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Tanzania Country Profile Jhpiego in Tanzania Background Quick Facts The United Republic of Tanzania has the largest land area of any East African Estimated total country. More than 70% of the population lives in rural areas, and about half the population:1 population lives below the poverty line. With high infant and maternal mortality, 47.7 million and high HIV and malaria prevalence, the government is striving to strengthen Maternal mortality ratio:2 quality and access of health services for the population. This goal is greatly 454 per 100,000 live births challenged by the vast size of the country, as well as inadequate human resources for health. The country faces a mature, generalized HIV epidemic, with an Neonatal mortality rate:2 estimated 6% of Tanzanians currently living with HIV/AIDS. Furthermore, an 26 per 1,000 live births estimated 8,000 women die in childbirth every year in Tanzania. Under-five mortality rate:2 Jhpiego began working in Tanzania in 1999, initially with funding from the 81 per 1,000 live births U.S. Agency for International Development (USAID) to provide technical assistance to develop Essential Maternal and Neonatal Health Guidelines. Total fertility rate:2 Subsequently, under the Maternal and Neonatal Health (MNH) Program, 5.4 Jhpiego worked to improve antenatal care in two districts (Arusha and Iringa) as a part of a larger, multi-organizational performance improvement initiative. In Contraceptive prevalence:2 27% (modern methods) 2005, Jhpiego’s role in Tanzania expanded into the area of community mobilization for malaria prevention and control, with funding from the U.S. HIV prevalence:3 Centers for Disease Control and Prevention (CDC). Currently, Jhpiego is 6% implementing a variety of programs as described in more detail below. Births with skilled Program Highlights provider:2 Mothers and Infants, Safe, Healthy, and Alive 51% With USAID funding, Jhpiego is collaborating with the Tanzanian and Sources: Zanzibari Ministries of Health and Social Welfare (MOHSW) to strengthen 1 Population Reference Bureau 2012 antenatal care, basic emergency obstetric and newborn care, and community- World Population Data Sheet; level services to reduce maternal and neonatal morbidity and mortality. The 2 2010 Demographic and Health Survey; 3 2007–2008 Tanzania HIV and Malaria MAISHA Program also incorporates infection prevention and control, pre- Indicator Survey. service education in medical and nursing schools, cervical cancer prevention services and prevention of mother-to-child transmission of HIV. The project aims to reduce: 1) maternal deaths associated with the major direct causes of mortality, including postpartum hemorrhage; 2) newborn mortality due to infection; 3) the prevalence of low birth weight babies, stillbirths and newborn mortality due to malaria and congenital syphilis; and 4) the number of HIV infections transmitted from mother to child. MAISHA is active in every region of the country, as well as in Zanzibar. i_l Universal HIV/AIDS Counseling and Testing (UHAI-CT) Knowing one’s HIV status is critical for preventing the spread of the disease and for receiving life-extending treatment. With funding from USAID, Jhpiego is: 1) providing innovative, high-quality, community-based HIV counseling and testing services for women and their families in Tanzania; and 2) working with hospitals and clinics to help them implement the Tanzanian government’s new provider-initiated counseling and testing (PICT) strategy. Under the former strategy, Jhpiego is supporting and mentoring local nongovernmental organizations to scale up counseling and testing and bring the services to the high-risk populations they represent. For the latter strategy, health care providers offer counseling and testing for HIV to all patients who come to health facilities, especially those coming for diseases associated with HIV, such as tuberculosis. UHAI-CT is active in nine regions of Tanzania. The Communication and Malaria Initiative in Tanzania Jhpiego is a partner in the USAID-funded COMMIT (the Communication and Malaria Initiative in Tanzania) program. Led by The Johns Hopkins Center for Communication Programs (JHU-CCP), COMMIT is implementing a comprehensive strategy for behavior change and communication in the prevention and case management of malaria in Tanzania. The program includes promotion of insecticide-treated nets, use of artemisinin-based combination therapies for malaria treatment, intermittent preventive treatment of malaria for pregnant women and indoor residual spraying. Under this program, Jhpiego is working with health care providers at different levels of the health system to improve their interpersonal communication skills to counsel clients on malaria prevention and prompt case management. Maternal and Child Health Integrated Program Jhpiego/Tanzania has received USAID funds under MCHIP to scale up voluntary medical male circumcision services (VMMC) for HIV prevention. As the lead for VMMC activities in Tanzania, Jhpiego is responsible for developing and adapting VMMC training and supervision materials, orienting and preparing VMMC scale- up sites, and establishing a pilot program at Iringa Regional Hospital, which is located in the region with both the highest prevalence of HIV and the lowest prevalence of male circumcision in all of Tanzania. In 2010, Jhpiego-Tanzania implemented sub-Saharan Africa’s first high-volume VMMC campaign using Models for Optimizing Volume and Efficiency (MOVE) techniques, circumcising 10,352 clients at just five sites in 36 days. As of July 2012, Jhpiego has supported the MOHSW to circumcise a total of more than 100,000 men in Iringa and Tabora regions of Tanzania. Infection Prevention and Control in Tanzanian Hospitals With funding from CDC, Jhpiego is building the capacity of the MOHSW to address infection prevention and control in hospitals across Tanzania. Using a whole-site quality improvement approach, Jhpiego and the MOHSW work with teams in each hospital to address infection control and develop targeted interventions for provider and patient safety, health care waste management, A mother brings her baby to a health injection safety and the provision of post-exposure prophylaxis for HIV/AIDS. facility for immunizations, Morogoro region, Tanzania. Building on past efforts in this area, Jhpiego is supporting the government to develop and disseminate guidelines and standards, train health care workers, provide essential supplies, and promote behavior change and communication. The goal of the program is to reduce the toll of health care-associated infections in Tanzania. Wazazi na Mwana Under a subaward with Plan International, Jhpiego is working to improve maternal, newborn and child health for underserved populations, particularly women of childbearing age, in four districts in Tanzania (two each in Mwanza and Rukwa regions). Under this initiative, Jhpiego is leading efforts to strengthen all 201 health centers and dispensaries in the four districts to provide quality services for basic emergency obstetric and newborn care, and for integrated management of childhood illness. In addition, Jhpiego is building the capacity of four health centers to provide comprehensive emergency obstetric and newborn care services. Anticipated project results are to increase the number of: 1) frontline health workers trained, equipped and retained to deliver essential preventive and curative Health care provider at Mugolele Health Center, Morogoro region, Tanzania. services for pregnant women, new mothers and newborns; 2) pregnant women accessing health services during the pre- and postnatal period; 3) pregnant women exclusively breastfeeding infants up to six months of age; 4) women assisted during childbirth by skilled birth attendants; and 5) effectively treated cases of common childhood illnesses in children under five years of age. Research Studies In addition to the programs above, Jhpiego is currently implementing the following three research studies in Tanzania: Jhpiego is working with JHU-CCP on the USAID-funded Systemic Monitoring of Male Circumcision Scale-Up Program to coordinate and implement a study at VMMC sites in Iringa to determine if the adoption of higher-efficiency techniques is associated with higher levels of productivity of VMMC services while maintaining adequate quality in Kenya, South Africa, Tanzania and Zimbabwe. With funding from CDC and USAID, Jhpiego is testing two different models of PICT in outpatient settings. This multi-country study is being conducted in nine sites in Tanga, Tanzania. Jhpiego is working with the National Institute for Medical Research on a CDC-funded study aimed at increasing uptake of VMMC among men aged 20 to 49 years of age in the Iringa and Tabora Regions of Tanzania. With funding from USAID, Jhpiego is working with the Zanzibar Malaria Control Program to examine the prevalence of the malaria parasite in the placentas of recently delivered mothers in order to determine the necessity of presumptive treatment of malaria in pregnancy. Key Accomplishments The UHAI-CT Program has counseled and tested nearly 650,000 people. More than 2,300 health care providers in six implementing regions have been trained in PICT, and many of those trained have in turn trained other providers. Under the MAISHA Program, 100% of antenatal care providers in the country have been trained in focused antenatal care (FANC), and an estimated 74% of facilities have a provider trained in FANC on staff. Jhpiego has provided essential medical equipment and clinical supplies for quality maternity services to over 150 facilities totaling more than $320,000. In 2010, Jhpiego/Tanzania implemented sub-Saharan Africa’s first high- volume VMMC campaign—circumcising 10,352 clients at just five sites in 36 days—and provided a model that other countries in the region are now following. Of those circumcised, 99% were also tested for HIV and learned their HIV status—the highest acceptance rate in all VMMC programs internationally. In 2012, the latest campaign served 25,840 clients in two regions in only six weeks, bringing the total number of men and boys circumcised under the MCHIP program in Tanzania to over 100,000. Vaccination day at Kivunge Health Center, Zanzibar, Tanzania. Partners and Donors Jhpiego’s primary donors in Tanzania have been USAID and CDC. The Canadian International Development Agency (CIDA) is a new donor, through the partnership with Plan International. Key local partners include the MOHSW, the White Ribbon Alliance for Safe Motherhood in Tanzania, T-MARC (a Tanzanian social marketing organization), nursing, midwifery and medical councils and associations, and others. The MAISHA consortium, led by Jhpiego, includes Save the Children, as well as partnership with JHU-CCP’s Tanzania Capacity and Communication Project. Under the UHAI-CT program, Jhpiego’s partners include Africare and T-MARC. The COMMIT consortium, led by JHU-CCP, consists of Jhpiego, PSI and the Research Triangle Institute. Under the CIDA-funded Wazazi na Mwana, Jhpiego is partnering with Plan International (as the prime awardee) and Africare. References Population Reference Bureau. 2012 World Population Data Sheet. Washington, D.C. Tanzania Commission for AIDS (TACAIDS), Zanzibar AIDS Commission (ZAC), National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), and Macro International Inc. 2008. Tanzania HIV/AIDS and Malaria Indicator Survey 2007–08. Dar es Salaam, Tanzania: TACAIDS, ZAC, NBS, OCGS, and Macro International Inc. Tanzania National Bureau of Statistics and ICF Macro. 2010. Tanzania Demographic and Health Survey: 2010. Dar es Salaam, Tanzania: National Bureau of Statistics and ICF Macro.
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