1. United Republic of Tanzania Ministry of Health London, 13-14 Dec 2005 Tanzania Under five Mortality Reduced by a Quarter: Why?? United Republic of Tanzania Ministry of Health Countdown to 2015 Child Survival Dr. Theopista John, WHO Country Office - Tanzania

2. United Republic of Tanzania Ministry of Health Outline 3 Key Messages and supporting evidences Conclusions Challenges Implications for universal access to Child survival interventions

3. United Republic of Tanzania Ministry of Health Key message 1 Child survival in Tanzania has improved substantially in the past few years.

4. United Republic of Tanzania Ministry of Health Evidence for recent child survival gains National DHS An improvement of 24% in under 5 mortality represents 39,200 fewer child deaths per year in Tanzania -24% -31% Source: URT Measure DHS

5. United Republic of Tanzania Ministry of Health Key message 2 Child survival is improving because of better access to higher quality essential health services for children.

6. United Republic of Tanzania Ministry of Health Evidence for coverage gains Situation19992005 National IMCI coverage (Districts) 20 districts (17.5) % 107 districts (93.8%) National Measles immunization coverage 78%97% National ITN coverage of children under 5 2%10% Under-fives with fever treated with anti- malarial 53%58% National Vitamin A supplementation (12-23m) 21%46% National ORT coverage 55%70% Exclusive breastfeeding at 6 months 11%41% Skilled attendant at birth 38%47%

7. United Republic of Tanzania Ministry of Health Evidence from MCE-IMCI Key messages from Multi Country Evaluation of IMCI  Improved quality of care for sick children  IMCI cost less per child managed correctly ($4.02) compared to routine care ($ 25.70)  Contribution to Child mortality reduction by 13%  Significant reduction in stunting

8. United Republic of Tanzania Ministry of Health Evidence from MCE-IMCI… DistrictsU5MR per 1000 live births BeforeAfter IMCI (Morogoro, Rufiji)128115 Comparison (Kilombero, Ulanga) 127133 Quality of child care in first level facilities Difference in mortality between IMCI and comparisons districts Mortality was 13% lower in IMCI districts

9. United Republic of Tanzania Ministry of Health IMCI improves quality of care Sick children managed correctly in IMCI and comparison facilities

10. United Republic of Tanzania Ministry of Health Cost per child managed correctly in Tanzania

11. United Republic of Tanzania Ministry of Health Evidence for recent child survival gains Rufiji District Sentinel surveillance (RDSS) -48% -60% Source: MOH TEHIP / NSS

12. United Republic of Tanzania Ministry of Health Key message 3 Better access to quality health services as a result of policies and investments supporting the Tanzanian Health System.

13. United Republic of Tanzania Ministry of Health 19701990 1980197019602000 Strong Investment in Rural Health Infrastructure & Primary Health care Structural adjustment and Debt Crisis Health Sector Reforms Essential health interventions & Sector wide Approach Evolution of health sector in Tanzania

14. United Republic of Tanzania Ministry of Health 1996-97  Before basket funding and planning tools……….. 2000-01  After basket funding and planning tools……….. Aligning budgets with priorities

15. United Republic of Tanzania Ministry of Health Challenges  Sustaining the observed child health gains  Inadequate coverage of interventions and tools e.g District burden-of-disease planning tool & health budget mapping tools  HIV/AIDS pandemic threatening to reverse the gains  Co-ordination at national, district and community level

16. United Republic of Tanzania Ministry of Health Conclusions Tanzania has a comparative advantage for Child Survival  Good access & utilization of health facilities  Health sector reform  Poverty Reduction Strategy- PRSP II (NSGRP) Potential for achieving the child survival ;  Mobilizing available resources for child health interventions  Scaling up of and universal access to effective interventions  Strengthening Partnership at all levels e.g. Maternal, Newborn and Child Health Partnership

17. United Republic of Tanzania Ministry of Health Implications for universal coverage National Health Sector Strategic plan and Development frameworks to support Child survival  Increasing resource allocation for scaling up of child survival delivery interventions and strategies Decentralization at district including ;  capacity building for planning and budgeting  Use of data for decision making and resource allocation e.g. DHA, BOD,SHM Prioritization of essential interventions Harmonization and convergence of partners through National Partnerships e.g. Maternal Newborn and Child Survival Partnership

18. United Republic of Tanzania Ministry of Health Implications for Universal Coverage It is never too late to invest in developing sustainable health systems that provide evidence based, cost effective and high impact interventions with high coverage and quality.

19. United Republic of Tanzania Ministry of Health Thank you