SITUATION OF MATERNAL HEALTH IN TANZANIA
“OBSTACLES AND PARTNERSHIP WITH GRASSROOT”
PAPER PRESENTED TO FLEMATA MEETING ON KISARAWE INITIATIVE,
31 AUGUST 2007
LENA MFALILA (MRS)
SAFE MOTHERHOOD COORDINATOR
MINISTRY OF HEALTH AND SOCIAL WELFARE
PRESENTATION OUTLINE:

BACKGROUND

DEFINITIONS

MATERNAL AND CHILD HEALTH SITUATION IN TANZANIA

WHY MATERNAL AND NEWBORN DEATHS

HEALTH DELIVERY SYSTEMS FOR MCH

CONSTRAINTS

CHALLENGES

WHAT CAN BE DONE?

ROAD MAP

CONCLUSSION
BACKGROUND:
IN THIS WORLD, EVERY MINUTE …. ONE WOMAN DIES OF PREGNANCY
OR BIRTH RELATED COMPLICATIONS
WHO DEFINES MATERNAL DEATH AS:
DEATH OF A WOMAN WHILE PREGNANT OR WITHIN 42 DAYS OF
TERMINATION OF PREGNANCY, IRRESPECTIVE OF THE DURATION AND
SITE OF PREGNANCY FROM CAUSE RELATED TO OR AGGRAVATED BY
THE PREGNANCY OR ITS MANAGEMENT, BUT NOT FROM ACCIDENTAL
OR INCIDENTAL CAUSES
PERINATAL DEATH:
DEATH OF A FOETUS FROM 28 WEEKS OF GESTATION TO SEVEN
COMPLETE DAYS OF LIFE INCLUDING STILLBIRTHS
PERINATAL MORTALITY;
IS A SENSITIVE INDICATOR OF HEALTH STATUS OF WOMEN, THE
HEALTH OF THE NEWBORN AND QUALITY OF HEALTH CARE PROVIDED
DURING PERINATAL PERIOD ESPECIALLY DELIVERY AND IMMEDIATE
POSTNATAL PERIOD
MAJOR DIRECT CAUSES OF MATERNAL DEATHS:
HAEMORRHAGE

SEPSIS

OBSTRUCTED LABOUR


UN-SAFE ABORTION

PREGNANCY INDUCED HYPERTENSION
INDIRECT CAUSES:

ANAEMIA

MALARIA

HIV/AIDS
MAJOR CAUSES OF PERINATAL DEATHS:

ASPHYXIA

SEPSIS

LOW BIRTH WEIGHT/PRE-TERM
Most of these deaths occur within first 24 hours of life
DIRECT CAUSES OF NEONATAL DEATHS IN TANZANIA
MATERNAL AND CHILD HEALTH SITUATION: According to TDHS 2004/5

TOTAL FERTILITY RATE= 5.7

CONTRACEPTIVE PREVALENCE RATE (CPR): Modern methods= 20%; All methods = 26%

ADOLESCENT CHILD-BEARING= 26%

HIGH ANTENATAL CARE COVERAGE- 94% AT LEAST ONE VISIT; 62%
MAKES FOUR OR MORE VISITS

MATERNAL MORTALITY RATIO- 578/100,000 LIVE BIRTHS

UNDER 5 MORTALITY RATE = 112/1000 LIVE BIRTHS

INFANT MORTALITY RATE = 68/1000 LIVE BIRTHS

NEONATAL MORTALITY RATE = 32/1000 LIVE BIRTHS
CARE DURING DELIVERY

47% DELIVER IN A HEALTH FACILITY

46%- SKILLED ATTENDANCE AT DELIVERY

53% DELIVER AT HOME
-19% BY TBA
-31% RELATIVES
-3% NO ASSISTANCE

POSTNATAL CARE-15% OF WOMEN WHO DELIVER OUTSIDE HEALTH
FACILITY RECEIVE CARE DURING THE FIRST SEVEN DAYS AFTER
 BIRTH- MATERNAL DEATHS:
TANZANIA IS AMONGST COUNTRIES WITH VERY
HIGH NUMBER OF MATERNAL DEATHS IN THE WORLD. THE HIGH
MATERNAL AND NEWBORN MORTALITY CONSTITUTE A SILENT
EMERGENCY IN AFRICA, (WHO, 2004)

TWO DECADES AFTER SAFE MOTHERHOOD INITIATIVE (SMI);
THE MATERNAL AND PERINATAL MORTALITY LEVELS HAVE
SADLY CONTINUED TO RISE INSTEAD OF DECLINING.
HEALTH INDICATORS ARE NOT IMPROVING WHICH MAY BE
ATTRIBUTED BY POOR QUALITY OF HEALTH SERVICES PROVIDED
(Reproductive and Child Health Survey, 1999; TDHS, 2004/5)
POVERTY, SOCIAL EXCLUSION, LOW LEVELS OF EDUCATION AND
WOMEN VIOLENCE/ABUSE ARE AMONGST THE CONTRIBUTING
FACTORS.
REASONS FOR FAILURE TO SIGNIFICANTLY REDUCE MATERNAL AND
NEONATAL MORTALITY INCLUDE:
LACK OF NATIONAL COMMITMENT AND FINANCIAL SUPPORT

LACK OF ACCESS TO, AVAILABILITY AND USE OF QUALITY SKILLED
CARE DURING PREGNANCY, CHILDBIRTH AND THE IMMEDIATE
POSTNATAL PERIOD

INADEQUATE MALE INVOLVEMENT COUPLED WITH LOW STATUS OF
WOMEN WITH POOR DECISION MAKING POWER REASONS

POORLY FUNCTIONING HEALTH SYSTEMS, WITH WEAK REFERRAL
SYSTEMS, ESPECIALLY DURING OBSTETRIC AND NEONATAL
EMERGENCIES
 WEAK NATIONAL HUMAN RESOURCE DEVELOPMENT AND
MANAGEMENT, INCLUDING THE CONTINUING BRAIN DRAIN OF
SKILLED PERSONNEL WITHIN AND OUTSIDE AFRICA, AND FROM
PUBLIC TO PRIVATE SECTOR

GROWING POVERTY PARTICULARLY AMONG WOMEN

HARMFUL SOCIO-CULTURAL BELIEFS AND PRACTICES.

POOR CO-ORDINATION AMONGST PARTNERS
THESE DEATHS ARE HIGHLY PREVENTABLE WITH HIGH QUALITY
MATERNAL HEALTH SERVICES THAT ARE APPROPRIATE, EFFECTIVE,
ACCESSIBLE, AFFORDABLE AND ACCEPTABLE TO WOMEN WHO NEED
THEM. (WHO, 1998)
WHY A MATERNAL DEATH OCCURS
1) Women has to become pregnant
2) Develop complication/s during pregnancy, delivery or postpartum period
3) Complication/s developed is/are not addressed adequately or not addressed at all.
TO PREVENT MATERNAL DEATHS
FAMILY PLANNING , PREVENTION OF UNWANTED AND HIGH RISK
PREGNANCIES

ENSURE SKILLED CARE DURING CHILDBIRTH

ENSURE ACCESS TO QUALITY EMERGENCY CARE WHEN A
COMPLICATION ARISES

ABOVE INTERVENTIONS REQUIRES A FUNCTIONING HEALTH SYSTEM

FAMILY PLANNING

FOCUSED ANTENATAL CARE

SKILLED ATTENDANCE AT BIRTH

IMMUNIZATION
HEALTH DELIVERY SYSTEM- FOR MATERNAL HEALTH
 POST INDEPENDENCE TANZANIA IDENTIFIED POVERTY, IGNORANCE
AND DISEASES AS THREE MAJOR ENEMIES FOR DEVELOPMENT AND
ADOPTED A SOCIALIST POLICY

INCLINED TO EQUITY IN DISTRIBUTION OF RESOURCES,

FREE HEALTH SERVICES FOR ALL, PRIORITY TO VULNERABLE
GROUPS- UNDER FIVE CHILDREN AND PREGNANT WOMEN (POLICY OF
FREE SERVICES)

ESTABLISHED COMPREHENSIVE MCH CLINICS AT ALL LEVELS OF
HEALTH FACILITIES INCLUDING CARE OF PREGNANT WOMEN AND
UNDER FIVE CHILDREN, FAMILY PLANNING, POSTNATAL CARE (IN 1974)

OTHER SERVICES- GRADUALLY ADDED- HIV COUNSELLING AND
TESTING INCLUDING STI TREATMENT, PREVENTION OF MOTHER TO
CHILD TRANSMISSION OF HIV (PMCTC)
CONSTRAINTS- INADEQUATE SKILLED HUMAN RESOURCE –IN NUMBER
AND SKILL MIX:

ONLY 32% OF THE REQUIRED HUMAN RESOURCE

AVAILABLE PROVIDERS ARE OVERWORKED

INADEQUATE ESSENTIAL EQUIPMENTS, SUPPLIES AND MEDICINES
CONSTRAINTS.. CONT…

ONLY 5% OF HEALTH CENTRES PROVIDE BASIC EMERGENCY
OBSTETRIC CARE

ONLY 64.5% OF HOSPITALS PROVIDE COMPREHENSIVE EMERGENCY
OBSTETRIC CARE

COMPETING DEMANDS ON THE HEALTH SYSTEM- OTHER DISEASE
BURDEN-E.G HIV/AIDS,MALARIA AND TUBERCLOSIS
INADEQUATE ESSENTIAL EQUIPMENT, SUPPLIES AND MEDICINES
CONSTRAINTS
POOR REFERRAL SYSTEM

TRANSPORT

COMMUNICATION SYSTEM

BAD ROADS
POLICY ISSUES

INADEQUATE RESOURCES FOR MATERNAL HEALTH

INADEQUATE PRIORITISATION OF MATERNAL HEALTH IN DISTRICT
HEALTH PLANS


EXEMPTION POLICY- FREE MATERNAL HEALTH CARE SERVICES NOT
ALWAYS IMPLEMENTED

WEAK HEALTH INFRASTRUCTURE-INADEQUATE EQUIPMENT AND
SUPPLIES
POOR MALE INVOLVEMENT
 AS POLITICAL/ LEADERS IN GOVERNMENT-POLICY LEVEL WILL
ENSURE POLITICAL COMMITMENTAND ADEQUATE RESOURCES
ALLOCATIONS TO IMPROVE MATERNAL HEALTH AND REDUCE
MATERNAL DEATHS
 LEADERS IN THE COMMUNITY E.G RELIGIOUS LEADERS, AND
LEADERS OF NGOS&CBOS- ADVOCATE FOR MATERNAL AND CHILD
HEALTH SERVICES E.G. FAMILY PLANNING SERVICES, SAFE BLOOD,
HIV TESTING AND USE OF CONDOMS
MALE INVOLVEMENT- COMMUNITY/FAMILY LEVEL

MEN HAVE ROLE IN THE PROMOTION OF REPRODUCTIVE RIGHTS
AND SUCCESS OF THEIR OWN REPRODUCTIVE HEALTH AS WELL AS OF
WOMEN, CHILDREN AND YOUNG PEOPLE
E.G. SUPPORT THEIR SPOUSES IN BIRTH AND EMERGENCY
PREPAREDNESS, USE CONTRACEPTIVES-TO PLAN THEIR FAMILIES,
AND TO AVOID UNWANTED PREGNANCIES AND HIGH RISK
PREGNANCIES
CHALLENGES

ACCESS TO COMPREHENSIVE SEXUAL REPRODUCTIVE HEALTH
SERVICES (SRH) LIMITED TO ALL POPULATION SEGMENTS
ESPECIALLY ADOLESCENTS AND MEN

ADOLESCENT FRIENDLY SERVICES LIMITED IN COVERAGE AND
SCOPE OF SRH SERVICES DELIVERY

POOR QUALITY AND ACCESS TO SRH SERVICES
CHALLENGES CONT…..

STRATEGIES TO INVOLVE MEN IN MATERNAL HEALTH CARE

ACCEPTABILITY BY PROVIDERS- WILL NEED TRAINING AND
ORIENTATION

STRUCTURE OF THE CLINICS- SPACE, TIMING ETC

COORDINATION OF SRH ACTORS AT ALL LEVELS
THE RIGHT TO LIVE IS A BASIC HUMAN RIGHT
WHAT CAN BE DONE??
ACTIVE PROMOTION & IMPLEMENTATION OF ROAD MAP TO
ACCELERATE THE REDUCTION OF MATERNAL AND NEWBORN
MORTALITY TOWARDS THE ATTAINMENT OF THE MDGS IN AFRICA.
THE MINISTRY OF HEALTH AND SOCIAL WELFARE AT THE LEAD
WITH STRONG PARTNERSHIP AT ALL LEVELS

NATIONAL ROAD MAP STRATEGIC PLAN TO ACCELERATE REDUCTION
OF MATERNAL NEWBORN DEATHS
BACKGROUND:
 REGIONAL LEVEL ROAD MAP – ENDORSED BY THE AFRICAN
REGIONAL COMMITTEE OF HEALTH MINISTERS AND AFRICAN UNION
(SEPTEMBER 2004)
 NATIONAL ROADMAP STRATEGIC PLAN DEVELOPED BY MOHSW
WITH KEY STAKEHOLDERS THROUGH A CONSULTATIVE PROCESS:
 CONTRIBUTES TO THE ACHIEVEMENT OF MDGS (4 & 5) AND MKUKUTA
CLUSTER 2 GOALS (2.2,2.5) AND TARGETS (2.3, 2.4)
 PROVIDES GUIDANCE TO ACCELERATE NATIONAL EFFORTS TO
ADDRESS MATERNAL AND NEWBORN HEALTH
MDGs RELATED TO MATERNAL,NEWBORN AND CHILD HEALTH
 MDG 1: Eradicate Poverty and hunger
 Indicator: Rate of malnutrition in children under five
 MDG 4: Reduce Child Mortality
 Target 5: Reduce by two thirds, between 1990 and 2015, the under five mortality rate

INDICATORS: U5 MORTALITY RATE, INFANT MORTALITY AND
PROPORTION OF UNDER ONE IMMUNIZED AGAINST MEASLES
 MDG 5: Improve Maternal Health
 Target 6: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

INDICATORS: MMR, PROPORTION OF BIRTHS ATTENDED BY A
SKILLED ATTENDANT
 MDG 6: Combat HIV/AIDS, Malaria and other diseases
 Target 7: Halve halted by 2015 and began to reverse the spread of HIV/AIDS
 Target 8: Have halted by 2015 and begun to reverse the incidence of Malaria and other diseases

INDICATORS: HIV PREVALENCE AMONG 15-24 OLD PREGNAT WOMEN,
CONDOM USE RATE, ORPHANED CHILDREN
PROGRESS TOWARDS MDG 5 IN TANZANIA
PROGRESS TOWARDS MDG 4 IN TANZANIA
ROAD MAP OPERATIONAL TARGETS BY 2010
 REDUCED MATERNAL MORTALITY FROM 578 TO 265 PER 100,000 LIVE
BIRTHS BY 2010
 INCREASED COVERAGE OF BIRTHS ATTENDED BY SKILLED
ATTENDANTS FROM 46% IN 2004 TO 80% BY 2010
 REDUCED INFANT MORTALITY FROM 68 PER 1000 LIVE BIRTHS IN 2004
TO 41 BY 2010

 REDUCED NEONATAL MORTALITY FROM 32 PER 1000 LIVE BIRTHS IN
2004 TO 19 BY 2010
 REDUCED HIV PREVALENCE AMONG PREGNANT WOMEN FROM 8.7%
IN 2004 TO LESS THAN 5% BY 2010
STRATEGIES
1.ADVOCACY AND RESOURCE MOBILIZATION
 Increased commitment and resources for MNH
2. HEALTH SYSTEM STRENGTHENING AND CAPACITY DEVELOPMENT
 Provision and access to quality MNH care including FP services
 District health planning & management for MNH including FP
 Strengthening Referral system
 Research, monitoring and evaluation
3. COMMUNITY MOBILIZATION
 Promoting the household to hospital continuum of care
 Empowering communities for MNH
4. PROMOTION OF REPRODUCTIVE HEALTH BEHAVIOUR CHANGE

Intensify IEC & BCC interventions
5. FOSTERING PARTNERSHIP AND COORDINATION

Multi sectoral approach at all levels
1.ADVOCACY AND RESOURCE MOBILIZATION- KEY ACTIVITIES:
 COSTING THE PACKAGE FOR MATERNAL AND NEWBORN HEALTH
INCLUDING FP AND NUTRITION
 MOBILIZE HUMAN AND FINANCIAL RESOURCES FROM GOVERNMENT,
POLITICAL AND COMMUNITY LEADERS
 SENSITIZE THE NATIONAL LEADERS, CABINET AND
PARLIAMENTARIANS AND THEIR COMMITTEES ON MATERNAL AND
NEONATAL HEALTH ISSUES
 ESTABLISH AND CONDUCT MOTHER BABY DAY/ WEEK ANNUALLY AT
ALL LEVELS
 REVIEW REGULATIONS AND LEGISLATIONS
 ADVOCATE FOR RECRUITMENT AND DEPLOYMENT OF HEALTH
WORKERS

2. HEALTH SYSTEMS STRENGTHENING AND CAPACITY DEVELOPMENT-
KEY ACTIVITIES:

REVIEW/DEVELOP USER FRIENDLY PROTOCOLS, SERVICE
STANDARDS FOR ANTENATAL CARE, POSTNATAL CARE, NEWBORN
CARE, EMOC, FP AND NUTRITION

UPDATE TUTORS FROM VARIOUS SCHOOLS AND HEALTH
INSTITUTIONS ON MATERNAL AND NEWBORN CARE INCLUDING FP
AND NUTRITION

UPDATE KNOWLEDGE AND SKILLS OF SUPERVISORS, SERVICE
PROVIDERS ON MATERNAL AND NEWBORN CARE INCLUDING FP AND
NUTRITION .

UPGRADE ALL DISPENSARIES AND ALL HEALTH CENTRES TO
PROVIDE BASIC EMOC AND ESSENTIAL NEWBORN CARE

STRENGTHEN ALL HOSPITALS AND UPGRADE 50% OF HEALTH
CENTRES TO PROVIDE COMPREHENSIVE EMOC AND ESSENTIAL NEW
BORN CARE

DEPLOYMENT OF SKILLED PERSONNEL

PROVISION OF ESSENTIAL DRUGS, EQUIPMENT AND SUPPLIES
 INFRASTRUCTURAL IMPROVEMENT FOR SERVICE DELIVERY

FORECASTING, PROCURING, SUPPLY LOGISTICS MANAGEMENT OF
ESSENTIAL COMMODITIES FOR MATERNAL AND NEWBORN CARE AND
CONTRACEPTIVES
REFERRAL SYSTEM - KEY ACTIVITIES
 PROCURE AND INSTALL COMMUNICATION EQUIPMENT IN DISTRICT
HOSPITALS, SELECTED HEALTH CENTRES AND DISPENSARIES
 PROCURE AND UTILIZE AMBULANCES FOR REFERRAL PURPOSES
 ESTABLISH/REVIVE COMMUNITY EMERGENCY COMMITTEE TO
MOBILIZE COMMUNITY RESOURCE FOR EMERGENCY TRANSPORT,
BLOOD DONORS
 ESTABLISH MATERNITY WAITING HOMES WHERE APPLICABLE
RESEARCH, MONITORING AND EVALUATION

KEY ACTIVITIES
 UPDATE MONITORING DATA COLLECTION TOOLS TO INCLUDE EMOC
PROCESS INDICATORS AND OTHER MISSING INFORMATION ON
NUTRITION, POST ABORTAL, POSTNATAL CARE, NEWBORN CARE AND
REFERRAL FORMS, REGISTER FOR REFERRAL, LOG-BOOKS
 CONDUCT SUPPORTIVE SUPERVISION IN BOTH PUBLIC AND PRIVATE
HEALTH FACILITIES
 CONDUCT PERIODIC MINI SURVEY ON QUALITY OF CARE, CLIENT
SATISFACTION AND CARE SEEKING BEHAVIOUR IN SELECTED
DISTRICTS
 CONDUCT MATERNAL AND PERINATAL DEATH REVIEWS AT
FACILITY, DISTRICT, REGION AND CENTRAL LEVEL
3. COMMUNITY MOBILIZATION

SENSITIZE/ORIENTATE COMMUNITY OWNED RESOURCE PERSONS,
CORPS, ON MATERNAL AND NEONATAL HEALTH ISSUES IN ALL
DISTRICTS
4. BEHAVIOUR CHANGE
KEY ACTIVITIES:

DESIGN, DEVELOP IEC/BCC MESSAGES AND MATERIALS FOR
COMMUNITY MEMBERS (MEN, WOMEN AND ADOLESCENTS) FOR
SPECIFIC MATERNAL AND NEWBORN ISSUES,

DISSEMINATE AND DISTRIBUTE IEC/BCC MESSAGES AND MATERIALS
FOR COMMUNITY MEMBERS THROUGH DIFFERENT MEDIA
5. FOSTERING PARTNERSHIP
KEY ACTIVITIES:

CONDUCT JOINT MEETINGS WITH STAKEHOLDERS/PARTNERS TO
SOLICIT INPUTS AND COMMITMENTS ON MATERNAL AND NEWBORN
CARE AT ALL LEVELS

CONDUCT INTEGRATED PLANNING MEETINGS AMONGST PARTNERS/
STAKEHOLDER AT ALL LEVELS
ROAD MAP IMPLEMENTATION
 DIFFERENT ACTORS AT ALL LEVELS WILL IMPLEMENT ACCORDING
TO THEIR MANDATE ,EXPERTISE, RESOURCE AVAILABLE, E.T.C.
 RESOURCE MOBILIZATION AT ALL LEVELS TO FILL IN FUNDING GAP
 INTEGRATE ROAD MAP PRIORITY ACTIONS IN MTEF & CCHPS
 FULL SCALE IMPLEMENTATION BY DISTRICTS
MATERNAL, NEWBORN AND CHILD HEALTH IS EVERYBODY’S
BUSSINESS (Getrude Mongella,MP- 2007)

EVIDENCE BASED COST EFFECTIVE INTERVENTIONS HAVE BEEN
IDENTIFIED;
SKILLED CARE IS THE FOCUS;
WITH EMPHASIS ON CONTINUUM OF CARE FROM COMMUNITY
TO HEALTH FACILITY
CALL FOR ACTION
“EVERYONE HAS THE RIGHT TO LIVE….
LET US REDUCE MATERNAL AND NEWBORN MORTALITY”
(2006 HEALH SECTOR CONFERENCE THEME)