Assessing Progress Against Targets and Goals

There are three sets of key goals and targets which are most relevant to the evaluation period: The health related goals of the first Poverty Reduction Strategy to be achieved by 2003, the goals of the MKUKUTA to be achieved by 2010 and the Millennium Development Goals in health to be achieved by 2015.

The table below presents an overview of key indicators for the Tanzania Mainland as they relate to PRS, MKUKUTA and MDG goals in health.

The overall picture presented in the table is one of significant progress toward goals in the area of reducing child mortality, having essentially achieved those goals in Mainland Tanzania for the PRS (2003), and trending downward toward the goals for MKUKUTA and the MDGs, although with considerable progress still needed.

Table 6: Progress Against Targets Indicator 1996 1999 2004/5 PRS Goals (2003) MKUKUTA Goals 2010107 MDG Goals (2015)108

Infant Mortality Rate109 _{88 99 68 85 50 40}

Under Five Mortality Rate110 _{137 147 112 127 79 47}

Prevalence of stunting in under five year olds

44 44 38 20 23.3

Prevalence of moderate or severely underweight (wasting) in under five year olds

29.5 21.9 14.4

Proportion of Children Vaccinated Against Measles111

81 78 80 85 85 90

Coverage of Diphtheria, Tetanus and Polio Vaccine among 12-23 months112

85 81 86 85 85

Maternal Mortality Rate 529113 _{578 265 133}

Percentage of births attended by trained personnel

36 46 80 90

% HIV/AIDS Prevalence among Adults

9.4 (2000)114

7 _<5.5 Number of People Living With

HIV/AIDS Receiving Anti-Retro- Viral Drugs (ARV)

125,312 in AIDS Care and Treatment and 60,341 on ARVs115 100,000 by Dec 2006

107) MKUKUTA Status Report 2006

108) Millennium Development Goals Implementation Report 2006 (2nd _Draft)

109) Using DHS data 110) Using DHS data

111) Using TRCHS/DHS data, which does not coincide 100% with EPI data of Ministry of Health 112) Using TRCHS/DHS data, which does not coincide 100% with EPI data of Ministry of Health 113) A number of key informants point out that this estimate for maternal mortality is contested with some

analysts and agencies suggesting it may have been much higher in 1996. 114) As reported in the MDG Implementation Report 2006.

      



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Similarly, immunisation coverage is close to the targets set for 2003, 2010 and 2015 (although it has not increased significantly since 1996). This coincides with the findings of the district case studies where health staff and community members reported a reduc- tion in measles cases and where facilities where generally well stocked with vaccines. Given diminishing returns on investment, it may still prove difficult to achieve the set goals for IMR and U5MR. As mentioned by key informants, most infant mortality occurs very early after birth (neonatal mortality), and interventions targeting neonatals will therefore have the biggest impact on IMR.

At the same time, there has been no progress in the reduction of maternal mortality, although the number of births attended by trained personnel increased considerably. This goal is clearly not on track to be met in either 2010 or 2015 unless very significant action is taken.

It is clear that finding an effective solution to the problem of Tanzania’s maternal mortal- ity rate will not be easy given the link between this indicator and effective emergency obstetric care and to issues relating to infrastructure and transport.

On the other hand, the district level case studies found little evidence of a concerted effort to address this problem within the health sector as a whole. The Tanzania Service Provision Assessment Survey 2006 points out the severe shortage of health facilities with capacity to undertake caesarean sections and blood transfusions. It also notes that less than 10% of facilities report ever offering the “signal functions” developed by the AMDD project in an effort to track progress in the area of facility preparedness to deal with maternal complications.

As one indicator of progress in health outcomes, Chart 6 below provides an overview of progress towards the MDG goals in IMR and U5MR.

     

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The six districts chosen for case studies during the evaluation also experienced declines in IMR and U5MR during the evaluation period. The most reliable data at council level is found in reports of the national census. Chart 7 illustrates the change in IMR in the six case study districts, and in mainland Tanzania as measured in the two 1988 and 2002 census. A very similar pattern is evident in changes in U5MR for the six districts.

While HMIS data at council or district level is not reliable enough to track trends in health outcomes over time, the census data suggests that the case study districts are expe- riencing similar improvements in at least IMR and U5MR as those reported for the country as a whole.

HIV/AIDS

Regarding progress in addressing HIV/AIDS, the THIS 2003/04 is the first comprehen- sive study on HIV/AIDS in Tanzania. Its most positive result was finding the overall prevalence rate at 7%, which is lower than had previously been estimated. The most important findings of the THIS are the following. The overall prevalence rate is higher among women (7.7%) than men (6.3%). About 1,070,000 people aged 15-59 years are HIV positive. The average prevalence among pregnant women is 6.8%. The overall prev- alence rate for blood donors is 8.8%, again showing a difference between males and females (8.2% male and 11.9% female). There are also great regional variations. For example, in Manyara and Kigoma, the overall prevalence is 2.0%, while in Dar es Salaam it is 10.9%, and in Iringa and Mbeya it is over 13%. The risk of being HIV posi- tive is twice as high for residents of urban areas as for rural residents (the overall urban infection rate is 12.0% and overall rural infection rate is 5.8%). More than 50% of tuberculosis patients are HIV positive.

Malaria and Tuberculosis

With regard to malaria, the 2004 Demographic Health Survey (DHS) indicates that the percentage of under-fives reported to have had fever in the two weeks prior to the survey, a proxy indicator for malaria, declined from 35% in 1999 to 23% in 2004, which is sig- nificant. Ifakara data indicate a decline in child deaths due to malaria or acute febrile ill-

ness from 10.4 per 1,000 person years in 2000 to 3.7 per 1,000 person years in 2003. The decline may be due to an increased usage of bed nets and more effective anti-malar- ial drugs. For example, UNICEF data shows that the percentage of under-fives who have slept under a bed net the night before the survey went from 21% in 1999 to 31% in 2004/05. Likewise, the percentage of under-fives with fever who were given anti-malarial drugs in the two weeks before the survey rose from 53% in 1999 to 58% in 2004/05. Similarly, MOHSW reports that the 2005 Roll Back Malaria survey for Tanzania con- firms a significant increase in the use of insecticide treated nets and further points out that the case fatality rate for severe malaria among under fives was now ranked much lower (5th_{) than previously among the 10 leading causes of death on the Tanzania main-}

land. They also point to a TEHIP study reporting a significant decline in malaria specific under-five mortality between 1999 and 2003.

With regard to tuberculosis, MOHSW reports a dramatic increase in the number of tuberculosis cases reported over the last two decades, although the number was reasona- bly constant from 2001 to 2005 when it fluctuated in a range from a low of 61,246 cases in 2001 to a high of 64,298 cases in 2003 before dropping back to 63,780 cases in 2005. The steady rise in TB cases during the 1990s is attributed to the precursor rise in HIV/ AIDS cases.