ON MY MIND: Achievements and challenges in maternal and child health

Tanzania has made significant strides in improving the health and wellbeing of its population, as measured by the Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS) 2015-2016. The report provides invaluable information on a range of issues which can help us understand better which factors support or hinder improvement in health conditions. 

At its launch, the Minister of Health, Community Development, Gender, Elderly and Children, Ummy Mwalimu, pointed out the achievements and challenges facing the health sector, and said, “These findings will play a key role in helping us to improve our policies and identify priority areas.”

Quality health for all is one of Tanzania’s major development goals according to numerous policy statements.Tanzania Vision 2025 cites “access to quality reproductive health services for all individuals and reduction in infant and maternal mortality” as among the most important health service goals. According to the report, improving maternal, newborn, and child health (MNCH) is one of government’s prime objectives. The Primary Health Service Development Programme (PHSDP/MMAM 2007- 2017) addresses the crucial issue of equity by calling for increased coverage and quality of primary health care services, including maternal health services for communities in rural and remote areas. The Health Sector Strategic Plan III 2016-2020 (HSSP IV) also addresses the importance of reducing maternal and child morbidity and mortality.

Given these and other favourable policies, why has there not been more improvement? A careful analysis of the report’s findings provides some answers. These include structural differences in access to quality health care within and outside of the health care system, neoliberal macroeconomic policies as applied to health (especially user fees and privatization) and basic socioeconomic inequalities in the Tanzanian population itself, rooted in class and gender differences in access to quality education, employment and income.

Achievements: Infant mortality has been halved during the last 24 years, from 92 deaths in every 1,000 live births in 1991/92 to 43 deaths in every 1,000 live births in 2015/16. Under-five mortality has also declined from 141 to 67 deaths in every 1,000 children during the same period. These improvements partly reflect the growing number of women who deliver their children in a health facility – 63 per cent in 2015/16 compared to 44 per cent in the 1999 TDHS. Moreover, more than 90 per cent of women in rural and urban areas seek antenatal services prior to delivery, and have done so for the last 20 years. The percentage of women aged 15-49 receiving such care from a skilled provider rose from 96 per cent in the 2010 TDHS to 98 per cent in the 2015-16 TDHS-MIS. The majority of women have basic elements of antenatal care: measurement of blood (87 per cent), blood pressure (71 per cent), and urine (60 per cent), and they receive iron tablets/syrup (81 per cent) to prevent anemia, antimalarial (71 per cent) and  anti-parasitic (63 per cent) drugs.

Fifty-one per cent of women had at least four ANC visits during their last pregnancy, per WHO standards, but only 24 per cent women started before the fourth month of pregnancy, and 26 per cent waited until the sixth month of pregnancy or later.

Another factor associated with reproductive and maternal health is the number of pregnancies a woman has had – having too many children too close together raises the risks of pregnancy and delivery, and also has a negative impact on the health of the child. Women’s fertility rate has decreased from 6.2 to 5.2 children per woman in 1991/92 and 2015/16 respectively. The decline may partly be due to the increase in use of modern contraceptives by currently married women, which rose over the last decade from 20 per cent in 2004-05 to 27 per cent in 2010 and 32 per cent  in 2015-16, but still remains very low. There has been little change in meeting the unmet demand for access to family planning among nearly one fourth of currently married women since 1999, ranging between 22 per cent and 24 per cent.

In spite of these achievements and many others documented in the report, the ultimate goal of ensuring good health and welfare for every Tanzanian girl and boy, woman and man, has not yet been achieved. Major inequalities persist as noted by the Minister, which represent a major challenge, and are the subject of the next article in this series.