09 Dec 2016 Country Highlights: Tanzania
Article posted on December 9, 2016.
A top performer in implementing GAPPD interventions with steady progress in reducing child mortality
- Tanzania is among the 12 countries to have achieved MDG4 by reducing under-5 child mortality to 49/1000 live births
- Despite successes, Tanzania ranks 15th in the globe for number of pneumonia & diarrhea child deaths
- Tanzania’s innovations: New vaccine information management system and new Health Scorecard
Beginning in November, Stop Pneumonia is featuring a series of excerpts from the 2016 Pneumonia and Diarrhea Progress Report: Reaching Goals Through Action and Innovation. The annual report identifies the 15 countries with the greatest number of deaths from pneumonia and diarrhea among children under the age of five. In addition, the country profiles, Q&As, and essays focus on how to save children’s lives through action and innovation. The report is produced by the International Vaccine Access Center, at the Johns Hopkins Bloomberg School of Public Health.
In the report, IVAC uses a scoring method based on the Global Action Plan for the Prevention of Pneumonia and Diarrhea (GAPPD). A country’s “GAPPD score” measures the use of 10 interventions that protect against, prevent and treat pneumonia and diarrhea, for which coverage data are publicly available. The higher the score out of the 86% target, the more interventions are being used. Learn more about the GAPPD score on page 11 of the report.
2016 Pneumonia and Diarrhea Progress Report
Country Highlights: Tanzania
Global rank in number of pneumonia & diarrhea child deaths: 15
2015 GAPPD score: 74
- Successfully reached MDG4 target by reducing under-five child mortality to 49/1000 live births; one out of 12 low-income countries to have reached the target.
- Completed joint PCV and rotavirus vaccine introduction in December 2012; and, high coverage achieved within three years of introduction (PCV3 -95%; rotavirus – 98%).
- There is strong political commitment to immunisation and child health.
- Under-5 child mortality from pneumonia and diarrhea remains significant and there have been no recent improvements.
- Data quality on vaccine coverage is poor in some areas of the country.
- Inequities in coverage and access to interventions remain.
- A new vaccine information management system (VIMS) is being rolled out.
- Development of Tanzanian reproductive, maternal, neonatal, and child health (RMNCH) Scorecard.
Over the past 15 years Tanzania has been very successful in reducing child mortality. These efforts resulted in the country going beyond its MDG 4 target with 49 deaths per 1000 live births recorded for 2015.* At this rate, Tanzania might be on track to attain even more ambitious targets, such as the 2030 goal of 14 deaths per 1000 live births under A Promise Renewed, an effort that brings together governments, civil society, the private sector and individual citizens to stop women and children from dying of causes that are easily avoidable. However, over the past couple of years progress has slowed.
The biggest gains in terms of child survival occurred between 2000 and 2012. These successes can be attributed to several factors including: political commitment to child survival and political leadership focused on the primary care level and more recently on further strengthening accountability.+,18
Immunization also strongly contributed to the increases in child survival. Tanzania introduced several new vaccines into its routine immunization programme (PCV, rotavirus vaccine, HPV, measles second dose/ measles rubella) and it remained a consistently high performer, with coverage for all antigens remaining above 90%.± In December 2012, Tanzania jointly introduced PCV and rotavirus vaccines and within three years, coverage for both vaccines increased rapidly, with PCV3 at 95% and Rota2 at 98% in 2015. Reported geographic equity of vaccine coverage is also high with 92% of districts reporting over 80% DTP3 coverage.19
Tanzania’s track record with other life-saving GAPPD interventions is also commendable. The country is among top performers in exclusive breastfeeding (50% of infants exclusively breastfed for the first six months of life). The data show that almost 71% of children with suspected pneumonia are taken to an appropriate healthcare provider and 44% of children under-5 with diarrhea receive ORS. Few children receive zinc supplements (4.7%) and unfortunately no data was found on antibiotic provision for those with suspected pneumonia. Given all these indicators, Tanzania’s overall GAPPD score is at 74 (the highest among the target 15 countries). Tanzania has a large population and due to its size, even with achievements towards controlling pneumonia and diarrhea, it still accounts for 2% of the global burden of child mortality from these diseases.
Making further progress will be more challenging, but not impossible. Many children have been reached with vaccines, yet there remain inequities in access that result in over 22,000 preventable deaths from pneumonia and diarrhea every year. The children yet to be reached are different from those who have been reached already. Many of them live in hard to reach areas, face socio-economic barriers, or security challenges. Tanzania’s southern regions show lower coverage than their northern neighbors. The influx of Burundi refugees results in increasing unplanned demands especially for immunization services.
Additionally, the quality of data available does not allow for accurate evaluation of the situation making it difficult to address gaps in coverage and access. Tanzania identified data visibility on stock status as one of its primary challenges and prioritized its improvement. In 2013, it launched its new eHealth strategy. The strategy includes a national electronic logistics management information system (eLMIS) to ensure adequate quality and quantities of health commodities are always available at all levels. To strengthen Tanzania’s immunization supply chain, which has particular needs, the country’s Immunization and Vaccine Development Program has created an integrated VIMS that works with the existing eLMIS. JSI with support from the Gates Foundation, Clinton Health Access Initiative (CHAI), PATH, and VillageReach are working closely with the project to develop the VIMS.20
While its progress has been very impressive, Tanzania must still step up efforts to exit from inclusion on the list of top 15 countries with the highest child mortality from pneumonia and diarrhea.
Development of RMNCH scorecards can help track progress and keep the issues front and center so improvements can continually be made. Additionally, improved data can also help in monitoring inequities, an objective that Tanzania will need to focus on in order to achieve ambitious goals and ensure progress continues. While political commitment remains strong, national ownership and government accountability can be strengthened further and partners will continue to work with Tanzania towards this goal.§,21
* Meanwhile the target of reducing child mortality by two thirds was at 55 deaths per 1000 live births
+ President Jakaya Kikwete co-chaired the WHO Commission on information and accountability for women’s and children’s health with Canadian Prime Minister Stephen Harper. Every Woman Every Child (WHO). Commission on information and accountability for women’s and children’s health. Keeping promises, measuring results. Geneva: World Health Organization, 2011. Kikwete also launched the RMNCH scorecard in 2014.
± The exception is measles second dose which faces coverage challenges due to falling in the second year of life (whereas all other vaccines are in the first year of life).
§ President Kikwete launched the Tanzanian RMNCH Scorecard in May 2014. The scorecard was developed to track progress and foster an environment of accountability at all levels.
18 Gavi. (2016, January). Gavi welcomes Global Ambassador for Immunisation Kikwete. Gavi
19 UNICEF. (2016, October). Immunization Coverage and System Performance Indicator Data. Retrieved from http://data.unicef.org/topic/child-health/ immunization/
20 Wright, C., Alenga, I., & Mwencha, M. (2015, August). Building the Next Generation Vaccine Information Management System: VIMS in Tanzania. The Pump, JSI. Retrieved from http://thepump.jsi.com/building-the-next-generation-vaccine-information-management-system-vims-in-tanzania/
21 Tanzania Ministry of Health and Social Welfare. (2008). The National Road Map Strategic Plan to Accelerate Reduction of Maternal, Newborn and Child Deaths in Tanzania, 2008-2015 [PDF document]. Retrieved from http://www.mcdgc.go.tz/data/ One_MNCH_plan.pdf