Progress for children in Tanzania

While many country reports regarding child mortality coming out of Sub-Saharan Africa can be dismal reading, one notable exception is Tanzania. A multitude of interventions has lead to a 24 percent drop in child mortality only in the last five years, translating into 280 000 childrens lives saved between 1999 and 2005.

In contrast to many of the countries recently surveyed through the Countdown 2015 tracking, Tanzania will probably reach the Millennium Development Goal (MDG) of a two third reduction in child mortality by 2015. Recent data demonstrate that mortality rates in children younger than five were reduced to 83.2 deaths per 1000 in 2004, down from 141.5 deaths per 1000 in 1990. Even more encouraging, the most significant changes have occurred since 1999, a drop by 24 percent the last five years.

These findings that were published recently in The Lancet, translate into 280 000 children's lives saved between 1999 and 2005.

A multitude of interventions

The coverage of interventions relevant to child survival in Tanzania improved between 1999 and 2005 surveys, according to The Lancet article. No single intervention singled itself out as more important, rather that the effects were due to multi-pronged systemic changes.

"The most noticeable changes were vitamin A supplementation (up from 14% in 1999 to 85% in 2005), Integrated Management of Childhood Illness (up from 19% to 73% of districts), households with mosquito nets (up from 21% to 46%), children sleeping under insecticide-treated nets (up from 10% to 29%), iron supplementation in pregnancy (up from 44% to 61%), oral rehydration therapy for children (up from 57% to 70%), and exclusive breastfeeding for those younger than 2 months of age (up from 58% to 70%) and younger than 6 months (up from 32% to 41%)", the article affirmed.

Reductions in mortality mostly occurred in post neonatal infants, meaning children older than 28 days and younger than 12 months, and were greater in rural areas. Neither neonatal nor maternal survival increased during this period, two areas where more intervention research is needed, according to Dr. Honorati Masanja, researcher at the Ifakara Health Research and Development Center in Tanzania anthe lead author of the Lancet article.

Increased funding

The researchers found that health systems improved substantially in the given time period. With respect to governance, financing, and resources, Tanzania adopted a sector-wide approach (SWAp) for medium- and long-term planning. While government led, the policy and expenditure programme was funded by pooled government and donor partners.

A so-called basket fund, jointly funded by partners, was created to provide an additional US$0.50 per person to districts as recurrent financing support, an approach implemented in 2000-01. Between 1999 and 2004 total government health expenditure increased by a 2.3-fold, from US$4.70 to $11.70 per person. When including private expenditure, the increase was from US$23 to $29 per person, which according to the study indicates that most of the growth in health spending was due to increases in government expenditure.

"Since 2004, Tanzania has doubled its per capita health spending. Furthermore, GFATM, PEPFAR, PMI and many other initiatives have started since the effects in the paper. We have a graphic that shows a number of initiatives and funding that happened after 2004 and their effects are probably going to be seen in the 2009 survey," writes Dr. Masanja in an email correspondence.