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

2. Presentation Outline Background of RMNCAH in Tanzania
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
RMNCAH Coordination Platform in Tanzania
Challenges
The Future

3. Demographic Information
Selected RMNCAH Indicators
Indicator
Data
Source
Total URT Population
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%)
Total Fertility Rate (TFR)
5.2
2015/16 TDHS
Maternal Mortality Rate (MMR)
556/100,000
Skilled Birth Attendance
64%
Antenatal care (first ANC visit)
98%
Neonatal Mortality Rate (NMR)
25/1,000
Infant Mortality Rate (IMR)
43/1,000
Under Five Mortality Rate (U5MR)
67/1,000
CPR (modern methods)
32%
Unmet need for FP
22%
Teenage pregnancy rate(15-19)
27%

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

5. Child Health

6. Maternal and Neonatal Health

7. Causes of Death

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

9. 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 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
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

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

11. 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

12. 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)
Star Rating Assessments

13. RMNCAH Coordination Platform in Tanzania
Development Partner Group (heads of agencies)
DPG-Health
DPG-Nutrition
DP Coordination Mechanisms
Health Basket Fund Steering Committee
Results-based Financing Steering Committee
Coordination for Funding Mechanisms
RMNCAH TWG
Sub-TWGs
Family Planning
RH Commodity Security
Safe Motherhood
Adolescent RH
Newborn and Child Health
RH Cancers
PMTCT
Immunization and Vaccines
Gender
RMNCAH-
specific TWGs
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
Other
TWGs
Technical Working Groups
Several donor coordination mechanisms exist in Tanzania, and it was purposely decided against establishing new GFF-specific coordination mechanisms. Technical Working Groups are co-led by Government and DPs. Some TWGs are RMNCAH-specific as shown here are. Others has indirect links with the RMNCAH agenda. For example, Health Commodities, Health Financing etc.
The new financing mechanisms also have coordination structures that comprise Government and DPs. These are led by the Ministry of Health. Examples include: the Health Basket Fund Steering Committee and the Results-based Financing Steering Committee, both chaired by the PS-Health.

14. (mostly related to service delivery) Human Resource for Health
Key Challenges
(mostly related to service delivery)
Health Facilities 1
Barriers to healthcare goals: healthcare infrastructure, equipment; health worker coverage/distribution, decentralisation of health system, procurement bottlenecks
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
Service Delivery 2
Widespread shortages (~ 50% - 70%) of qualified staff exist at all levels; esp. rural areas
Staff shortages exacerbated by increasing burden of disease (esp. NCDs)
Human Resource for Health 3
Health Financing 4
Budget execution
Financing Gap
Data 5
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.

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

16. Trends in Teenage Pregnancies, 1999-2015
Rural adolescents continue to experience pregnancy nearly 1.7 times the rate of urban adolescents.
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%.

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

18. Other Challenges: 3.Coverage and Equity
Family Planning
Care at Birth
Bars represent Inequities by urban/rural residence
Care at birth services too low – 50% deliver in a facility with large SES inequity of 56%. Less than half of pregnant women receiving 4+ ANC (yet almost universally receive1 ANC visit showing a missed opportunity). Only 31% of women receive PNC within 2 days.
Coverage for FP (demand satisfied) remains low at 46% and large SES inequities (22%)

19. Our Journey … 2016 to 2020 GFF Investment Case 2008 2010 2014 2013
Sharpened One Plan
2014–2015
GFF Investment Case
2008
2010
2014
2013
High impact interventions
Lowest CPR in Lake and Western zones
NFPCIP Mid-Term Review
One Plan
Mid-Term Review
Maternal, Newborn, and Child Health
Family Planning
Our Journey …
Reproductive, Maternal, Newborn, Child, and Adolescent Health
London Summit and FP2020 Commitments
Prioritize and scale MNCH high impact interventions
Better incorporate family planning
NFPCIP
2010–2015
Updated NFPCIP
2013–2015
One Plan II
2008–2015
2012

20. Where do we want to go?.. MMR SBA NMR IMR U5MR CPR SDPs providing YFS
Strategic Indicator
2015 Status
2020 Target
MMR
410 per 100,000 LB
(now 556)
292 per 100,000 LB
SBA
64%
80%
NMR
25 per 1,000 LB
16 per 1,000 LB
IMR
43 per 1,000 LB
U5MR
67 per 1,000
40 per 1,000 LB
CPR
27%
45%
SDPs providing YFS
30%
Teenage pregnancy rate (15-19)
TBD

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

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