THE LONG ROAD FORWARD

Tanzania 2015 | HEALTH & EDUCATION | REVIEW: HEALTH

The challenge of addressing high mortality factors is being met, often through simple but effective preventative measures. However, further development of the healthcare sector needs to be further addressed.

Tanzania is geographically the largest country in East Africa, making the provision of healthcare for its almost 50 million inhabitants a huge challenge. Moreover, pockets of the country suffer from severe poverty, with many of the population living on less than $2 per day. As a result, Tanzania is ranked 164th out of 177 countries in the UN Human Development Index. Tanzania is also one of the least urbanized countries in Africa; approximately 80% of the population lives in rural environments, where access to quality healthcare is often difficult to obtain. It is a stark truth, but Tanzania exemplifies the inexorable link between poverty and human health. Fortunately, the government is working with its international partners to tackle these problems head on, and has formulated a systematic set of plans on how to address the country's challenges.

The defining document in Tanzania's long-term development plan is the National Vision 2025. It outlines five main attributes that Tanzania is expected to have attained by the year 2025, specifically (a) a high-quality life for citizens; (b) peace and stability; (c) good governance; (d) a well-educated and healthy society; and (e) a competitive economy capable of producing sustainable growth. It envisages Tanzania's evolution from a least developed into a middle-income country, with the goal of eliminating severe poverty and maintaining a high economic growth rate of at least 8% per annum. Similarly, the Health Sector Strategic Plan III (HSSP III), July 2009-June 2015, provides an overview of the priority strategic directions across the health sector. Specifically the government aims to reduce morbidity and mortality by providing quality healthcare, ensuring that basic health services are available and accessible, preventing and controling communicable and non-communicable diseases, informing citizens about preventable diseases, improving partnership between the public and private sectors, training, increasing the number of capable health staff, and obtaining and maintaining health infrastructure and medical equipment. Yet policy alone is only the first step in the process.

According to the World Bank, the average life expectancy in Tanzania (2012) sits at 59 years for men and 63 years for women, and the death rate per 1,000 was 9 in 2013. This is a significant improvement on 2004, when only 64% of the population survived past the age of 40. Total expenditures for health, as a percentage of the overall budget, were 7% in 2012. The mortality rate for under fives (per 1,000 live births) was 54 in 2012. The most significant contribution to the reduction of under-five mortality is improved control measures of malaria, respiratory infections, diarrhea, improved hygiene and sanitation, and preventive as well as curative health services.

More troubling is that the average number of nurses and midwives per 1,000 people is 0.02. Moreover, recent WHO reports highlight the worryingly low number of doctors in Tanzania—only two for every 100,000 people. Lacking funds, trained staff, and a national health infrastructure leads to difficulties in accessing primary healthcare for vast numbers of the population, and complicates Tanzania's fight against its most enduring health issues: HIV/AIDS and malaria. According to the World Bank, malaria kills between 63,000-96,000 Tanzanians each year. However, in the battle against malaria a more effective drug treatment regime has been introduced and public information campaigns have shown signs of working. More children under five sleep under protective mosquito nets, up from 21% in 1999 to 64% in 2010—while in 2012 an impressive 91% of households had at least one insecticide treated net, the most effective deterrent against infection from malaria.

HIV/AIDS still poses a major threat to both health and national development. The average adult prevalence rate is 6.5%, with large variations between regions, as well as within regions. Prevalence rates have been decreasing, although adult females (between ages 15 and 49) are 40% more at risk of being infected than males. As a result, it is now widely recognized and accepted in Tanzania that gender issues need to be brought to the foreground in any effective campaign. In eastern and southern African countries, girls and young women between the ages of 15 and 24 are two to four times more likely to be infected with HIV than males of the same age. The “Girls Let's be Leaders" project in Tanzania, which focuses on HIV prevention and eradication of girl's vulnerability to HIV, pregnancy, and violence, has won international recognition for its innovative approach of improving reproductive health in Tanzania.

The Tanzania Commission for AIDS, organized out of the Prime Minister's office, has taken the lead in providing vital information and services for citizens suffering from HIV/AIDS. Given the lack of adequate medical infrastructure in many regions, Home-based care (HBC) has become a major pillar in caring for those afflicted by HIV/AIDS. HBC is defined as the provision of comprehensive services, including health and social services by formal and informal caregivers in the home. HBC includes physical, social, and psychological care. The service also focuses on reducing stigma and discrimination, while preventing the further spread of HIV/AIDS and mobilizing community resources for people living with the disease.

PROMISING START

Tanzania has shown signs of success in addressing many of its health challenges. Over the past two decades, it has experienced a substantial reduction in child mortality rates; while 101 children died per 1,000 live births in 1990, in 2012 this figure was down to 38 per 1,000. However, malaria, acute respiratory disease, and diarrhea persist as the most common childhood illnesses. Progress has been made in reducing HIV prevalence in adults from 9.4% in 2000 to 5.1% in 2012, achieving an important health target. The prevalence rates among women declined from 7.7% in 2003 to 6.2% in 2012, while that among men dropped from 6.8% in the same period. Maternal mortality, on the other hand, has not benefited from trends similar to those of child mortality. Maternal deaths in Tanzania, with a ratio of 578 per 100,000, represent 18% of all deaths of women aged 15-49. The main direct causes of maternal death are hemorrhages, infections, unsafe abortions, and obstructed labors. HIV and malaria exacerbate the presence of these causes, which is Tanzania's number one cause of death. According to the WHO, the fact that more than half of births in Tanzania occur at home also contributes to the elevated maternal mortality rate. Of all pregnant women, only 46% are assisted during childbirth by a doctor, clinical officer, nurse, or formally trained midwife.

Reducing poverty, lowering maternal mortality rates, decreasing childhood mortality, and continuing progress against both HIV/AIDS and malaria remain key development challenges. Yet at the present rate, Tanzania is likely to achieve a number of its health goals for 2025. The road ahead is long, and filled with challenges, but with continued resolve and international assistance, Tanzania's national health goals can be met and a virtuous cycle of improved health and development can be encouraged well into the future.