HIGHLIGHTS OF MDGs & MKUZA II IN ZANZIBAR HEALTH SYSTEM OPPORTUNITIES & CHALLENGES

Presented by : Dr. Mkasha Hija Mkasha (On behalf of Acting DG) 1

Introduction

• Eight Goals were set during 1990 Millennium Development earlier Declaration to guide the development process with defined targets for each goal which are to be achieved by 2015 or • Goal 4, 5 and 6 are directly related to health and the remaining are indirectly related 2

Intro. Cont……

• • • To reach the desired targets Zanzibar developed its national strategy (MKUZA ZSGRP), While at Ministerial level - Health Policy which is translated into sector Strategies and annual plan of action Robust Health systems are required to meet the MDGs in each of the six building blocks.

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Goal 1: Eradicate extreme poverty and hunger (Indirect)

Indicator Target 2015 Status

Reduce % of underweight for children Under 5 years 19.9% 13.9% (2014

National Nutrition Survey – Preliminary results)

Reduce % of stunting for children Under 5years 23.8% 24.4% (2014

National Nutrition Survey – Preliminary

results) Zanzibar has shown an improvement in reducing malnutrition 4

Goal 4: Reduce child mortality Progress has been made in reducing infant and child mortality

Indicator

Reduce Under-five mortality rate (U5MR)

Target 2015

67/1,000 live births Reduce infant mortality rate (IMR) Increase Proportion of children vaccinated against measles 40/1,000 live births 100%

Status

66/1,000 live births (

2012 census

preliminary results)

46/1,000 live births (2012 census

preliminary results)

>100% (HMIS Bulletin ,2013) Reduce Neonatal mortality rate (NMR)****MKUZA 15/1,000 live births 29/1,000 live-births (2009/10 TDHS) 5

Goal 5:

Improve maternal health 1. Reduce Maternal Mortality

Trend of MMR

MMR 2015 target = 170 /100,000 live births.

Remains a challenge Joints efforts are needed to reduce

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Indicator

Improve maternal health cont...

2 . Proportion of births attended by skilled health personnel

Target 2015

90%

Status

60% (HMIS Bulletin, 2013) 3. Increase percentage of births delivered in health facilities *** MKUZA 60% 56.6% (HMIS Bulletin, 2013 20% 12.4% (TDHS 2009/10) 4. Contraceptive prevalence rate *** MKUZA 7

Goal 6: Combat HIV/AIDS, malaria and other diseases

HIV: Indicator Target 2015 Status

HIV prevalence among general population

*** MKUZA

HIV prevalence among pregnant women aged 15 -24 years HIV Prevalence among CSW reduced

*** MKUZA

HIV Prevalence among MSM

*** MKUZA

HIV Prevalence among IDUs reduced

*** MKUZA

< 1% 0.3% 5.4% 6.1% 7.5% 1.1% (2012 THMIS) 0.6% (

2014 ANC surveillance)

8.6% (IBBSS, 2012) 2.6% ( IBBSS, 2012) 11.3% ( IBBSS, 2012) 8

HEALTH SYSTEM OPPORTUNITIES & CHALLENGES

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• • • • • •

Opportunities

Political stability and commitment Availability of national plans to support MDGs implementations (Vision 2020, MKUZA and sector policy and strategies Government commitment in health issues Partners financial and technical support to the health sector Extensive health system in Zanzibar Health management information system (HMIS) uses (DHIS2) 10

Challenges

• •

Governance

Implementation of the health policy Inadequate monitoring and follow up

Human Resource

• • Inadequate skills in caring neonates Treatment according to guidelines is a challenge at all levels 11

Challenges ….

•

Human Resource cont...

Shortage of medical specialist (high number of support staff) – Gynecologist: none available minimum staff requirement = 12 vs.

– Anesthetic nurses and doctors are not available all maternity emergencies in all hospitals 12

Challenges ….

•

Logistic, Drugs and Medical Supplies

Inadequate medical equipment, drugs and supplies 13

Challenges ….

• • • •

Finance

Underfunding of the health sector (per capita expenditure is ($23) which is lower than that recommended by WHO of $ 60 Donor - driven support Sustainability of Malaria financing Imbalance funding from vertical programmes (lots of fund are allocated to vertical programs than other areas) 14

Challenges …

• • • •

Service delivery

Negative attitudes in provision of health services (YFS and condom) No referral guidelines at all levels Low health education in the community In adequate interventions on neonatal death 15

• • • •

Challenges ….

Health Information

Incomplete data for neonatal deaths at community High stigma for PLHIV Insufficient of vital data on civil registration Causes of morbidity and mortality are not classified using ICD 10 16

Thank you

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