[A] Reviewing the PAST

Countdown to 2015 In-Depth Case Study: United Republic of Tanzania

Feedback from the HSP & Finance WorkshopNairobi, Kenya

3 March 2014

[A] Reviewing the PAST1. One Plan MTR Quantitative & Qualitative Analysis

2. HSSP III MTR of the HSSP III

3. Tanzanian Countdown Country Case Study

[B] Planning for the future1. Sharpened plan (2014 – 2015) and costing

2. One Plan (2016 – 2020) and costing (inline with the HSSP IV)

[C] Tracking progress1. Scorecards

Overview

Evaluation Framework for Countdown Country Case Study

Contextual factors including non-health system determinants- Economic growth, education, transport & communication -

NMR

MMR

Under 5 Mortality Rate

Total Fertility RateCoverage along the continuum of care

- Demand for family planning- Antenatal care visits - Delivery in a health facility- Caesarean section rate- Postnatal care- Exclusive breastfeeding- Vaccine coverage

Equity- Urban/rural residence- Socioeconomic status- Maternal education

Stillbirth Rate

INPUTS OUTPUTS OUTCOMES IMPACT

Health service readiness

Health service quality

Health service utilisation

Health Information Systems

Legislative framework

Health workforce

Infrastructure & commodities

Health system financing

Governance & leadership

WHO

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NMR

MMR





Stillbirth Rate







Health workforce




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Impact

Progress on MDG 4Reduce the under-five mortality rate by two-thirds

Absolute # of deaths

1990 2010

U5MR 170 035 179 286

NMR 43 436 52 337

Source: IHME

Impact

Progress on MDG 5.A.Reduce the maternal mortality ratio by three quarters

220

0

200

400

600

800

1000

1200

1400

1600

MM

R(D

eath

s/10

0 00

0 liv

e bi

rths)

1990 1995 2000 2005 2010 2015

Year

United Nations IHME DHS MDG 5

Maternal Mortality Ratio

MMR Average annual rate of

reduction (%)

2000 - 2010 4.6

Source: Countdown to 2015 Report (2012)

Absolute # of deaths

2010

MMR 8500

Source: Countdown Report

Global goal = <50 by 2035

One Plan Goal= 193 by 2015

Impact

Progress on MDG 5.B. – FAMILY PLANNINGAchieve universal access to reproductive health

0

20

40

60

80

100

Mar

ried

wom

en 1

5-49

(%)

1991 1996 1999 2004 2010

DHS Survey

Traditional Method CPR Modern Method CPR Unmet need

Source: DHS; (CPR: Contraceptive Prevalence Rate)

(Contraceptive prevalence plus unmet need for family planning)Demand for family planning

DHS Survey

Modern Methods

CPR

Unmet need

1991 7 27

1996 13 26

1999 19 22

2004 20 24

2010 27 25

One Plan CPR Goal= 60% by 2015

Impact

0

1

2

3

4

5

6

7

8

TFR

(chi

ldre

n/w

oman

)

1985 1990 1995 2000 2005 2010Year

UN Estimates DHSCensus

(TFR)Total Fertility Rate

Source: United Nations, Department of Economic and Social Affairs, Population Division (2011). World Population Prospects: The 2012 Revision, CD-ROM Edition; Demographic and Health Surveys; Tanzania census 1988 & 2002.

London School Analysis for Tanzanian Countdown

Total Fertility RateImpact



NMR

MMR





Stillbirth Rate







Health workforce




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Outcomes

Demand for family 1991planning satisfied 1999

2010

Antenatal care 1991(4+ visits) 1999

2010

Births in a 1991health facility 1999

2010

Measles 1991immunisation 1999

2010

0 10 20 30 40 50 60 70 80 90 100

Coverage (%)

Poorest 20% Richest 20%

Trend in Coverage along theContinuum of Care

Source: DHS

Coverage along the Continuum of Care& identifying health gaps

Source: Demographic and Health Surveys, Tanzania London School Analysis for Tanzanian Countdown

Demand for family 1991planning satisfied 1999

2010

Antenatal care 1991(4+ visits) 1999

2010

Births in a 1991health facility 1999

2010

Measles 1991immunisation 1999

2010

0 10 20 30 40 50 60 70 80 90 100

Coverage (%)

Poorest 20% Richest 20%

Trend in Coverage along theContinuum of Care

Source: DHS

Focus of In depth Country Case Study

Family Planning

Care at Birth

Focus of the Tanzanian In-Depth Country Case Study

1. Family Planning

Better understand why the unmet need for family planning has remained constant between 1990 and the current year, and explore which women are not being reached and why?

2. Coverage and Quality of Care at Birth

Further explore which women and children are not receiving the necessary care at birth, how to bridge the inequities and to improve quality of care.

Family PlanningFamily Planning Who is being left behind?

Equity gaps: Who’s being left behind?

RURAL

POOR

LEAST EDUCATED

FROM THE WESTERN

& LAKE ZONE

MWANZA, MARA & SHINYANGA

W O M E N

LAKE

WESTERN

Care at BirthWho is being left behind?

Equity gaps: Who’s being left behind?

RURAL

POOR

LEAST EDUCATED

W O M E N

BIRTH IN A HEALTH FACILITY

BIRTH BYCASEAREAN

WHY?

Focus of this Tanzania Country Case Study



NMR

MMR





Stillbirth Rate







Health workforce




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Health System and Policy and Finance Workshop

(Nairobi 25 – 28 Feb)

Objectives

• Build capacity for analysis of health system and health policy- related factors that have an impact on progress in reducing maternal, newborn and child mortality

• Build capacity for analysis of health financing for maternal, newborn and child health through tracking of resource flows

Specific objectives

• Health system and policy analysis– Assess adoption of technical, health sector, and multi-

sectoral policies and contextual factors that have an impact of RMNCAH and develop a policy timeline

– Assess adoption of Countdown policy tracer indicators and develop a dashboard

– Assess the extent to which policies have been translated into effective programmes

– Assess key health system characteristics and identify facilitating factors and bottlenecks for access, quality and coverage of interventions

Specific objectives

• Health financing analysis– Review types of analysis for resource tracking relevant to

country case studies– Discuss resource tracking efforts underway in countries– Refine the analysis plans

• Work in teams to familiarize with the proposed tools and methods and conduct analysis

• Develop a plan of action for the country case study and identify needs for technical assistance

Team members present at the workshop

1) Moke Magoma – E4A

2) Clement Kihinga – MoHSW

3) Theopista John – WHO

4) Melisa Martinez-Alvarez – LSHTM

5) Arin Dutta – Futures Group/USAID

6) Joy Lawn – LSHTM

7) Hoviyeh Afnan-Holmes – LSHTM

Other Countries present: Afghanistan,

Ethiopia, Kenya, Malawi, Pakistan, Peru,

Rwanda

.

What the Tanzanian team aimed to get out of this workshop?

1. Describe the overall story of policy change for women, newborns and children in Tanzania between 1990 and the current year.

2. Explore reasons for the inequity present in the provision of family planning and care at birth, understand why specific women are missing out on these essential services and how to address this need.

3. Further inform where to focus attention and resources needed for the Tanzanian Sharpened Plan.

4. Documentation of the Countdown HSP Analysis Tools 1 – 3 and further progress on the health finance analysis & scientific journal article.

5. Further plan for the National RMNCH Event (Technical products etc)

1. Describe the overall story of policy change for women, newborns and children in Tanzania between 1990 and the current year.

Accomplished this week: A better understanding of previous progress in country for MDG 4 and 5 and what needs to be done differently for the future.

Progress Made in the Workshop - HSP analyses -


2. Explore reasons for the inequity present in the provision of family planning and care at birth, understand why specific women are missing out on these essential services and how to address this need.

Accomplished this week: Further explored the qualitative data collected at a district level to answer why the inequities are present in country.

(Further analyses still to be completed.)


3. Further inform where to focus attention and resources needed for the Tanzanian Sharpened Plan.

Accomplished this week: Agreed on resources and further analyses required to inform the Tanzanian Sharpened Plan.Developed a timeline. (See later slide)


4. Documentation of the Countdown HSP Analysis Tools 1 – 3 and further progress on the scientific journal article.

Accomplished this week: Completed Tool 1 and Tool 2. Identified the demand and supply bottlenecks specific to the focus of the case study (Tool 3). Created an E-Library in Dropbox with all policy documents.

(Still to finalise the graphics to be includedin the scientific journal article.)

Progress Made in the Workshop - Finance analyses -

Accomplished this week: Reviewed the current information

Identified new data sources that need further analysis – to inform the gap analysis

Feb1 2 3 4

March1 2 3 4

April1 2 3 4

May1 2 3 4

June1 2 3 4

July1 2 3 4

RMNCH EVENT

Products

Analysis

Process

Policy BriefReport CardSharpened Plan One RMNCH Plan to 2020

HSSP (IV)

Partners Forum Meeting

Analysis completed- Impact, Coverage, Equity

Analysis to be finalised- Finance analysis – Gap Analysis- LiST – a) Short term (2015); b) Medium term (2020); c) Universal coverage- One Health Costing – Short Term (by April); Medium Term (post April)- Qualitative analysis of district performance

PLANNING MEETINGS

Details of roles and responsibilities to be drafted into a Gantt Chart

Timeline

FINALISE SCIENTIFIC ARTICLE

Next Steps• What?

– Policy Brief– Report Card– Sharpened Plan (Priority actions and Costing)– Finalize the analysis (LiST, Financial)

• Who?– Case study Team– Core team for the RMNCH Event

• When?– By End of March /First week of April ready for RMNCH Event– May for the Case study

Only 632 days left to achieve the MDG’s

Only 36-40 days to the National RMNCH Event

We need to start sprinting rather than running normally!

Kazi ni Kwetu!

Asanteni!

Dr Theopista – please change this photo to be Tanzania specific.

Timeline for In-Depth Case Study1. Start date: July 2013

2. End date: July 2014

3. Proposed products: - PPT library of slides and policy brief;- Scientific journal article; - Scorecards

4. Is a Country Countdown event planned? Yes – April 2014 (Guest of honor: President JM

Kikwete)

5. Is the in-depth case study linked to other processes in-country? Yes Please specify. - HSSP III MTR and The One Plan MTR- Sharpened RMNCH Plan (2008 – 2015); Second RMNCH Plan (2015 - 2020) which will be in line with the HSSP IV- Costed priorities for both a) Sharpened Plan (2014-2015); & b) Second RMNCH Plan (2015 – 2020)

- A Promised Renewed Campaign and The Every Newborn Action Plan- National RMNCH Scorecards

Documents

[A] Reviewing the PAST