor

m p

hysi

cal e

xam

inat

ion,

m

onito

r pr

ogre

ss o

f pre

gnan

cy a

nd

asse

ss m

ater

nal a

nd f

etal

wel

l-be

ing

Dev

elop

an

indi

vidu

alis

ed b

irth

pl

an (

e.g.

pla

ce o

f de

liver

y, b

irth

at

tend

ant,

emer

genc

y pr

epar

edne

ss)

Perf

orm

sta

ndar

d te

stin

g:

•S

yphi

lis (

incl

udin

g tr

eatm

ent a

s ne

eded

) •

Uri

naly

sis

•H

aem

oglo

bin

•P

regn

ancy

con

firm

atio

n

Scr

een

for

othe

r S

TD

s w

here

ap

plic

able

and

pro

vide

app

ropr

iate

tr

eatm

ent a

nd c

ouns

ellin

g

Ass

ess

Fem

ale

geni

tal m

util

atio

n

Man

age

min

or c

ompl

icat

ions

suc

h as

m

ild a

naem

ia, u

ncom

plic

ated

uri

nary

tr

act i

nfec

tion

and

mild

vag

inal

in

fect

ions

, unc

ompl

icat

ed m

alar

ia

Pro

vide

teta

nus

toxo

id im

mun

izat

ion

Pro

vide

inte

rmitt

ent p

resu

mpt

ive

trea

tmen

t of

mal

aria

Sel

l/dis

pens

e IT

Ns

Tre

at in

test

inal

par

asit

es a

s ne

eded

Pro

vide

iron

, fol

ic a

cid

and

othe

r m

icro

nutr

ient

sup

plem

enta

tion

Man

age

cert

ain

prob

lem

s an

d co

mpl

icat

ions

(e.

g. a

naem

ia, P

IH,

As

at d

ispe

nsar

y le

vel,

plus

:

Man

age

cert

ain

prob

lem

s an

d co

mpl

icat

ions

(e.

g. m

ild p

re-e

clam

psia

, in

com

plet

e ab

ortio

n); r

efer

mor

e se

riou

s co

mpl

icat

ions

Off

er v

olun

tary

cou

nsel

ling

and

test

ing

for

HIV

as

poss

ible

Prov

ide

FP a

nd p

ost a

bort

ion

care

Pre

-ref

erra

l tre

atm

ent o

f se

vere

co

mpl

icat

ions

-

pre-

ecla

mps

ia

-ec

lam

psia

-

blee

ding

-

infe

ctio

n -

com

plic

ated

abo

rtio

n

Supp

ort o

f w

omen

with

spe

cial

nee

ds

e.g.

ado

lesc

ents

and

wom

en li

ving

with

vi

olen

ce

Man

age

or r

efer

for

PM

TC

T

Tre

atm

ent o

f m

ild to

mod

erat

e op

port

unis

tic in

fect

ions

in p

regn

ant

wom

en w

ith H

IV

As

at h

ealth

cen

tre

leve

l, pl

us:

Man

age

maj

or p

robl

ems

and

com

plic

atio

ns

- e

ctop

ic p

regn

ancy

-

Ana

emia

-

seve

re p

re-e

clam

psia

-

ecla

mps

ia

- bl

eedi

ng

- in

fect

ion

- ot

her

med

ical

com

plic

atio

ns

Tre

atm

ent o

f ab

ortio

n co

mpl

icat

ions

Tre

atm

ent o

f se

vere

HIV

infe

ctio

n

Tre

atm

ent o

f se

vere

mal

aria

Com

mun

ity

leve

l IE

C m

essa

ges/

mat

eria

ls a

bout

: •

The

nee

ds o

f pr

egna

nt w

omen

•

Dan

ger

sign

s an

d ap

prop

riat

e ac

tion

•B

irth

pre

pare

dnes

s, in

clud

ing

loca

l tra

nspo

rtat

ion

for

emer

genc

ies

•H

IV/S

TD

pre

vent

ion

•In

sect

icid

e-tr

eate

d be

d ne

ts (

ITN

s)

•T

he im

port

ance

of

mal

e in

volv

emen

t

Ref

resh

er in

-ser

vice

trai

ning

for

com

mun

ity-l

evel

hea

lth

wor

kers

abo

ut u

sing

IE

C m

essa

ges/

mat

eria

ls

In-s

ervi

ce tr

aini

ng f

or s

uper

viso

rs o

f co

mm

unity

-lev

el

heal

th w

orke

rs to

ena

ble

them

to c

ondu

ct r

efre

sher

on

job

trai

ning

of

com

mun

ity-l

evel

wor

kers

In-s

ervi

ce tr

aini

ng f

or c

omm

unity

-lev

el h

ealth

wor

kers

in

volv

ed in

ant

enat

al c

are,

incl

udin

g pr

oble

m/c

ompl

icat

ion

iden

tific

atio

n an

d re

ferr

al; f

ollo

w u

p su

ppor

t, re

cord

ing

Dis

pens

ary

leve

l In

-ser

vice

trai

ning

for

hea

lthca

re p

rovi

ders

res

pons

ible

for

an

tena

tal c

are

abou

t: •

Con

tent

of

ante

nata

l car

e •

Rev

ised

sch

edul

e of

vis

its

•A

sses

smen

t ski

lls (

hist

ory

taki

ng a

nd p

hysi

cal

exam

inat

ion;

rou

tine

test

ing)

•

Car

e pr

ovis

ion,

incl

udin

g th

e de

velo

pmen

t of

indi

vidu

aliz

ed b

irth

pla

n, h

ealth

edu

catio

n an

d co

unse

lling

Supp

lies

for

syph

ilis

test

ing,

uri

naly

sis,

hae

mog

lobi

n, a

nd

othe

r ST

D te

sts

as n

eces

sary

Con

sist

ent s

uppl

y of

TT

vac

cine

, syr

inge

s/ne

edle

s,

antih

elm

inth

ic d

rugs

, bas

ic d

rugs

suc

h as

ant

imal

aria

l dru

gs

(SP)

, ant

ibio

tics

and

fung

icid

es (

(SP

) an

d IT

Ns,

iron

, fol

ic

acid

and

oth

er m

icro

nutr

ient

sup

plem

ents

TR

AIN

ED

HE

AL

TH

CA

RE

P

RO

VID

ER

CO

MM

UN

ITY

D

ISP

EN

SAR

Y

HE

AL

TH

CE

NT

RE

H

OSP

ITA

L

SUG

GE

STE

D I

NP

UT

S

slig

ht b

leed

ing)

; ref

er o

ther

pr

oble

ms

Prov

ide

addi

tiona

l hea

lth

educ

atio

n an

d co

unse

lling

abo

ut:

•Pr

epar

atio

n fo

r br

east

feed

ing

•Pr

even

tion

and

reco

gniti

on o

f ST

Ds/

HIV

/AID

S •

Prev

entio

n of

mal

aria

and

he

lmin

th in

fest

atio

n M

othe

r-to

-chi

ld tr

ansm

issi

on o

f H

IV/A

IDS

Hea

lth

Cen

tre

leve

l A

ll of

the

abo

ve a

nd:

•

Supp

lies

for

HIV

test

ing,

IV

flu

ids,

par

enta

l dru

gs

(ant

ibio

tics,

MgS

O4,

ant

imal

aria

ls)

Su

pplie

s an

d tr

aini

ng f

or M

anua

l Vac

uum

Asp

irat

ions

In-s

ervi

ce tr

aini

ng f

or h

ealth

care

pro

vide

rs r

espo

nsib

le f

or

ante

nata

l car

e ab

out:

•C

onte

nt o

f an

tena

tal c

are

and

trea

tmen

t mild

co

mpl

icat

ions

as

wel

l as

pre-

refe

rral

trea

tmen

t •

Rev

ised

sch

edul

e of

vis

its

•A

sses

smen

t ski

lls (

hist

ory

taki

ng a

nd p

hysi

cal

exam

inat

ion;

rou

tine

test

ing)

•

Car

e pr

ovis

ion,

incl

udin

g th

e de

velo

pmen

t of

indi

vidu

alis

ed b

irth

pla

n, h

ealth

edu

catio

n an

d co

unse

lling

Hos

pita

l lev

el

All

of t

he a

bove

and

: C

ompe

tenc

y-ba

sed

trai

ning

for

doc

tors

in th

e m

anag

emen

t of

ecl

amps

ia, s

ever

e an

aem

ia, e

ctop

ic p

regn

ancy

Supp

lies,

equ

ipm

ent a

nd d

rugs

for

the

man

agem

ent o

f co

mpl

icat

ions

(bl

ood

tran

sfus

ion,

labo

rato

ry te

sts,

obs

tetr

ic

care

and

sur

gery

)

CA

RE

DU

RIN

G C

HIL

DB

IRT

H in

clud

ing

obst

etri

c em

erge

ncy

sit

uat

ion

s

TR

AIN

ED

HE

AL

TH

CA

RE

P

RO

VID

ER

CO

MM

UN

ITY

D

ISP

EN

SA

RY

H

EA

LT

H C

EN

TR

E

HO

SP

ITA

L

SU

GG

ES

TE

D I

NP

UT

S

Pro

vide

a w

arm

and

car

ing

appr

oach

to

the

wom

an

Mon

itor

prog

ress

of

labo

ur u

sing

si

mpl

e ai

de

If d

eliv

ery

occu

rs a

t com

mun

ity le

vel:

Fol

low

cle

an a

nd s

afe

deliv

ery

prac

tice

s

Dis

cuss

and

rea

ch c

onse

nsus

on

the

labo

ur a

nd b

irth

ing

posi

tion

of

mot

her’

s ch

oice

Rec

ogni

se p

robl

ems

or c

ompl

icat

ions

ea

rly

and

refe

r

Insp

ect p

lace

nta;

exa

min

e pe

rine

um

for

inju

ries

and

ref

er a

s ne

eded

Aft

er d

eliv

er, n

otif

y m

ater

nal a

nd

foet

al o

utco

mes

and

rep

ort t

o ne

xt

leve

l

Car

e fo

r th

e ne

wbo

rn b

aby

incl

udin

g K

MC

, rec

ogni

se d

ange

r si

gns

and

refe

r as

app

ropr

iate

Per

form

obs

tetr

ic f

irst

aid

incl

udin

g st

abili

satio

n

Arr

ange

for

tran

spor

t and

acc

ompa

ny

mot

her

to th

e ne

xt le

vel

Rec

ord

com

mun

ity-b

ased

hea

lth

info

rmat

ion

(e.g

. num

ber

of w

omen

w

ith c

ompl

icat

ions

ref

erre

d

As

at c

omm

unity

leve

l, pl

us:

Obt

ain

targ

eted

his

tory

and

pe

rfor

m p

hysi

cal e

xam

inat

ion

Dia

gnos

e la

bour

and

mon

itor

prog

ress

usi

ng a

dapt

ed W

HO

pa

rtog

raph

Pro

vide

sup

port

ive

care

and

pa

in r

elie

f P

erfo

rm in

terv

entio

ns s

uch

as

amni

otom

y an

d ep

isio

tom

y,

only

if n

eces

sary

Insp

ect p

lace

nta

and

vagi

na f

or

inju

ries

Rep

air

min

or la

cera

tion

s an

d ep

isio

tom

ies

Act

ivel

y m

anag

e th

e th

ird

stag

e of

labo

ur (

oxyt

ocin

, co

ntro

lled

cord

trac

tion,

fun

dal

mas

sage

)

Car

e fo

r th

e ba

by a

fter

bir

th

incl

. KM

C, m

onito

r th

e ba

by

and

trea

t or

refe

r as

app

ropr

iate

N

ewbo

rn r

esus

cita

tion

Rec

ogni

ze c

ompl

icat

ions

ear

ly

(e.g

. mal

pres

enta

tions

, pr

olon

ged

or o

bstr

ucte

d la

bour

, hy

pert

ensi

on, b

leed

ing

and

infe

ctio

n) a

nd m

anag

e or

ref

er

as a

ppro

pria

te

Per

form

em

erge

ncy

obst

etri

c pr

oced

ures

incl

udin

g:

•R

epai

r of

vag

inal

and

cer

vica

l la

cera

tion

s •

Vac

uum

ext

ract

ion

•M

anua

l vac

uum

asp

irat

ion

(MV

A)

Man

ual r

emov

al o

f th

e pl

acen

ta

As

at d

ispe

nsar

y le

vel,

plus

:

Tre

atm

ent o

f ab

norm

aliti

es a

nd

com

plic

atio

ns (

prol

onge

d la

bour

, va

cuum

ext

ract

ion,

bre

ach

pres

enta

tion,

epi

siot

omy,

rep

air

of

geni

tal t

ears

, man

ual r

emov

al o

f pl

acen

ta a

nd tr

eatm

ent o

f m

oder

ate

post

-hae

mor

rhag

ic a

naem

ia

Pre

-ref

erra

l man

agem

ent o

f se

riou

s co

mpl

icat

ions

(ob

stru

cted

labo

ur,

feta

l dis

tres

s, p

rete

rm la

bour

, sev

ere

peri

- an

d po

stpa

rtum

hae

mor

rhag

e)

Em

erge

ncy

man

agem

ent o

f co

mpl

icat

ions

if b

irth

is im

min

ent

Sup

port

for

the

fam

ily in

cas

e of

m

ater

nal d

eath

As

at h

ealt

h ce

ntre

, plu

s:

Tre

atm

ent o

f se

vere

com

plic

atio

ns i

n ch

ildbi

rth

and

the

imm

edia

te

post

part

um p

erio

d, in

clud

ing

caes

area

n

sect

ion,

blo

od tr

ansf

usio

n an

d hy

ster

ecto

my)

-

obst

ruct

ed la

bour

-

mal

pres

enta

tion

s -

ecla

mps

ia

- se

vere

infe

ctio

ns

- bl

eedi

ng

Indu

ctio

n an

d au

gmen

tatio

n of

labo

ur

Man

agem

ent o

f co

mpl

icat

ions

rel

ated

to

FG

M

Pre

vent

ion

of M

othe

r to

Chi

ld

tran

smis

sion

of

HIV

by

mod

e of

de

liver

y, p

rovi

sion

of

AR

V’s

, gu

idan

ce

and

supp

ort f

or c

hose

n in

fant

fee

ding

op

tion.

Com

mu

nit

y le

vel

In-s

ervi

ce tr

aini

ng f

or c

omm

unity

-lev

el h

ealt

h w

orke

rs

abou

t app

ropr

iate

inte

rper

sona

l sup

port

for

the

wom

an

duri

ng c

hild

birt

h; s

impl

e la

bour

mon

itori

ng; c

lean

and

sa

fe d

eliv

ery

prac

tices

; ear

ly r

ecog

nitio

n of

and

res

pons

e to

obs

tetr

ic c

ompl

icat

ions

Bas

ic d

eliv

ery

kits

WH

O a

dapt

ed p

arto

grap

h fo

rms

Dis

pen

sary

leve

l A

s fo

r th

e co

mm

unity

leve

l, pl

us:

In-s

ervi

ce tr

aini

ng a

bout

: •

Ass

essm

ent o

f w

oman

in la

bour

•

Cle

an a

nd s

afe

deliv

ery

prac

tices

•

Use

of

WH

O a

dapt

ed p

arto

grap

h •

Am

niot

omy/

epis

ioto

my

•A

ctiv

e m

anag

emen

t of

thir

d st

age

•R

ecog

nitio

n of

and

res

pons

e to

pro

blem

s/

com

plic

atio

ns

•E

ssen

tial n

ewbo

rn c

are

•K

MC

C

onsi

sten

t sup

ply

of

Glo

ves,

apr

ons,

soa

p an

d w

ater

, ant

isep

tic s

olut

ion,

bas

ic

inst

rum

ents

for

am

niot

omy

and

epis

ioto

my,

oxy

toci

n,

Vita

min

A b

asic

ora

l dru

gs, p

arto

grap

h fo

rms,

sut

ure

mat

eria

ls/n

eedl

e ho

lder

, Vag

inal

spe

culu

m,,

sutu

re

mat

eria

ls/n

eedl

e ho

lder

, vac

uum

ext

ract

or, M

VA

eq

uipm

ent,

IV

flu

ids

and

infu

sion

set

s In

-ser

vice

trai

ning

abo

ut:

Com

pete

ncy-

base

d sk

ills

trai

ning

for

clin

ical

off

icer

s an

d nu

rse-

mid

wiv

es in

: •

Rep

air

of v

agin

al a

nd c

ervi

cal l

acer

atio

ns

•V

acuu

m e

xtra

ctio

n •

MV

A

•M

anua

l rem

oval

of

the

plac

enta

•

Em

erge

ncy

man

agem

ent o

f co

mpl

icat

ions

if b

irth

is

imm

inen

t •

Pre

-ref

erra

l man

agem

ent o

f se

riou

s co

mpl

icat

ions

•

Tre

atm

ent o

f m

inor

com

plic

atio

n •

Ess

entia

l new

born

car

e

Ava

ilabi

lity

of

New

born

res

usci

tatio

n eq

uipm

ent

Hea

lth

Cen

tre

leve

l

TR

AIN

ED

HE

AL

TH

CA

RE

P

RO

VID

ER

CO

MM

UN

ITY

D

ISP

EN

SAR

Y

HE

AL

TH

CE

NT

RE

H

OSP

ITA

L

SUG

GE

STE

D I

NP

UT

S

Initi

ate

man

agem

ent a

nd r

efer

pa

tient

s w

ith:

•H

aem

orrh

age

•E

clam

psia

•

Obs

truc

ted

labo

ur

Puer

pera

l inf

ectio

ns

Del

iver

y an

d im

med

iate

car

e of

th

e ne

wbo

rn in

clud

ing

KM

C

and

imm

edia

te in

itiat

ion

of

brea

stfe

edin

g

Imm

edia

te p

ostp

artu

m c

are

of

the

mot

her:

-

Ass

essm

ent o

f m

ater

nal w

ell

bein

g an

d de

tect

ion

of

com

plic

atio

ns (

e.g.

ble

edin

g,

infe

ctio

ns, h

yper

tens

ion

and

anae

mia

) -

Adv

ice

on d

ange

r si

gns,

em

erge

ncy

prep

ared

ness

and

fo

llow

-up

Vita

min

A a

dmin

istr

atio

n

Rec

ordi

ng a

nd r

epor

ting

on

deliv

ery

All

of th

e ab

ove

plus

: C

ontin

uous

Sup

ply

of: V

acuu

m e

xtra

ctio

n eq

uipm

ent,

IV

flui

ds a

nd I

V s

ets,

MG

SO4,

par

enta

l ute

roto

nics

and

an

tibio

tics,

dru

gs a

nd e

quip

men

t for

ess

entia

l new

born

ca

re.

Hos

pita

l lev

el

All

of th

e ab

ove

plus

:

Hea

lth w

orke

rs tr

aine

d in

: •

Man

agem

ent o

f ob

stet

ric

com

plic

atio

ns a

nd

emer

genc

ies

incl

udin

g Su

rger

y (c

aesa

rean

sec

tion

an

d ot

her

abd

omin

al o

bste

tric

sur

gery

ect

opic

pre

gnan

cy,

hyst

erec

tom

y)

•Pr

ovid

ing

safe

ana

esth

esia

for

pre

gnan

t wom

en

•Sa

fe b

lood

tran

sfus

ion

•PM

TC

T

Stab

le s

uppl

y of

: E

quip

men

t and

dru

gs f

or a

naes

thes

ia, i

nstr

umen

ts a

nd

cons

umab

le s

uppl

ies

for

obst

etri

c su

rger

y, b

lood

tr

ansf

usio

n eq

uipm

ent ,

Oxy

gen,

labo

rato

ry e

quip

men

t for

bo

th b

ioch

emic

al a

nd m

icro

biol

ogic

al a

sses

smen

ts a

nd

AR

V’s

.

NE

WB

OR

N C

AR

E

TR

AIN

ED

HE

AL

TH

CA

RE

P

RO

VID

ER

CO

MM

UN

ITY

D

ISP

EN

SA

RY

H

EA

LT

H C

EN

TR

E

HO

SP

ITA

L

SU

GG

ES

TE

D I

NP

UT

S

Pro

vide

imm

edia

te c

are

of th

e ne

wbo

rn, i

nclu

ding

the

follo

win

g:

• K

MC

st

imul

ate

and

war

m

baby

• C

lear

air

way

if

nec

essa

ry to

est

abli

sh

r

espi

rati

on

• T

ie, c

ut a

nd c

are

of c

ord

usin

g cl

ean,

saf

e pr

oced

ures

• E

stab

lish

bre

astf

eedi

ng

imm

edia

tely

aft

er b

irth

Avo

id c

onta

cts

wit

h si

ck

fam

ily

mem

bers

Ext

ra c

are

for

low

-bith

wei

ght

babi

es in

clud

ing

KM

C

Rec

ogni

tion

of

dang

er s

igns

an

d re

ferr

al

Cou

nsel

ling

on

hom

ecar

e,

dang

er s

igns

, saf

e di

spos

al o

f ba

by s

tool

s, n

utri

tion

, IT

N

and

hygi

ene

for

new

born

, ne

ed f

or g

row

th m

onit

orin

g an

d im

mun

izat

ions

As

at c

omm

unity

leve

l, pl

us:

Ens

ure

war

mth

of

sick

or

pret

erm

/low

bir

th w

eigh

t bab

ies

as

nece

ssar

y

Per

form

bas

ic n

ewbo

rn

Res

usci

tati

on

Pro

vide

new

born

imm

uniz

atio

ns a

nd

adm

inis

ter

eye

care

Pro

vide

cou

nsel

ling

and

supp

ort f

or:

•C

are

of th

e ne

wbo

rn

•C

are

of p

rete

rm/lo

w b

irth

wei

ght

babi

es, i

nclu

ding

ski

n-to

-ski

n m

etho

d •

Bre

astf

eedi

ng

•C

ouns

ellin

g an

d su

ppor

t on

feed

ing

fro

HIV

pos

itive

mot

hers

Mon

itori

ng a

nd a

sses

smen

t of

wel

lbei

ng, d

etec

tion

of

com

plic

atio

ns (

brea

thin

g, in

fect

ions

, pr

emat

urel

y, lo

w b

irth

wei

ght,

inju

ry, m

alfo

rmat

ion)

Infe

ctio

n pr

even

tion,

con

trol

and

ro

omin

g-in

Imm

uniz

atio

n ac

cord

ing

to n

atio

nal

guid

elin

e

Initi

ate

man

agem

ent o

f ne

wbo

rn

illne

ss a

nd r

efer

to a

ppro

pria

te le

vel

of c

are

Add

ition

al f

ollo

w-u

p vi

sits

for

hig

h ri

sk b

abie

s (p

rete

rm, a

fter

sev

ere

com

plic

atio

ns, l

ow-b

irth

wei

ght

babi

es H

IV-e

xpos

ed b

abie

s, b

abie

s w

ith f

eedi

ng p

robl

ems

and

bab

ies

on r

epla

cem

ent f

eedi

ng

Sup

port

ing

mot

her

if p

erin

atal

dea

th

As

at d

ispe

nsar

y le

vel,

plus

:

Car

e if

mod

erat

ely

pret

erm

, low

bir

th

wei

ght o

r tw

in; s

uppo

rt f

or

brea

stfe

edin

g, w

arm

th, f

requ

ent

asse

ssm

ent o

f w

ellb

eing

and

det

ecti

on

of c

ompl

icat

ions

e.g

. fee

ding

di

ffic

ultie

s, ja

undi

ce o

r ot

her

peri

nata

l pr

oble

ms.

Tre

atm

ent o

f m

ild to

mod

erat

e:

- lo

cal i

nfec

tions

(co

rd, s

kin,

eye

, th

rush

) -

birt

h in

juri

es

Pre

ref

erra

l man

agem

ent o

f in

fant

s w

ith s

ever

e pr

oble

ms:

-

very

pre

term

bab

ies

And

/or

low

bir

th

wei

ght

- se

vere

com

plic

atio

ns

- m

alfo

rmat

ions

Pre

sum

ptiv

e tr

eatm

ent o

f co

ngen

ital

syph

ilis

Man

agem

ent o

f m

inor

to m

oder

ate

prob

lem

s su

ch a

s fe

edin

g di

ffic

ultie

s

pre-

refe

rral

man

agem

ent o

f se

vere

pr

oble

ms

such

as

conv

ulsi

ons

and

inab

ility

to f

eed

Rec

ogni

ze d

ange

r si

gns

give

ap

prop

riat

e pr

e-re

ferr

al tr

eatm

ent a

nd

refe

r as

app

ropr

iate

As

at h

ealt

h ce

ntre

leve

l, pl

us:

Man

agem

ent o

f se

vere

new

born

pr

oble

ms

such

as:

-

neon

atal

sep

sis

- ne

onat

al J

aund

ice

- ne

onat

al T

etan

us

- br

eath

ing

diff

icul

ties

- se

vere

bir

th tr

aum

a an

d as

phyx

ia

- co

rrec

tabl

e m

alfo

rmat

ions

-

Neo

nata

l syp

hilis

-

failu

re to

thri

ve

Ref

er f

or f

urth

er c

are,

if n

eces

sary

Com

mu

nit

y le

vel

In-s

ervi

ce tr

aini

ng f

or c

omm

unity

-lev

el h

ealt

h w

orke

rs

in e

ssen

tial n

ewbo

rn c

are

IEC

mes

sage

s/m

ater

ials

abo

ut:

•T

he d

ange

r si

gns

of n

ewbo

rn il

lnes

s an

d th

e ne

ed to

see

k im

med

iate

car

e

•T

he im

port

ance

of

imm

uniz

atio

ns, g

row

th

mon

itori

ng a

nd f

ollo

w u

p •

Infa

nt a

nd y

oung

chi

ld f

eedi

ng

In-s

ervi

ce tr

aini

ng f

or c

omm

unity

-lev

el h

ealt

h w

orke

rs

in e

ssen

tial n

ewbo

rn c

are

Dis

pen

sary

leve

l A

ll of

the

abov

e pl

us:

Tra

inin

g of

hea

lth w

orke

rs in

ess

entia

l new

born

car

e

Con

tinuo

us s

uppl

y of

: Ess

entia

l dru

gs a

nd v

acci

nes

and

equi

pmen

t for

new

born

res

usci

tatio

n (m

ucou

s ex

trac

tor,

new

born

tube

and

mas

k de

vice

for

new

born

re

susc

itati

on)

Hea

lth

cen

tre

leve

l A

ll of

the

abov

e pl

us:

Con

tinuo

us s

uppl

y of

: oxy

gen,

I.V

. flu

ids,

par

enta

l an

tibio

tics

Hos

pit

al:

All

of th

e ab

ove

plus

:

Tra

inin

g of

hea

lth w

orke

rs a

nd la

b-te

chni

cian

s in

: -

man

agem

ent o

f th

e se

vere

ly s

ick

new

born

bab

y

Con

tinuo

us s

uppl

y of

labo

rato

ry te

st e

quip

men

t, eq

uipm

ent a

nd s

uppl

ies

for

anae

sthe

sia

and

surg

ery

PO

STP

AR

TU

M C

AR

E

TR

AIN

ED

H

EA

LT

HC

AR

E P

RO

VID

ER

A

T C

OM

MU

NIT

Y

DIS

PE

NSA

RY

H

EA

LT

H C

EN

TR

E

HO

SPIT

AL

SU

GG

EST

ED

IN

PU

TS

Prov

ide

IEC

to w

omen

, men

, fa

mil

ies

and

com

mun

ities

abo

ut:

•

the

need

s of

po

stpa

rtum

wom

en

•

bre

astf

eedi

ng

•

dan

ger

sign

s fo

r m

othe

r an

d ba

by

•

the

impo

rtan

ce o

f so

cial

su

ppor

t -

ITN

Prom

ote

bene

fici

al

trad

ition

al p

ract

ices

and

di

scou

rage

har

mfu

l one

s

Ref

er f

or f

irst

pos

tpar

tum

car

e vi

sit

with

in 4

8 ho

urs

of d

eliv

ery

Prov

ide

follo

w-u

p ca

re a

nd

supp

ort b

etw

een

post

part

um c

linic

vi

sits

an

d re

fer

for

prob

lem

s an

d co

mpl

icat

ions

Rec

ord

com

mun

ity-b

ased

hea

lth

info

rmat

ion

(e.g

., nu

mbe

r of

w

omen

re

ferr

ed f

or p

ostp

artu

m c

are)

As

at c

omm

unity

leve

l plu

s:

Obt

ain

preg

nanc

y/bi

rth

hist

ory

and

perf

orm

ph

ysic

al e

xam

inat

ion

of

mot

her

and

baby

Rec

ogni

se p

robl

ems

or

com

plic

atio

ns e

arly

(i

nfec

tions

, ble

edin

g an

d an

aem

ia)

and

man

age

appr

opri

atel

y or

ref

er f

or

furt

her

care

Iron

and

fol

ic a

cid

supp

lem

enta

tion

Prov

ide

vita

min

A a

nd

Mic

ronu

trie

nt

supp

lem

enta

tion

whe

re

App

ropr

iate

Prov

ide

coun

selli

ng a

bout

: -

Bre

astf

eedi

ng a

nd b

aby

care

-

Mat

erna

l nut

ritio

n -h

ome

care

-

ITN

-

Dan

ger

sign

s an

d ap

prop

riat

e ca

re s

eeki

ng

C

ontr

acep

tion

and

resu

mpt

ion

of s

exua

l act

ivity

•

Oth

er R

H c

once

rns

(e

.g.,

STD

s/H

TV

)

As

at d

ispe

nsar

y le

vel,

Man

age

mod

erat

e po

stpa

rtum

pr

oble

ms/

com

plic

atio

ns

incl

udin

g:

• m

ild to

mod

erat

e an

aem

ia

- M

ild p

uerp

eral

dep

ress

ion

Pre

-ref

erra

l tre

atm

ent o

f se

vere

pr

oble

ms

such

as

seve

re p

ost p

artu

m

blee

ding

, pue

rper

al s

epsi

s an

d se

vere

pu

erpe

ral d

epre

ssio

n.

As

at h

ealth

cen

tre

leve

l,

Man

age

seve

re p

ostp

artu

m

com

plic

atio

ns p

robl

ems

-

seve

re h

aem

orrh

age

-

seve

re p

ost p

artu

m in

fect

ions

-

seve

re p

ost p

artu

m d

epre

ssio

n -

fem

ale

ster

iliza

tion

Com

mu

nity

Lev

el:

IEC

mes

sage

s ab

out:

•

the

nee

ds o

f po

stpa

rtum

wom

en

•br

east

feed

ing

•im

mun

izat

ion

• d

ange

r si

gns

for

mot

her

and

baby

•

ben

efic

ial t

radi

tiona

l pra

ctic

es a

nd th

e im

port

ance

of

avoi

ding

har

mfu

l one

s I

n-se

rvic

e tr

aini

ng f

or c

omm

unity

-lev

el

heal

th w

orke

rs a

bout

the

impo

rtan

ce o

f ea

rly

post

part

um

refe

rral

and

fol

low

up

care

, rec

ordi

ng

Dis

pen

sary

leve

l In

-ser

vice

trai

ning

for

hea

lthca

re p

rovi

ders

res

pons

ible

for

po

stpa

rtum

car

e ab

out:

•C

onte

nt o

f po

stpa

rtum

car

e •

Sche

dule

of

visi

ts

•A

sses

smen

t ski

lls (

hist

ory

taki

ng a

nd p

hysi

cal

exam

inat

ion

of m

othe

r an

d ba

by

•C

are

prov

isio

n, in

clud

ing

mic

ronu

trie

nt

supp

lem

enta

tion

and

coun

selli

ng a

bout

bre

astf

eedi

ng,

baby

car

e, m

ater

nal n

utri

tion,

con

trac

eptio

n, a

nd o

ther

R

H c

once

rns

I(e.

g. S

TD

s/H

IV)

•P

re-r

efer

ral t

reat

men

t and

ref

erra

l of

wom

en w

ith

com

plic

atio

ns

Con

sist

ent s

uppl

y of

vit

amin

A a

nd o

ther

m

icro

nutr

ient

s an

d ba

sic

oral

dru

gs

Hea

lth

cen

tre

leve

l A

ll o

f th

e ab

ove

plus

: C

onsi

sten

t sup

ply

of I

V. F

luid

s, P

aren

tal d

rugs

(a

ntib

iotic

s, a

ntim

alar

ials

, MgS

O4)

, glo

ves,

soa

p an

d ot

her

equi

pmen

ts f

or m

anua

l rem

oval

of

plac

enta

Hos

pita

l Lev

el

All

of th

e ab

ove

plus

: T

rain

ing

of h

ealth

wor

kers

in m

anag

ing

seve

re

com

plic

atio

ns in

clud

ing

surg

ical

, lab

orat

ory

and

anae

sthe

siol

ogic

al p

roce

dure

s C

ontin

uous

sup

ply

of e

quip

men

t and

uti

litie

s fo

r su

rger

y , l

abor

ator

y te

sts

both

mic

robi

olog

y an

d bi

oche

mis

try,

ox

ygen

, equ

ipm

ent a

nd u

tilit

ies

for

bloo

d tr

ansf

usio

n.

PO

STA

BO

RT

ION

CA

RE

TR

AIN

ED

HE

AL

TH

CA

RE

P

RO

VID

ER

CO

MM

UN

ITY

D

ISP

EN

SAR

Y

HE

AL

TH

CE

NT

RE

H

OSP

ITA

L

SUG

GE

STE

D I

NP

UT

S

Pro

vide

IE

C to

wom

en, m

en,

adol

esce

nts

and

com

mun

ities

abo

ut:

•T

he d

ange

rs o

f un

safe

abo

rtio

n •

The

nee

d to

see

k im

med

iate

car

e at

a

heal

th f

acil

ity f

or c

ompl

icat

ions

Rec

ogni

se s

igns

of

abor

tion

earl

y

Rap

idly

ass

ess

cond

ition

of

patie

nt

Sta

bilis

e an

d re

fer

imm

edia

tely

As

at c

omm

unity

leve

l, pl

us:

Rap

idly

ass

ess

con

ditio

n of

pa

tient

Initi

ate

man

agem

ent o

f sh

ock

Initi

ate

trea

tmen

t of

seps

is

Ref

er p

atie

nt f

or f

urth

er c

are,

if

nece

ssar

y

Prov

ide

post

abo

rtio

n co

unse

lling

and

fam

ily

plan

ning

met

hods

Prov

ide

othe

r R

H s

ervi

ces

as

nece

ssar

y (e

.g. t

reat

men

t of

STD

s)

As

at d

ispe

nsar

y le

vel,

plus

:

Perf

orm

man

ual v

acuu

m a

spir

atio

n (M

VA

)

Ref

er c

ases

not

app

ropr

iate

for

MV

A

Initi

ate

pre-

refe

rral

trea

tmen

t of

and

refe

r fo

r fu

rthe

r ca

re a

s ne

eded

As

at h

ealth

cen

tre

leve

l, pl

us:

Man

age

com

plic

atio

ns, i

nclu

ding

:

•In

tra-

abdo

min

al in

jury

•

Ute

rine

per

fora

tion

•

Tra

nsfu

sion

for

bloo

d lo

ss

•Sh

arp

cure

ttage

•

Infe

ctio

n

Initi

ate

man

agem

ent o

f sh

ock

Initi

ate

trea

tmen

t of

seps

is

Ref

er p

atie

nt f

or f

urth

er c

are,

if

nece

ssar

y

Pro

vide

pos

t-ab

ortio

n fa

mily

pla

nnin

g (F

P)

coun

selli

ng a

nd m

etho

ds a

nd

othe

r R

H s

ervi

ces

as n

eces

sary

(e.

g.

ST

Ds/

HIV

)

Com

mun

ity

leve

l

IEC

mes

sage

s/m

ater

ials

abo

ut:

•T

he d

ange

rs o

f un

safe

abo

rtio

n •

The

nee

d to

see

k im

med

iate

car

e at

a h

ealth

fac

ility

for

co

mpl

icat

ions

•

Opt

ions

for

fam

ily p

lann

ing

and

acce

ss to

FP

serv

ices

In s

ervi

ce tr

aini

ng f

or C

omm

unity

hea

lth w

orke

rs a

bout

th

e ea

rly

reco

gniti

on o

f an

d re

spon

se to

sig

ns o

f ab

ortio

n

Dis

pens

ary

leve

l In

-ser

vice

trai

ning

for

hea

lthca

re p

rovi

ders

abo

ut th

e ea

rly

reco

gniti

on o

f an

d re

spon

se to

sig

ns o

f ab

ortio

n In

-ser

vice

ser

vice

trai

ning

for

hea

lth c

are

prov

ider

s ab

out

post

abo

rtio

n FP

cou

nsel

ling

and

met

hods

C

onsi

sten

t sup

ply

of I

V f

luid

s an

d in

fusi

on s

ets,

in

tram

uscu

lar(

IV/A

M)

antib

iotic

s, s

yrin

ges

Hea

lth

cent

re

All

of th

e ab

ove

plus

: Se

rvic

e pr

ovid

ers

trai

ned

in a

sses

smen

t of

com

plic

atio

ns

rela

ted

to p

ost a

bort

ion,

per

form

ance

of

MV

A ,

earl

y re

cogn

ition

of

dang

er s

igns

, pre

-ref

erra

l, re

ferr

al

man

agem

ent a

nd p

ost a

bort

ion

coun

selli

ng o

f w

omen

on

FP C

onsi

sten

t sup

ply

of I

V f

luid

s an

d in

fusi

on s

ets,

in

trav

enou

s/in

tram

uscu

lar

(IV

/IM

) an

tibio

tics,

sy

ring

es/n

eedl

es, c

ontr

acep

tives

(or

al p

ills,

inje

ctab

les,

co

ndom

s), M

VA

equ

ipm

ent,

glov

es, s

oap

and

wat

er,

antis

eptic

sol

utio

n

Hos

pita

l lev

el

All

of th

e ab

ove

plus

: C

ompe

tenc

y-ba

sed

skill

s tr

aini

ng f

or d

octo

rs in

sur

gica

l pr

oced

ures

for

intr

a-ab

dom

inal

inju

ry a

nd u

teri

ne

perf

orat

ion

Equ

ipm

ent a

nd d

rugs

for

ana

esth

esia

, ins

trum

ents

and

co

nsum

able

sup

plie

s fo

r ob

stet

ric

surg

ery,

blo

od

tran

sfus

ion

equi

pmen

t

FA

MIL

Y P

LA

NN

ING

TR

AIN

ED

HE

AL

TH

CA

RE

P

RO

VID

ER

CO

MM

UN

ITY

D

ISP

EN

SA

RY

H

EA

LT

H C

EN

TR

E

HO

SP

ITA

L

SU

GG

ES

TE

D I

NP

UT

S

Pro

vide

IE

C to

wom

en, m

en,

adol

esce

nts

and

com

mun

ities

abo

ut

the

heal

th b

enef

its

of:

•D

elay

ing

firs

t pre

gnan

cy

•S

paci

ng b

irth

s an

d lim

iting

fam

ily

size

Cou

nsel

cli

ents

for

FP

, inc

ludi

ng a

ll m

etho

ds

Pro

vide

con

trac

eptiv

e pi

lls

Pro

vide

bar

rier

met

hods

(co

ndom

s,

foam

s, je

llies

)

Ref

er c

lien

ts f

or o

ther

FP

ser

vice

s as

ne

cess

ary

Rec

ord

com

mun

ity-b

ased

hea

lth

info

rmat

ion

(e.g

. num

ber

of c

lient

s re

crui

ted

for

FP

)

As

at c

omm

unity

leve

l, pl

us:

Obt

ain

targ

eted

his

tory

; pe

rfor

m p

hysi

cal e

xam

inat

ion

Scr

een

for

ST

Ds;

trea

t as

nece

ssar

y

Pro

vide

cou

nsel

ling

abou

t all

met

hod

and

prov

ide

met

hod

of

choi

ce, i

nclu

ding

IU

D a

nd

inje

ctab

les

(whe

re s

kills

and

su

pplie

s ar

e av

aila

ble)

Ref

er a

s ne

eded

As

at d

ispe

nsar

y le

vel,

plus

:

Pro

vide

Nor

plan

t ins

ertio

n an

d re

mov

al

Ref

er c

lien

ts w

ho d

esir

e su

rgic

al

ster

iliza

tion

As

at h

ealt

h ce

ntre

leve

l, pl

us:

Per

form

sur

gica

l ste

riliz

atio

n (p

erm

anen

t met

hods

)

Com

mu

nit

y le

vel

IEC

mes

sage

s/m

ater

ials

abo

ut th

e he

alth

ben

efits

of:

•

Del

ayin

g fi

rst p

regn

ancy

•

Spa

cing

bir

ths

and

limit

ing

fam

ily s

ize

In-s

ervi

ce tr

aini

ng f

or c

omm

unity

leve

l hea

lth w

orke

rs

abou

t FP

cou

nsel

ling

for:

•

Con

dom

s an

d ot

her

barr

ier

met

hods

•

Spe

rmic

ides

•

Ora

l and

inje

ctab

le c

ontr

acep

tives

•

IUD

•P

erm

anen

t met

hods

In

-ser

vice

trai

ning

for

com

mun

ity le

vel h

ealth

wor

kers

ab

out

•D

istr

ibut

ion

of p

ills

and

barr

ier

met

hods

•

Ref

erra

l •

Rec

ordi

ng

Dis

pen

sary

leve

l A

ll of

the

abov

e pl

us:

In-s

ervi

ce tr

aini

ng f

or h

ealth

care

pro

vide

rs r

espo

nsib

le f

or

FP

ser

vice

s ab

out a

sses

smen

t and

scr

eeni

ng, i

nclu

ding

hi

stor

y an

d ph

ysic

al e

xam

inat

ion;

cou

nsel

ling;

ST

D

scre

enin

g an

d tr

eatm

ent,

met

hod

prov

isio

n; r

efer

ral

Con

sist

ent s

uppl

y of

Vag

inal

spe

culu

m, g

love

s, s

oap

and

wat

er, I

UD

inse

rtio

n ki

ts, a

ntis

epti

c so

luti

on

Hea

lth

Cen

tral

leve

l A

ll of

the

abov

e pl

us:

Con

tinuo

us s

uppl

y of

ora

l and

inje

ctab

le c

ontr

acep

tive

s,

IUD

s, c

ondo

ms,

foa

ms,

jelli

es, N

orpl

ant a

nd e

quip

men

t for

re

mov

al.

Hos

pit

al le

vel

All

of th

e ab

ove

plus

:

Com

pete

ncy-

base

d sk

ills

trai

ning

for

doc

tors

in m

ale

and

fem

ale

ster

iliz

atio

n pr

oced

ures

and

ana

esth

esio

logy

Con

tinuo

us s

uppl

y of

Sur

gica

l ins

trum

ents

and

sup

plie

s as

w

ell a

s su

pplie

s an

d dr

ugs

for

loca

l and

gen

eral

an

aest

hesi

a

PR

EV

EN

TIO

N A

ND

MA

NA

GE

ME

NT

OF

CH

ILD

HO

OD

IL

LN

ES

S

TR

AIN

ED

HE

AL

TH

CA

RE

P

RO

VID

ER

CO

MM

UN

ITY

D

ISP

EN

SA

RY

H

EA

LT

H C

EN

TR

E

HO

SP

ITA

L

SU

GG

ES

TE

D I

NP

UT

S

Pro

vide

IE

C to

mot

hers

, fat

hers

, fa

mili

es a

nd c

omm

uniti

es a

bout

: •

Rec

ogni

tion

of d

isea

ses

•T

he d

ange

r si

gns

of il

lnes

ses

•P

rom

otio

n of

key

hea

lthca

re

prac

tice

s •

Ava

ilabi

lity

and

use

of o

ral

rehy

drat

ion

solu

tion

(OR

S)

•

Nut

ritio

n •

Bre

astf

eedi

ng

•Im

mun

izat

ion

•In

sect

icid

e tr

eate

d be

dnet

s •

Wat

er a

nd s

anit

atio

n •

Hou

seho

ld p

repa

redn

ess

for

prev

entio

n an

d tr

eatm

ent o

f ill

ness

As

at c

omm

unity

leve

l, pl

us:

Ass

ess

and

man

age

acc

ordi

ng

to th

e IM

CI

guid

elin

e un

com

plic

ated

cas

es o

f::

•D

iarr

hoea

•

Acu

te r

espi

rato

ry in

fect

ion

(AR

I)

•M

alar

ia

•M

alnu

trit

ion

•O

ther

chi

ldho

od il

lnes

ses

•P

aedi

atri

c H

IV

Use

of

oral

and

IM

ant

ibio

tics

, m

edic

atio

ns

Rec

ogni

tion

of d

ange

r si

gn a

nd

pre-

refe

rral

trea

tmen

t and

re

ferr

al a

ccor

ding

to I

MC

I gu

idel

ine.

Cou

nsel

car

egiv

er o

n ap

prop

riat

e ho

mec

are

and

nutr

ition

Pro

vide

gro

wth

mon

itori

ng,

vita

min

A s

uppl

emen

tatio

n

and

vacc

inat

ion

serv

ices

Ens

ure

all c

hild

ren

are

asse

ssed

and

man

aged

co

mpr

ehen

sive

ly d

urin

g al

l po

ints

of

cont

act w

ith th

e he

alth

fac

ility

incl

udin

g (a

sses

smen

t and

trea

tmen

t of

illne

sses

, gro

wth

mon

itori

ng

and

nutr

ition

al c

ouns

ellin

g,

imm

uniz

atio

n st

atus

)

As

at d

ispe

nsar

y le

vel,

plus

:

Use

of

IV f

luid

s m

edic

atio

ns

As

at h

ealt

h ce

ntre

leve

l, pl

us:

Lab

orat

ory

diag

nosi

s of

res

pira

tory

in

fect

ions

, dia

rrho

ea, m

alar

ia, a

naem

ia

Tre

atm

ent o

f ch

ild w

ith c

ompl

icat

ed

illne

sses

Pro

visi

on o

f H

IV te

stin

g an

d tr

eatm

ent

for

Chi

ldre

n w

ith H

IV

Com

mu

nit

y le

vel

IEC

mes

sage

s/m

ater

ials

abo

ut:

•R

ecog

nitio

n of

dis

ease

s •

The

dan

ger

sign

s of

illn

esse

s •

Pro

mot

ion

of k

ey h

ealth

care

pra

ctic

es

•A

vaila

bili

ty a

nd u

se o

f O

RS

•

Nut

ritio

n •

Bre

astf

eedi

ng

•Im

mun

izat

ion

•In

sect

icid

e tr

eate

d be

dnet

s •

Wat

er a

nd s

anit

atio

n •

Hou

seho

ld p

repa

redn

ess

for

prev

entio

n an

d tr

eatm

ent o

f ill

ness

Com

mun

ity-l

evel

hea

lth w

orke

rs w

ith im

prov

ed s

kills

abo

ut

the

prev

entio

n, r

ecog

nitio

n, h

ome

care

and

ref

erra

l of

com

mon

chi

ldho

od d

isea

ses

Dis

pen

sary

leve

l In

-ser

vice

trai

ning

for

hea

lthca

re p

rovi

ders

in T

he

prev

entio

n an

d m

anag

emen

t of

child

hood

illn

ess,

gro

wth

m

onito

ring

, im

mun

izat

ion

serv

ices

, cou

nsel

ling

for

pare

nts

of s

ick

child

ren,

rec

ogni

tion

of d

ange

r si

gns,

pre

-ref

erra

l tr

eatm

ent a

nd ti

mel

y re

ferr

al

Con

sist

ent s

uppl

y of

: Inj

ecta

ble

med

icat

ions

, Ant

imal

aria

ls,

Ant

ibio

tics,

Syr

inge

s/ne

edle

s, O

RS

, Zin

c

Hea

lth

cen

tre

leve

l A

s ab

ove

plus

:

Tra

inin

g of

lab

assi

stan

t in

bio

chem

ical

and

m

icro

biol

ogic

al te

sts

Con

tinuo

us s

uppl

y of

IV

set

s, s

yrin

ges,

nee

dles

and

par

enta

l dr

ugs

(ant

icon

vuls

ants

, ant

ibio

tics,

ant

imal

aria

ls, I

V f

luid

s),

equi

pmen

t and

util

itie

s fo

r bi

oche

mic

al a

nd m

icro

biol

ogic

al

labo

rato

ry te

sts

Hos

pit

al le

vel

All

of th

e ab

ove

plus

:

Tra

inin

g of

hea

lth w

orke

rs in

man

agem

ent o

f se

vere

ly il

l ch

ild in

clud

ing

tria

ge, e

valu

atio

n of

x-r

ays

TR

AIN

ED

HE

AL

TH

CA

RE

P

RO

VID

ER

CO

MM

UN

ITY

D

ISP

EN

SAR

Y

HE

AL

TH

CE

NT

RE

H

OSP

ITA

L

SUG

GE

STE

D I

NP

UT

S

Con

tinuo

us s

uppl

y of

ess

entia

l dru

gs f

or m

anag

emen

t of

the

seve

rely

sic

k ch

ild, n

asog

astr

ic tu

bes,

oxy

gen

equi

pmen

t, se

lf in

flat

ing

resu

scita

tion

bags

with

mas

ks, f

olly

cat

hete

rs,

Glo

ves,

dis

infe

ctan

ts, n

ebul

iser

, equ

ipm

ent f

or lu

mba

r pu

nctu

re, f

orm

ulas

for

man

agem

ent o

f se

ver

acut

e m

alnu

triti

on, e

quip

men

t for

blo

od tr

ansf

usio

n,

X-r

ay f

acili

ty


ANNEX 3RELEVANT POLICY DOCUMENTS

MoHSW (2004). Reproductive and Child Health Strategy, 2005-2010..

MoHSW- Expanded Programme on Immunization (2005). Comprehensive Multiyear Plan, 2006-2010.

MoHSW (1999). Staffing Levels for Health Facilities and Institutions.

MoHSW (2002) EPI Multi Country Evaluation Report

MoHSW (2004). National Adolescent Health and Development Strategy, 2004 -2008.

MoHSW (2005). Guidelines for Reforming Hospitals at Regional and District Levels.

MoHSW (2005). Communication Strategy for Child Health, 2005-2010.

MoHSW (2005). National Tracer Standards and Indicators for Quality Improvement in Health Care (Draft).

MoHSW (2005). Proposed Staffing levels for Health Facilities and Training Institutions.

MoHSW (2006). The National Road Map Strategic Plan to Accelerate Reduction of Maternal and NewbornDeaths in Tanzania, 2006-2010.

MoHSW (2006). Situation Analysis of Emergency Obstetric Care for Safe Motherhood in Public HealthFacilities in Tanzania

MoHSW (2007). Primary Health Services Development Programme (PHSDP/MMAM), 2007-2017.

MoHSW (2007). Tanzania National Health Policy (draft).

MoHSW (2007) Tanzania National Voucher Scheme Survey.

MoHSW (2008). Human Resource for Health Strategic Plan, 2008-2013.

MoHSW (2008). National Supervision Guidelines for Quality Health Care Services (Draft).

MoHSW (2007) Postnatal Care Guidelines (draft)

MoHSW (2007) Maternal and Perinatal Death Audit Guidelines (draft)

MoHSW (2007) Kangaroo Mother Care Guidelines (draft)

MoHSW, Prime Ministers Office Regional Administration and Local Government (2007). ComprehensiveCouncil Health Planning Guidelines.

MoPE (2006). Tanzania Population, Reproductive Health and Development. Population and Planning SectionTanzania Partnership for Maternal Newborn and Child Health Work Plan, 2007-2008.

Vice President’s Office ( 2005). National Strategy for Growth and Reduction of Poverty (NSGRP).


ANNEX 4

MOST COST EFFECTIVE INTERVENTIONS BASED ON EVIDENCE TO DATE FORREDUCTION OF PERINATAL AND NEONATAL MORTALITY

Source: Neonatal Survival 2 Darmstadt, G. Bhutta, ZA, Cousens, S, Taghreed, A, Walker, N, de Bernis, L, Evidence-Based, Low-costinterventions: How many newborn babies can we save? www.the lancet.com published on line 3 March 2005 http:// image. The lancet.com/extras/05 art 17 web. The authors use scale rangingfrom 1 to 5, with 5 having the most evidence of effectiveness1

Pre conceptionAmount ofEvidence

Reduction (%) in all cause neonatalmorbidity and mortality/major riskfactor if specified (effect range)

Folic acid supplementation 1V Incident in neural tube defect: 72% (42-87%)

Antenatal

Tetanus toxoid immunization. V 1V

33%-58% Incidence of neonatal tetanus 88-100%

Syphilis screening and treatment 1V Prevalence dependant Pre eclampsia and eclampsia. prevention (calcium supplementation

1V Incidence of prematurity 34%(-1-57%) Incidence of low birth weight31%(-1-53%)

)%35-1-(%23V1.airalamrofTPIDetection and treatment of symptomatic bacteriuria

1V Incidence of prematurity, low birth weight 40 %( 20-55%)

Intrapartum

Antibiotics for pre term rupture of membranes.

1V Incidence if infections 32 %( 13-47%)

Corticosteroids for preterm labour 1V 40 %( 25-52%) Detection and treatment of breech (c-section)

1V 40%(25-52%

Labour surveillance (including partograph)

1V Early neonatal death40%

Clean delivery practices 1V Incidence of neonatal tetanus.55-90%latantsoP

Resuscitation of new born V 6-42% %78-55VgnideeftsaerB

Prevention and management of hypothermia

1V 18-42%

Kangaroo mother care 1V Incidence of infections52 %( 7-75%) Community based pneumonia case management.

V 27% (18-35%).


ANNEX 5Evidence-Based Interventions that Influence Child Health

Various evidence-based child health interventions have been identified. These interventions can contribute toreduction in neonatal and under-five mortality when implemented in high coverage 90%. The packaging ofthese interventions results into great/significant impact.

Community mobilization and engagement and antenatal and postnatal domiciliary. Behaviour change communication to promoteevidence-based neonatal care practices (breastfeeding, thermal care, clean and cord care), care seeking, demand for quality clinicalcare) Promotion of clean delivery and referral of complications (home birth) Kangaroo mother care.

Interventions Preventive % of reduction Neonates Child Pregnantmother

Lactatingmother

XX%31gnideeftsaerB XComplementary feeding 6% X Vitamin A supplementation 2% X X XVaccination-measles 1% XFamily and Community care package 10-20% X X X X

%7NTI X X X Water, sanitation and hygiene 3% X X X X KMC for low birth weight 2% X Resuscitation of newborn 4% X

%5cniZ XX%4yrevilednaelC X

Nevirapine and replacement feeding 2% X Treatment interventions Antibiotics for dysentery 3% xAntibiotic for sepsis 6% X X

XX%51noitardyherlarOAntibiotic for pneumonia 6% X X

%5airalamitnA X X %4cniZ X

Emergence neonatal care: managementOf serious illness (infections Asphyxia, prematurity,jaundice)

X


ANNEX 6

EVIDENCE-BASED INTERVENTIONS FOR MATERNAL, NEWBORN AND CHILD HEALTH

Intervention packageThe following evidence based interventions are expected to be provided at all levels.

1. For Adolescent girls and women in childbearing age (Pre-pregnancy)• Adolescent friendly health services• Family planning• Folic acid.• Iron tablets• Tetanus toxoid• Prevention, care and treatment for HIV/AIDS

2. Post abortion care• Manual vacuum aspiration and if not available sharp curettage• Uterotonic drug (ergometrin or misoprostol)• I.V. antibiotics if infection suspected

3. During Antenatal period: at least 4 antenatal care visits for normal pregnancies, including one visitwithin the first 3 months of pregnancy.

Key ante-natal services include• Confirmation of pregnancy• Monitoring of progress of pregnancy and assessment of maternal fetal well-being• Prevention, care and treatment for HIV/AIDS (PMTCT).• Tetanus toxoid immunization.• Counselling on nutrition, breastfeeding, healthy life style.• Insecticide treated bed nets• Development of birth preparedness plan, emergencies, referral care in case of complication,

breastfeeding and advice on danger signs.• Screen for protein and anaemia including blood group• Iron and folic acid supplementation.• Deworming• Identification and treatment of bacteriuria • Identification and treatment of problems complicating pregnancy: hypertension, bleeding,

malpresentation, multiple pregnancy, etc.• Screening and treatment of syphilis and malaria. (IPT and promotion of ITN).• Assessment for female genital mutilation

4. Services delivered during Labour, delivery, and first 1 to 2 hours• killed attendance at birth• Monitoring progress of labour, maternal and fetal well being with partograph• Providing supportive care and pain relief• Clean and safe delivery • Temperature maintenance of mother and child including Kangaroo Mother Care.• Immediate and exclusive breast-feeding.• Cord and eye care.• Emergency obstetric care for complications including*:


• Treatment of abnormalities and complications (prolonged labour, vacuum extraction, breechpresentation, episiotomy, repair of genital tears, manual removal of placenta)

• Pre-referral management of serious complications (e.g. obstructed labour, fetal distress, preterm labour,severe peri- and postpartum haemorrhage)

• Emergency management of complications if birth is imminent• Treatment of severe complications in childbirth and immediate postpartum period, including caesarean

section, blood transfusion and hysterectomy:• Induction and augmentation of labour• Antibiotics for premature rupture of membranes*• Neonatal resuscitation. *• Management of newborn complications. *• Prevention, care and treatment of HIV/AIDS(PMTCT) • Active management of third stage of labour• Vitamin A supplementation

5. Maternal care: 1 to 2 hours care and after delivery to six weeks.• Prevention and detection of complications (e.g. infections, bleeding and anaemia)• Anaemia prevention and control (iron and folate supplementation)• Information and counselling on nutrition, safe sex and family planning• Advice on danger signs and emergency preparedness• Provision of contraceptive methods• Promote use of ITN• Pre-referral treatment of complications (e.g. severe postpartum bleeding and puerperal sepsis)*• Treatment of complications (anaemia, postpartum bleeding, infections and postpartum depression)*

6. Newborn care: 1 to 2 hours care and after delivery to 2 months.• Promotion, protection and support for exclusive breast-feeding.• Monitoring and assessment of wellbeing and detection of complications• Rooming-in• Eye care• Temperature management (kangaroo mother care)• Cord care and hygiene.• Information and counselling on home care, breastfeeding, hygiene and advice on danger signs and care

seeking.• Promotion of ITN • Recognition of danger signs and prompts care seeking.• Detection and management of local infections, diarrhoea, and feeding problems• Special care for the small baby (low birth weight). *• Treatment of infections*• Pre-referral management of infants with severe problems (Very preterm babies and/or very low birth

weight; severe complications; malformations)*• Presumptive treatment of congenital syphilis*• Prevention, care and treatment of HIV/AIDS (PMTCT). *• Management of complication, serious infections, severe jaundice, very low birth weight babies, preterm

birth, breathing difficulties, severe birth trauma and asphyxia*.• Management of correctable malformations*• Treatment of neonatal tetanus*• Follow up of new born in need of special care*


7. Older infants and children (2 month to 5 years)Preventive

• Assessment of infants wellbeing, detection of complications and responding to maternal concerns• Information and counselling on home care• Additional follow-up visits for high risk babies (pre-term or after complicated delivery or neonatal

period)• Exclusive breast-feeding up to 6 months• Continued breastfeeding (at least up to 2 years)• Nevirapine and replacement feeding (PMTCT)• Safe and appropriate complementary feeding (from 6 months)• Insecticide treated nets• Immunization• Vitamin A supplementation twice a year• De worming twice a year• Water, sanitation, hygiene.• Growth monitoring and follow-up interventions• Salt iodation

Curative• Integrated management of childhood illnesses• Oral rehydration therapy and Zn for diarrhoea*• Antibiotics for dysentery*• Antibiotics for pneumonia*• Treatment of malaria with recommended combination therapy*• Vitamin A for measles*• Detection and management of severe and moderate malnutrition*• Care and treatment of HIV/AIDS*• Pre-referral management of severe conditions*• Quality management of seriously sick children*

Note: All interventions should be available for all pregnant women, newborns and children except thosemarked* which need to be provided only for illness or complications.

*Indicates care if condition arises adapted from: Newborn Health; Policy and Planning Framework, Part 1, 2004/5 WHO and

Save the Children.


PROCEDURE SCORE % DEFICIT EXPECTED 2015 Antenatal care four visit 68% 32% 90% Blood Pressure taken 65% 35% All must have BP checked Blood taken for Haemoglobin and Syphilis screening

50% 50% More than 70% must be screened

Urine Analysis 41% 59% All must have urine checked if equipment available

Information of danger signs in pregnancy childbirth

47% 53% At risk mothers should be identified

Delivery at health facilities 47% 53% Health facility deliveries 80%

Skilled birth attendant deliveries

46% 54% Skilled birth attendant 80%

Delivery by Caesarean Section

3% 12% 15% should be delivered by C/S

Emergency Obstetric Care in hospitals

64.5% 35.5% All first referral centres must provide EmOC

Emergency Obstetric Care Health Centres

5.5% To achieve MDG 5 all Health Centres must provide EmOC

Breastfeeding at any given time

95% 5% All women should breast feed

Exclusive breastfeeding rate 0 – 6ms

41% 58% EBF rate 0-6 mo 80%

Vitamin A supplementation within 2 months after delivery

20% 80% All post delivery mothers should receive Vitamin A

Iron tablets for at least 90 days to pregnant mothers

10% 90% All women for ANC must be given Iron/Folic acid

Tetanus Toxoid Current usage of contraceptives

26% married, 41% unmarried

Family planning to address unmet needs

Community Based Programmes RCH

46 districts out of 124

78 districts have no CBD Programme

All districts should target to have CBD

ANNEX 7

WHERE DOES TANZANIA STAND IN TERMS OF MNCHSERVICE DELIVERY?


Basic Essential Newborn Care with Resuscitation equipment like AMBU BAGS and Oxygen

None in DSM for secondary and primary health facilities

Municipalities hospitals in DAR and health centres must establish Basic Essential Newborn Care to decongest MNH neonate ward

All labour wards in the country must have a small unit for care of neonates

PMTCT Plus 700 sites so far established by Sept. 2007

Ideally all hospitals and health centres country wide should have PMTCT established and coordinated through RCH services

Paediatric HIV care and treatment

Integrated case management of Childhood Illnesses

60% of sick children seen by IMCI trained HW

100% of sick children seen by IMCI trained HW

80% of health facilities have 60 % of health workers trained in IMCI

Community IMCI 41 out of 114 LGA’s implementing

73 LGA’s All districts should have c-IMCI CORP’s in at least 75% of villages

ORS use rate 54% 46% 90% ORS use rates Zinc supplements for diarrhoea

0% 100% 80%

Anti- Malarial treatment within 24hrs of fever onset

57% 43% 80% prompt treatment

ITN coverage for under-fives

21% 79% 80%

Immunization coverage for all antigens

71% 29% Over 85%

Facility management of severe malnutrition

6 hospitals All hospitals

Community Management of Severe Malnutrition

0 LGA’s 114 LGA’s Established in all LGA’s

Baby friendly health facilities

28% 72% All hospitals baby friendly


ANNEX 8

ESSENTIAL MATERNAL NEWBORN AND CHILD HEALTHMEDICINES, EQUIPMENT AND SUPPLIES

A. Neonate and Child medicines1. Chloramphenicol inj 1g2. Benzathine Penicillin inj 5 MU3. Gentamicin inj 40mg4. Procaine Penicillin Fortified inj; 4 MU/vial5. Cotrimoxzole syrup 200/40 mg /5 ml susp6. Cotrimoxzole tab 400/80mg7. Cotrimoxzole paediatric tab 100/20mg8 Amoxycillin 250mg tab9 Amoxycillin syrup 250mg/5ml or 125mg/5ml10 Salbutamol metred dose inhaler 100µg/puff

(0.1mg/enhale)11. Salbutamol tab 1mg12. IV infusion Ringers Lactate 250mls13. IV infusion Normal Saline14. Low Osmolarity Oral Rehydration Solution sachets15. Zinc dispersable tablets 20mg16. Quinine injection 300mg/ml; 2ml17. Quinine tab 300mg18. Quinine syrup 150/300mg 19. 25% Dextrose IV infusion20. Artemether Lumefantrine (Alu) (paediatric21. Paracetamol tab 500mg22. Paracetamol syrup 120mg23. Vitamin A 200,000 IU oil capsule with nipple24. Vitamin A 100,000 IU oil capsule with nipple25. Vitamin A 50,000 IU oil capsule with nipple26. Oxytetracycline eye ointment 0.1% 5g tube27. Ciprofloxacin ear drops28. Ferrous Sulphate 100mg/ml29. Ferrous fumarate 20mg/ml30. Fe/folic acid tab 200mg/0.25 mg31. Nystatin oral susp 100,000IU/ml32. Gentian Violet paint 0.5%33. Mebendazole tab 500mg34. Formula 100 (F100)35. Formula 75 (F-75)36. Combined Mineral Vitamin Mix37. Metronidazole 250mg38. Daizepam inj 5mg/ml; 2ml vial39. Phenobarbitone inj 200mg/ml;40. Vitamin K1 inj41. Savlon solution42. Povidone Iodine solution10%43. Water for inj44. Metered infusion giving sets45. Cannula size 25G46. Cannula size 24G47. Scalp vien 23 G48. Blood infusion giving sets

B. Child Essential equipment and supplies1. Oxygen concentrator2. Haemoglobimometers3. Glucometers4. Glucostics5. Suction Machines6. Suction catheters 6FG, 8FG7. Paediatric resuscitation kit8. Nebulisers9. Paediatric infusion pump10. Warming devices11. Thermometers- normal reading12. Thermometers-low reading13. NGT, 5-814. Feeding cups15. Nasal prongs16. Weighing scale17. Syringes, disposable- 2mls/5mls18. Feeding syringes 20mls19. Feeding syringes 50mls20. Cotton wool absorbent non sterile 500gm21. Plaster adhesive, plastic perforated 25mm x 10m22. RCH 1 card23. Methylated spirit24. Inpatient record book25. Inpatient monitoring form

C. Neonatal Essential Equipments and supplies:1. Towels2. Cord ties or clamp, sterile blade3. Container of eye ointment/drops4. Clock with second hand5. Clinical thermometers (preferably low reading6. Secca weighing scales7. Newborn size Masks, size 0 and 18. Self inflating bag9. Suction machine10. Suction tubes11. Surgical blades12. Surgical gloves and clean gloves13. Canulas14. Bucket of water15. Small graduated feeding cups16. Container for expressed breast milk17. Kettle or jug18. Gallipot19. Heater radiant/movable20. Resuscitation tables21. Phototherapy machines22. Pulse Oxemetry23. Stands24. Exchange blood transfusion set


25. Linen Baby Package, blankets, sheets and pillowsfor mothers

26. Scissors27. Waste disposal containers

D. Maternal medicines1. Ergometrine 0.5mg inj2. Oxytocin 5 IU/ml , 10 IU/ml;3. Frusemide 10mg / ml4. Magnesium Sulphate inj 50% (500mg / ml)5. Fe/ Folic acid 200mg /0.250mg tab6. Folic acid 5mg tab7. Ferrous Sulphate 100mg/ml8. Ferrous fumarate 20mg/ml9. Lidocaine inj 1% 10ml vial10. Mebendazole 100mg tab11. Aminophyline 100mg tab12. Aminophyline 25mg/ml 10ml inj13. Amoxycillin 250mg tab14. Methlydopa (Aldoment) 250mg15. Chloramphenicol inj 1g16. Co-trimoxazole 400/80mg tabs17. Cloxacillin 250mg tab 18. Clotrimazole vaginal pessary19. Ceftriaxone 500mg tab20. Erythromycin 500mg tab21. Ciprofloxacin 500mg tab22. Tetracycline or doxycycline500mg tab23. Diazepam 5mg/ml 2ml inj24. Doxycycline 100mg tabs25. Epinephrine (Adrenaline) 1mg/ml inj; 1ml26. Metronidazole 250mg tab27. Procaine penicillin Fort. 4MU/vial28. Sulfadoxine 500mg/Pyrimethamine 25 mg (SP) tabs29. Nevirapine (adult, infant) 30. Zidovudine (AZT) (adult, infant) 31. Lamivudine (3TC) 32. FP contraceptive - pills (COC,POC), injectables,

IUCD, condoms ( FP & HIV prevention)33. Vaccine - Tetanus toxoid , BCG, OPV, DTP, Measles 34. Dextrose 5% (IV infusion)35. Normal Saline 0.9% (IV infusion)36. Ringers lactate IV infusion37. Glucose 50% solution38. Water for injection

E. Maternal essential equipment and supply1. Infusion giving sets (I.V giving set)2. Blood infusion giving sets3. Cannula size 14 – 18 G4. Catgut chromic 2.0, 3.0 5. Cotton wool absorbent non sterile 500g6. Gauze absorbent BPC 90 cm x 100m hosp quality7. Surgical latex rubber sterile gloves 7.58. Syringe disposable 5ml + needle9. Syringe disposable 2ml + needle10. Catheters 30cc two ways11. Umbilical cord tie, cotton, (Ligature) 3mm; 100m12. Sheeting rubber Mackintosh 1 meter13. Cotton sheet / green 1 meter14. Savlon solution15. Povidone Iodine solution 10%16. Bleach (chlorine base compound) 17. Soap bar 113g18. Impregnated bed net 19. Register Books for – ANC, FP, Delivery, Neonatal,

Child, Postnatal 20. Client cards - Ante-natal cards -RCH 4, FP card -

RCH 5

F. Maternal equipment1. Blood pressure machine and stethoscope 2. Foetal stethoscope 3. Delivery kit 4. Laparatomy set5. IUCD insertion kit6. Manual Aspiration kit 7. Vacuum extractor, Bird, manual/SET,8. D&C curettage /SET:9. Dressing Tray, sets, 300 x 200 x 30 mm

G. Maternal tests reagents1. RPR testing kit; 2. Test strips for urinalysis, glucose ,protein ,; 3. HIV testing kit (2 types), 4. Hemoglobin testing kit 5. Container for catching urine,


GLOSSARY

Basic emergency obstetric care: Functions that can be provided by an experienced nurse/midwife or physician, saving the lives of many women, and stabilizing women who need to go further for more sophisticated treatment

Caesarean section rate Number of caesarean section performed per total number of births

Comprehensive emergency obstetric care

Includes basic EMOC functions as well as blood transfusion and caesarean sections Comprehensive Post Abortion Care

Contraceptive Prevalence rate The percentage of women using method of family planning

Exclusive breast feeding An infant receives only breast milk and no other liquids or solids, NOT even water, with the exception of drops or syrups consisting vitamins, mineral supplements of medicines.

Infant mortality rate The probability of dying before the first birthday expressed per 1000 live births

Maternal death The death of a woman while pregnant or within 42 days of termination of pregnancy

Maternal mortality ratio The number of pregnancy rated deaths per 100,000 live births

Neonatal death Probability of dying within the first 28 days birth.

Neonatal mortality rate Probability of dying within the first month of life expressed per 1000 live birth

Perinatal deaths Death of a foetus from 28 weeks of gestation to seven completed days of life including still births

Reproductive health Reproductive health is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity, in all matters relating to reproductive system and its functions and process. This implies the rights to have satisfying and safe sex life, the capability to reproduce and the freedom to decide if, when and how often to do so.

Skilled care Refers to the care provided to the woman and her newborn during pregnancy, childbirth and immediately after, by an accredited and competent provider who has at her/his disposal necessary equipment and the support of a functioning health system including transport and referral facilities for emergency obstetric and newborn care.

Skilled attendants Is an accredited health professional such as the midwife, doctor or a nurse who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complication in women and newborns.

Under-five mortality rate The probability of dying between birth and fifth birthday

ANNEX 9


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