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September 2013 MIDTERM ANALYTICAL REVIEW OF PERFORMANCE OF THE HEALTH SECTOR STRATEGIC PLAN III 2009–2015 September 2013 Ministry of Health and Social Welfare United Republic of Tanzania in collaboration with Ifakara Health Institute National Institute for Medical Research World Health Organization MIDTERM ANALYTICAL REVIEW OF PERFORMANCE OF THE HEALTH SECTOR STRATEGIC PLAN III 2009–2015 September 2013 Ministry of Health and Social Welfare United Republic of Tanzania in collaboration with Ifakara Health Institute National Institute for Medical Research World Health Organization TABLE OF CONTENTS Contents ..............................................................................................................................................................................................iii Foreword .............................................................................................................................................................................................iv Acknowledgements ............................................................................................................................................................................v FIGURES and TABLES ......................................................................................................................................................................vi ACRONYMS ......................................................................................................................................................................................viii EXECUTIVE SUMMARY ......................................................................................................................................................................x 1 | BACKGROUND, APPROACH AND MAIN IMPLICATIONS ..........................................................................................................1 2 | MORTALITY AND MORBIDITY ......................................................................................................................................................7 3 | REPRODUCTIVE AND CHILD HEALTH ......................................................................................................................................19 3.1 MATERNAL & NEWBORN CARE ..................................................................................................................................19 3.2 FAMILY PLANNING .......................................................................................................................................................29 3.3 IMMUNIZATION .............................................................................................................................................................34 3.4 CHILD HEALTH AND NUTRITION.................................................................................................................................39 4 | MALARIA, HIV/AIDS, TB & OTHER INFECTIOUS DISEASES ..................................................................................................43 4.1 MALARIA ........................................................................................................................................................................43 4.2 HIV/AIDS ........................................................................................................................................................................49 4.3 TUBERCULOSIS ............................................................................................................................................................58 4.4 NEGLECTED TROPICAL DISEASES ............................................................................................................................64 4.5 OUTBREAK/NOTIFIABLE DISEASES ...........................................................................................................................65 5 | NONCOMMUNICABLE CONDITIONS AND INJURIES ..............................................................................................................69 5.1 NONCOMMUNICABLE DISEASES ...............................................................................................................................69 5.2 MENTAL DISORDERS ...................................................................................................................................................72 5.3 INJURIES .......................................................................................................................................................................73 6 | HEALTH SYSTEMS ......................................................................................................................................................................75 6.1 POLICIES .......................................................................................................................................................................75 6.2 HEALTH FINANCING .....................................................................................................................................................80 6.3 HEALTH WORKFORCE .................................................................................................................................................84 6.4 HEALTH INFRASTRUCTURE & SERVICE DELIVERY ................................................................................................87 7 | PERFORMANCE ASSESSMENT .................................................................................................................................................93 ANNEX ..............................................................................................................................................................................................103 MIDTERM ANALYTICAL REVIEW OF PERFORMANCE OF THE HEALTH SECTOR STRATEGIC PLAN III 2009–2015 iii Foreword The Analytical Review Report on the Performance of the Third Health Sector Strategic Plan 2009–2015 (HSSP III) is an important input to the overall Mid-Term Review (MTR) of HSSP III. The report provides a comprehensive overview of the current status of the health sector in Tanzania mainland, using all available data from the health management information system of the Ministry of Health, household surveys, and many other sources. The focus is on the core indicators and targets of HSSP III and the performance during 2009– 2012. The analytical report clearly highlights many areas where significant progress has been made and also shows areas where efforts need to redoubled to achieve the targets for 2015. The report pays special attention to equity and for the first time presents a comprehensive regional analysis. The equity analysis will help to guide us on which populations or regions of the country need a larger infusion of resources, efforts and investments in order to achieve parity as well as improve the national average. A comparative analysis with neighbouring countries in the East and Southern Africa (ESA) region and the African continent as a whole helps to give an idea where we stand in relation to global goals and target. The publication of this report is a major input to the main MTR and will prove handy to the senior management and technical experts of the Ministry of Health and Social Welfare (MOHSW) and other government ministries, departments and agencies (MDA) that have an impact on the health sector. These include, but not limited to, President’s office, Public Service Management (POPSM), Prime Minister’s Office, Regional Administration and Local Government (PMORALG), Ministry of Finance (MOF) and National Bureau of Statistics. The report will also be useful for policy makers, parliamentarians, the civil society and the community at large. Some of these may need some assistance in interpreting some sections of the report and the MOHSW is prepared to do as we, as the custodian of the national Health Policy, are accountable for some or most of those results. The analytical review report was prepared using information from existing reports – from surveys, health information system and research. Also the MOHSW prepared this report using experts from national institutions or international partners based in Tanzania. This means local capacity exists or has been unleashed by working closely with seasoned experts from WHO. It is my anticipation that future reports from the MOHSW programme will contain a similar level of analytical thinking with comparative and equity considerations. On a personal level, being new to the health sector, the report provides me with a perfect audit of where we are and what I need to focus on as I take a senior leadership position in the sector. It is my hope therefore that all stakeholders in the health sector will use the report to increase efforts in service provision and raise standards for recording, documenting and reporting. We look forward to producing improved Annual Health Sector Performance Profile Reports in future. On behalf of the Ministry of Health and Social Welfare, I would like to express appreciation to the Global Fund to Fight AIDS, Tuberculosis and Malaria for its financial support, the World Health Organization for providing the technical support and to the National Institute for Medical Research and Ifakara Health Institute for undertaking the assignment. Charles Amos Pallangyo PERMANENT SECRETARY Dar es Salaam, September 2013 iv MIDTERM ANALYTICAL REVIEW OF PERFORMANCE OF THE HEALTH SECTOR STRATEGIC PLAN III 2009–2015
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