Transcript magnitude of maternal mortality

PRIVATE HEALTH SECTORS ROLE IN THE
PROVISION OF MATERNAL AND CHILD
HEALTH SERVICES IN TANZANIA
PRESENTED BY PROF. R. S. M.LEMA‐ DIRECTOR,
MASSANA HOSPITAL AND COLLEGE OF NURSING
APHFTA EAHF SCIENTIFIC
CONFERENCE
26TH - 28TH FEBRUARY 2013
DIAMOND JUBILEE, DAR ES SALAAM
OUTLINE OF OVERVIEW
• Magnitude and Causes of Maternal
Mortality in Tanzania.
• Factors contributing to Maternal and
Newborn Mortality.
• Private contribution to Strategies to
reduce
Maternal Child Health Mortality.
• Conclusion and Recommendation
MAGNITUDE OF MATERNAL
MORTALITY
• Worldwide more than 600,000
women die annually of pregnancy
and childbirth.
• Africa accounts for 50% of worlds
Maternal Mortality burden although
only 12% of world population and
20% of births occur in Africa.
Maternal Mortality Ratio in Tanzania:
YEAR
MMR
1976
520/100,000
1986
529/100,000
1999(DHS)
527/100,000
2004(DHS)
578/100,000
2010(WHO)
454/100,000
Causes of Maternal Mortality
•
•
•
•
•
•
•
TDH (2004/2005)
Obstetric Haemorrhage
28%
Abortion Complication
19%
Pregnancy Induced Hypertension
17%
Obstructed Labour
11%
Sepsis
11%
Indirect Cause
14%
NMR (TDHS 2004/2005) – 578/100,000 live births
Causes of Neonatal Mortality
Sepsis and Pneumonia
Birth Asphyxia
Preterm Births
Congetal Malformation
Diarrhea
Tetanus
Others
29%
27%
23%
7%
3%
3%
8%
TDHS – 2004/2005 – NMR = 32 per 1000 live
births
FACTORS CONTRIBUTING TO HIGH
MATERNAL MORTALITY IN TANZANIA
• Direct Factors – The three delay model:
1. Delay in decision making on pregnancy
care and childbirth significantly influence
poor pregnancy outcome.
2. Poor access to appropriate and affordable
health facility when emergency occurs.
Lack of transport (ambulances)emergencies
and poor infrastructure.
Direct Cause cont…..
3. Lack of Essential Emergency Obstetric care
facilities at all levels from District to
National Hospitals (only 40% facilities have
Basic Essential Emergency Obstetric care
facilities).
4. Lack of skilled health providers at delivery
units.
Indirect Causes:1. Low contraceptive Prevalence Rate – CPR
34.8%% (2010)
2. Illiteracy – Low education for women
3. Inappropriate Health Seeking behaviour
40% of women who attended ANC deliver at
home under care of untrained birth
attendants. Decline Facility Delivery –
1992(52%), 1996 (47%), 1999 (44%).
Indirect Cause cont…..
4. Social-cultural determinants –
women oppression, Low status of
women making decision delay.
5. Indirect causes – HIV / AIDS,
Malaria, Anaemia (on increase).
STRATEGY FOR REDUCTION OF MATERNAL
AND NEWBORN MORBIDITY AND
MORTALITY
Consists of six main national programs:
1. Family Planning
2. Safe Motherhood initiative
3. Expanded Program on Immunization.
4. Integrated Management of Childhood Illness
5. Community Based Health Care (CBHC)
6. School Health Program
STRATEGY OF MOHSW
• Liaison with Ministries, Partners and other
relevant organizations at all levels.
• Formulation of Advisory Committee which is
multi-sectoral and multi disciplinary chaired
by Population planning unit in President’s
Office.
• Active involvement and participation of
districts and local communities in process of
implementation.
STRATEGIES CONT…..
• Make use of existing resources and empower
districts to provide quality services based on
national guidelines and protocols - translating
relevant policies and strategies into operational
plans which can be implemented and sustainable.
• Adopt performance improvement approach as
model to lead and steer towards achievement of
these goals and objectives. (on job skill training)
Service Delivery
•
•
•
•
Policy Guidelines for RCH services
Service Delivery Standards for RCH
RCH Essential Health Package
Guidelines for implementation of CBD
activities.
• Policy guidelines in School Health promotion
CONTRIBUTIN OF PRIVATE HEALTH
FACILITY IN SERIVE DELIVERY
• A wide range of facilities
managed by the private health
sector make a significant
contribution to health prevosion
in Tanzania.
• A total of 6.342 health facilities are
operating in Tanzania 1,924 run PFP
or PNFP organization i.e. one third of
health services the country are
offered by private sector,
Total Number Of Health Facilities
In Tanzania
Facility
Type
Governm parastat
ent
al
PNFP
PFP
Total
Hospital
95
8
101
36
240
Health
Centres
Dispensaries
434
10
134
55
633
3,889
168
625
787
5,469
Total
4418
186
860
878
6,342
69.6%
3.0%
13.6%
13.8%
100.0%
Percent of
Total
• Private Health sector particularly play a
big role in offering HIV/AIDS, RCH, TB,
and malaria services.
• Private sector mainly FBO are involved
in National Multi-secteral Strategic
Framework jointly coordinated with
NACP and TACAIDS.
PMTC SERVICES
• Women receiving PMTCT services
increased from 8.5% in 2004 to 55%
in 2010.
• The private sector accounts for only
14% in providing PMTCT services.
DISTRIBUTION OF PMTCT SERVICES
(2010) TESTING AT ANC
FACILITY STATUS
%
PUBLIC
86%
PNFP
12%
PFP
2%
Almost all women receive PMTC services exclusively from
public sector.
This pattern is similar to patient seeking HIV testing.
Source of Contraceptives 2010
Source
Tanzania
Mainland
Urban
Mainland
Rural
Mainland
PUBLIC
63%
50%
69%
PNFP
7%
5%
6%
PFP
27%
42%
20%
OTHERS
3%
3%
5%
• Source 2010 DHS
• Source of contraceptive relatively stable over past 10
years
REPRODUCTIVE AND CHILD HEALTH
SERVICES
• Access and provision of services remain a
significant barrier to Tanzania.
• Total fertility rate remain high – 5.4
children per women.
• Only 54.1 percent delivery in health
facilities.
•
ANTENATAL CARE
Source of Antenatal Care for women 4 visits 2010
Source
PUBLIC
PNFP
PFP
OTHERS
Mainland
32%
9%
57%
2%(< 4 Visits)
Urban
Tanzania
58%
10%
7%
25%
Rural
Tanzania
24%
9%
1%
66%
Most women attending ANC in PFP where those of upper
quintile 40% and above who were 64%.
DELIVERY SERVICES
Source of Delivery 2010
Source
Mainland
Urban
Tanzania
Rural
Tanzania
PUBLIC
41%
68%
34%
PNFP
8%
11%
7%
PFP
7%
5%
1%
OTHERS
49%
16%
58%
Notes also that 60% of women who delivered in private sector
where those in upper quantity.
This is consistent with women who seek care in private sector.
DIARRHEAL DISEASE
Source of Diarrhea Treatment
Source
%
PUBLIC
44%
PNFP
5%
PFP
20%
NONE
31%
MALARIA
. Fever or Cough 2010
• Source of Treatment for
mainly public.
• Fever and cough are proxy for Malaria.
• High malaria burden 40% of outpatient visits.
• 17-20 million annual cases.
• 80,000 annual deaths.
• Leaking cause of morbidity and mortality
• 17.7 percent children under 5 test positive.
•
Source of Treatment for Fever and
Cough 2010
Source
PUBLIC
PNFP
PFP
NONE
%
51%
6%
24%
19%
• ROLE OF PRIVATE HEALTH
FACILITIES IN MCH SERVICES IN
DAR ES SALAAM
DISTRIBUTION OF HEALTH FACILITIES
IN DAR ES SALAAM
DISTRICT
Ilala
Temeke
PUBLIC
PRIVATE
TOTAL
S
22 (13.3%) 144 (86.7%)
166
29 (27%)
79 (73%)
108
Kinondoni
30 (13.5%) 192 (86.5%)
222
Totals
81 (6.1%)
496
415(93.9% )
Role of Private Health Facilities in
Providing MCH Services:
Almost all private health facilites in Dar
es Salaam offer free MCH and
Vaccination services for free as their
community social responsibility (CSR)
. There is no compensation neither is there
any motivation.
MCH/VACCINATION SERVICES
–Private Health facilities contribute
significantly in Tanzania of
MCH/Vaccination as shown in table I
and II below:
I. VACCINATION IN DAR ESSALAAM –
2008
MUNICIPAL
COUNCIL
TOT NO OF
FACILITIES
VACCINATION
PUBLIC
29 (35%)
PRIVATE
TEMEKE
83
54 (65%)
ILALA
55
21 (38.2%)
34 (61.8%)
KINONDONI
83
33 (39.8%)
50 (60.2%)
II. MCH AND PMTCT SERVICES
MUNICIPAL
COUNCIL
NO OF
FACILITIES
MCH
PMTCT
TEMEKE
76
33 (42%)
28 (35.4%)
ILALA
144
19 (13.2%) 15 (10.4%)
KINONDONI
192
31 (16.1%) 40 (20.8%)
2. MCH/VACCINATION SERVICES
IN TEMEKE MUNICIPALITY
• Temeke Municipality has 79 private
health facilities out of these 54 (68.4%)
provide vaccination doing vaccination
campaigns and 33 (42%) provided
routine MCH services. Twenty eight i.e.
35.4% provide routine PMTCT services.
1. MCH/VACCINATION SERVICES
IN ILALA MUNICIPALITY
• Ilala has a total of 144 private health facilities.
• 34 (61.8%) offer vaccination during
vaccination campaign.
• Routine MCH services are provide by 19
(13.2%) of the private health facilities and
fifteen (10.4) provide PMTCT services
3. MCH VACCINATION SERVICES IN
KINONDONI MUNICIPALITY
• Kinondoni Municipality has 192
private health facilities of these
31(161%) provide routine MCH
services and 50(26%) provide
vaccination services during
vaccination campaigns and 40(20%)
provide PMTCT services.
WAY FORWARD /RECOMMENDATION
• Private Health sectors should be taken on
board from planning point of RCH
services.
• Government should be committed to 3P.
It should not be a lip service. We are
contributing significantly as noted.
• MOHSW should extend its PPP universal
coverage of RCH services by supporting
the private health sector.
WAY FORWARD/ RECOMMENDATION
Cont..
• Encourage continuous dialogue with the
Ministry of Health in offering RCH
services to women, Newborn and
Children.
• Government should n come up with a
program to give coupon to pregnant
women so that when they have an
emergency they can go to the nearest
private hospital.
WAY FORWARD /RECOMMENDATION
Cont..
• Equal partners – Government must treat
private sector as equal partners for a strong
partnership.
• Private partnership – Private partnership
should be encouraged for referral among
private facilities.
• Government should Encourage private sector
to grow by financial human resources and
moral support
IT CAN BE DONE WE PLAY
OUR PART
Thank you for listening