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Tanzania's countdown to 2015: an analysis of two decades of progress and gaps for reproductive, maternal, newborn, and child health, to inform priorities for post-2015.
Lancet Glob Health. 2015 Jul; 3(7):e396-409.LG

Abstract

BACKGROUND

Tanzania is on track to meet Millennium Development Goal (MDG) 4 for child survival, but is making insufficient progress for newborn survival and maternal health (MDG 5) and family planning. To understand this mixed progress and to identify priorities for the post-2015 era, Tanzania was selected as a Countdown to 2015 case study.

METHODS

We analysed progress made in Tanzania between 1990 and 2014 in maternal, newborn, and child mortality, and unmet need for family planning, in which we used a health systems evaluation framework to assess coverage and equity of interventions along the continuum of care, health systems, policies and investments, while also considering contextual change (eg, economic and educational). We had five objectives, which assessed each level of the health systems evaluation framework. We used the Lives Saved Tool (LiST) and did multiple linear regression analyses to explain the reduction in child mortality in Tanzania. We analysed the reasons for the slower changes in maternal and newborn survival and family planning, to inform priorities to end preventable maternal, newborn, and child deaths by 2030.

FINDINGS

In the past two decades, Tanzania's population has doubled in size, necessitating a doubling of health and social services to maintain coverage. Total health-care financing also doubled, with donor funding for child health and HIV/AIDS more than tripling. Trends along the continuum of care varied, with preventive child health services reaching high coverage (≥85%) and equity (socioeconomic status difference 13-14%), but lower coverage and wider inequities for child curative services (71% coverage, socioeconomic status difference 36%), facility delivery (52% coverage, socioeconomic status difference 56%), and family planning (46% coverage, socioeconomic status difference 22%). The LiST analysis suggested that around 39% of child mortality reduction was linked to increases in coverage of interventions, especially of immunisation and insecticide-treated bednets. Economic growth was also associated with reductions in child mortality. Child health programmes focused on selected high-impact interventions at lower levels of the health system (eg, the community and dispensary levels). Despite its high priority, implementation of maternal health care has been intermittent. Newborn survival has gained attention only since 2005, but high-impact interventions are already being implemented. Family planning had consistent policies but only recent reinvestment in implementation.

INTERPRETATION

Mixed progress in reproductive, maternal, newborn, and child health in Tanzania indicates a complex interplay of political prioritisation, health financing, and consistent implementation. Post-2015 priorities for Tanzania should focus on the unmet need for family planning, especially in the Western and Lake regions; addressing gaps for coverage and quality of care at birth, especially in rural areas; and continuation of progress for child health.

FUNDING

Government of Canada, Foreign Affairs, Trade, and Development; US Fund for UNICEF; and the Bill & Melinda Gates Foundation.

Authors+Show Affiliations

MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK.Evidence for Action, Dar es Salaam, Tanzania.World Health Organization, Dar es Salaam, Tanzania. Electronic address: kabutenit@who.int.Ifakara Health Institute, Dar es Salaam, Tanzania.Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK; Evidence for Action, Dar es Salaam, Tanzania.MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK.Save the Children, Edmonton, AB, Canada; University of the Western Cape, Bellville, South Africa.Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.UNICEF, Dar es Salaam, Tanzania.MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK.No affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

26087986

Citation

Afnan-Holmes, Hoviyeh, et al. "Tanzania's Countdown to 2015: an Analysis of Two Decades of Progress and Gaps for Reproductive, Maternal, Newborn, and Child Health, to Inform Priorities for Post-2015." The Lancet. Global Health, vol. 3, no. 7, 2015, pp. e396-409.
Afnan-Holmes H, Magoma M, John T, et al. Tanzania's countdown to 2015: an analysis of two decades of progress and gaps for reproductive, maternal, newborn, and child health, to inform priorities for post-2015. Lancet Glob Health. 2015;3(7):e396-409.
Afnan-Holmes, H., Magoma, M., John, T., Levira, F., Msemo, G., Armstrong, C. E., Martínez-Álvarez, M., Kerber, K., Kihinga, C., Makuwani, A., Rusibamayila, N., Hussein, A., & Lawn, J. E. (2015). Tanzania's countdown to 2015: an analysis of two decades of progress and gaps for reproductive, maternal, newborn, and child health, to inform priorities for post-2015. The Lancet. Global Health, 3(7), e396-409. https://doi.org/10.1016/S2214-109X(15)00059-5
Afnan-Holmes H, et al. Tanzania's Countdown to 2015: an Analysis of Two Decades of Progress and Gaps for Reproductive, Maternal, Newborn, and Child Health, to Inform Priorities for Post-2015. Lancet Glob Health. 2015;3(7):e396-409. PubMed PMID: 26087986.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tanzania's countdown to 2015: an analysis of two decades of progress and gaps for reproductive, maternal, newborn, and child health, to inform priorities for post-2015. AU - Afnan-Holmes,Hoviyeh, AU - Magoma,Moke, AU - John,Theopista, AU - Levira,Francis, AU - Msemo,Georgina, AU - Armstrong,Corinne E, AU - Martínez-Álvarez,Melisa, AU - Kerber,Kate, AU - Kihinga,Clement, AU - Makuwani,Ahmad, AU - Rusibamayila,Neema, AU - Hussein,Asia, AU - Lawn,Joy E, AU - ,, PY - 2014/10/24/received PY - 2015/02/16/revised PY - 2015/03/19/accepted PY - 2015/6/20/entrez PY - 2015/6/20/pubmed PY - 2016/3/16/medline SP - e396 EP - 409 JF - The Lancet. Global health JO - Lancet Glob Health VL - 3 IS - 7 N2 - BACKGROUND: Tanzania is on track to meet Millennium Development Goal (MDG) 4 for child survival, but is making insufficient progress for newborn survival and maternal health (MDG 5) and family planning. To understand this mixed progress and to identify priorities for the post-2015 era, Tanzania was selected as a Countdown to 2015 case study. METHODS: We analysed progress made in Tanzania between 1990 and 2014 in maternal, newborn, and child mortality, and unmet need for family planning, in which we used a health systems evaluation framework to assess coverage and equity of interventions along the continuum of care, health systems, policies and investments, while also considering contextual change (eg, economic and educational). We had five objectives, which assessed each level of the health systems evaluation framework. We used the Lives Saved Tool (LiST) and did multiple linear regression analyses to explain the reduction in child mortality in Tanzania. We analysed the reasons for the slower changes in maternal and newborn survival and family planning, to inform priorities to end preventable maternal, newborn, and child deaths by 2030. FINDINGS: In the past two decades, Tanzania's population has doubled in size, necessitating a doubling of health and social services to maintain coverage. Total health-care financing also doubled, with donor funding for child health and HIV/AIDS more than tripling. Trends along the continuum of care varied, with preventive child health services reaching high coverage (≥85%) and equity (socioeconomic status difference 13-14%), but lower coverage and wider inequities for child curative services (71% coverage, socioeconomic status difference 36%), facility delivery (52% coverage, socioeconomic status difference 56%), and family planning (46% coverage, socioeconomic status difference 22%). The LiST analysis suggested that around 39% of child mortality reduction was linked to increases in coverage of interventions, especially of immunisation and insecticide-treated bednets. Economic growth was also associated with reductions in child mortality. Child health programmes focused on selected high-impact interventions at lower levels of the health system (eg, the community and dispensary levels). Despite its high priority, implementation of maternal health care has been intermittent. Newborn survival has gained attention only since 2005, but high-impact interventions are already being implemented. Family planning had consistent policies but only recent reinvestment in implementation. INTERPRETATION: Mixed progress in reproductive, maternal, newborn, and child health in Tanzania indicates a complex interplay of political prioritisation, health financing, and consistent implementation. Post-2015 priorities for Tanzania should focus on the unmet need for family planning, especially in the Western and Lake regions; addressing gaps for coverage and quality of care at birth, especially in rural areas; and continuation of progress for child health. FUNDING: Government of Canada, Foreign Affairs, Trade, and Development; US Fund for UNICEF; and the Bill & Melinda Gates Foundation. SN - 2214-109X UR - http://www.nlm.medscape.idmu.unboundmedicine.unboundmedicine.com/medline/citation/26087986/Tanzania's_countdown_to_2015:_an_analysis_of_two_decades_of_progress_and_gaps_for_reproductive_maternal_newborn_and_child_health_to_inform_priorities_for_post_2015_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2214-109X(15)00059-5 DB - PRIME DP - Unbound Medicine ER -