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

2. 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)

3. 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.

4. 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

5. 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 (1988 census). U5MR Mkuza Targets - 50
IMR baseline (1988 census). IMR Mkuza target - 48
NMR baseline – 31/1000 in 2008

6. 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.

7. 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 the rate was 1.7%

8. 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 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 years is used as a proxy to the general population

9. HEALTH SYSTEM OPPORTUNITIES & CHALLENGES

10. 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)

11. 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

12. 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

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

14. 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)

15. 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

16. 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

17. Thank you