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OUTLINE OF OVERVIEW

PRIVATE HEALTH SECTORS ROLE IN THE PROVISION OF MATERNAL AND CHILD HEALTH SERVICES IN TANZANIA PRESENTED BY PROF. R. S. M.LEMA‐ DIRECTOR, MASSANA HOSPITAL AND COLLEGE OF NURSING APHFTA EAHF SCIENTIFIC CONFERENCE 26 TH - 28 TH FEBRUARY 2013 DIAMOND JUBILEE, DAR ES SALAAM.

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OUTLINE OF OVERVIEW

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  1. PRIVATE HEALTH SECTORS ROLE IN THE PROVISION OF MATERNAL AND CHILD HEALTH SERVICES IN TANZANIA PRESENTED BY PROF. R. S. M.LEMA‐ DIRECTOR, MASSANA HOSPITAL AND COLLEGE OF NURSINGAPHFTA EAHF SCIENTIFIC CONFERENCE 26TH - 28TH FEBRUARY 2013DIAMOND JUBILEE, DAR ES SALAAM

  2. OUTLINE OF OVERVIEW • Magnitude and Causes of Maternal Mortality in Tanzania. • Factors contributing to Maternal and Newborn Mortality. • Private contribution to Strategies to reduce Maternal Child Health Mortality. • Conclusion and Recommendation

  3. MAGNITUDE OF MATERNAL MORTALITY • Worldwide more than 600,000 women die annually of pregnancy and childbirth. • Africa accounts for 50% of worlds Maternal Mortality burden although only 12% of world population and 20% of births occur in Africa.

  4. Maternal Mortality Ratio in Tanzania:

  5. Causes of Maternal Mortality TDH (2004/2005) • Obstetric Haemorrhage 28% • Abortion Complication 19% • Pregnancy Induced Hypertension 17% • Obstructed Labour 11% • Sepsis 11% • Indirect Cause 14% • NMR (TDHS 2004/2005) – 578/100,000 live births

  6. Causes of Neonatal Mortality Sepsis and Pneumonia 29% Birth Asphyxia 27% Preterm Births 23% Congetal Malformation 7% Diarrhea 3% Tetanus 3% Others 8% TDHS – 2004/2005 – NMR = 32 per 1000 live births

  7. FACTORS CONTRIBUTING TO HIGH MATERNAL MORTALITY IN TANZANIA • Direct Factors – The three delay model: 1. Delay in decision making on pregnancy care and childbirth significantly influence poor pregnancy outcome. 2. Poor access to appropriate and affordable health facility when emergency occurs. Lack of transport (ambulances)emergencies and poor infrastructure.

  8. Direct Cause cont….. 3. Lack of Essential Emergency Obstetric care facilities at all levels from District to National Hospitals (only 40% facilities have Basic Essential Emergency Obstetric care facilities). 4. Lack of skilled health providers at delivery units.

  9. Indirect Causes:- 1. Low contraceptive Prevalence Rate – CPR 34.8%% (2010) 2. Illiteracy – Low education for women 3. Inappropriate Health Seeking behaviour 40% of women who attended ANC deliver at home under care of untrained birth attendants. Decline Facility Delivery – 1992(52%), 1996 (47%), 1999 (44%).

  10. Indirect Cause cont….. • Social-cultural determinants – women oppression, Low status of women making decision delay. 5. Indirect causes – HIV / AIDS, Malaria, Anaemia (on increase).

  11. STRATEGY FOR REDUCTION OF MATERNAL AND NEWBORN MORBIDITY AND MORTALITY Consists of six main national programs: • Family Planning • Safe Motherhood initiative • Expanded Program on Immunization. • Integrated Management of Childhood Illness • Community Based Health Care (CBHC) • School Health Program

  12. STRATEGY OF MOHSW • Liaison with Ministries, Partners and other relevant organizations at all levels. • Formulation of Advisory Committee which is multi-sectoral and multi disciplinary chaired by Population planning unit in President’s Office. • Active involvement and participation of districts and local communities in process of implementation.

  13. STRATEGIES CONT….. • Make use of existing resources and empower districts to provide quality services based on national guidelines and protocols - translating relevant policies and strategies into operational plans which can be implemented and sustainable. • Adopt performance improvement approach as model to lead and steer towards achievement of these goals and objectives. (on job skill training)

  14. Service Delivery • Policy Guidelines for RCH services • Service Delivery Standards for RCH • RCH Essential Health Package • Guidelines for implementation of CBD activities. • Policy guidelines in School Health promotion

  15. CONTRIBUTIN OF PRIVATE HEALTH FACILITY IN SERIVE DELIVERY • A wide range of facilities managed by the private health sector make a significant contribution to health prevosion in Tanzania.

  16. A total of 6.342 health facilities are operating in Tanzania 1,924 run PFP or PNFP organization i.e. one third of health services the country are offered by private sector,

  17. Total Number Of Health Facilities In Tanzania

  18. Private Health sector particularly play a big role in offering HIV/AIDS, RCH, TB, and malaria services. • Private sector mainly FBO are involved in National Multi-secteral Strategic Framework jointly coordinated with NACP and TACAIDS.

  19. PMTC SERVICES • Women receiving PMTCT services increased from 8.5% in 2004 to 55% in 2010. • The private sector accounts for only 14% in providing PMTCT services.

  20. DISTRIBUTION OF PMTCT SERVICES (2010) TESTING AT ANC Almost all women receive PMTC services exclusively from public sector. This pattern is similar to patient seeking HIV testing.

  21. Source of Contraceptives 2010 • Source 2010 DHS • Source of contraceptive relatively stable over past 10 years

  22. REPRODUCTIVE AND CHILD HEALTH SERVICES • Access and provision of services remain a significant barrier to Tanzania. • Total fertility rate remain high – 5.4 children per women. • Only 54.1 percent delivery in health facilities.

  23. ANTENATAL CARESource of Antenatal Care for women 4 visits 2010 Most women attending ANC in PFP where those of upper quintile 40% and above who were 64%.

  24. DELIVERY SERVICES Source of Delivery 2010 Notes also that 60% of women who delivered in private sector where those in upper quantity. This is consistent with women who seek care in private sector.

  25. DIARRHEAL DISEASESource of Diarrhea Treatment

  26. MALARIA . • Source of Treatment for Fever or Cough 2010 mainly public. • Fever and cough are proxy for Malaria. • High malaria burden 40% of outpatient visits. • 17-20 million annual cases. • 80,000 annual deaths. • Leaking cause of morbidity and mortality • 17.7 percent children under 5 test positive.

  27. Source of Treatment for Fever and Cough 2010

  28. ROLE OF PRIVATE HEALTH FACILITIES IN MCH SERVICES IN DAR ES SALAAM

  29. DISTRIBUTION OF HEALTH FACILITIES IN DAR ES SALAAM

  30. Role of Private Health Facilities in Providing MCH Services: Almost all private health facilites in Dar es Salaam offer free MCH and Vaccination services for free as their community social responsibility (CSR) . There is no compensation neither is there any motivation.

  31. MCH/VACCINATION SERVICES • Private Health facilities contribute significantly in Tanzania of MCH/Vaccination as shown in table I and II below:

  32. I.VACCINATION IN DAR ESSALAAM – 2008

  33. II. MCH AND PMTCT SERVICES

  34. 2. MCH/VACCINATION SERVICES IN TEMEKE MUNICIPALITY • Temeke Municipality has 79 private health facilities out of these 54 (68.4%) provide vaccination doing vaccination campaigns and 33 (42%) provided routine MCH services. Twenty eight i.e. 35.4% provide routine PMTCT services.

  35. 1. MCH/VACCINATION SERVICES IN ILALA MUNICIPALITY • Ilala has a total of 144 private health facilities. • 34 (61.8%) offer vaccination during vaccination campaign. • Routine MCH services are provide by 19 (13.2%) of the private health facilities and fifteen (10.4) provide PMTCT services

  36. 3. MCH VACCINATION SERVICES IN KINONDONI MUNICIPALITY • Kinondoni Municipality has 192 private health facilities of these 31(161%) provide routine MCH services and 50(26%) provide vaccination services during vaccination campaigns and 40(20%) provide PMTCT services.

  37. WAY FORWARD /RECOMMENDATION • Private Health sectors should be taken on board from planning point of RCH services. • Government should be committed to 3P. It should not be a lip service. We are contributing significantly as noted. • MOHSW should extend its PPP universal coverage of RCH services by supporting the private health sector.

  38. WAY FORWARD/ RECOMMENDATION Cont.. • Encourage continuous dialogue with the Ministry of Health in offering RCH services to women, Newborn and Children. • Government should n come up with a program to give coupon to pregnant women so that when they have an emergency they can go to the nearest private hospital.

  39. WAY FORWARD /RECOMMENDATION Cont.. • Equal partners – Government must treat private sector as equal partners for a strong partnership. • Private partnership – Private partnership should be encouraged for referral among private facilities. • Government should Encourage private sector to grow by financial human resources and moral support

  40. IT CAN BE DONE WE PLAY OUR PARTThank you for listening

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