United Republic of Tanzania

Between 2010 and 2015, Tanzania saw notable improvements in life expectancy (from 61.6 to 64.9 years), infant mortality rate (from 51 to 43 per 1,000 live births), under-five mortality rate (from 81 to 67 per 1,000 live births), and under-five stunting prevalence (from 42 to 34.4 percent). However, during this period the country’s maternal mortality rate increased from 454 to 556, and its total fertility rate remained stubbornly high at 5.2 (as of 2015). The increase in maternal mortality elevated maternal health to a national priority. To address this and other lingering challenges in RMNCAH-N, in 2015 Tanzania began implementing its RMNCAH-N investment case, known as One Plan II.

One Plan II prioritizes pivotal interventions to accelerate RMNCAH-N improvements focused on increased quality, access, and use of RMNCAH-N services. These include antenatal care, use of skilled birth attendants, and a package known as Basic Emergency Obstetric and Newborn Care (BEmONC) and Comprehensive Emergency Obstetric and Newborn Care (CEmONC).

Moving Toward Universal Health Coverage and Equitable Access

To facilitate long-term sustainability of health gains, the Government of Tanzania is taking critical steps to increase the resources for and sustainability of health financing. The government is currently developing a five-year Health Financing Strategy to move toward universal health coverage, a critical step to ensure financial protections for the poor and reduce catastrophic health expenditures. The GFF supports the government in this effort with technical assistance, capacity development, and analytics to finalize the Health Financing Strategy and promote a related single national health insurance bill.

The government is also implementing key initiatives to improve equity in access to health services. Improved access to services for the poor is essential for Tanzania to ensure RMNCAH-N achievements are reached and equitable.

Early progress noted

In regions implementing results-based financing, the number of individuals identified by the Tanzania Social Action Fund as being below the poverty line who receive outpatient care increased considerably between mid-2016 and the end of 2017 (see Figure 7).

A Results Focus

One Plan II implementation has a strong results focus. A district-level scorecard is currently used at all levels (national, regional, and district) to monitor One Plan II results and allow continuous programmatic improvements—all based on data.

Early progress noted

A recent review of One Plan II results shows improvements between 2014 and 2017 in key service delivery interventions to improve RMNCAH-N, including increases in institutional deliveries, the percentage of pregnant women receiving at least four antenatal care visits (ANC4), the percentage of facilities receiving at least three stars (out of five) in the star-rating quality assessment, and coverage of intermittent preventative treatment (IPT2) for malaria during antenatal care visits (Figure 8). Although it is too early to tell if maternal mortality will be impacted by these interventions, improvements in their coverage should result in reductions in the maternal mortality ratio. In addition, the continuous availability of 10 tracer medications has undergone notable improvement: there has been a doubling in the number of facilities that have the entire tracer drug package (from 31 percent in 2014-15 to 60 percent in 2016-17). These increases represent gradual, substantive quality and coverage improvements.

Areas where progress is lagging

Along with the above-noted improvements, however, iron supplementation coverage declined during this period. Analysis into the reasons behind this decline found gaps in the availability of iron tablets. In addition, ANC4 coverage improvements have been more modest than hoped. The 2014 baseline for ANC4 coverage was low at 35.1 percent and increased only to 46 percent by 2017.

Corrective Actions

These results have spurred the government to conduct in-depth analysis into the underlying reasons for lagging ANC4 coverage. The analysis revealed substantial geographic disparities between regions, with coverage ranging from a low of 34 percent to a high of 69 percent (Figure 9). Further exploration into the root causes of low ANC4 coverage has found that it is influenced by women’s reluctance to disclose that they are pregnant during the early stages, health workers encouraging patients to seek initial antenatal care appointments only after 12 weeks of pregnancy, and low availability of pregnancy tests to confirm early pregnancy. Based on this in-depth data and qualitative analysis, the government is taking action to improve ANC4 coverage, including improving the RMNCAH-N component of community health workers’ training, conducting refresher trainings on antenatal care guidelines for health workers, strengthening the antenatal care component of the facility supervision checklist, and improving data use at the facility level.