Draft Policy Brief | UNA Tanzania/ AFP Project

Attaining Maternal Health Targets in Tanzania: Addressing Skills Gap in

Increasing Family Planning Coverage.
Background
In September 2000 the United Nations Member States agreed to a landmark commitment that
was to characterize global development efforts for 15 years. This commitment ushered in a new
paradigm to address key development challenges through global cooperation, which emphasized
the need to work in local context to mitigate development challenges for a global impact. This
formed the famous eight Millennium Development Goals (MDGs). Out of the eight MDGs, three
were health related goals; goal 4, 5, and 6 that focused on child and maternal health, and
addressing HIV/AIDS, Malaria, Tuberculosis (TB), and other diseases.
Aiming at becoming a middle income country by the year 2025, Tanzania committed, among
other things, to improve the quality of life through ensuring, among others, access to quality and
free family planning services to improve maternal and child health. At the onset of the MDGs in
2000, Tanzania like the rest of the world had committed to reduce child mortality by two thirds
and decrease maternal deaths by three quarters by the year 2015. While progress has been
made to significantly reduce child mortality in those 15 years, progress in improving maternal
health and reducing maternal mortality has registered fewer gains than targeted.

Policy Commitments and the Current Situation

By policy, the Tanzania prioritizes maternal health and specific targets are included in its policies,
plans, and strategies. The National Health Policy (2007), Health Sector Strategic Plan III (HSSP III
2009-2015), National Strategy for Growth and Reduction of Poverty II (NSGPR II / MKUKUTA II,
2010-2015), One Plan (2008-2015), and the Sharpened One Plan (2014-2015) all contain targets
to reduce maternal deaths, improve
reproductive health, increase access to
quality services and skilled attendants,
essential medicines, family planning
services and commodities.
In
particular,
the
government
committed to reduce maternal deaths
by 75% and child deaths by two thirds
by the year 2015. These commitments
were localized in national frameworks
including the NSGRP II, Five Year
Development Plan (FYDP, 2011-2015)
and Big Results Now (BRN).

Draft Policy Brief | UNA Tanzania/ AFP Project

Maternal deaths in Tanzania are one of the highest in the world, with the current ratio at 454
deaths per 100,000 live births; meaning that more than 20 women die every day due to
complications during pregnancy and birth. Conversely, about 40,000 children die during the first
28 days of life; 100,000 die before reaching the age of five; and about 50,000 are stillborn with
half of them dying during delivery.
A large percent of maternal deaths occur because women cannot access the services they need,
and these include family planning. Other common causes of maternal deaths include
early/teenage pregnancies, unsafe abortions especially among young/adolescent girls and risky
pregnancies (among women aged below 20 years or those above 35 years, for spacing of less
than two years between one birth and a successive conception or for having more than four
pregnancies in a womans lifetime)1.
In Tanzania, 23% of women of reproductive
age have their first child before the age of
20. These proportions are higher in the
Western and Lake Zones of Tanzania where
30% and 29% of women of reproductive age
have their first children before reaching the
age of 20 respectively.
Risky pregnancies result from lack of correct
information on sexual and reproductive
health and inability to access family planning
services. Despite this, all the causes of
maternal and child deaths are preventable.
Studies have shown that family planning in particular can prevent up to 44% of maternal deaths
and more than 20% of child deaths2. By ensuring adequate access to family planning information
and services, the lives of countless women and children in Tanzania can be saved.
Access to family planning services is further
compounded by the low numbers of skilled
service providers able to deliver the needed
services and contraceptives. In the Lake
Zone, for instance, it has been observed
that more than 100 family planning service
providers are needed in order to place at
least one (1) trained provider at health
facility level, able to provide Long Acting
and Permanent FP methods. The
government has a national target of having
at least two (2) providers at each facility.
1
2

TDHS, 2010
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960478-4/abstract

Draft Policy Brief | UNA Tanzania/ AFP Project

From the minimal allocations made towards family planning services, training for family planning
providers has not been conducted for a number of years. As a result, there are fewer and fewer
skilled service providers in existing health facilities. On the part of contraceptives, it is reported
that commitments from various sources, especially development partners, have ensured
availability of contraceptive stocks for up to 2016. What remains is the challenge of ensuring
there are skilled FP service providers.
For clients living in hard to reach, resource strapped communities; reaching them with outreach
and mobile services also remains difficult. At this time, when the Government finds itself
grappling with the lack of adequate financial resources, allocations to honor its commitment to
increase the number of skilled FP service providers will be a strategic decision to take that will
undoubtedly facilitate gains. Globally, every dollar spent on SRHR/FP can save up to seven dollars
in direct health costs3. In Tanzania, for instance, implementing the National Family Planning
Costed Implementation Plan (NFPCIP 2010-2015) would avert more than 9.7 million unintended
pregnancies, 1.3 million unsafe abortions, and more than 24,000 maternal deaths between 2010
and 2015. By 2015, the CIP would also save a total of USD$529 million in direct healthcare
spending.4

What the government can do?

In order to improve outcomes in maternal and child health:
a) Increase allocations for family planning to Tshs. 5 Billion for 2015/16 to cover costs of
training more family planning service providers
b) Expand community participation in the provision of family planning services by using
trained community health workers to expand services at community level,
c) Widen provision of outreach and mobile services to reach those who live in rural and
hard to reach areas.

3
4

WHA Resolution 58.33 Geneva: WHO; 2005. United Nations General Assembly Resolution. A/67/L.36 (6 December 2012)
Impact 2 Marie Stopes International (MSI), 2012

Draft Policy Brief | UNA Tanzania/ AFP Project

d) References
1. Ahmed, Saifuddin. 2012. Maternal deaths averted by contraceptive use: an analysis of
172 countries.
2. Ministry of Finance and Economic Affairs. Medium Term Expenditure Framework for
Financial Year 2010/11; Dar es Salaam, June 2010.
3. Ministry of Finance and Economic Affairs. Medium Term Expenditure Framework for
Financial Year 2011/12; Dar es Salaam, June 2010.
4. Ministry of Health and Social Welfare. Health Sector Strategic Plan III (2009-2015); Dar es
Salaam, 2009.
5. Ministry of Health and Social Welfare. Human Resources for Health Strategic Plan, 2008
2013; Dar es Salaam, January, 2008.
6. Ministry of Health and Social Welfare. Medium Term Expenditure Framework (MTEF
2011/12); Dar es Salaam, 2011.
7. Ministry of Health and Social Welfare. National Adolescent Reproductive Health Strategy
2011 -2015; Dar es Salaam, 2011.
8. Ministry of Health and Social Welfare. National Health Policy 2007; Dar es Salaam, 2007.
9. Ministry of Health and Social Welfare. National Road Map Strategic Plan to Accelerate
Reduction of Maternal, Newborn and Child Deaths in Tanzania 2008-2015 (One Plan); Dar
es Salaam, 2008.
10. Ministry of Health and Social Welfare. National Strategy for Growth and Poverty
Reduction (NSGPR/MKUKUTA) 2010-2015; Dar es Salaam, 2010.
11. Ministry of Health and Social Welfare. Primary Health Services Development Program
2007-2017 (PHSDP or MMAM in Swahili); Dar es Salaam, 2007.
12. Presidents Office, Planning Commission. Five Years Development Plan (2011/122015/16); Dar es Salaam, June 2011.
13. Presidents Office, Planning Commission. Long Term Perspective Plan (LTPP 2011/2012 2025/2026); Dar es Salaam, March 2012.
14. Tanzania Demographic and Health Surveys (TDHS), 2010.
15. United Nations. Millennium Development Goals (MDGs); New York, 2000.
16. United Republic of Tanzania. 2008. Millennium Development Goals Report: Midterm
Evaluation. Ministry of Finance & Economic Affairs, Poverty Eradication and Economic
Empowerment Division.