Transcript Countdown to Child Survival in Tanzania

Tanzania Under five
Mortality Reduced by a
Quarter: Why??
Countdown to 2015 Child Survival
Dr. Theopista John,
WHO Country Office - Tanzania
United Republic of Tanzania
London , 13-14 Dec 2005
Ministry of Health
Outline

3 Key Messages and supporting evidences

Conclusions

Challenges

Implications for universal access to Child survival
interventions
United Republic of Tanzania
Ministry of Health
Key message 1
Child survival in Tanzania
has improved substantially
in the past few years.
United Republic of Tanzania
Ministry of Health
Evidence for recent child survival gains
National DHS
180
160
162
141
145
136
Mortality (nq0)
140
147
-24%
120
100
112
91
92
87
80
-31%
60
40
37.9
32
Under-five
99
40.4
Infant
68
48.4
32
Neonatal
MDG
Target
20
0
1990
1992
1996
1999
2004
2009
2015
Source: URT Measure DHS
An improvement of 24% in under 5 mortality represents
39,200 fewer child deaths per year in Tanzania
United Republic of Tanzania
Ministry of Health
Key message 2
Child survival is improving
because of better access to
higher quality essential
health services for children.
United Republic of Tanzania
Ministry of Health
Evidence for coverage gains
Situation
National IMCI coverage (Districts)
1999
2005
20 districts 107 districts
(17.5) %
(93.8%)
National Measles immunization coverage
78%
97%
National ITN coverage of children under 5
2%
10%
Under-fives with fever treated with antimalarial
53%
58%
National Vitamin A supplementation (12-23m)
21%
46%
National ORT coverage
55%
70%
Exclusive breastfeeding at 6 months
11%
41%
Skilled attendant at birth
38%
47%
United Republic of Tanzania
Ministry of Health
Evidence from MCE-IMCI

Key messages from Multi Country Evaluation
of IMCI




Improved quality of care for sick children
IMCI cost less per child managed correctly ($4.02)
compared to routine care ($ 25.70)
Contribution to Child mortality reduction by 13%
Significant reduction in stunting
United Republic of Tanzania
Ministry of Health
Evidence from MCE-IMCI…
Effect of IMCI on treatment of sick children
Quality of child care in first
level facilities
Percentage of children
IMCI HFS 00
no IMCI HFS 00
100
80
86
IMCI HFS 03
73
60
60
57
67
35
40
20
0
Oral antibiotics or
antimalarials correctly
prescribed, for children
needing them
Children not needing
antibiotics left facility without
antibiotics
Difference in mortality between IMCI and comparisons districts
Districts
U5MR per 1000 live
births
Before
After
IMCI (Morogoro, Rufiji)
128
115
Comparison (Kilombero,
Ulanga)
127
133
United Republic of Tanzania
Mortality was 13%
lower in IMCI
districts
Ministry of Health
IMCI improves quality of care
% ch ild ren correctly m an ag ed
100
C om parison districts
IMC I districts
80
75
69
65
60
40
23
20
24
16
0
A ll ch ild ren
C h ild ren w ith
C h ild ren w ith
p rio rity
n o n -p rio rity
co n d itio n s
co n d itio n s
Sick children managed correctly in IMCI and comparison facilities
United Republic of Tanzania
Ministry of Health
Cost per child managed correctly
in Tanzania
Cost per child correctly managed, Tanzania
(1999 US$)
$25
$4
IMCI
United Republic of Tanzania
Non-IMCI
Ministry of Health
Evidence for recent child survival gains
Rufiji District Sentinel surveillance (RDSS)
180
160
141
Mortality (nq0)
140
120
108
113
102
110
100
-48%
Under-five
Infant
73
80
66
68
73
-60%
46
60
40
Source: MOH
TEHIP / NSS
20
0
1999
2000
United Republic of Tanzania
2001
2002
2003
Ministry of Health
Key message 3
Better access to quality
health services as a result
of policies and investments
supporting the Tanzanian
Health System.
United Republic of Tanzania
Ministry of Health
Evolution of health sector in Tanzania
Strong Investment in
Rural Health
Infrastructure &
Primary Health care
1960
1970
Health Sector Reforms
Structural
adjustment and Debt
Crisis
1970
United Republic of Tanzania
1980
Essential health
interventions &
Sector wide Approach
1990
1990
2000
Ministry of Health
Aligning budgets with
priorities

1996-97


Before basket funding
and planning
tools………..
2000-01

After basket funding
and planning
tools………..
United Republic of Tanzania
Ministry of Health
Challenges

Sustaining the observed child health gains

Inadequate coverage of interventions and tools e.g
District burden-of-disease planning tool & health budget
mapping tools

HIV/AIDS pandemic threatening to reverse the gains

Co-ordination at national, district and community level
United Republic of Tanzania
Ministry of Health
Conclusions


Tanzania has a comparative advantage for Child
Survival

Good access & utilization of health facilities

Health sector reform

Poverty Reduction Strategy- PRSP II (NSGRP)
Potential for achieving the child survival ;

Mobilizing available resources for child health
interventions

Scaling up of and universal access to effective
interventions

Strengthening Partnership at all levels e.g. Maternal,
Newborn and Child Health Partnership
United Republic of Tanzania
Ministry of Health
Implications for universal coverage

National Health Sector Strategic plan and Development
frameworks to support Child survival


Increasing resource allocation for scaling up of child survival
delivery interventions and strategies
Decentralization at district including;


capacity building for planning and budgeting
Use of data for decision making and resource allocation e.g. DHA,
BOD,SHM

Prioritization of essential interventions

Harmonization and convergence of partners through
National Partnerships e.g. Maternal Newborn and Child
Survival Partnership
United Republic of Tanzania
Ministry of Health
Implications for Universal Coverage
It is never too late to invest in developing sustainable
health systems that provide evidence based, cost
effective and high impact interventions with high
coverage and quality.
United Republic of Tanzania
Ministry of Health
Thank you
United Republic of Tanzania
Ministry of Health