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

26TH - 28TH FEBRUARY 2013DIAMOND JUBILEE, DAR ES SALAAM

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

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.

YEAR MMR

1976 520/100,000

1986 529/100,000

1999(DHS) 527/100,000

2004(DHS) 578/100,000

2010(WHO) 454/100,000

Maternal Mortality Ratio in Tanzania:

Causes of Maternal MortalityTDH (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

Causes of Neonatal MortalitySepsis 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

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.

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.

Indirect Causes:-1. Low contraceptive Prevalence Rate – CPR

34.8%% (2010)2. Illiteracy – Low education for women3. 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%).

Indirect Cause cont…..4. Social-cultural determinants –

women oppression, Low status of women making decision delay.

5. Indirect causes – HIV / AIDS, Malaria, Anaemia (on increase).

STRATEGY FOR REDUCTION OF MATERNAL AND NEWBORN MORBIDITY AND

MORTALITY

Consists of six main national programs:1. Family Planning2. Safe Motherhood initiative3. Expanded Program on Immunization.4. Integrated Management of Childhood Illness5. Community Based Health Care (CBHC)6. School Health Program

• 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.

STRATEGY OF MOHSW

• 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)

STRATEGIES CONT…..

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

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.

• 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,

Total Number Of Health Facilities In Tanzania

Facility Type

Government

parastatal

PNFP PFP Total

Hospital 95 8 101 36 240

Health Centres

434 10 134 55 633

Dispensaries 3,889 168 625 787 5,469

Total 4418 186 860 878 6,342

Percent of Total

69.6% 3.0% 13.6% 13.8% 100.0%

• 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.

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.

DISTRIBUTION OF PMTCT SERVICES (2010) TESTING AT ANC

FACILITY STATUS %

PUBLIC 86%

PNFP 12%

PFP 2%

Almost all women receive PMTC services exclusively from public sector. This pattern is similar to patient seeking HIV testing.

Source of Contraceptives 2010

• Source 2010 DHS• Source of contraceptive relatively stable over past 10

years

Source Tanzania Mainland

Urban Mainland

Rural Mainland

PUBLIC 63% 50% 69%

PNFP 7% 5% 6%

PFP 27% 42% 20%

OTHERS 3% 3% 5%

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.

•  

ANTENATAL CARE

Source of Antenatal Care for women 4 visits 2010Source Mainland Urban

TanzaniaRural

TanzaniaPUBLIC 32% 58% 24%PNFP 9% 10% 9%PFP 57% 7% 1%OTHERS 2%(< 4 Visits) 25% 66%

Most women attending ANC in PFP where those of upper quintile 40% and above who were 64%.

DELIVERY SERVICES

Source of Delivery 2010

Source Mainland UrbanTanzania

RuralTanzania

PUBLIC 41% 68% 34%

PNFP 8% 11% 7%

PFP 7% 5% 1%

OTHERS 49% 16% 58%

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.

DIARRHEAL DISEASE

Source of Diarrhea Treatment

Source %PUBLIC 44%PNFP 5%PFP 20%NONE 31%

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.•  

Source of Treatment for Fever and Cough 2010

Source %PUBLIC 51%

PNFP 6%PFP 24%

NONE 19%

• ROLE OF PRIVATE HEALTH FACILITIES IN MCH SERVICES IN

DAR ES SALAAM

DISTRIBUTION OF HEALTH FACILITIES IN DAR ES SALAAM

 

 

DISTRICT PUBLIC PRIVATE TOTALS

Ilala 22 (13.3%) 144 (86.7%) 166

Temeke 29 (27%) 79 (73%) 108

Kinondoni 30 (13.5%) 192 (86.5%) 222

Totals 81 (6.1%) 415(93.9% ) 496

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.

MCH/VACCINATION SERVICES

–Private Health facilities contribute significantly in Tanzania of MCH/Vaccination as shown in table I and II below:

I. VACCINATION IN DAR ESSALAAM – 2008

MUNICIPAL COUNCIL

TOT NO OF FACILITIES

VACCINATION

PUBLIC PRIVATE

TEMEKE 83 29 (35%) 54 (65%)

ILALA 55 21 (38.2%) 34 (61.8%)

KINONDONI 83 33 (39.8%) 50 (60.2%)

II. MCH AND PMTCT SERVICES

MUNICIPAL COUNCIL

NO OF FACILITIES

MCH PMTCT

TEMEKE 76 33 (42%) 28 (35.4%)

ILALA 144 19 (13.2%) 15 (10.4%)

KINONDONI 192 31 (16.1%) 40 (20.8%)

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.

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

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.

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.

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.

• 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

WAY FORWARD /RECOMMENDATION Cont..

IT CAN BE DONE WE PLAY OUR PART

Thank you for listening