Health Sector Performance 2009/2010 Presented at the Joint Annual Health Sector Review Technical Meeting 7 th – 9 th September 2010, Dar es Salaam By J.J. Rubona 1

Outline  Report Structure  Update of the HSSP III indicators  Progress towards Health Status  Progress in improving Service Delivery  Progress in Health Systems  Key Messages 2

Report Structure Chapter 1: Introduction Chapter 2: Progress against 46 health sector indicators Progress towards Health Status Progress in improving Service Delivery Progress in Health Systems Chapter 3: Milestones Report Chapter 4: MTEF Implementation Status Chapter 5: Review of Council Health Performance Chapter 6: Highlights from the Public Expenditure Review Update Chapter 7: Human Resource Status in the Health Sector Chapter 8: Conclusion, Issues & Challenges 3

2.0 Performance against HSSP III indicators  HSSP III has 46 performance indicators clustered under the following thematic areas;  Service Delivery (e.g. vaccinations, access to reproductive health services etc)  Health status of the population (e.g. mortality rates, child nutrition, HIV prevalence etc).  Health systems (health financing and logistics) 4

Progress towards Health Status (1)  Substantial decline of CMR  Rate of decline is on truck with MDG target by 2010  high neonatal deaths remain a major challenge accounting for 32% of all U5 deaths in Tanzania 5

Progress towards Health Status (2) Indicators on Nutritional Status:  Malnutrition is a direct result of insufficient food intake or repeated infectious diseases or a combination of both  Two out of three indices are widely used to measure nutrition status as follows: -  children who are stunted, too short for their age (Chronic malnutrition)  children who are wasted are too thin for their height (current status of malnutrition)  In 2005 survey shows that 38% of under 5 were severely stunted compared with 16.5% in 2009/10 and for wasting, severe malnutrition in 2005 was 3.7% compared with 3.8% in 2009/10.  Target for HSPSIII by 2015 is 20% for stunted and 2% for wasting. 6

Progress towards Health Status (3) Indicator: Maternal Mortality Rate (MMR)  Recent results from THMIS shows MMR is 578 it has remained high compared with TDHS 2004/05 (529) new results are expected from TDHS 2009/10  Facility based shows a notable decline from 162 (2008) to 96 (2009)  Facility results predict general decline of MMR (To be confirmed 2009/10 TDHS) 7

8 Indicator: Life Expectancy at birth  Due to CMR decline, and some of the diseases, Life Expectancy is probably increasing more rapidly than projected  This is confirmed by Rufiji DSS results which shows increase of 5-10 years in life expectance since 1999 up to This was after gains in CMR and diseases due to intercensions  NBS projection of Dec.2006 anticipates life expectancy in 2010 for Male 57 and Female 59 From 51 (M), 52(F) in 2002 census.. Progress towards Health Status (4)

Progress towards Service Delivery(1) Indicator: OPD attendance per capita  The indicator assess provision of health services particularly HF utilization  OPD attendance per capita in 2009 is 0.74, and it increased from 0.68 of the previous year  This is below HSPS III target of 0.80 to be attained by 2015 but it is on truck.  The index is high in Mara and lowest in Kagera 9

Progress towards Service Delivery(2) Indicator: Measles vaccination  the percentage of total number of children below one year of age vaccinated against measles  It has high impact on child mortality reduction  Performance in 2009 is 91% a notable increase from 88% in year 2008  It is above HSPSIII target of 85%  Mara, Manyara and Lindi performed below HSPS III target 10

Progress towards Service Delivery(3) Indicator: Proportion of children under one vaccinated 3 times against DPT –Hb3  Performance is 85.7% in 2009 slightly below 2008 performances. In spite of this, still it is above HSPSIII target of 85% by  On the other hand, more improvement is required in the following regions: Rukwa (65.7%), Kigoma (67.5%), Lindi (70.8%) and Tabora (73.5%). 11

Progress towards Service Delivery(4) Indicator: Tetunus Toxoid vaccination  Tetanus toxoid injections are given during pregnancy to prevent neonatal tetanus, an important cause of infant deaths  Vaccination coverage has declined from 85% in 2008 to 73.1% in 2009 which is below HSPS III target of 85% by 2015  Pwani,Dodoma, Tanga and Morogoro performed above target while Mwanza and Kigoma regions performed below 50% 12

Progress towards Service Delivery(5) Indicator: Proportion of pregnant women start ANC before 16 weeks of gestation age There is significant increase of the proportion of women attending ANC before 16 weeks of gestation from 14% in 2004/05 to 48% in 2008 and slightly declined to 47% in Comparing regional differentials, Morogoro is leading by 90% and Arusha region has least performance (26%) 13

Progress towards Service Delivery(6) Indicator: Maternal Case Fatality Rate in Health Facilities for women admitted due to maternal complications  No data on women admitted due to maternal compilications  Available information is on maternal deaths and in 2009 a total of 1665 deaths occurred and Mwanza region took a lead (176) while Lindi region had least cases (39)  Major causes of deaths include Post Partum Hemorrhage (PPH) followed by eclampsia and anemia 14

Progress towards Service Delivery(6) Indicator: Percentage of HIV positive women receiving ARVs to prevent MTCT and Number of persons with advanced HIV infection receiving ARV combination Significant increase in the number of HIV positive women receiving ARV for PMCT; from 34% in 2007 to 55% in However, in 2009 a decline up to 43 is noted. More efforts are required to meet 2015 target which is 80% A total of 80,628 persons receive ARV by the end of 2007 which increased to 248,280 by May 2009 and then by May This is a significant increase but the number is far below the 440,000 target to be reached by

Progress towards Service Delivery(6) Indicator: Percent of TB Treatment success rate  Great improvement in treatment success rate from of 84.7% in 2006, 2007 (88%) to 87.7% in The achievement surpassed the global target 85% and HSPS III target of 82%.  Almost all regions have surpassed the HSPSIII target.  The challenge to the program is maintain these high rates. 16

Key Messages on Health Sector Performance (1) Health status  As indicated in the previous report, Tanzania is highly commended for the continuing spectacular gains in Child Survival with progressive and significant decline in Under Five Mortality Rate and Infant Mortality Rate which makes Tanzania well on track for the MKUKUTA and MDG indicators. However, less gain has been experienced with neonatal deaths which making up 32% of all under five deaths in Tanzania. This is a challenge in the whole process of reducing Child Mortality.  A substantial decline in child mortality is putting life expectancy projections at 57 for male and 59 for female in This will be confirmed by 2012 population census results.  Maternal mortality ratios remain very high; however, recent information from health facilities indicates a declining trend. This may predict general decline of MMR in the community 17

Key Messages on Health Sector Performance (2) Key Messages on Health Sector Performance (2) Health Status (Cont’d)  Much improvement have been made on chronic malnutrition unlike for current malnutrition where no progess has been made from 2005 – 2010  TFR declined from 5.7 in 2005 to 5.4 in 2010 Service Delivery  More Tanzanians are seeking health services from health facilities  TB treatment success rate is among the highest in the world it has surpassed international and local set target  The number of HIV patients on ARVS is very encouraging as it close to set target  Most of vaccination coverage surpass the set target by HSSPS III 18

Thank you for Listening 19