United Republic of Tanzania Ministry of Health and Social ...

1 The National Road Map Strategic Plan -2008 - 2015iUnited Republic of TanzaniaMinistry of Health and Social WelfareThe National Road Map Strategic PlanTo Accelerate Reduction of Maternal, Newbornand Child Deaths in Tanzania2008 - 2015 April 20082iiWhen a womanundertakes her biologicalrole of becomingpregnant and undergoingchildbirth, the society hasan obligation to fulfil herbasic human rights,which include the right tolife, liberty socialsecurity, maternityprotection and National Road Map Strategic Plan -2008 - 2015iiiTABLE OF CONTENTSA bbreviations .. viiAcknowledgements .. viiiChapter 1:Overview .. Initiatives to Improve Maternal, Newborn and Child Health in Rationale for the Strategic Plan to Accelerate Reduction of Maternal, Newborn and Child Deaths in 2 Chapter 2:SituationAL Analysis of maternal, newborn and child Health in Tanzania .. Maternal Newborn Health .. Child Health .. Cross Cutting Issues .. 11 Chapter 3:Strategic 15 Chapter 4:Implementation Framework.

2 18 Chapter 5:Strategic plan and activities 2008-2015 .. 24 Chapter 6:MONITORING FRAMEWORK .. 47 ANNEXESSWOT 57 Inputs for Improving MNCH at All Levels .. 71 Relevant Policy Documents .. 42 Most Cost Effective Interventions Based on Evidence to Date for Reduction of Perinatal and Neonatal 83 Evidence-Based Interventions that Influence Child Health .. 84 Evidence-Based Interventions for MNCH .. 85 Where Does Tanzania Stand in Terms of MNCH Service Delivery?.. 88 Essential MNCH Medicines, Equipment and 93 ABBREVIATIONSADDOSA ccredited Drug Dispensing OutletsAIDSA cquired Immuno Deficiency SyndromeALuArtemether LumefantrineAMOA ssistant Medical OfficerANCA ntenatal CareARHA dolescent Reproductive HealthARIA cute Respiratory Tract InfectionBCCB ehaviour Change CommunicationBEmOCBasic Emergency Obstetric CareBFHIBaby Friendly Hospital InitiativeBMIBody Mass IndexCBDC ommunity Based DistributorCBIMSC ommunity Based Information Management SystemCBOC ommunity Based OrganizationCCHP Comprehensive Council Health PlanCEmOCComprehensive Emergency Obstetric CareCHMT Council Health Management Teamc-IMCIC ommunity Integrated Management of Childhood IllnessCPRC ontraceptive Prevalence RateCSOC ivil Society OrganizationDHRD irector Human ResourcesDPSD irector Preventive ServicesEmOCEmergency Obstetric CareENCE ssential Newborn CareEPIE xpanded Programme on ImmunizationFANCF ocused Antenatal CareFBOF aith Based OrganizationFPFamily PlanningHIVH uman Immuno Deficiency

3 VirusHMIS Health Management Information SystemHPVH uman Papilloma VirusHSSPH ealth Sector Support ProgrammeICPDI nternational Conference on Population and DevelopmentIDWEI nfectious Disease Week Ending reportIECI nformation Education and CommunicationIMCII ntegrated Management of Childhood IllnessIMRI nfant Mortality RateIPTI ntermittent Preventive TreatmentITNI nsecticide Treated NetIYCFI nfant Young Child FeedingivThe National Road Map Strategic Plan -2008 - 2015 The National Road Map Strategic Plan -2008 - 2015vKMCK angaroo Mother CareLLINsLong Lasting Insecticide Treated NetsLSSLife Saving SkillsMDGsMillennium Development GoalsMKUKUTA Mkakati wa Kukuza Uchumi na Kupunguza Umaskini Tanzania (The National Strategy forGrowth and Reduction of Poverty)MMAMM pango wa Maendeleo wa Afya ya Msingi (The Primary Health Services DevelopmentProgramme)MMRM aternal Mortality RatioMNCHM aternal, Newborn and Child HealthMNTM aternal and Newborn TetanusMoAFSCM inistry of Agriculture, Food Security and CooperativesMoCDGCM inistry of Community Development, Gender and ChildrenMoEVTM inistry of Education and Vocational TrainingMoFEAM inistry of Finance and Economic AffairsMoHSWM inistry of Health and Social WelfareMoICSM inistry of Information, Culture and SportsMoIDMinistry of Infrastructure DevelopmentMoLEYDM inistry of Labour.

4 Employment and Youth DevelopmentMVAM anual Vacuum AspirationNACPN ational AIDS Control ProgrammeNBSN ational Bureau of StatisticsNGOsNon Governmental OrganizationNMCPN ational Malaria Control ProgrammeNMWN urse MidwifeNORADN orwegian Development CooperationNPEHIN ational Package of Essential Health InterventionsNPERCHI National Package of Essential Reproductive and Child Health Interventions ORSOral Rehydration SolutionORTOral Rehydration TherapyPACPost Abortion CarePHASTP articipatory Hygiene and Sanitation TransformationPHCP rimary Health CarePHSDPP rimary Health Services Development ProgrammePMNCHP artnership for Maternal, Newborn and Child HealthPMO-RALG Prime Minister s Office, Regional Administration and Local GovernmentPMTCTP revention of Mother to Child TransmissionPOPSMP resident s Office Public Service ManagementQIRIQ uality Improvement and Recognition InitiativeREDR eaching Every DistrictRECR eaching Every ChildRCHR eproductive and Child HealthRCHSR eproductive and Child Health SectionRHMTR egional Health Management TeamRTIR eproductive Tract InfectionSMSafe MotherhoodSMISafe Motherhood InitiativeSNLS aving Newborn LivesSRHS exual and Reproductive HealthSTIS exually Transmitted InfectionSWOTS trengths, Weaknesses, Opportunities and ThreatsTAMWAT anzania Media Women AssociationTASAFT anzanian Social Action FundTBAT raditional Birth AttendantTHIST anzania HIV/AIDS Indicator SurveyTDHST anzania Demographic and Health SurveyTFNCT anzania Food and Nutrition CentreTFRT otal Fertility RateTGNPT anzania Gender Networking GroupTPMNCHT anzanian Partnership for Maternal.

5 Newborn and Child HealthTRCHST anzania Reproductive and Child Health SurveyTSPAT anzania Service Provision AssessmentTTTetanus ToxoidUNFPAU nited Nations Population FundUNICEFU nited Nations Children FundVVFV esico Vaginal FistulaWBWorld BankWHOW orld Health OrganizationWRATZW hite Ribbon Alliance TanzaniaZRCHZ onal Reproductive and Child Health viThe National Road Map Strategic Plan -2008 - 2015 The National Road Map Strategic Plan -2008 - 2015viiFOREWORDR eduction of maternal, newborn and child deaths is a high priority for all, given the persistently high maternal,newborn and child morbidity and mortality rates over the past two decades in African countries, Tanzaniaincluded. It is one of the major concerns addressed by various global and national commitments, as reflectedin the targets of the Millennium Development Goals, Tanzania Vision 2025, the National Strategy for Growthand Reduction of Poverty (NSGRP-MKUKUTA), and the Primary Health Services Development Program(PHSDP-MMAM), among deaths are caused by factors attributable to pregnancy, childbirth and poor quality of Health deaths are related to the same issues and occur mostly during the first week of life.

6 Child healthdepends heavily on availability of and access to immunizations, quality management of childhood illnessesand proper nutrition. Improving access to quality Health services for the mother, newborn and child requiresevidence-based and goal-oriented Health and Social policies and interventions that are informed by best of this plan for reducing maternal, newborn and child mortality is in line with the tenets of theNew Delhi Declaration 2005. Tanzania and other countries committed to develop one national MNCH plan foraccelerating the reduction of maternal, newborn and child deaths, in order to improve coordination, alignresources and standardize monitoring. Further support for incorporating child Health interventions into this planwas voiced by various stakeholders and development partners following the April 2007 launch of the TanzaniaPartnership for Maternal, Newborn and Child Health (TPMNCH). The National Road Map Strategic Plan toAccelerate Reduction of Maternal, Newborn and Child Deaths in Tanzania (2008 2015) was subsequentlydeveloped as Tanzania s national response to the renewed commitment to improve maternal, newborn and childcare.

7 The Reproductive and Child Health Section (RCHS) of the Ministry of Health and Social welfare (MoHSW), in collaboration with a number of different stakeholders, has developed this strategic plan to guideimplementation of all maternal, newborn and child Health interventions in National Road Map Strategic Plan stipulates various strategies to guide stakeholders for Maternal, Newbornand Child Health (MNCH), these include the Government, development partners, non-governmentalorganizations, civil society organizations, private Health sector, faith-based organizations and communities, inworking together towards attainment of the Millennium Development Goals (MDGs) as well as other regionaland national commitments and targets related to maternal, newborn and child Health It is the expectation of the Government, particularly the MoHSW, that all stakeholders will make optimal useof this strategic framework to support the implementation of maternal, newborn and child Health interventions,as this is in line with the National Health Policy and existing MNCH standards, guidelines and Government highly values your partnership in working towards realization of the objectives of the NationalRoad Map Strategic Plan to Accelerate Reduction of Maternal, Newborn and Child Deaths.

8 Together, we canimprove the Health of Tanzanian mothers, babies and children, and build a stronger and more prosperous David Homeli Mwakyusa (MP),Minister for Health and Social WelfareviiiThe National Road Map Strategic Plan -2008 - 2015 ACKNOWLEDGEMENTSThe MoHSW wishes to express its gratitude to the many individuals and development partners who worked withthe Ministry in the development of The National Road Map Strategic Plan to Accelerate Reduction of Maternal,Newborn and Child Deaths in Tanzania , 2008 2015 . The completion of the document is a result of extensiveconsultations and collaboration with various stakeholders including the RCHS of the MoHSW, developmentpartners, interested organizations as well as committed MoHSW would like to acknowledge all those stakeholders who contributed in one way or another to thesuccessful development of the document. The Ministry particularly wishes to acknowledge the invaluablecontribution of the PMNCH Country Support Working Group: Dr.

9 Nancy Terreri (UNICEF HQ); Dr. CiroFranco (BASICS, USA); and Dr. Koki Agarwal (ACCESS/Jhpiego, USA). The MoHSW also acknowledgesthe contribution of the technical group members: Dr. Theresa Nduku Nzomo (WHO/AFRO Harare); Dr. SamMuziki (WHO/AFRO Harare); Dr. Thierry Lambrechts (WHO/HQ); and local Consultants led by Dr. Ali Mzigeand Dr. Rosemary Kigadye. Other national technical experts who contributed in the development include: Sanga (RCHS, MoHSW), Dr. Neema Rusibamayila (IMCI, MoHSW), Dr. Georgina Msemo(IMCI/SNL, MoHSW), Dr. Mary Kitambi (EPI, MoHSW); Ms. Lena Mfalila (RCHS/SMI, MoHSW); Mapella (ARH, MoHSW); Ms. Hilda Missano (TFNC); Dr. Rutasha Dadi and Dr. Chilanga Asmani(UNFPA); Dr. Theopista John, Dr. Josephine Obel and Dr. Iriya Nemes (WHO Tanzania ); Dr. Asia Hussein(UNICEF, Tanzania ); and Maryjane Lacoste (ACCESS/Jhpiego, Tanzania ).The Ministry would also like to acknowledge Ms. Hassara Maulid (MoHSW) for her secretarial work with theinitial drafts of this document.

10 Lastly, the Ministry would like to acknowledge technical and financial support provided by EC, WHO, UNFPA,UNICEF and One UN Fund for the development and printing of the MNCH strategic C. MukamaPermanent Secretary, MoHSWThe National Road Map Strategic Plan -2008 - 20151 CHAPTER 1:OVERVIEWP urpose of the documentThis document has been conceived for various purposes. The Health of the mother is closely linked to the healthand survival of the child. In addition, the socio-economic level of the mother and the maternal Health status(HIV/AIDS, malaria, nutrition) has an impact on the survival of the child. Thus the primary purpose of OneIntegrated Maternal Newborn and Child Health Strategic Plan is to ensure improved coordination ofinterventions and delivery of services across the continuum of care. Another purpose of the document is toguide implementation across operational levels of the system so that policy drawn at national level will becarried out at the district and community levels, with support from the regional level.