HIGHLIGHTS OF MDGs & MKUZA II IN ZANZIBAR HEALTH SYSTEM OPPORTUNITIES & CHALLENGES Presented by : Dr. Mkasha Hija Mkasha (On behalf of Acting DG)

Introduction Eight Goals were set during 1990 Millennium Development Declaration to guide the development process with defined targets for each goal which are to be achieved by 2015 or earlier Goal 4, 5 and 6 are directly related to health and the remaining are indirectly related Direct means all targets belongs to health sector Indirect means there are some indicators which has to be provided by other sector MKUZA: Zanzibar Strategy for Growth & Reduction of Poverty (ZSGRP)

Intro. Cont…… To reach the desired targets Zanzibar developed its national strategy (MKUZA- ZSGRP), While at Ministerial level - Health Policy which is translated into sector Strategies and annual plan of action Robust Health systems are required to meet the MDGs in each of the six building blocks.

Goal 1: Eradicate extreme poverty and hunger (Indirect) Zanzibar has shown an improvement in reducing malnutrition Indicator Target 2015 Status Reduce % of underweight for children Under 5 years 19.9% 13.9% (2014 National Nutrition Survey – Preliminary results) Reduce % of stunting for children Under 5years 23.8% 24.4% (2014 National Nutrition Survey – Preliminary results) Mkuza II targets for underweight - reduce from 19% in 2010 to 15% by 2015 Stunting - reduce from 23% in 2010 to 20% by 2015 The above achievements is due to ................................

Goal 4: Reduce child mortality Progress has been made in reducing infant and child mortality Indicator Target 2015 Status Reduce Under-five mortality rate (U5MR) 67/1,000 live births 66/1,000 live births (2012 census preliminary results) Reduce infant mortality rate (IMR) 40/1,000 live births 46/1,000 live births (2012 census preliminary results) Increase Proportion of children vaccinated against measles 100% >100% (HMIS Bulletin ,2013) Reduce Neonatal mortality rate (NMR)****MKUZA 15/1,000 live births 29/1,000 live-births (2009/10 TDHS) U5 MR Baseline - 202 (1988 census). U5MR Mkuza Targets - 50 IMR baseline - 120 (1988 census). IMR Mkuza target - 48 NMR baseline – 31/1000 in 2008

Goal 5: Improve maternal health 1. Reduce Maternal Mortality MMR 2015 target = 170 /100,000 live births. Remains a challenge Joints efforts are needed to reduce Trend of MMR Due to lack of national survey which can provide the rate of maternal deaths, the available information is from routine hospital data ie, Facility base/Institutional.

Improve maternal health cont... Indicator Target 2015 Status 2. Proportion of births attended by skilled health personnel 90% 60% (HMIS Bulletin, 2013) 3. Increase percentage of births delivered in health facilities*** MKUZA 60% 56.6% (HMIS Bulletin, 2013 4. Contraceptive prevalence rate*** MKUZA 20% 12.4% (TDHS 2009/10) *** Not included in MDGs target these belongs to MKUZA II targets Target set for anaemia pregnancy was not reliastic. 2010 the rate was 1.7%

Goal 6: Combat HIV/AIDS, malaria and other diseases HIV: Indicator Target 2015 Status HIV prevalence among general population*** MKUZA < 1% 1.1% (2012 THMIS) HIV prevalence among pregnant women aged 15 -24 years 0.3% 0.6% (2014 ANC surveillance) HIV Prevalence among CSW reduced *** MKUZA 5.4% 8.6% (IBBSS, 2012) HIV Prevalence among MSM*** MKUZA 6.1% 2.6% (IBBSS, 2012) HIV Prevalence among IDUs reduced *** MKUZA 7.5% 11.3% (IBBSS, 2012) Progress has been made in this goal. Zanzibar has reached at an eliminating stage of malaria. IBBSS - Integrated Biological & Behaviuoral Survey HIV prevalence among pregnant women aged 15-24 years is used as a proxy to the general population

HEALTH SYSTEM OPPORTUNITIES & CHALLENGES

Opportunities Political stability and commitment Availability of national plans to support MDGs implementations (Vision 2020, MKUZA and sector policy and strategies Government commitment in health issues Partners financial and technical support to the health sector Extensive health system in Zanzibar Health management information system (HMIS) uses (DHIS2) Health facility network, with at least one trained staff each)

Challenges Governance Implementation of the health policy Inadequate monitoring and follow up Human Resource Inadequate skills in caring neonates Treatment according to guidelines is a challenge at all levels Health policy - free health services

Challenges …. Human Resource cont... Shortage of medical specialist (high number of support staff) Gynecologist: none available vs. minimum staff requirement = 12 Anesthetic nurses and doctors are not available all maternity emergencies in all hospitals

Challenges …. Logistic, Drugs and Medical Supplies Inadequate medical equipment, drugs and supplies

Challenges …. Finance Underfunding of the health sector (per capita expenditure is ($23) which is lower than that recommended by WHO of $ 60 Donor - driven support Sustainability of Malaria financing Imbalance funding from vertical programmes (lots of fund are allocated to vertical programs than other areas)

Challenges … Service delivery Negative attitudes in provision of health services (YFS and condom) No referral guidelines at all levels Low health education in the community In adequate interventions on neonatal death

Challenges …. Health Information Incomplete data for neonatal deaths at community  High stigma for PLHIV Insufficient of vital data on civil registration Causes of morbidity and mortality are not classified using ICD 10

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