June 2015 arushatimes; Tanzania has achieved Millennium Development Goal (MDG) 4 for child survival, yet progress for maternal and newborn survival is off track, according to the Tanzanian Countdown to 2015 Country Case Study, published in The Lancet Global Health on 16th June to mark the Day of the African Child.
This study collected and analysed the best available data from 1990 (MDG baseline) to assess changes in maternal, newborn and child mortality, determinants of this change and who was being left behind.
Co-author Professor Joy Lawn, from London School of Hygiene & Tropical Medicine, and a leader in Countdown to 2015, commented “Across Africa very few countries have achieved these targets, and we commend Tanzania. Many neighbouring countries are not on target and this study advances our understanding of how progress was made, and also what the urgent actions are to make sure women and their babies are not left out of this progress.”
Tanzania has made remarkable progress for reducing child deaths after the first month of life, and this progress increased to over 8% per year during the last decade, almost 50% faster than in the 1990s.
This study estimated how many lives have been saved and which interventions may have contributed the most, with the most lives saves estimated to be from vaccines (12,500), malaria (9300) and HIV/AIDS (5800) programmes.
Notably these programmes received significantly more donor funding. Yet progress is about 50% slower for newborn and maternal deaths, and even slower for stillbirths (deaths during the last 3 months of pregnancy). Newborn deaths now account for 40% of child deaths nationally, and the rate of progress since 1990 has been half that for children after the first month of life.
Approximately 3,300 maternal deaths are estimated to have been prevented each year, the majority (70%) associated with skilled care at birth. Any assessment of progress in Tanzania needs to take account of the doubling of the population during the past two decades, putting huge pressures onto the healthcare system (and other social services such as education), which would need to have doubled in size just to reach the same proportion.
However the gap for addressing family planning needs has remained the same for 20 years. While modern contraceptive use has increased even in rural areas, there are two geographical regions (Western and Lake zones) where use remains extremely low. Improving health services around the time of birth are a key missed opportunity.
The study reveals that the rural poor are being left behind, with rural women twice as likely to deliver outside a health facility and three times less likely to have a caesarean, in part related to gaps in access, especially to human resources notably midwives, and to the poor quality of care at birth (including labour and delivery, immediate care after birth and during the postnatal period).
Dr Neema Rusimabayila, Director of Preventive Services, Ministry of Health and Social Welfare Mainland Tanzania, said “We can be proud of progress for child survival, but know that more must be done for Tanzania’s mothers and newborns, and that is why we have prioritised these actions in a short term national plan that we call the “Sharpened One Plan”.
This is already being implemented in the regions and districts. With the national and subnational level score cards, we will be able to track progress and improve accountability.”
The authors outline the following urgent priorities for Tanzania, already incorporated into the Sharpened One Plan, in order to end preventable maternal, newborn and child deaths by 2030 and contribute to the achievement of the Sustainable development Goals (SDGs):
1. Address family planning needs especially in the Western and Lake zones, and for adolescents;
2. Ensure all women and newborns receive quality care around the time of birth, especially close the urban/rural gap; and
3. Finish the unfinished agenda for child survival to sustain the gains in MDG 4.