Ministry of Health and Social Welfare Reproductive and Child Health Section Tanzania Provides Over 900,000 Implants in Last Six Years International FP Conference Addis Ababa, November 14, 2013 Presenter: Richard Killian, (EngenderHealth, Tanzania [EHT]): Co-Authors: Mwanga, F (EHT); Hiza, M, (Ministry of Health and Social Welfare-Tanzania); Kanama, J (EHT)

Current FP situation in Tanzania Total population: 44.9 million (2012) Population growth rate: 2.7% (2012) Three in four Tanzanians reside in rural areas Total Fertility rate (TFR): 5.4 Modern CPR: 27% (20% in ) LARC/PM CPR: 6% Implants CPR: 2.3% (2010 DHS): 265% increase from 2004 (0.5%) Unmet need for FP: 25% Data Sources: Tanzania Census 2012; Tanzania DHS 2010

FP Programme Objectives and Action Areas (from National FP Strategy) Contraceptive Security Capacity Building Service Delivery Advocacy and Demand Generation Management, Monitoring and Evaluation (2008 National FP goal: 60% total CPR by 2015)

USAID support to Tanzania’s public sector FP program “Flagship” USAID projects, managed by EngenderHealth, 2007-present, for comprehensive technical assistance to Tanzania’s public sector FP program –Follows EngenderHealth’s holistic SEED Programming Model –Country-wide coverage / national scale, district focus: >All 30 regions;110 of 169 districts >> 3,700 public sector health care facilities >> 9,000 service providers trained >~2,200 service providers trained in implant insertion & removal –Capacity-building / system strengthening approach, to build public- sector capacity and increase delivery of FP/RH services –Direct support for public sector mobile outreach to serve hard-to-reach and under-served individuals and communities

Tanzania’s LARC/PM service delivery achievements Selected LARC/PM Results, 2007/08 to 2012/13 (70% in public sector; 50-60% of total via mobile services) Annual LARC/PM clientsNearly tripled, from 157,107 to 424,761 Cumulative total of 1,671,067 clients in IUD clientsSix-fold increase, 16,429 ( ) to 99,552 ( ), cumulative total of 350,242 IUDs provided Implants clientsMore than tripled, with a 265% increase, from 78,687 ( ) to 247,620 (2012/13) cumulative total of 900,045 implants provided Minilap clients (Female sterilization) 419,863 clients chose and received minilap (female sterilization) from Source: National HMIS (MTHUA), 2007/ /13

Rising trends in total numbers of LARC/PM clients being served, and rising number of implants users

Factors in the increase in implants acceptors The clinical method most preferred by clients and providers More trained providers are available for implants than other LARC/PMs Less provider bias than for other LARCs/PMs Mobile outreach services are bringing providers to lower-level health facilities for services, including implants Good supplies of implants generally available (except for ) Approval and stocking of Jadelle by the MOHSW, so there are choices of two implants Price reductions in by manufacturers of Jadelle and Implanon

A client receiving implant services at a public facility

Current use of implants in Tanzania (TDHS 2010) 3.7 % 0.3% 2.1% 1.5% 2.2.5% Urban 2.5% of urban women 2.2% of rural women currently using implant for FP …Of wom en usin g impl ant that are curr ently marr ied age : 3.6% A majority of married women age currently using implants live in rural areas

LARC/PM provision according to service modality The increasing trend of LARCs/PMs by Routine services is evidence of system strengthening and capacity building in the public sector. Total LARC/PM OUTREACH SERVICE DAY ROUTINE

Conclusions: Good progress has been made in Tanzania in increasing LARC/PM availability FP service delivery and system strengthening ˗ Number of government hospitals, health centres and dispensaries able to provide at least one LARC/PM has doubled since 2007 and is continuing to rise ˗ The popularity and availability of implants continues to increase ˗ The public sector and its partners are reaching underserved people and communities through mobile outreach ˗ Mobile services also are providing the opportunity for practical skills development, with associated supervision and QA

The Way Forward: Further increase access and choice by building on the strong foundation Continue to build public sector capacity Enhance public-private partnership and coordination Fine tune approaches to reduce unmet need, reach underserved populations and increase equity, and offer a full range of methods Mobilize resources for FP, including FP2020 commitments, several of which specify implants

ASANTE SANA