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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.pptx

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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.pptx Powered By Docstoc
					  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 2013
     DIAMOND 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.
Maternal Mortality Ratio in Tanzania:

     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
     Causes of Maternal Mortality
    TDH (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 Mortality
Sepsis 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 women
3. 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 Planning
2. Safe Motherhood initiative
3. Expanded Program on Immunization.
4. Integrated Management of Childhood Illness
5. Community Based Health Care (CBHC)
6. School Health Program
      STRATEGY OF MOHSW

• 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.
        STRATEGIES CONT…..

• 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)
              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
               Governm parastat   PNFP
  Facility                                PFP     Total
   Type          ent      al

Hospital         95        8       101     36      240
Health           434      10       134     55      633
Centres
Dispensaries    3,889     168      625     787    5,469
Total           4418      186      860     878    6,342
Percent of      69.6%    3.0%     13.6%   13.8%   100.0%
Total
• 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         Tanzania        Urban        Rural
                     Mainland       Mainland     Mainland

  PUBLIC               63%             50%         69%
  PNFP                  7%             5%           6%
  PFP                  27%             42%         20%
  OTHERS                3%             3%           5%
• Source 2010 DHS
• Source of contraceptive relatively stable over past 10 
  years
  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 2010
    Source       Mainland        Urban      Rural
                                Tanzania   Tanzania
 PUBLIC            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               Urban            Rural
                                                Tanzania         Tanzania

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 TOTAL
                                     S
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    TOT NO OF     PUBLIC      PRIVATE
 COUNCIL     FACILITIES
            VACCINATION



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     NO OF        MCH       PMTCT
  COUNCIL    FACILITIES


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.
 WAY FORWARD /RECOMMENDATION
            Cont..
• 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
IT CAN BE DONE WE PLAY
       OUR PART

  Thank you for listening

				
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