T A N Z A N I A (Mainland & Zanzibar) EARLY CHILDHOOD DEVELOPMENT & HIV CHALLENGES & STRATEGIES

Positive Factors High coverage of immunization (DPT/HB3-89%) High coverage of immunization (DPT/HB3-89%) Wide coverage of Vitamin A supp. (over 90%) Wide coverage of Vitamin A supp. (over 90%) High use of iodised salt (83%) High use of iodised salt (83%) Good provision of antenatal care services. Good provision of antenatal care services. Recent Estab. of the Directorate of Childrens Dev. in MCDG&C (2003) & Public Expenditure Review. Recent Estab. of the Directorate of Childrens Dev. in MCDG&C (2003) & Public Expenditure Review. Active ECD network of NGO & Govt. partners. Active ECD network of NGO & Govt. partners. Govts call for multi-sectoral partnership for community-based ECD support. Govts call for multi-sectoral partnership for community-based ECD support.

SURVIVAL & HEALTH More infants & young children struggling to survive than 10 yrs ago (IMR 99/1000; U5MR 147/1000;) More infants & young children struggling to survive than 10 yrs ago (IMR 99/1000; U5MR 147/1000;) Mortality signif. higher in rural areas (113% vs. 89%) Mortality signif. higher in rural areas (113% vs. 89%) Most deaths (75%) due to preventable conditions (HIV/AIDS, malaria, pneumonia, diarrhoea, malnutrition) Most deaths (75%) due to preventable conditions (HIV/AIDS, malaria, pneumonia, diarrhoea, malnutrition) 8 out of 10 die at home. Majority no contact w/ health facility High MMR (530/100,000) related to Womens high poverty levels, low social status, low educ. levels, early pregnancies, high work burden & declining access to health services. High MMR (530/100,000) related to Womens high poverty levels, low social status, low educ. levels, early pregnancies, high work burden & declining access to health services.

SURVIVAL & HEALTH RELATED TO HIV/AIDS Reported AIDs cases for children under 5 - 4% ( ) 80% of infants infected by HIV at birth do not survive 2nd birthday. Girls yrs 6 times more likely to be infected than boys. Approx. 2 million orphans & children affected by HIV/AIDs.

FOOD & NUTRITION High prevalence of Low birthweight & malnutrition – limited no. of feeding posts. High prevalence of Low birthweight & malnutrition – limited no. of feeding posts. Heavy workload & poor nutrition of women. Heavy workload & poor nutrition of women. Poor access to clean, potable water esp. in rural areas. Poor access to clean, potable water esp. in rural areas. Seasonal hunger in rural areas. Seasonal hunger in rural areas. Insufficient integration of micro-nutrient interventions within overall nutrition efforts. Insufficient integration of micro-nutrient interventions within overall nutrition efforts. Insufficient focus on child nutrition in Primary School children. Insufficient focus on child nutrition in Primary School children.

STIMULATION, EARLY LEARNING & TRANSITION TO SCHOOL Limited culturally & developmentally appropriate, family & community-based, integrated Care & Ed. opportunities that support diverse caregivers (teens, siblings, elders, relatives) in their multiple roles as carers & providers. Limited culturally & developmentally appropriate, family & community-based, integrated Care & Ed. opportunities that support diverse caregivers (teens, siblings, elders, relatives) in their multiple roles as carers & providers. Limited maternal awareness re importance of early stimulation. Limited maternal awareness re importance of early stimulation. Inadequate childcare arrangements & insufficient male involvement. Inadequate childcare arrangements & insufficient male involvement. ECD Progs. limited to urban areas, low quality, & fee paying which excludes the most vulnerable. ECD Progs. limited to urban areas, low quality, & fee paying which excludes the most vulnerable. Insufficient opportunities for stimulation, play, early learning, pre-school participation due to:

PROTECTION & PARTICIPATION Low levels of birth registration (esp. Rural) Low levels of birth registration (esp. Rural) High levels of child neglect, abuse & labour. High levels of child neglect, abuse & labour. Insufficient concrete support for OVCs during EC. An Orphan is only an orphan when they reach Standard 1. Insufficient concrete support for OVCs during EC. An Orphan is only an orphan when they reach Standard 1. Insufficient concrete progs. for affected children & their caregivers (ie. pschosocial support, food, shelter, clothing, health needs, ARVs, school fees). Insufficient concrete progs. for affected children & their caregivers (ie. pschosocial support, food, shelter, clothing, health needs, ARVs, school fees). Need for greater representation of Women in village governments. Need for greater representation of Women in village governments.

POLICIES & LEGISLATION Insufficient integration of ECD issues in social sector policies & guidelines Insufficient integration of ECD issues in social sector policies & guidelines (eg. Health, food & nutrition, water & sanitation, labour, gender/womens development, community development, adult education, culture) Need for alignment of 1981 Day Care Act & 1995 MOEC Pre-primary policy for 5-6 yr olds in order to provide clear framework for action at community & national levels. Need for alignment of 1981 Day Care Act & 1995 MOEC Pre-primary policy for 5-6 yr olds in order to provide clear framework for action at community & national levels.

COORDINATION Insufficient coordination of social service agency in supporting families. Insufficient coordination of social service agency in supporting families. Lack of national mechanism/structure for coordination. Lack of national mechanism/structure for coordination. Local Govt. Reform structures not maximized for coordination of ECD interventions at ward & district levels. Local Govt. Reform structures not maximized for coordination of ECD interventions at ward & district levels.

CAPACITY BUILDING Limited & uncoordinated human resource development initiatives. Limited & uncoordinated human resource development initiatives. ECD Training Limited, Expensive & Insufficient Govt. involvement. ECD Training Limited, Expensive & Insufficient Govt. involvement. Inadequate supervision of staff. Inadequate supervision of staff. VHWs not institutionalized. VHWs not institutionalized. Insufficient linkage between Extension Workers & VHWs Insufficient linkage between Extension Workers & VHWs

PUB ED./ ADVOC / SOC. MOB. EC not included in human resource dev. agenda EC not included in human resource dev. agenda Inadeq. focus of HIV AIDs efforts on YOUNG CHILD issues Inadeq. focus of HIV AIDs efforts on YOUNG CHILD issues ECD/HIV responses largely isolated projects with limited coverage. ECD/HIV responses largely isolated projects with limited coverage. No coordinated communication strategy and national IEC programme for ECD. No coordinated communication strategy and national IEC programme for ECD. Insufficient sensitization of community leaders/members re HIV & cultural practices, status of women, stigma of HIV infected infants, children & caregivers, child abuse etc. Insufficient sensitization of community leaders/members re HIV & cultural practices, status of women, stigma of HIV infected infants, children & caregivers, child abuse etc. Insufficient participation of young children & women in issues affecting them. Insufficient participation of young children & women in issues affecting them.

FINANCING & RES. MOBILIZATION ECD not yet mainstreamed or prioritized in TZs PRSP. ECD not yet mainstreamed or prioritized in TZs PRSP. Funding requirements for scaling-up successful interventions have not been determined. Funding requirements for scaling-up successful interventions have not been determined. Insufficient developmt partners & intl NGO support for ECD initiatives. Insufficient developmt partners & intl NGO support for ECD initiatives. Funds for CSOs re ECD/HIV programmes difficult to access via District Councils. Funds for CSOs re ECD/HIV programmes difficult to access via District Councils. Insufficient income generating activities to strengthen community ECD responses. Insufficient income generating activities to strengthen community ECD responses.

RESEARCH, MONITORING, EVALUAT. & DOCUMENTATN Insufficient relevant, disagregated data on child status and existing support structures to guide programming. Insufficient relevant, disagregated data on child status and existing support structures to guide programming. Insufficient documentation & information exchange re. childrearing practices & successful ECD / HIV programmes. Insufficient documentation & information exchange re. childrearing practices & successful ECD / HIV programmes. Lack of research agenda for ECD. Lack of research agenda for ECD.

ECD STRATEGIES - GENERAL Facility based IMCI in 80/131 districts. Community IMCI in 7 districts. Commitment of govt. to budget and scale up Community IMCI as part of national strategy. Facility based IMCI in 80/131 districts. Community IMCI in 7 districts. Commitment of govt. to budget and scale up Community IMCI as part of national strategy. Integration of immunization strategies with other health interventions Integration of immunization strategies with other health interventions Linking Promotion of Participatory Hygiene & Sanitation Transformation & ORS promotion. Linking Promotion of Participatory Hygiene & Sanitation Transformation & ORS promotion. Quarterly Growth monitoring linked to breast feeding and complementary feeding promotion in 57 RCH clinics. Limited No. of feeding posts for severely malnourished. Quarterly Growth monitoring linked to breast feeding and complementary feeding promotion in 57 RCH clinics. Limited No. of feeding posts for severely malnourished. National provision of Vitamin A supplements (over 90% coverage) & new strategy for linking deworming efforts. National provision of Vitamin A supplements (over 90% coverage) & new strategy for linking deworming efforts.

ECD STRATEGIES - GENERAL Malaria communication strategy being developed as pathfinder for integrated ECD. Malaria communication strategy being developed as pathfinder for integrated ECD. Introduction of ITN Voucher scheme in 2 districts. Introduction of ITN Voucher scheme in 2 districts. Inclusion of initial 3 ECD indicators in Community Based Information system. Inclusion of initial 3 ECD indicators in Community Based Information system. 1,264 Day Care Centres (2-6 yrs) but mostly in urban areas. 1,264 Day Care Centres (2-6 yrs) but mostly in urban areas. Baseline survey/ needs assessment & Pilot project on EC stimulation in 1 district and development of parent education module. Baseline survey/ needs assessment & Pilot project on EC stimulation in 1 district and development of parent education module.

ECD / HIV STRATEGIES PMTCT programme in 132 sites providing Voluntary Testing & Counselling services. Baseline research and emerging strategies to establish community-based PMTCT in 9 districts. PMTCT recently incorp. in National HIV strategy. Documentation of best practices in refugee camps of Western Tanzania (PMTCT & Prevent. Of LBW) National Plan of Action for OVCs. Counselling support for Most Vulnerable Children & Families in 15 districts.