Health Sector Performance Health Sector Performance 2009/20102009/2010

Presented at the Joint Annual Health Sector Presented at the Joint Annual Health Sector Review Technical MeetingReview Technical Meeting

66th th –– 99thth September 2010, Dar es SalaamSeptember 2010, Dar es SalaamBy J.J. By J.J. RubonaRubona

1

Outline Outline

�Report Structure

�Update of the HSSP III indicators

� Progress towards Health Status

� Progress in improving Service Delivery � Progress in improving Service Delivery

� Progress in Health Systems

�Key Messages

2

Report StructureReport Structure

Chapter 1: Introduction

Chapter 2: Progress against 46 health sector indicators

Progress towards Health StatusProgress in improving Service Delivery

Progress in Health Systems Progress in Health Systems

Chapter 3: Milestones Report

Chapter 4: MTEF Implementation Status

Chapter 5: Review of Council Health Performance

Chapter 6: Highlights from the Public Expenditure Review Update

Chapter 7: Human Resource Status in the Health Sector

Chapter 8: Conclusion, Issues & Challenges

3

2.0 Performance against HSSP III indicators2.0 Performance against HSSP III indicators

�HSSP III has 46 performance indicators clustered under the following thematic areas;

� Service Delivery (e.g. vaccinations, access to reproductive health services etc)reproductive health services etc)

� Health status of the population (e.g. mortality rates, child nutrition, HIV prevalence etc).

� Health systems (health financing and logistics)

4

Progress towards Health Status (1)Progress towards Health Status (1)

� Substantial decline of CMR

� Rate of decline is on truck with MDG target by 2010 100

120

140

160147

112

91

99

Deaths per 1000 live births

Indicators on Child Mortality

U5MR IMR NMR

2010

� high neonatal deaths remain a major challenge accounting for 32% of all U5 deaths in Tanzania

5

0

20

40

60

80

TRCH -1999

TDHS-2005

THMIS-2008

TDHS-2010

MDG Target by 2015

81

51

68

58

51

3832

2926

19

Deaths per 1000 live births

Progress towards Health Status (2)Progress towards Health Status (2)

Indicators on Nutritional Status:

� Malnutrition is a direct result of insufficient food intake or repeated infectious diseases or a combination of both

� Two out of three indices are widely used to measure nutrition status as follows: -

� children who are stunted, too short for their age (Chronic malnutrition)malnutrition)

� children who are wasted are too thin for their height (current status of malnutrition)

� In 2005 survey shows that 38% of under 5 were severely stunted compared with 16.5% in 2009/10 and for wasting, severe malnutrition in 2005 was 3.7% compared with 3.8% in 2009/10.

� Target for HSPSIII by 2015 is 20% for stunted and 2% for wasting.

6

Progress towards Health Status (3)Progress towards Health Status (3)

Indicator: Maternal Mortality Rate (MMR) � Recent results from THMIS shows MMR is 578 it has remained high compared

with TDHS 2004/05 (529) new results are expected from TDHS 2009/10

� Facility based shows a notable decline from 162 (2008) to 96 (2009)

� Facility results predict general decline of MMR (To be confirmed 2009/10 TDHS)

265

250

300

100,000 per live birhs

7

45 5673 75 75 78 78 80 83 84 88 97 97 111

116123124130132137143

162

96

0

50

100

150

200

KAGER

A

ARUSH

A

TANGA

PWANI

MANYARA

MARA

KIG

OMA

SHIN

YANGA

RUVUMA

RUKWA

MBEY

A

KILIM

ANJA

RO

SINGID

A

DODOMA

MTWARA

MWANZA

IRIN

GA

DAR ES SA

LAAM

LINDI

MOROGORO

TABORA

Facility Based

200

8

Facility Based

200

9

Targ

et by 20

15100,000 per live birhs

Indicator: Life Expectancy at birthIndicator: Life Expectancy at birth

� Due to CMR decline, and some of the diseases, Life Expectancy is probably increasing more rapidly than projected

� This is confirmed by Rufiji DSS results which shows increase of 5-10 years in life

Progress towards Health Status (4)Progress towards Health Status (4)

60

65

70

Rufiji DSS: Life Expectancy at Birth

8

increase of 5-10 years in life expectance since 1999 up to 2007. This was after gains in CMR and diseases due to intercensions

� NBS projection of Dec.2006 anticipates life expectancy in 2010 for Male 57 and Female 59 From 51 (M), 52(F) in 2002 census.

.

50

55

60

1999

2000

2001

2002

2003

2004

2005

2006

2007

Male Female

Progress towards Service Delivery(1)Progress towards Service Delivery(1)

Indicator: OPD attendance per capita � The indicator assess provision of health services particularly HF utilization

� OPD attendance per capita in 2009 is 0.74, and it increased from 0.68 of the previous year

� This is below HSPS III target of 0.80 to be attained by 2015 but it is on truck.

� The index is high in Mara and lowest in Kagera

1.6

9

0.23

0.44 0.46 0.470.52

0.570.64 0.65 0.66 0.67 0.68

0.720.77 0.78 0.79 0.8 0.82

1.07

1.2

1.351.45

0.680.74

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

KAGERA

MBEYA

MANYARA

RUKWA

DODOMA

MTWARA

SHINYAN

GA LINDI

MOROGO

RO

IRINGA

TABORA

KILIMANJ

ARO

RUVUMA

MWANZA

SINGIDA

TANGA

KIGOMA

ARUSHA

DAR ES

SALAAM

PWANI

MARA

TOTAL

2008

TOTAL

2009

Progress towards Service Delivery(2)Progress towards Service Delivery(2)Indicator: Measles vaccination � the percentage of total number of children below one year of age vaccinated

against measles

� It has high impact on child mortality reduction

� Performance in 2009 is 91% a notable increase from 88% in year 2008

� It is above HSPSIII target of 85%

� Mara, Manyara and Lindi performed below HSPS III target

102111 112120

10

53

7078 82 82 86 86 87 88 88 88 89 89 93 94 97 100 100 102

88 9185

0

20

40

60

80

100

RUKW

A

MANYARA

LINDI

IRIN

GA

TABORA

KAGER

A

SHIN

YANGA

PW

ANI

MBEY

A

MTW

ARA

RUVUMA

KILIM

ANJA

RO

MARA

ARUSH

A

MOROGORO

DAR ES SA

LAAM

SINGID

A

TANGA

KIG

OMA

MW

ANZA

DODOMA

TOTAL 2008

TOTAL 2009

HSP

S Targe

t by 2015

Progress towards Service Delivery(3)Progress towards Service Delivery(3)

Indicator: Proportion of children under one vaccinated 3 times against DPT –Hb3

� Performance is 85.7% in 2009 slightly below 2008 performances. In spite of this, still it is above HSPSIII target of 85% by 2015.

� On the other hand, more improvement is required in the following regions: Rukwa (65.7%), Kigoma (67.5%), Lindi (70.8%) and Tabora (73.5%).

9496

11

87

89 89

94

90

87

83

86 85.7

76

78

80

82

84

86

88

90

92

94

96

2001

2002

2003

2004

2005

2006

2007

2008

2009

Progress towards Service Delivery(4)Progress towards Service Delivery(4)Indicator: Tetunus Toxoid vaccination

� Tetanus toxoid injections are given during pregnancy to prevent neonatal tetanus, an important cause of infant deaths

� Vaccination coverage has declined from 85% in 2008 to 73.1% in 2009 which is below HSPS III target of 85% by 2015

� Pwani ,Dodoma, Tanga and Morogoro performed above target while Mwanza and Kigoma regions performed below 50%

93.1 95.3100

120

12

32.2

48.456.1

64.1 67.8 68.0 69.7 70.2 70.7 71.076.4 76.8 78.3 78.8 81.3 82.9 84.2 86.2 87.7

93.1 95.385.0

73.185.0

0

20

40

60

80

100

KIGOMA

MWANZA

MTWARA

MANYARA

SINGIDA

IRINGA

MBEYA

TABORA

RUKWA

RUVUMA

KAGERA

MARA

KILIMANJARO

SHINYANGA

LINDI

ARUSHA

DSM

PWANI

DODOMA

TANGA

MOROGORO

TOTAL 2008

TOTAL 2009

HSSPSIII Target by 2015

Percent

Progress towards Service Delivery(5)Progress towards Service Delivery(5)Indicator: Proportion of pregnant women start ANC before 16 weeks of gestation age

� There is significant increase of the proportion of women attending ANC before 16 weeks of gestation from 14% in 2004/05 to 48% in 2008 and slightly declined to 47% in 2009.

� Comparing regional differentials, Morogoro is leading by 90% and Arusha region has least performance (26%)

90100

13

26 30 30 33 33 36 40 40 41 4146 50 50 51

57 58 61 6471

90

34

14

47

60

0102030405060708090100

ARUSHA

KILIMANJARO

PWANI

SHINYANGA

TABORA

MANYARA

MTWARA

RUVUMA

KAGERA

KIGOMA

MBEYA

MWANZA

RUKWA

LINDI

MARA

SINGIDA

DAR ES SALAAM

IRINGA

DODOMA

MOROGORO

TANGA

TOTAL 2008

TOTAL 2009

TRCH Target by 2010

Percent

Progress towards Service Delivery(6)Progress towards Service Delivery(6)Indicator: Maternal Case Fatality Rate in Health Facilities for women admitted due to maternal complications

� No data on women admitted due to maternal compilications

� Available information is on maternal deaths and in 2009 a total of 1665 deaths occurred and Mwanza region took a lead (176) while Lindi region had least cases (39)

� Major causes of deaths include Post Partum Hemorrhage (PPH) followed by eclampsia and anemia

14

Septice Septicaemiamia

6%

Others10%

Ruptured Uterus4%Relapsing Fever1%

Pulmonary Oedema1%

Puerperial Sepsis8%

PPH22%

Pneumonia1%

Obstructed Labour4%

Meningitis1%

Malaria6%

HIV/AIDS8%

EPH Gestosis1%

Eclampsia13%

APH4%

Anaemia9%

Cardio mayopathy

2%

Progress towards Service Delivery(6)Progress towards Service Delivery(6)Indicator: Percentage of HIV positive women receiving ARVs to prevent MTCT and Number of persons with advanced HIV infection receiving ARV combination

� Significant increase in the number of HIV positive women receiving ARV for PMCT; from 34% in 2007 to 55% in 2008. However, in 2009 a decline up to 43 is noted. More efforts are required to meet 2015 target which is 80%

� A total of 80,628 persons receive ARV by the end of 2007 which increased to 248,280 by May 2009 and then 342981 by which increased to 248,280 by May 2009 and then 342981 by May 2010.

� This is a significant increase but the number is far below the 440,000 target to be reached by 2010.

15

Progress towards Service Delivery(6)Progress towards Service Delivery(6)Indicator: Percent of TB Treatment success rate

� Great improvement in treatment success rate from of 84.7% in 2006, 2007 (88%) to 87.7% in 2008. The achievement surpassed the global target 85% and HSPS III target of 82%.

� Almost all regions have surpassed the HSPSIII target.

� The challenge to the program is maintain these high rates.

100

16

8284

86 86 8687 87 87

88 8889 89

9091

92 92 92 9293

95 95

88 88

82

75

80

85

90

95

IRINGA

KILIMANJARO

DAR ES SALAAM

LINDI

SHINYANGA

ARUSHA

KIGOMA

MWANZA

SINGIDA

TABORA

MANAYARA

MBEYA

MARA

RUVUMA

DODOMA

PWANI

RUKWA

TANGA

MOROGORO

KAGERA

MTWARA

TOTAL 2007

TOTAL 2008

Target by 2015

Percent

Key Messages on Health Sector Performance (1)Key Messages on Health Sector Performance (1)

Health status

� As indicated in the previous report, Tanzania is highly commended for the continuing spectacular gains in Child Survival with progressive and significant decline in Under Five Mortality Rate and Infant Mortality Rate which makes Tanzania well on track for the MKUKUTA and MDG indicators. However, less gain has been experienced with neonatal deaths which making up 32% of all under five deaths in Tanzania. This is a challenge in the whole process of reducing Child Mortality.

� A substantial decline in child mortality is putting life expectancy projections at 57 for male and 59 for female in 2010. This will be confirmed by 2012 population census results.

� Maternal mortality ratios remain very high; however, recent information from health facilities indicates a declining trend. This may predict general decline of MMR in the community

17

Key Messages on Health Sector Performance (2)Key Messages on Health Sector Performance (2)

Health Status (Cont’d)

� Much improvement have been made on chronic malnutrition unlike for current malnutrition where no progess has been made from 2005 – 2010

� TFR declined from 5.7 in 2005 to 5.4 in 2010

Service Delivery

� More Tanzanians are seeking health services from health facilities

� TB treatment success rate is among the highest in the world it has surpassed � TB treatment success rate is among the highest in the world it has surpassed international and local set target

� The number of HIV patients on ARVS is very encouraging as it close to set target

� Most of vaccination coverage surpass the set target by HSSPS III

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Thank you for ListeningThank you for Listening

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