Countdown to 2015 In-Depth Case Study: United Republic of Tanzania Feedback from the HSP & Finance Workshop Nairobi, Kenya 3 March 2014

[A] Reviewing the PAST 1.One Plan MTR Quantitative & Qualitative Analysis 2.HSSP III MTR of the HSSP III 3.Tanzanian Countdown Country Case Study [B] Planning for the future 1.Sharpened plan (2014 – 2015) and costing 2.One Plan (2016 – 2020) and costing (inline with the HSSP IV) [C] Tracking progress 1.Scorecards Overview

Evaluation Framework for Countdown Country Case Study

Evaluation Framework for Countdown Country Case Study Impact

Progress on MDG 4 Reduce the under-five mortality rate by two-thirds Absolute # of deaths U5MR NMR Source: IHME Impact

Progress on MDG 5.A. Reduce the maternal mortality ratio by three quarters MMRAverage annual rate of reduction (%) Source: Countdown to 2015 Report (2012) Absolute # of deaths 2010 MMR8500 Source: Countdown Report Global goal = <50 by 2035 One Plan Goal = 193 by 2015 Impact

Progress on MDG 5.B. – FAMILY PLANNING Achieve universal access to reproductive health DHS Survey Modern Methods CPR Unmet need One Plan CPR Goal = 60% by 2015 Impact

Source: United Nations, Department of Economic and Social Affairs, Population Division (2011). World Population Prospects: The 2012 Revision, CD-ROM Edition; Demographic and Health Surveys; Tanzania census 1988 & London School Analysis for Tanzanian Countdown Total Fertility Rate Impact

Evaluation Framework for Countdown Country Case Study Outcomes

Coverage along the Continuum of Care & identifying health gaps Source: Demographic and Health Surveys, Tanzania London School Analysis for Tanzanian Countdown

Focus of In depth Country Case Study Family Planning Care at Birth

Focus of the Tanzanian In-Depth Country Case Study 1. Family Planning Better understand why the unmet need for family planning has remained constant between 1990 and the current year, and explore which women are not being reached and why? 2. Coverage and Quality of Care at Birth Further explore which women and children are not receiving the necessary care at birth, how to bridge the inequities and to improve quality of care.

Family Planning Who is being left behind? Equity gaps: Who’s being left behind? RURAL POOR LEAST EDUCATED FROM THE WESTERN & LAKE ZONE MWANZA, MARA & SHINYANGA W O M E N LAKE WESTERN

Care at Birth Who is being left behind? Equity gaps: Who’s being left behind? RURAL POOR LEAST EDUCATED W O M E N BIRTH IN A HEALTH FACILITY BIRTH BY CASEAREAN

WHY? Focus of this Tanzania Country Case Study

Evaluation Framework for Countdown Country Case Study Health System and Policy and Finance Workshop (Nairobi 25 – 28 Feb)

Objectives Build capacity for analysis of health system and health policy- related factors that have an impact on progress in reducing maternal, newborn and child mortality Build capacity for analysis of health financing for maternal, newborn and child health through tracking of resource flows

Specific objectives Health system and policy analysis – Assess adoption of technical, health sector, and multi- sectoral policies and contextual factors that have an impact of RMNCAH and develop a policy timeline – Assess adoption of Countdown policy tracer indicators and develop a dashboard – Assess the extent to which policies have been translated into effective programmes – Assess key health system characteristics and identify facilitating factors and bottlenecks for access, quality and coverage of interventions

Specific objectives Health financing analysis – Review types of analysis for resource tracking relevant to country case studies – Discuss resource tracking efforts underway in countries – Refine the analysis plans Work in teams to familiarize with the proposed tools and methods and conduct analysis Develop a plan of action for the country case study and identify needs for technical assistance

Team members present at the workshop 1)Moke Magoma – E4A 2)Clement Kihinga – MoHSW 3)Theopista John – WHO 4)Melisa Martinez-Alvarez – LSHTM 5)Arin Dutta – Futures Group/USAID 6)Joy Lawn – LSHTM 7)Hoviyeh Afnan-Holmes – LSHTM Other Countries present: Afghanistan, Ethiopia, Kenya, Malawi, Pakistan, Peru, Rwanda.

What the Tanzanian team aimed to get out of this workshop? 1. Describe the overall story of policy change for women, newborns and children in Tanzania between 1990 and the current year. 2. Explore reasons for the inequity present in the provision of family planning and care at birth, understand why specific women are missing out on these essential services and how to address this need. 3. Further inform where to focus attention and resources needed for the Tanzanian Sharpened Plan. 4. Documentation of the Countdown HSP Analysis Tools 1 – 3 and further progress on the health finance analysis & scientific journal article. 5. Further plan for the National RMNCH Event (Technical products etc)

1.Describe the overall story of policy change for women, newborns and children in Tanzania between 1990 and the current year. Accomplished this week: A better understanding of previous progress in country for MDG 4 and 5 and what needs to be done differently for the future. Progress Made in the Workshop - HSP analyses -

Progress Made in the Workshop - HSP analyses - 2.Explore reasons for the inequity present in the provision of family planning and care at birth, understand why specific women are missing out on these essential services and how to address this need. Accomplished this week: Further explored the qualitative data collected at a district level to answer why the inequities are present in country. (Further analyses still to be completed.)

Progress Made in the Workshop - HSP analyses - 3.Further inform where to focus attention and resources needed for the Tanzanian Sharpened Plan. Accomplished this week: Agreed on resources and further analyses required to inform the Tanzanian Sharpened Plan. Developed a timeline. (See later slide)

Progress Made in the Workshop - HSP analyses - 4. Documentation of the Countdown HSP Analysis Tools 1 – 3 and further progress on the scientific journal article. Accomplished this week: Completed Tool 1 and Tool 2. Identified the demand and supply bottlenecks specific to the focus of the case study (Tool 3). Created an E-Library in Dropbox with all policy documents. (Still to finalise the graphics to be included in the scientific journal article.)

Progress Made in the Workshop - Finance analyses - Accomplished this week: Reviewed the current information Identified new data sources that need further analysis – to inform the gap analysis

Feb March April May June July RMNCH EVENT Products Analysis Process Policy Brief Report Card Sharpened Plan One RMNCH Plan to 2020 HSSP (IV) Partners Forum Meeting Analysis completed -Impact, Coverage, Equity Analysis to be finalised - Finance analysis – Gap Analysis - LiST – a) Short term (2015); b) Medium term (2020); c) Universal coverage - One Health Costing – Short Term (by April); Medium Term (post April) - Qualitative analysis of district performance PLANNING MEETINGS Details of roles and responsibilities to be drafted into a Gantt Chart Timeline FINALISE SCIENTIFIC ARTICLE

Next Steps What? – Policy Brief – Report Card – Sharpened Plan (Priority actions and Costing) – Finalize the analysis (LiST, Financial) Who? – Case study Team – Core team for the RMNCH Event When? – By End of March /First week of April ready for RMNCH Event – May for the Case study

Only 632 days left to achieve the MDG’s Only days to the National RMNCH Event We need to start sprinting rather than running normally! Kazi ni Kwetu!

Asanteni! Dr Theopista – please change this photo to be Tanzania specific.

Timeline for In-Depth Case Study 1.Start date: July End date: July Proposed products: - PPT library of slides and policy brief; - Scientific journal article; - Scorecards 4.Is a Country Countdown event planned? Yes – April 2014 (Guest of honor: President JM Kikwete) 5.Is the in-depth case study linked to other processes in-country? Yes Please specify. - HSSP III MTR and The One Plan MTR - Sharpened RMNCH Plan (2008 – 2015); Second RMNCH Plan ( ) which will be in line with the HSSP IV - Costed priorities for both a) Sharpened Plan ( ); & b) Second RMNCH Plan (2015 – 2020) - A Promised Renewed Campaign and The Every Newborn Action Plan - National RMNCH Scorecards