Reproductive Maternal Newborn Child and Adolescent Health Past

Reproductive, Maternal, New-born, Child and Adolescent Health: Past, Present and Future DPGH Retreat Protea Courtyard Hotel, 04 October 2017

Presentation Outline 1. Background of RMNCAH in Tanzania 2. Government’s Approach to RMNCAH 1. Align all Partners behind a Single Plan 2. Focus on Results 3. Use an Integrated Service Delivery approach to RMNCAH 3. RMNCAH Coordination Platform in Tanzania 4. Challenges 5. The Future 2

Demographic Information Indicator Total URT Population Selected RMNCAH Indicators Data Source 50. 1 million NBS 2016 (projections) Young people aged 10 – 24 14. 4 million (32%) 2012 census Population aged 0 -14 19. 7 Million (44%) 2012 census 5. 2 556/100, 000 64% 98% 25/1, 000 43/1, 000 67/1, 000 32% 27% 2015/16 TDHS 2015/16 TDHS 2015/16 TDHS 3 2015/16 TDHS Total Fertility Rate (TFR) Maternal Mortality Rate (MMR) Skilled Birth Attendance Antenatal care (first ANC visit) Neonatal Mortality Rate (NMR) Infant Mortality Rate (IMR) Under Five Mortality Rate (U 5 MR) CPR (modern methods) Unmet need for FP Teenage pregnancy rate(15 -19)

Reproductive Health One Plan CPR Goal = 60% by 2015 4

Child Health 5

Maternal and Neonatal Health 6

Causes of Death 7

Policy Environment • Health Policy (2007) prioritized RMNCH services (under review) HSSP IV and within that BRN in Health • RMNCAH services built on the HSSP IV which implements Health Policy • Sharpened One Plan 2014 -15 launched together with the RMNCAH Score Card in May 2014 One Plan II • One Plan II 2016 -2020 8

The One Plan II MISSION: To promote, facilitate, and support in an integrated manner, the provision of comprehensive, high impact, and cost effective RMNCAH and nutrition services, along the continuum of care to men, women, newborns, children, and adolescents KEY STRATEGIES: • Strengthen reproductive, maternal, newborn, child, and adolescent health • Scale-up the child health program • Strengthen response to cross-cutting issues, e. g. , commodities, community involvement, demand, HMIS KEY AREAS OF FOCUS: • Re-defined FP within the broader RMNCAH context • Care at birth, Post Partum and PNC (HRH - Skilled health care providers) • Commodity Security • Prioritized Adolescent and youth SRH services 9

Government’s Approach Align all partners behind a Single Plan • All partners are obliged to implement “One Plan II” (2016 -2020) HSSP IV and within that BRN in Health One Plan II • Through SWAp arrangement • Planning and Monitoring done by RMNCH TWG • Constitutes the Investment Case for the GFF for Tanzania 10

Government’s Approach Strong Focus on Results • There have been significant achievements over past decade … WHAT WILL DRIVE THE NEXT SET OF GAINS? • Government increasingly focused on Quality of service delivery, Results and getting Value for Money Hapa Kazi Tu! • DPs support to government increasingly results-oriented Entry points for performance-based initiatives Star Rating Assessment Results-based Financing LGA Scorecard Regional Scorecard National Scorecard 11

Government’s Approach Use an Integrated Service Delivery Approach to RMNCAH • Performance-based initiatives are all focused on RMNCAH-related indicators or factors affecting RMNCAH service delivery: • Examples; 1. Star Rating Assessment with focus on Quality of care 2. LGA Scorecards 3. Results-Based Financing (RBF) 12

RMNCAH Coordination Platform in Tanzania Technical Working Groups Other TWGs RMNCAHspecific TWGs § § • • • RMNCAH TWG Sub-TWGs Family Planning RH Commodity Security Safe Motherhood Adolescent RH Newborn and Child Health RH Cancers PMTCT Immunization and Vaccines Gender Coordination for Funding Mechanisms § § § § Health Financing Health Commodities and Technologies Human Resources for Health District, Regional, Zonal and National Health Services Public Financial Management Public Private Partnership Social Protection and Nutrition § § Health Basket Fund Steering Committee Results-based Financing Steering Committee DP Coordination Mechanisms § § § Development Partner Group (heads of agencies) DPG-Health DPG-Nutrition 13

Key Challenges (mostly related to service delivery) 1 Health Facilities • Barriers to healthcare goals: healthcare infrastructure, equipment; health worker coverage/distribution, decentralisation of health system, procurement bottlenecks Service Delivery • Poor quality of healthcare at all levels. Performance and efficiency of the forecasting, procurement, quality control for drugs and vaccines are inadequate • Barriers to access: long travel distance, lack of transportation and unfriendly services • Referral system has serious challenges including limited number of ambulances; unreliable logistics and communication systems Human Resource for Health • Widespread shortages (~ 50% - 70%) of qualified staff exist at all levels; esp. rural areas • Staff shortages exacerbated by increasing burden of disease (esp. NCDs) 2 3 4 Health Financing 5 Data • Budget execution • Financing Gap • Data completeness, consistency challenges; significant improvements in recent years. • Further improvements will arguably only come from improved use – e. g. accountability for results and as the basis of disbursements.

Other Challenges: 1. Teenage Childbearing Percent currently married women age 15 -19 Teenage childbearing appears to be rising and contraceptive use among married youth remains low 15

Trends in Teenage Pregnancies, 1999 -2015 35 30 25 28, 7 26 25 24, 5 23, 1 31, 5 26, 3 26, 7 22, 8 20 19, 6 15 18, 6 14, 6 10 5 0 1999 2005 Urban 2010 Rural 2015 Rural adolescents continue to experience pregnancy nearly 1. 7 times the rate of urban adolescents. National The gain made towards reducing adolescent pregnancies that was observed between 1999 and 2010 in urban areas has been lost, with adolescent pregnancy rates increasing substantially in both urban and rural areas. In 2015, the national adolescent pregnancy rate had increase nearly 4 percentage points from 2010 to about 27%. 16

Other Challenges: 2. Nutrition Status in Under-five children 17

Other Challenges: 3. Coverage and Equity Family Planning Care at Birth Bars represent Inequities by urban/rural residence 18

Maternal, Newborn, and Child Health Family Planning 2008 Our Journey … One Plan Mid-Term Review One Plan 2008– 2015 Sharpened One Plan 2014– 2015 • Prioritize and scale MNCH high impact interventions • Better incorporate family planning GFF Investment Case One Plan II NFPCIP 2010– 2015 2010 NFPCIP Mid-Term Review Updated NFPCIP 2013– 2015 • High impact interventions • Lowest CPR in Lake and Western zones London Summit and FP 2020 Commitments 2012 2013 2014 Reproductive, Maternal, Newborn, Child, and Adolescent Health 2016 to 2020 19

Where do we want to go? . . Strategic Indicator MMR SBA NMR IMR U 5 MR CPR SDPs providing YFS Teenage pregnancy rate (15 -19) 2015 Status 2020 Target 410 per 100, 000 LB (now 556) 292 per 100, 000 LB 64% 80% 25 per 1, 000 LB 16 per 1, 000 LB 43 per 1, 000 LB 25 per 1, 000 LB 67 per 1, 000 40 per 1, 000 LB 27% 45% 30% 80% 27% TBD 20

What need to be done… 1. Alignment and harmonization by DPs on our support to improve ; 1. 2. 3. Quality of care for RMNCAH Reduce inequities Health system support for delivery of RMNCAH interventions 2. Strengthening RMNCAH health information system within the Broader health information system and health data collaborative for tracking progress and accountability 3. Strengthening health system to deliver the recommended interventions 4. Resource mobilization 5. Strengthen Coordination mechanisms through TWGs and TC SWAp 6. Strengthening Evidence based planning especially MPDSR 7. Innovative approaches 21

Opportunities…. 1. Availability of Integrated RMNCAH strategic plan and HSSP IV 2. Commitment from Partners 3. Availability of evidence based guidelines 22