Tanzanian Countdown Case Study
As the end of 2015 is fast approaching, attention turns to what has and has not been achieved for the Millennium Development Goals (MDGs) and why – and what lies ahead for the global development agenda. The Tanzanian Countdown Country Case Study is one of a series of Countdown to 2015 country case studies evaluating progress for MDGs 4 and 5 regarding Reproductive, Maternal, Newborn, and Child Health (RMNCH).
Tanzania has demonstrated mixed progress for RMNCH. It has already achieved MDG 4, with an under five-mortality rate of 54 deaths per 1000 live births (2012). However, similar gains in maternal and newborn survival have not been seen. Neonatal mortality – deaths in the first 28 days of life – has declined at only half the speed of child mortality and now makes up 40% of all deaths in children less than five years. Tanzania is off track to achieving MDG 5 with a maternal mortality rate of 410 deaths per 100 000 live births (2013).
Project Aim and Methods
This case study aims to document and critically evaluate the reasons for this mixed progress. It uses an evaluation framework that takes into account the broader contextual factors when assessing the effects of health system strengthening reforms and RMNCH interventions on impact indicators. The four focus areas for Countdown to 2015 (coverage, equity, financing and health system, and policy) are incorporated into this framework and are given particular emphasis in this study.
This case study has five main objectives:
1. Systematically evaluate trends in maternal, newborn, and child mortality in Tanzania since 1990, considering contextual changes.
2. Examine the health system, through a standardized analysis of Reproductive, Maternal, Newborn, and Child Health Policy Finance and Workforce.
3. Critically explore the coverage and equity levels for the Commission on Information and Accountability indicators that may contribute to progress, or lack thereof in the Under-five Mortality Rate; Neonatal Mortality Rate, and Maternal Mortality Ratio.
4. For impact indicators, mentioned in objective 3, with an ARR of more than 5 between 2000 and 2012: conduct a retrospective Lives Saved Tool Analysis to identify coverage determinants that may have contributed to this progress in survival.
For impact indicators, mentioned in objective 3, with an ARR of less than 5 between 2000 and 2012: conduct an in-depth equity analysis of the pertinent Commission on Information and Accountability indicators, to explore who is being left behind and why.
5. Highlight the implications of this research through a prospective Lives Saved Tool Analysis that calculates the number of lives that could be saved by addressing the key coverage and equity gaps identify through the analyses above.
The expected outputs of this case study includes a rigorous evaluation of what has contributed to the remarkable progress in child survival and why similar gains in maternal and newborn survival have not been seen. This will be documented in a scientific journal article and a Power Point library of slides.
The results from this case study will also be used to inform accelerated focused action towards the end of the MDGs and will contribute to ending preventable maternal, newborn, and child deaths by the end of the Sustainable Development Goals in 2030. A policy brief with key messages on who is being left behind and where to focus efforts has already been published and informed the evidence based Sharpened One Plan (2014 – 2015). The policy brief and the Plan were disseminated at a high level event attended by His Excellency President JM Kikwete of Tanzania.
The main institutions involved in this case study includes: Evidence for Action Tanzania, The World Health Organisation Tanzania, The Ifakara Health Institute, and the London School of Hygiene and Tropical Medicine. This team works closely with the Ministry of Health and Social Welfare and other development partners in Tanzania.