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The United Republic of Tanzania
National Report on Follow-up to the
World Summit for Children
Ministry of Community Development,
Women’s Affairs and Children
December 2000
4
CONTENTS
Page
Foreword ii
List of Abbreviations iv
A: Introduction and Background 1
B: Process established for the end of decade review 3
C: Action at National and International levels 4
D: Specific actions for Child Survival, Protection and Development 7
(a) Tanzania Mainland 7
(b) Zanzibar 14
E: Lessons learnt 17
F: Future Actions 20
Statistical Appendix
5
FOREWORD
This report provides an account of progress made in the implementation of World
Declaration and Programme of Action by Tanzania for achieving the goals set at the World
Summit for Children in 1990.
The World Summit for Children held in New York in September 1990 and attended
by World leaders including the President of the United Republic of Tanzania set eight
goals to be achieved by all member states of the United Nations. As a follow up to the
World Summit for Children, the Government of Tanzania in collaboration with UNICEF and
other development partners held a National Summit for Children in 1991. The National
Summit for Tanzanian children set seven goals for Child Survival, Protection and
Development together with implementation structures.
Tanzanian children, like those of other developing countries, have been facing
serious challenges for survival and development. Such challenges include high infant and
child mortality rates, high maternal mortality rates, malnutrition, limited access to clean
and safe water, sanitary disposal problems and related consequences, enrolment and
retention in schools, violence and the HIV/AIDS. It is in recognition of this situation that
the Government of Tanzania in collaboration with its development partners undertook
concerted efforts to address the challenges.
The government of Tanzania has instituted policies and strategies to address the
challenges and created conducive environment for NGOs and CBOs to play their role in
addressing the problems affecting children. Such policies include the Child Development
Policy, the Youth Development Policy, the Community Development Policy, the Education
and Training Policy and the Women and Gender Development Policy. Associated
programmes and strategies being implemented include the Tanzania Development Vision
2025, the Poverty Reduction Strategy, the Child Survival, Protection and Development
Programme, and other sector reforms.
In addition to the policies, strategies and programmes, the government of
Tanzania has taken specific measures relevant to survival, protection and development of
children in the country. Such measures include reviewing and enacting laws to protect
children from societal harassment, torture, abuses of all types and denial of their basic
human rights.
The Education Act 1978 and the Sexual Offences (Special Provisions Act) 1998,
are some of the laws intended to specifically address these challenges. National
campaigns of different types have also been carried out simultaneously in the period of
this report. National campaigns for school enrolment, immunization against killer
diseases, village child days were set on 16th June each year to monitor growth, protection
and development of children in the country. In Addition, Special National Assembly
Sessions on the Child have all been part of the implementation strategy aimed at
improving the poor conditions of children in the country.
The major constraints to the implementation of the WSC have been the persistent
situation of poverty. The government of Tanzania took measures to deal with this
problem and the results led to the economic recovery programme and the HIPC
arrangements within the Tanzania Assistance Strategy. The government also took
measures to strengthen democracy, good governance and respect of law whereby every
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person including children are beneficiaries. With the infrastructure already established in
terms of policies, laws, strategies and programmes, there is a bright future for Tanzanian
children.
The Government of Tanzania would like to thank most sincerely the UN system
and UNICEF in particular, development partners, government ministries, NGOs, CBOs for
the financial and technical support which assisted in the implementation of activities that
contributed to the progress to meet the goals set for the survival, protection and
development of children in the country.
Dr. Asha-Rose Migiro
MINISTER FOR COMMUNITY DEVELOPMENT,
WOMEN’S AFFAIRS AND CHILDREN
TANZANIA
December 2000
7
List of Abbreviations
AIDS - Acquired Immuno Deficiency Syndrome
ARI - Acute Respiratory Infections
CNSPM - Children in Need of Special Protection Measures
CRC - Convention on the Rights of the Child
CSPD - Child Survival, Protection and Development Programme
DAC - The Day of the African Child
DPT - Diphtheria, Pertussis and Tetanus
EPI - Expanded Programme on Immunization
GER - Gross Enrolment Rate
GMP - Growth Monitoring and Promotion
GOT - Government of Tanzania
HIPC - Highly Indebted Poor Countries
HIV - Human Immuno Deficiency Virus
IDD - Iodine Deficiency Disorders
IMCI - Integrated Management of Childhood Illness
IMR - Infant Mortality Rate
MCH - Maternal and Child Health
MMR - Maternal Mortality Rate
MTEF - Medium Term Expenditure Framework
NACP - National AIDS Control Programme
NCHS - National Child Health Surveys
NER - Net Enrolment Rate
NGO - Non Governmental Organisation
NPA - National Programme of Action for Children (Tanzania)
NPES - National Poverty Eradication Strategy
NSC - National Summit for Children
ORT - Oral Rehydration Therapy
PHC - Public Health Committee
PPM - Parts per Million
PRSP - Poverty Reduction Strategy Paper
TDHS - Tanzania Demographic Health Survey
TRCHS - Tanzania Reproductive and Child Health Survey
U5MR - Under Five Mortality Rate
UPE - Universal Primary Education
UN - United Nations
UNICEF - United Nations Children’s Fund
WES - Water and Environmental Sanitation
WHO - World Health Organisation
WSC - World Summit for Children
ZEMAP - Zanzibar Education Master Plan
8
A: INTRODUCTION AND BACKGROUND
The United Republic of Tanzania delegation to the World Summit For Children
(WSC), held in September 1990 in New York was led by H.E. Ali Hassan Mwinyi,
the President of the United Republic of Tanzania. A high-powered delegation
representing government ministries and other institutions accompanied him. The
objective of the summit was to assess the situation of the world’s children and
adopted the Declaration on Child Survival, Protection and Development and a Plan
of Action to achieve the goals by the year 2000.
The WSC set the following goals to be achieved by all the nations.
WSC goal 1: Between 1990 and the year 2000, reduction of infant and under-
five child mortality rate by one third or to 50 and 70 per 1,000 live
births respectively, whichever is less.
WSC goal 2: Between 1990 and the year 2000, reduction of maternal mortality
rate by half.
WSC goal 3: Between 1990 and the year 2000, reduction of severe and
moderate malnutrition among under-five children by half1.
WSC goal 4: Universal access to safe drinking water.
WSC goal 5: Universal access to sanitary means of excreta disposal.
WSC goal 6: Universal access to basic education, and achievement of primary
education by at least 80 per cent of primary school-age children,
through formal schooling or non-formal education of comparable
learning standard, with emphasis on reducing the current disparities
between boys and girls.
WSC goal 7: Reduction of the adult illiteracy rate (the appropriate age group to
be determined in each country) to at least half its 1990 level, with
emphasis on female literacy.
WSC goal 8: Provide improved protection of children in especially difficult
circumstances and tackle the root causes leading to such situation.
Apart from these 8 major goals there were 19 other goals. Most of these goals
were only for estimation at global and regional level and not for measurement at
national level. WSC also required all countries to provide additional information on
the following:
Monitoring children’s rights
Monitoring Integrated Management of childhood illnesses (IMCI) initiative and
malaria
Monitoring HIV/AIDS
1
Malnutrition estimates and goals set (2 percent severe malnutrition and 22 percent moderate malnutrition) in the 1980’s
used the Harvard standards instead of the NCHS references. 80 percent of Harvard standards coincides with
approximately a –2SD cut-off for the NCHS reference.
9
The statistical appendix to the report highlights the situation achieved in all the 27
goals of WSC and provide information on additional indicators for monitoring
children’s rights, Integrated Management for Child Illness (IMCI) initiative, malaria
and HIV/AIDS.
As a follow up to the World Summit, Tanzania held a National Summit for Children,
in Dar es Salaam in June 1991 where the seven major goals for Child Survival,
Protection and Development were adopted and the implementation structures to
achieve these goals were endorsed. The child protection measures were further
strengthened when the national Parliament resolved to give children first priority
in national plans and agreed to support measures that will lead to achieving the
Goals for Children in Tanzania by the year 2000.
Following the National Summit for Children, programmes of action for achieving
the goals for Tanzanian children by the Year 2000 were prepared. These
programmes of action were adopted for implementation in 1991 in Zanzibar, and
in 1993 on the Tanzanian Mainland. The Tanzania National Programme of Action
(NPA) is an integrated synergistic programme designed to address the situation of
children and women, through developing strategies for achieving the set targets.
NPA decided to combine the goals on safe drinking water and sanitation and
reduce the number of goals to seven. The preparation of the NPA involved a broad
spectrum of officials from sectors of health, education, water, social welfare,
agriculture, planning, finance, local government, community development, and
related institutions. Apart from government officials, NGOs, academia, private
sector and civil society were involved in the preparation of the NPA through a
consultative process. Goals articulated by NPA were endorsed by the National
Parliament at a special session held in Dar es Salaam on 7 June 1991. These
goals were articulated as follows:
Goal 1:
Between 1990 and the year 2000, to reduce infant and under five mortality rates
by one third or to 50 and 70 per 1,000 live births respectively, whichever is less.
According to the 1978 census, the infant mortality rate was then 138 and 104 and
U5MR was 249 and 179 in rural and urban areas respectively. This means that by
the year 2000, infant mortality rate should be reduced to 50 and U5MR to 70.
Goal 2:
Between 1990 and the year 2000, to reduce maternal mortality by half. According
to available statistics in 1991 shows that between 200 and 400 women die every
year due to complications of pregnancy or child birth 100,000 live births. The
objective was to reduce these rates to between 100 to 200.
Goal 3:
Between 1990 and the year 2000, to reduce moderate and severe malnutrition
among children under five by half. According to available statistics, nearly 6 per
cent of children under five are severely malnourished and 45 per cent have
moderate malnutrition. Aim was to reduce these rates to 2 percent and 22 percent
respectively.
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Goal 4:
Universal access to safe drinking water and sanitary means of excreta disposal by
the year 2000. According to statistics available in 1991, only 45 per cent and 65
per cent of the rural and urban population respectively have access to safe
drinking water; and 62 per cent and 74 per cent of the rural and urban population
respectively have sanitary means of excreta disposal.
Goal 5:
Universal access to basic education and enrolment of all school-age children
(7 years old) by the year 2000. At least 80 per cent of these children should
complete primary education by the age of 15 and should be able to read, write
and be able to live independently. Although primary school enrolment rates are
70 per cent in total, according to available statistics in 1991, only 12 per cent of
standard one enrolees are of the appropriate age, the rest are older than seven.
Overall completion rates are 75 per cent.
Goal 6:
By the year 2000, to reduce adult illiteracy to at least half of the 1990 level, with
special emphasis on female literacy. According to Ministry of Education and
Culture’s statistics for 1989 adult literacy rates were 93 for men and 88 for
women. These rates should reach 96 and 94 for men and women respectively.
Goal 7:
Improved protection of children in especially difficult circumstances by the year
2000.
Tanzania also incorporated into NPA the Mid-Decade (1995) goals which were
adopted in Dakar Senegal at the Organisation of African Unity (OAU), International
Conference for Assistance to African Children held in November 1992.
The NPA provided an institutionalised mechanism under the Planning Commission
in the President’s Office to monitor progress made in the implementation of the
NPA. A strategy for effective implementation of the NPA and for co-ordinating its
activities with the Tanzania/UNICEF Programme of Co-operation on Child Survival,
Protection and Development (CSPD) was also developed. Periodic annual and
mid-term reviews on implementation of the NPA/CSPD have been undertaken.
The United Republic of Tanzania submitted her periodic report on the
Implementation of the Convention on the Rights of the Child in 1998 as required
under article 44 of the Convention. The report is scheduled to be discussed mid –
2001 by the Committee on the Rights of the Child.
B: PROCESS ESTABLISHED FOR THE END DECADE REVIEW
The process for the End Decade Review started in 1998/99, with the Mid-term
review of the Country Programme of Co-operation on CSPD, which took stock of
achievements and constraints towards implementation of the original objectives.
The review was done under the guidance of the Country Programme Steering
Committee comprising of Permanent Secretaries of the relevant government
ministries. A Technical Working Group on the Mainland and a Technical Committee
on the Isles supported the Steering Committee in this task.
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A multi-disciplinary approach was chosen in each theme because the 1998 CSPD
annual review, which involved 55 districts on the Mainland and the whole of
Zanzibar, had noted that one of the major problems emerging during the
implementation of the programme was lack of co-ordination and integration of
activities.
Since 1991, the Day of the African Child has been used to create awareness about
children’s rights and collect children’s views on various issues affecting their lives.
The Day of the African Child in 2000 was used to take stock of the implementation
of the Summit Goals. A special session of the National Assembly was organised on
17 June 2000 to inform Members of Parliament on progress made in implementing
the National Summit Goals, and other issues related with children’s rights, notably
HIV/AIDS.
Several studies have been carried out on various aspects related with children and
women’s issues. Findings of these studies were widely disseminated and
discussed through workshops, round table discussions and through the mass
media.
C. ACTION AT NATIONAL AND INTERNATIONAL LEVELS
1. The National Summit for Children (NSC)
The National Summit set up a bottom up approach in carrying out activities to
achieve the set goals. In implementing the goals, households, the villages, wards
and eventually the districts were to set their own goals on the basis of capacities
and resources available at each level. Back-up support was to be co-ordinated at
the national level in collaboration with the regional machinery. The National Co-
ordinating Committee for Child Survival, Protection and Development chaired by
the Planning Commission in the President’s Office was charged with co-ordinating,
planning and reviewing implementation.
In each village implementation and follow-up committees were set up. Members
in these committees were drawn from each neighbourhood and it was intended
that half of them were to be women. In practice however, in many Tanzanian
communities women have the same opportunity as men to air their views. These
committees were responsible for maintenance of village registers where births and
deaths are recorded. Children under five are regularly weighed and these records
are included in the village register. Results of weighing are analysed to determine
nutrition status. Information collected on infant, child and maternal deaths, and
results from weighing are discussed in a joint meeting of all villagers. Community
capacity in identifying the problems, collecting and analysing data and making
informed decisions was built through this process.
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2. The National Programme of Action/Country Programme of Co-operation
between The Government of Tanzania and UNICEF
Some of the priorities identified for NPA were incorporated in the 1992-1996
Country Programme of Co-operation between the Government of Tanzania and
UNICEF, Child Survival Protection and Development (CSPD).
The implementation of the CSPD has been participatory in nature, involving key
actors including government, NGOs, civil society, communities, village
governments and mass media in creating awareness, and sensitisation. Advocacy
materials were produced and widely disseminated using mass media, schools,
NGOs, commemoration of the Day of the African Child, youth groups and other
means.
Through CSPD programme, community-based management information systems
were established with information on three key indicators: nutrition status and
growth monitoring, monitoring enrolment in primary schools, immunisation to
ensure children are protected against the six killer diseases. Statistics are
aggregated by gender in some cases. Progress towards the goals was also
facilitated through research and development, including studies on the girl child
and on children in need of special protection measures.
3. Policy and Strategies.
Tanzania has taken several policy initiatives that will have direct and indirect effect
on the implementation of the NPA. These initiatives provide the context within
which the NPA is operating. Some of these initiatives are discussed below:
Tanzania Development Vision 2025
This is a national vision with economic and social objectives to be attained by
the year 2025. It lays out the long-term development goals and perspectives,
against which the National Poverty Eradication Strategy (NPES) was
formulated.
The Tanzania Development Vision 2025 has three principal objectives: -
achieving quality and good life for all, good governance and the rule of law;
and building a strong and resilient economy that can effectively withstand
global competition.
The vision sees the future of Tanzania to be a country at peace, tranquillity
and national unity; a country with an educated population imbued with an
ambition to develop; and an economy which is competitive and which ensures
sustained growth for the benefits of all people.
Poverty Reduction Strategy:
At the core of the problems facing women and children in the country is abject
poverty which affects the majority of Tanzanians. A study based on a national
household survey carried out in 1991 found out that 51 percent of the
population had incomes of less than an absolute poverty line of US $1 per day
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per person, 42 percent had incomes of less than US $0.75 per day. The
poverty profile suggests that poverty in Tanzania is very much a rural
phenomenon. While 59 percent of the population live in rural areas, about
85percent of the below-US$1-a-day poor and 90 percent of the below-
US$0.75-a-day poor live in rural areas. Income levels are strongly associated
with other social indicators. Children of poor parents are more likely to die
during infancy; they are more likely to be malnourished; they are less likely to
be enrolled in school; and, if enrolled, more likely to perform poorly. Given the
fact that poverty affects all the social indicators negatively and thus national
development, the government has decided to put poverty reduction at the
centre of its development efforts. The GOT published an Interim Poverty
Reduction Strategy Paper (PRSP) in March 2000, and a more comprehensive
PRSP was published in October 2000. The PRSP explicitly emphasises the
importance of participatory planning at village and district level. Through this
approach, human potential will be unleashed to help solve the numerous
problems confronting people. The PRSP aims at facilitating the mainstreaming
of a poverty and welfare monitoring system into the budget instruments, such
as the Medium Term Expenditure Framework (MTEF). The PRSP aims at
strengthening the prioritisation of actions within and across sectors targeting
poverty. Two areas that have received particular attention are primary health
and education.
Through the PRSP more resources will be allocated for fighting poverty.
Before PRSP and Tanzania’s qualification to the enhanced Highly Indebted
Poor Countries (HIPC) initiatives, the nation was spending about 40percent of
the public budget on debt servicing; more than allocations for education and
health sectors combined.
Child Development Policy
The Ministry of Community Development, Women’s Affairs and Children was
established in November 1990. A Child Development Policy was formulated
and approved for implementation in 1996. The policy enshrines the basic
principles of Convention on the Rights of the Child (CRC) namely non-
discrimination, the best interests of the child, right to life, views of the child
and indivisibility. A revision of the policy and its implementation framework
has been initiated in order to address pertinent issues such as child
participation rights, the challenge of HIV/AIDS, street children, child labour
and related aspects of poverty and marital relationship. The implementation
framework of the Child Development Policy contains guidelines addressed to
different key actors which include the central government, local government,
NGOs, mass media, international agencies, community, parents/ guardians,
and children themselves in ensuring children rights for survival, protection,
development, non-discrimination and participation.
Youth Development Policy
The Government formulated the National Youth Development Policy in 1996.
This is the key document guiding the formulation and implementation of
programmes and projects by the government and all stakeholders involved in
youth development. The policy is intended to help foster proper upbringing of
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women and men, and for them to become responsible citizens and develop
their full potentials in all aspects and promote their full involvement and
participation for socio-economic development.
Future programmes of the youth development will be based on the Youth
Empowerment Programme vision 2025. Hence, the National Youth
Development Policy, which is under review, includes strategies and
statements, which will facilitate the youth in their capacity building and
empowerment.
Reform Programmes – Local Government Reform and Sector
Development Reforms
Local Government Reform (LGR) is intended to improve the quality and
quantity of service delivery to the people. The Local Government Reform and
the devolution of political, administrative and development responsibilities,
including the authority to raise and use revenue, provides a major opportunity
for facilitating and overseeing development in a comprehensive and holistic
manner. This requires that the district and sub-district officials be sensitive to
community priorities and respect their capacity to develop, own and co-
ordinate their own plans, resources and partners.
The Local Government Reform is going hand in hand with other sector reforms
such as Health, Education, Water, and Agriculture, all intended to improve
provision and delivery of various services to the people. Educating and
sensitising people on their roles as far as cost sharing is concerned is one of
the activities being undertaken now.
D. SPECIFIC ACTIONS FOR CHILD SURVIVAL, PROTECTION AND
DEVELOPMENT
This section, presents actions that the United Republic of Tanzania has taken on
the seven goals identified by the World Summit for Children.
(a) Tanzania Mainland
The United Republic of Tanzania signed the World Declaration in September
1990. A special session of the mainland Parliament held on 7 June 1991 endorsed
the seven major goals of WSC. As discussed in the previous section, Tanzania has
put in place several policy initiatives that will help the country to achieve its
commitment towards children of this nation.
Goal 1: Reduction of Infant Mortality Rate (IMR) and Under-Five
Mortality Rate (U5MR)
Goals set for IMR and U5MR have not been achieved. Information on IMR and
U5MR has been derived from three national household surveys that were
conducted in Tanzania during the 1990s. These surveys show that IMR dropped
from 92 per 1,000 live births in 1992 to 88 in 1996 only to rise again to 99 in
15
1999. Similar pattern was observed for U5MR, which dropped from 141 per 1,000
live births in 1992 to 137 in 1996 and rose to 147 in 1999.
Vaccination coverage for at least all antigens has dropped since early 90s and
especially after 1996 for several reasons. Irregular supply of kerosene and lack of
spare-parts for cold storage facilities meant that for some period of time
refrigerators were not working and could not be used for storing vaccines.
Vaccination programmes have been affected by global shortage of polio vaccine.
Several measures have been put in place to remedy the situation. Government
has allocated funds to districts to enable them purchase kerosene regularly. In
case of shortage of funds, district authorities have been asked to make funds
available from other sources. In districts where the coverage of vaccination has
not been high, efforts are made to re-establish outreach activities and health
workers have been provided with bicycles to carry out this task. Special strategies
such as accelerated measles control programme (1999 –2003) and polio
eradication programme (1996 – 2001) have shown encouraging results. Nation
wide active surveillance on acute flaccid paralysis has reported no cases of wild
poliovirus. A new vaccine against Hepatitis B, has been introduced in the
immunisation programme. This will reduce preventable infections and hence help
to reduce IMR and U5MR.
Goal 2: Reduction in Maternal Mortality Rates:
The most recent reliable estimate of maternal mortality from a 1996 survey is that
529 women die in every 100,000 live births. The major direct causes of maternal
deaths are unsafe abortion, anaemia, eclampsia, haemorrhage, obstructed labour
and puerperal infections. The principle indirect causes are HIV/AIDS, malaria,
viral hepatitis, pulmonary tuberculosis and tetanus. In addition harmful traditional
practices, inadequate emergency referral system, shortage of service providers
with life saving skills, basic equipment and supplies in health facilities contribute
largely to maternal deaths.
The rate of HIV/AIDS is increasingly being reported in antenatal clinics. In 1997,
the prevalence of HIV infection among pregnant women attending ante-natal
clinics ranged from 7.3 to 44.4 per cent in rural areas and from 22.0 to 36.0 per
cent in urban areas. Opportunistic infections are also common, while perinatal
outcome is also poor with increased frequencies of abortion, ectopic pregnancies
and other complications.
Data shows a drop in the care provided to pregnant women. Indicators of
antenatal and postnatal care all show a downward trend. Antenatal care coverage
has dropped from 62.2 percent in 1992 to 45.6 percent in 1999. Perhaps more
worrying is the fact that more and more women, both in urban and rural areas are
delivering outside health facilities. In 1992, 52.6 percent of all births were
delivered in health facilities compared to 45.1 percent of births delivered in health
facilities in 1999. Childbirth care dropped from 43.9 percent in 1992 to
31.1percent in 1999. Decreasing use of health facilities for delivery, pre-natal and
post-natal care may be an indication of poor services offered by the health
facilities or due to the cost of services provided. However, the government policy
is to provide maternal health services free of charge throughout the country.
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Goal 3: Reduction of Malnutrition among Children:
Tanzania set itself a target of reducing the severe and moderate malnutrition
among under-fives by half. This was to be achieved through encouraging women
to breast-feed their children exclusively for four to six months; and then to
supplement child’s diet with other foods while continuing to breast-feed. Data
collected during the three National Demographic Health Surveys (NDHS) show that
there has been no marked improvement in the nutritional levels of the children
over the decade.
Data on children who are underweight, who suffer from stunting and wasting
show no change over the decade. About a third of all children are moderately
underweight and around 6 percent are severely underweight. Nearly half of the
children are moderately stunted and nearly one fifth are severely stunted. Data by
gender is mixed. There are more under-five girls who are moderately or severely
underweight than there are boys. However, incidences of stunting and wasting
are higher among boys than in girls. Generally, more children in rural areas are
underweight, stunted or wasted than children in urban areas.
Tanzania has made progress in reducing micronutrient malnutrition. This has
been especially significant in reduction of vitamin A and iodine deficiencies. A
national survey, to map out the extent of vitamin A deficiency problem was carried
out in 1997. It showed that 24.2 per cent of children between the ages of six
months and six years were Vitamin A deficient. To overcome the problem,
training of relevant service providers was carried out on diagnosis and
management of vitamin A deficiency, as well as management of vitamin A
capsules supplementation. Vitamin A tablets were made available in all
government and non-government health facilities. Through radio programmes
and other means public awareness campaigns were carried out to educate the
public on the effects and control of vitamin A deficiency. Also the massive Vitamin
A capsule supplementation was carried out through National Immunization Days.
The programme for the control of iodine deficiency disorders (IDD) started in
1985. It aimed at eliminating areas of severe IDD by the year 1993, and virtually
eliminating IDD as a problem of public health significance by 2000. To achieve
this iodinated oil capsules were distributed in 27 highly endemic districts as a
short-term measure. A more permanent solution was to require universal
iodination of cooking salt. Iodinated salt is now widely available and about 66
percent of salt is iodised in the country (TRCHS,1999). A survey carried out in
1999 shows that the prevalence of goitre has gone down from 67.8 per cent in
1980s to 23.5 per cent in 1999.
Efforts are currently underway to reduce the levels of anaemia in the country
through iron supplementation and de-worming of U5 children in pilot districts. To
encourage women to breast feed their children, between 1993 and 1996 nearly
2000 health workers were trained on lactation management.
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Goal 4: Increased Supply of Safe Water and Improved Sanitation:
Adequate and safe water supply, and improved sanitation facility are widely
recognised as being important determinants of the public health of any country.
In Tanzania, however, there is a problem of long distances to water sources
especially in rural areas, a major factor contributing to increasing women’s
workload. Also, there is a problem of adequate clean and safe water. The goal of
universal coverage of clean water and sanitation facilities, if achieved, will
therefore make a major contribution to improving the situation of women and
children.
According to the goals set at the beginning of the decade, Tanzania Mainland had
to achieve universal access to safe drinking water and sanitary excreta disposal by
year 2000.
The 1991 National Water Policy focused on the involvement of the community in
all aspects of the water projects, including operation and maintenance. One of
the problems with the earlier schemes was that there was no community
participation in the establishment of water schemes. However, several initiatives
have been undertaken by the government to empower communities to identify
their problems such as establishment of water funds and water committees. The
policy also advocated an integrated approach where water and sanitation activities
were to be integrated with activities of the sectors of health and community
development. By 1999, 92.1 per cent of the urban population and 56.3 per cent
of the rural population have access to safe water.
In urban areas, sanitation is closely tied to availability of water. In rural areas
excreta disposal is through pit latrines. There has been a slight improvement in
access to safe sanitation. Number of people who had access to safe sanitation
rose from 83.4 per cent in 1991/92 in rural areas to 84.3 per cent in 1999. In
urban areas nearly all have access to safe sanitation. However, figures estimating
safe water and sanitation should in general be regarded with some caution,
bearing in mind that within communities, degrees of access vary considerably.
Also it is estimated that at any given time, up to 30percent of water schemes are
out of service.
Goal 5: Improved Access to and Achievement in Basic Education:
Education is a basic human right of every child as well as a basic necessity for the
social and economic development of the nation. Education has important benefits
in improving productivity, raising income levels, lowering fertility rates, and
improving health and nutrition. Therefore the importance of education for child
survival, protection and development cannot be over emphasised. There are two
issues that need to be discussed in provision of basic education: access and
quality.
The policy on Education for Self-Reliance (ESR) set the framework for the national
education following the Arusha Declaration in 1967. Through ESR, the
government committed itself to providing basic education to every child in the
country, with the purpose of ensuring gender equality in education. The
government called for general mobilisation to accelerate the achievement of
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Universal Primary Education (UPE). Earlier plans expected UPE to be reached in
1989. More than 90 percent of the children between the ages of 7 and 13 were
enrolled in schools. The results of the national UPE campaign were impressive,
especially in quantitative terms. In 1978, 878,321 pupils were enrolled in
Standard One, an increase of 254 percent over the 248,000 Standard One pupils
in 1974. The total primary school population rose from 1,228,886 in 1974 to a
peak of 3,553,144 in 1983, an increase of 189percent. This striking achievement
gained during this period was due to political determination and community
mobilisation. However, it was not possible to sustain the high level enrolment.
As a follow up to the WSC, Tanzania reaffirmed its commitment to achieving
universal access to basic education. This has not been achieved. Hardly any
improvements have occurred in the Gross Enrolment Rate (GER) and Net
Enrolment Rate (NER) in the last ten years. The GER and NER have remained
around 75 percent and 56 percent throughout the decade. The difference
between the GER and NER is mainly due to the implementation of previous/former
government policy to enrol in school all children between 7 – 13 years. However
in the new Education Policy enrolment is seven years. Twenty-five out of every
hundred children who enrol in standard one do not complete seven years of
primary education. Drop out is a major problem in mining and urban areas, where
boys drop out of schools to supplement family income by doing petty trade. On
performance in school, over 80 percent of students entering the Primary School
Leaving Examination (PLSE) score less than 50 percent of the subject scores.
Only 14 percent of children who complete primary school proceed to public
secondary schools and the secondary enrolment rate is as low as 6 percent.
However, the girls’ performance is low compared to boys in which more than half
of the girls sitting for the PLSE score less than 20 percent. This is due to gender
disparities in the society.
Goal 6: Reduction of Adult Illiteracy:
Given the importance of literacy in the lives of individuals and their effect on socio-
economic development, Tanzania set itself a goal of reducing illiteracy rate by half
of the 1990 level. Special attention was to be paid to female illiteracy.
Tanzania intensified its efforts to eradicate illiteracy in the 70s and 80s. By 1986,
Tanzania was able to reduce the illiteracy rate to 10 percent, one of the lowest in
the developing countries. Since then the rates have been on the increase. By
1990, literacy test results showed that 16 percent of the population were illiterate.
The task of halving the illiteracy rate has proved difficult. The number of illiterates
has kept on increasing. Enrolment in literacy classes has dropped significantly.
Between 1997 and 1999 there was a drop of 40 percent in the number of adults
enrolled in literacy classes. The number of illiterate is further inflated by low
levels of enrolment and high levels of dropout in primary schools. Current
illiteracy rates are estimated to be around 30 percent. Around 36 percent female
and 22 percent male are estimated to be illiterate.
19
Goal 7: Improved Protection of Children in Need Of Special
Protection Measures (CNSPM)
Extended families have traditionally provided a safety net for children when
difficulties arise. However, in the last ten years the combined impact of extreme
economic hardship which lead to abject poverty, and the impact of HIV/AIDS and
disintegration of the extended family system have damaged the social fabric. This
has resulted in a drastic increase in the numbers of children in need of special
protection measures.
In Tanzania the following categories of children are considered as in need of
special protection measures:
Children in institutions e.g. orphanages, approved schools, remand homes,
children with disabilities living in institutions; prisons;
Orphans;
Abused and neglected children;
Girls who are married and get pregnant before attaining
physical maturity;
Working children;
Children living on the street;
Child commercial sex workers; and
Children with disabilities.
In terms of numbers, the category that is currently of great concern to the nation
is that of orphans. According to the Tanzania Reproductive and Child Health
Survey (TRCHS) carried out in 1999, there were 1.3m orphans, most of them as a
result of losing one or both parents due to AIDS. The traditional coping
mechanisms in such cases where extended families take over care of such children
are increasingly under stress. We are seeing the emergence of child headed
families where the eldest child takes over the responsibility of looking after
younger siblings. Very old family members care for the majority of the orphans
and they have limited access to basic social services. Orphans, who are HIV
positive, heads of households and with terminally ill parents are the most
vulnerable. Orphans often end up as children on street, child prostitutes or
domestic workers. They are often vulnerable to sexual and physical abuse. Abuse
and the sense of hopelessness that many orphans feel compound the trauma of
losing their parents.
Efforts to provide institutional care for CNSPM are shared by the government and
several NGOs, religious institutions and CBOs. As a first step, the government has
strengthened the legal provisions as a step towards protecting these children.
(b) Zanzibar
The situation faced by women and children on the mainland is replicated to a large
extent on the Isles as well. Heavy workload, poor nutrition, poor economic conditions,
high illiteracy rates, high risk of contracting diseases such as malaria, as well as the
HIV/AIDS pandemic all affect women and children in the Isles.
20
Women still provide 70 percent of the labour force for agriculture but their earning
potential is constrained by small plots and limited access to credit and modern
technology. Some women have turned to non traditional acitivities such as seaweed
farming to supplement their income but recent downward trends in the world price
have reduced enthusiasm for this endeavour. Low earning capacity and limited
authority within the household are important factors, which reduce the capacity of
women to provide quality care for their children.
Goal 1: Reduction of Infant Mortality:
The mortality rates as of 1992 were 120 for infants and 202 per 1000 live births for
under five. Currently the IMR and under U5MR are estimated to be 83 and 114
respectively. The goal of reducing mortality rates to 50 and 70 respectively by year
2000 has not been achieved. This is due to the high prevalence of malaria,
malnutrition and acute respiratory infection and diarrhoea.
With regard to combating childhood diseases through low-cost remedies and through
strengthening primary health care and basic health services, the Integrated
Management of Childhood Illness (IMCI) has been adopted by the Zanzibar
government, with UNICEF supporting its introduction in three districts (North A, South
and Micheweni districts). Capacity building exercises for communities at high risk for
malaria have been done to establish strategies aimed at improving malaria prevention
and control activities. Routine EPI services (also supported by UNICEF) have helped
maintain immunisation rates at over 80 per cent. NIDs coverage in 1998 stood at
94.4 percent and 99.6 percent in the first and second round respectively.
Goal 2: Reduction in Maternal Mortality Rates:
The maternal mortality rate (MMR) which in 1991 was 314 per 100,000 live births has
gone up to 377. The major causes of MMR are eclampsia, puerperal sepsis,
obstructed labour, and antepartum haemorrhage. Increasing rates of HIV/AIDS cases
in recent years have had a marked effect on MMR. HIV/AIDS prevalence among
pregnant women jumped from 1.0 percent in 1994 to 3.7 percent in 1995. On the
prevention and treatment of AIDS, District AIDS Committees (DAC) have been
established together with community committees.
Goal 3: Reduction of Malnutrition among Children:
The 1992 levels for the moderate and severe malnutrition in under fives were 37
percent and 5 percent respectively. The current status is estimated at 25.8 percent
for moderate and 7.0 percent for severe malnutrition respectively. The desired levels
have not been reached due to several factors which include the low purchasing power
of the community, diseases e.g. malaria, ARI and diarrhoea as well as food production
and feeding practices. The burden of Protein Energy Malnutrition (PEM) is seen more
in North Unguja and North Pemba regions.
To overcome malnutrition, several village committees have received CSPD integrated
training so as to be able to address health and nutrition problems. This has resulted
in the re-establishment of community based growth monitoring and promotion (GMP).
Growth monitoring and promotion training have also been conducted with PHC staff.
21
Breast feeding topics were included in the training workshops in order to protect,
promote and support breast-feeding activities.
Goal 4: Increased Supply of Safe Water and Improved Sanitation:
Water in Zanzibar is primarily obtained from ground water. In 1992, the access to
safe water for Unguja Island was estimated at 65 percent while that for Pemba was
16 percent. Sanitary means of excreta disposal was 67 percent and 24 percent
respectively. The current (2000) status of access to good quality water is estimated at
75 percent for the urban population and 50 percent for the rural population. In 1999
access to safe water has increased to 74 percent in Unguja and to 73 percent in
Pemba. The Sanitary excreta disposal has increased from 67 percent to 73 percent in
Unguja and 24 percent to 51.6 per cent in Pemba. These levels of coverage are a
result of completion of small water projects built through community mobilisation.
Goal 5: Improved Access to Basic Education:
The GOZ reiterated its commitment to provide access to education to all its citizens.
The adoption of resolutions of the World Conference on Education for All and the
National Summit for Children resulted in the formulation of Zanzibar Education Policy
in 1991 and its revision in 1995. An education sector review was carried out in 1995
and a ten-year Zanzibar Education Master Plan (ZEMAP) (1996 – 2006) was launched.
In implementing the Master Plan, the government of Zanzibar committed to increasing
the share of education budget from 14 percent to 20 percent of total expenditure.
Some of the goals of the World Conference on Education For All and the National
Summit for Children were incorporated in the ZEMAP. The Master Plan envisaged
attainment of a pre-school GER of 100 percent (for the 4-6 age group population) by
the year 2006. Access to primary education was to be raised from the (1996) GER of
81.2 percent to 100 percent by the year 2006. In order to negate the effect of
dropouts on the literacy rates, it was planned to involve 50 percent of dropouts of
ages between 10 to 16 in non-formal and informal alternative education arrangements
by the year 2001 and all of them (100 percent) by the year 2006.
The NER in primary education has increased from 50.9 percent in 1991 to 67 percent
in 1997. At primary school level female/male ratio has been around 1.0 throughout
the decade. In order to increase access to basic education, communities in many
areas have started building classrooms to alleviate the shortage of space in schools.
The recent move by the government to allow private provision of education is also
expected to further increase access.
Major problems in the education sector still remain to be addressed. Throughout the
90s, education sector has remained under funded. Allocations to education in the
budget have never exceeded 14 percent of total. Shortages of classrooms have limited
the number of pupils enrolled in schools. The drop out in primary school is high,
around 30 percent. The quality of education has remained poor, most of the school
leavers lack necessary skills for employment or for self-employment.
In Zanzibar, child-care is traditionally provided at home by the family. Women are
responsible for taking care of infants and young children. Pre-schools have in recent
years been playing a more prominent role in providing care and education for young
22
children between the ages of four to six years. Currently there are 15 formal pre-
school centres with an enrolment of 13,046 children. Koranic schools, which number
around 1000, have an enrolment of over 200,000.
Goal 6: Reduction of Adult Illiteracy:
In 1986, the adult literacy was estimated to be 61.5 percent. Literacy among men is
higher than in women and in Unguja compared to Pemba. Throughout the decade,
efforts to reduce adult illiteracy have not been successful due to low attendance and
high dropout from literacy classes. The literacy campaigns, which were very active in
1970s and early 1980s, have lost steam. Most of the traditional literacy programmes,
which emphasised 3R’s, were not well received by many of the learners. According to
ZEMAP the adult literacy rate was to increase from 60 percent to 85 percent by the
year 2006.
Data on the current situation of adult literacy in Zanzibar are not available, but it is
assumed that the rate has not increased significantly from the 61.5 percent in 1986.
In order to create more interest in literacy, the department of Adult Education has
started demand- driven adult literacy programmes targeting specific clients such as
fishermen, farmers and women’s income-generating groups. However, the number of
such programmes is still too small to generate a significant increase in the literacy
rate.
Goal 7: Improved Protection of Children in Need Of Special
Protection Measures (CNSPM)
In Zanzibar children included in CNSPM categories are children with disabilities;
children with HIV/AIDS, orphans, children of children due to early marriage and high
divorce rate; children in the labour market; and sexually abused children. Despite the
efforts of the government and various NGOs, the problem remains critical due to
economic changes and weak support from their respective families as well as
communities. Efforts to support this group of children are made more difficult by lack
of accurate data in each category.
E. LESSONS LEARNT
In summary, most of these statistics show that there has been little progress for children in
the 1990s and some critical indicators have worsened. There are reasons for the little
progress. In 1991, Tanzania adopted the WSC goals out of which further analysis show that
national capacity, both in terms of financial and human resources could not adequately
provide resources for smooth implementation of programmes to achieve these goals. The
following section examines some of the factors influencing the achievements or non-
achievement of the goals.
1. Political will:
Tanzania political will was demonstrated by Tanzania delegation to the WSC led by the
President of the country. In 1991, a special session of the Parliament was held to endorse
the WSC goals and set out modalities on how these goals would be achieved.
23
2. HIV/AIDS:
A key factor in explaining why progress has been reversed in several areas, such as infant,
under-five and maternal mortality rates, is the growing HIV/AIDS pandemic. HIV/AIDS has
over the decade evolved from being a health crisis to become a developmental crisis. One
likely impact of the increasing HIV prevalence rate in Tanzania, which currently is estimated
to be 10 percent, is a higher rate of child mortality. Still many babies are being infected with
the virus at birth, and recent figures from National Aids Control Programme (NACP) show that
70,000-80,000 newly born were infected annually. It is also known that 80 percent of those
infected at birth do not survive their second birthday and at the age of five very few will still
be alive. Being infected with HIV through breast milk as well, children are indeed suffering in
the most direct way from the HIV/AIDS pandemic.
3. Poverty:
At the core of Tanzania’s problems is the basic poverty that is prevalent in the country.
Initiatives taken to overcome or reduce poverty have not yet borne fruits. Policies such as
PRSP and benefits to accrue as a result of HIPC initiatives will take time to filter down to the
grassroot level. Tanzania has put in place policies, which should begin to affect positively the
lives of women and children in the country soon. The Country, like many third world
countries, is trapped in the cycle of debt. The recent initiatives taken at the macro level has
qualified Tanzania for HIPC assistance.
4. Prevalence of Disease:
Another important factor affecting mortality rates is the consistently high rate of malaria and
diarrhoea infections among children below five years. Increasing resistance of common
malaria drugs to the parasite suggest that the treatment of malaria is becoming still less
effective and it is estimated that up to 45 percent of all child deaths are attributable to
malaria. Likewise the prevalence of diarrhoea is a threat to the health. Poor nutrition
exacerbates the impact of disease.
5. Declining Use of Facilities:
Inspite of the fact that there are safe motherhood initiatives and free MCH services, it has
been reported that in rural areas there are more women delivering at home where traditional
birth attendants attend majority of deliveries instead of health facilities. This situation has
arisen largely due to direct and indirect costs of using health facilities.
6. Social Practices:
Several social practices affect both children’s and maternal mortality rates. Women’s heavy
workload during pregnancy, especially in rural settings affect both their health and that of
their children. The culture that glorifies motherhood in terms of children borne encourages
women to have many children with inadequate time between pregnancies. This prevents
women from recovering and gaining strength. Fertility rates are over 5.8 and the rate of
contraceptive acceptance is only 16 percent. The mean interval between births is less than
two years. Conditions for mother and child are also affected by early marriages. Over one-
third of women give birth before they are physically mature. Chronic under-nutrition
throughout childhood contributes to young women having short stature, which puts them at
24
greater risk at childbirth. Women’s poor health combined with heavy workload, even during
pregnancy, result in high maternal deaths.
7. Education:
One area that is of major concern is that of education. Stagnant enrolment, high dropout
rate, relevance of the education provided, are, all issues of concern. The resources for
education are not sufficient for the requirements and internal inefficiency in the education
system is a problem. In order to increase resources going to primary education, communities
are encouraged to contribute towards running of the schools.
8. Liberalization of the economy:
Liberalization of the provision special social services has increased the number of schools as
well as health facilities and many people have access to these facilities at a cost. This has
eased congestion in public facilities.
9. Cost Sharing:
The cost sharing policy has created an opportunity to improve the quality of education and
health services. However, due to poverty, there are some people who are unable to meet the
costs. However, the government has instituted measures to allow them free access to
essential health services such as mother and child, prenatal and delivery care, and for
epidemic diseases such as cholera, tuberculosis, etc to pregnant mothers and children under
five years.
F: FUTURE ACTIONS
1. Political Will:
It is necessary to match political will with concrete action. One important way of ensuring
success is to put in place a monitoring and evaluation mechanism.
2. Co-operation:
Given the magnitude of the problems, it is through the concerted efforts of the Government,
community, NGOs and bi-lateral and multi-lateral donors that the problems facing women
and children can be addressed. Recent policy initiatives are aimed at devolving decision-
making powers from central government to local levels. Reforms such as Local Government
Reform aim to shift decision making to the district and village levels. As issues that concern
women and children have their roots in the culture of the people concerned and in their
economies, strategies adapted need to aim to make changes at the family, village
(community) and district levels, as well as at national and international levels.
25
3. Actions at different Levels:
Family Level:
Experience in Tanzania and in neighbouring countries has shown that there are effective
traditional mechanisms and practices that can be strengthened to the advantage of
children in general and vulnerable children in particular. Along side with traditional
practices, child rights and developmental approaches should be adopted.
Most of the care of children happens at the household level, and the community has the
crucial role to support the efforts of the family. Therefore efforts will be made to
strengthen the capacity of families and communities to effect optimal child-care and to
enhance the mother’s caring capacity as a primary duty-bearer. One important challenge
in this aspect is the nutrition of the mother. As shown earlier, many mothers are anaemic
during pregnancy which not only affects the babies they give birth to, but seriously affects
their ability to breast feed and care for their babies. Immediate improvement in nutrition
of mothers and reduction in the their workload, especially during pregnancy depends to a
large extent on the attitude of families towards women. As these differ among different
ethnic groups, programmes that take into consideration local conditions will have to be
developed. In this respect, the role of NGOs can be crucial - they can become the
sensitising agents within the community.
Village Level:
Integration of all aspects of childcare, that is health, nutrition, WES and early stimulation
has the potential to bring about optimum child development, with implications for policies
and programmes that address the child holistically. A multisectoral approach to early
childhood development has been found to be the most appropriate way of achieving
better results.
A community based strategy for early childhood survival, growth and development needs
to be developed. Communication strategies that address the issues of care for women
during pregnancy, child-care, care during illness, and hygiene need to be developed.
Improvement of routine community-based monitoring and evaluation of maternal deaths
should be given special attention, so that there is exhaustive analysis by community
health workers and leaders of each maternal death that occurs in the village. This will
lead to a better understanding of immediate underlying and basic causes of the death and
more rapid action to improve the situation. Community-driven management and
monitoring information systems must guide action at all levels.
Also there is need for promotion of positive cultural and social factors related to food
intake, reduction of women’s workload by introducing appropriate technologies and
reduction of workload in home and community. Advocacy and support for increased rest
for pregnant and breast feeding mothers should be enhanced.
Another area where communities could come together to solve their problems is water
and education. Communities should be encouraged to establish a water fund, which
could be used for rehabilitation of existing sources and for construction of new water
projects. In the field of primary education there are several initiatives that tap community
26
resources. There is a pilot project which is funded by the World Bank to support
government efforts in provision of basic education. The project provide financial support
for community education fund by providing matching grants to communities to be used at
the discretion of local communities. Many communities have been able to improve the
school environment through this scheme. HIV/AIDS is another issue that needs an open
debate at the village level.
National Level:
Community based action cannot occur overnight. Communities need support at national
level. The Local Government Reforms provide the framework within which communities
can be nurtured and supported to plan their development programmes. This will also
mean that resources be provided where they do not exist. These can be used more
effectively provided that people have improved knowledge and understanding concerning
their problems, and support from outside is available to them.
Empowerment:
A key component of community-based development approaches is empowerment of
communities and their institutions. This means building and strengthening organisational
and management capacities at community, village and district levels. The goal should be
to enable communities themselves to identify and analyse problems and take appropriate
action to address them through application of an empowerment framework. Advocacy,
training, management information system and support for resource mobilisation and
management are means through which communities can achieve empowerment. The
Local Government Reform will more systematically incorporate a participatory
methodology of identifying opportunities and obstacles to development to strengthen
community-based planning processes. The community should be economically
empowered especially women by providing entrepreneurial potential, more role in income
generation and employment opportunities.
Education:
The government is responsible for facilitating the provision of basic education to all its
people. Education and Training Policy (ETP) emphasises the government’s role in
providing the necessary infrastructure and the need for the communities to take more
control over the management of their schools. The government has instituted the cost
sharing policy.
Co-ordination:
Tanzania appreciates the efforts from all concerned, the government, communities,
NGOs, bi-lateral and multilateral donors. In the past this has often led to a multiplicity of
projects and duplication of efforts. In the field of education and health there are efforts
to co-ordinate activities of various donor and NGO supported projects to ensure maximum
benefits for the efforts made.
27
Self-Reliance:
Although, Tanzania realises the importance of donor support to various development
programmes in the country, it is also aware that such assistance is neither permanent nor
unconditional. The assistance provided should only be as supplementary to government
efforts. Tanzania, while welcoming assistance, will need to build a more self-reliant
approach to its development efforts.
Poverty Reduction:
Efforts need to be concentrated on poverty reduction. Poverty has an effect on all
aspects of women and children’s lives. Poverty reduction efforts should concentrate on
ensuring food security; provide social safety nets in cases of natural disasters such as
famine and floods; and providing employment and income generating opportunities for
youth and women.
Good Governance and Accountability:
Ensuring appropriate use of power, whereby the rights of children are respected and
protected. It is important that democratic processes are extended to children so that they
can contribute to decision making on issues that concern them as well as they concern
their families, communities and nation.
28
Statistical Appendix
29
Table of Contents
Page
Introduction 1
Goal 1: Reduction of Infant and Under-five Mortality 2
Goal 2: Reduction of Maternal Mortality 5
Goal 3: Reduction of Severe and Moderate Malnutrition 6
Goal 4: Universal Access to Safe Drinking Water 8
Goal 5: Universal Access to Sanitary Means of Excreta Disposal 9
Goal 6: Universal Access to Basic Education 10
Goal 7: Reduction of Adult Illiteracy 13
Goal 8: Improved Protection of Children in Especially Difficult
Circumstances 13
Goal 9: Special
Attention to the Health and Nutrition of the Female Child
and to
Pregnant and Lactating Women 14
Goal 10: Access by All Couples to Information and Services to
Prevent
Pregnancies that are to Early, too Closely Spaced, too Late or too
Many 14
Goal 11: Access by All Pregnant Women to Pre-natal Care and
Trained Attendants
During Childbirths 16
Goal 12: Reduction of Low Birth Weight 18
Goal 13: Reduction of Iron Deficiency Anemia in Women 18
Goal 14: Virtual Elimination of Iodine Deficiency Disorders 19
30
Goal 15: Virtual Elimination of Vitamin A Deficiency 19
Goal 16: Empowerment of All Women to Breast-feed their Children 20
Goal 17: Growth Promotion and its Regular Monitoring 21
Goal 18: Dissemination of Knowledge and Supporting Services to Increase
Food Production to Ensure Household Food Security 21
Goal 19: Global Eradication of Poliomyelitis by the Year 2000 21
Goal 20: Elimination of Neonatal Tetanus 22
Goal 21: Reduction in Measles Deaths and Cases 22
Goal 22: Maintenance of a High Level of Immunization Coverage 23
Goal 23: Reduction in Deaths Due to Diarrhoea and in the
Diarrhoea Incidence Rate 25
Goal 24: Reduction in Deaths Due to Acute Respiratory Infections 26
Goal 25: Elimination of Guinea-worm (Dracunculiasis) 27
Goal 26: Expansion of early Childhood Development Activities 27
Goal 27: Increased Acquisition by Individuals and Families of the Knowledge,
Skills and Values Required for Better Living 27
Additional Indicators:
Children’s Rights 28
Integrated Management of Child Illness (IMCI) and Malaria 30
HIV/AIDS 32
31
F. Introduction
The Declaration and Plan of Action adopted at the World Summit for
Children, held in September 1990, established a set of goals for the
decade 1990 to 2000. The World Summit for Children Goals were
endorsed and adopted by the National Assembly in Dar es Salaam, June
1991 and House of Representatives of Zanzibar, October 1991. The
National Programme of Action (NPA) to achieve the children’s goals was
submitted in December 1993.
A total of 27 goals have been identified plus additional indicators for
monitoring children’s rights, IMCI, malaria and HIV/AIDS. Initially, the
following 8 goals were given special attention by the Government of
Tanzania and highlighted in the National Plan of Action:, (1) Reduction
of infant and under-five mortality; (2) Reduction of maternal mortality;
(3) Reduction of severe and moderate malnutrition; (4) Universal access
to safe drinking water; (5) Universal access to sanitary means of excreta
disposal; (6) Universal access to basic education; (7) Reduction of adult
literacy; (8) Improved protection of children in especially difficult
circumstances2.
Targets to be met for each goal by the year 2000 were agreed upon by the participating
countries in the 1990 World Summit for Children. Thus, time has now come to take stock
of the situation and look into achievements made towards meeting the goals. In the
following report, the progress and current status of the goals will be analyzed by reference
to statistical data.
Data used in this statistical report is partly coming from administrative records, vital
registration and routine reporting systems by various ministries. However most data
referred to in the report are taken from the three national household surveys conducted in
the 1990s: Tanzania Demographic and Health Survey 1991/92 (TDHS91/92); Tanzania
Demographic and Health Survey 1996 (TDHS96); Tanzania Reproductive and Child
Health Survey 1999 (TRCHS99)3. These household surveys have provided substantial data
to monitor the achievements in meeting the targets for most of the World Summit for
Children goals.
The statistical report monitors the situation on a goal by goal basis. Each of the indicator/s
that follow a particular goal is presented and the quality of the data is likewise described.
2
In the National Programme of Action (NPA) the two goals; “Universal access to safe drinking
water” and “Universal access to sanitary means of excreta disposal”, were listed together. In the
following report they will be referred to separately.
3
The three surveys, all implemented by the National Bureau of Statistics in Tanzania, made use of
very similar questionnaires with the 1999 survey deliberately adding questions to monitor as many
of the end-decade goals as possible. Similarities in methodology makes it possible to compare data
from the various surveys. The surveys also provide data on differences or disparities within
Tanzania, such as by gender, by urban/rural and by mainland/Zanzibar. The TDHS91/92 and
TDHS96 had more than 8,000 female respondents, located in 357 clusters, whereas the TRCHS99
was about half the seize covering 4,029 female respondents in 176 clusters.
32
For indicators where data are available disparities by gender, urban/rural and
Mainland/Zanzibar are presented. The data are analyzed through use of tables, graphs and
maps to highlight trends and the current situation of women and children in Tanzania.
33
Goal 1: Between 1990 and the year 2000, reduction of infant and under-five mortality rate by
one-third or to 50 and 70 per 1000 live births respectively, whichever is less
Infant mortality rate (IMR) Probability of dying between births and exactly one year of age,
per 1000 live births
Under-five mortality rate Probability of dying between birth and exactly five years of age,
per 1000 live (U5MR) births
Sources of data: Tanzania Demographic and Health Survey 1991/1992
Tanzania Demographic and Health Survey 1996
Tanzania Reproductive and Child Health Survey 1999
A vital registrastion system that can provide mortality data is currently not in place and
Tanzania has relied on censuses and demographic surveys for estimates of childhood
mortalities. Mortality data from health facilities are being reported regularly, but
information from the Health Management Information System (HMIS) does not reflect the
mortality picture from a population perspective, because it is facility-based data and thus
does not include deaths that occur outside of facilities. Thus, in the following reference
will be made to mortality data from the three demographic surveys conducted in the 1990s.
Estimates of childhood mortality from the three surveys are based on birth history
information collected from each interviewed women. Considered to provide fairly robust
estimates of infant and child mortality results from this direct method are viewed with a
certain degree of uncertainty since they can underestimate mortality rates. Women tend to
omit deaths of babies who died shortly after birth or deaths
that occurred early in infancy. Infant Mortality Rate
five-year period preceding the survey
Infant Mortality Rate (IMR)
Referring to data for a five-year period preceding the surveys 1991/92 1996 1999
show a slight increase in IMR when comparing data from the Total 92 88 99
1996 TDHS and the 1999 TRCHS. In 1996 the IMR was
estimated to be 88 per 1,000 live births whereas the mortality figure in the 1999 survey
stands at 99. This recorded increase in infant
mortality occurs after a minor decrease in the 19-7891 69-2991 99-5991
rate in the first half of the 1990s, dropping 28
from 92 in the 1991/92 TDHS to the 48
mentioned 88 in the 1996 survey. 68
Recognising the uncertainty linked to 88
mortality estimates it seems likely that the
rebmuN
09
decline in infant mortality seen over the last
29
decades has leveled off and even a slight
upward trend in the number of children dying
49
before one year of age is recorded at the end 69
of the 1990s. 89
001
etaR ytilatroM tnafnI
When looking at disparities in mortality rates
34
by male/female and urban/rural it is necessary to refer to a ten year period preceding the
survey in order to have sufficient number of cases in each category. The ten year birth
history tend to record slightly higher mortality rates than data for the five-year period.
Infant Mortality Rate
Data for rural/urban disparities show a drop in IMR in urban
ten year period preceding the survey
areas from 108 in 1991/92 to 87 in 1999. Contrary the
probability of dying before one year of age has increased in 1991/92 1996 1999
rural areas from 97 in 1991/92 to 113 in 1999. Data for IMR
show that the probability for dying before one year of age is Total 99 94 108
higher in Mainland than on Zanzibar and that this trend seems Female 95 87 97
to have been further enforced when comparing data from the Male 104 101 118
1996 and 1999 survey. Rural 97 97 113
Urban 108 83 87
Mainland - 95 109
Zanzibar - 75 83
Infant Mortality Rate, Female/Male Infant Mortality Rate, Rural/Urban
140 120
Female
Rural
120 Male
100
Urban
100
80
80
Number
Number
60
60
40
40
20 20
0 0
1992 1996 1999 1992 1996 1999
U5MR
For U5MR the same trend as recorded for IMR is apparent. The positive gains made from
1991/92 to 1996 in further bringing down U5MR have been reversed, and a 10% increase
in the U5MR is recorded in the second half of the 1990s. After a drop from 141 Rate
Under-five Mortality
in 1991/92
to 137 in 1996, the latest data on U5MR estimates that per 1000 live births, 147 children
148
die before they reach the age of five when reference is made to data for a five-year period
preceding the survey. 146
144
142
Number
140
138
Under-five Mortality Rate,
five year period preceding the survey 136
134
1991/92 1996 1999 35
132
Total 141 137 147 1987-91 1992-96 1995-99
The rate of under-five deaths in respectively rural and urban settings shows that after a
noticeable decline in U5MR in urban areas in the first half of the
1990s an increase is registered in the years between the 1996 Under-five Mortality Rate,
survey and the 1999 survey. For rural settings the U5MR has ten year period preceding the survey
been relatively high throughout the decade, with a further
deterioration of the situation in the second half of the 1990s. In 1991/92 1996 1999
Total 154 145 161
the 1999 survey it was estimated for a ten year period preceding
Female 147 135 150
the survey that the U5MR was 166 in rural areas compared to
Male 160 154 172
142 in urban. As for IMR the U5MR is as well higher in Rural 152 151 166
Mainland than in Zanzibar, and it is especially interesting to see Urban 159 122 142
that the rise in U5MR has been much sharper in Mainland, as Mainland - 146 162
Zanzibar has only seen a minor increase in the estimated rates Zanzibar - 108 114
for under-five mortality.
Under-five Mortality Rate, Female/Male Under-five Mortality Rate, Rural/Urban
200 180
180 Female 160 Rural
Male Urban
160
140
140
120
120
Number
Number
100
100
80
80
60
60
40
40
20 20
0 0
1992 1996 1999 1992 1996 1999
36
Goal 2: Between 1990 and the year 2000, reduction of maternal mortality rate by
half
Maternal mortality ratio Annual number of deaths of women from pregnancy related
causes, when pregnant or within 42 days of termination of
pregnancy, per 100,000 live births
Source of data: Tanzania Demographic and Health Survey 1991/92
Tanzania Demographic and Health Survey 1996
Tanzania reproductive and Child Health Survey 1999
There is no vital registration system put in place, and those data that are
reported through hospital records are widely considered to reflect too
low estimates and hence to be of poor quality. In 1990 the level of MMR
was estimated to be between 200-400 per 1,000 live births but these
data were obtained from hospital records, hence not providing an
adequate picture of the mortality rate. It is problematic to give
estimates for maternal mortality at the national level as it requires
knowledge about deaths of women of reproductive age, the medical
cause of death, and also whether or not the women was pregnant at the
time of death or had recently been so. For these reasons data on
maternal mortality are almost none existing in Tanzania. As in the case
of IMR and U5MR, the only source of data for maternal mortality is
national household surveys. However, survey methods for estimating
maternal mortality, regardless of the specific technique used, produce
results with wide margins of uncertainty, which cannot be used for
regular and short-term monitoring.
To give an indication of the level of maternal mortality the data
available for reporting is taken from the Tanzania Demographic and
Health Survey 1996.
In 1996 the maternal mortality ratio was recorded to be 529 per 100,000 live
births
The number of women
dying from pregnancy Maternal Health Care
related causes can be 70
closely linked to the 62.2 Antenatal care coverage
access given to health 60 Births delivered in health facility
Childbirth care
care facilities and not
52.6
49.5 48.8
50
the least to the quality 43.9
46.5
of the services
45.6
40 38.2
Per cent
provided to the 31.1
pregnant women. Data 30
on access are available 20
for such ‘proxy’
indicators as antenatal 10
37
0
1992 1996 1999
care, childbirth care and birth delivered in health facilities. By looking at
trends in the coverage for these three indicators an indication is given
on the likely trend in maternal mortality. It is seen from the graph that
for all three indicators there has been a decline in coverage during the
1990s.
Less pregnant women are attending health care services, and the
downward trend seen in the 1990s might have had negative influence
on the maternal mortality ratio.
(See also goal 11)
Goal 3: Between 1990 and the year 2000, reduction of severe and moderate malnutrition
among under-five children by half
Underweight prevalence Proportion of under-fives who fall below minus 2 and
below minus 3 standard deviations from median
weight for age of NCHS/WHO reference population
Stunting prevalence Proportion of under-fives who fall below minus 2 and
below minus 3 standard deviations from median
height for age of NCHS/WHO reference population
Wasting prevalence Proportion of under-fives who fall below minus 2 and
below minus 3 standard deviations from median
weight for age of NCHS/WHO reference population
Sources of data: Tanzania Demographic and Health Survey 1991/1992
Tanzania Reproductive and Child Health Survey 1999
The three indicators used to Malnutrition 1991/92 1999 1991/92 1999
measure the level of malnutrition Moderate Moderate Severe Severe
are to some extent complementing & Severe & Severe
each other providing a general Underweight
picture of the nutritional status of Total <5 yr 28.8 29.4 7.1 6.5
under-five children in the country. Female 28.9 30.4 7.3 7
Male 28.7 28.5 6.8 6
Underweight is useful for
Rural 29.2 31.3 7.7 6.8
describing the overall level of Urban 27.4 20.6 4.2 4.9
malnutrition in a population and Mainland 28.5 29.5 7 6.5
for assessing changes over time, Zanzibar 39.9 25.8 12.3 7
whereas stunting is a composite of Stunting
cumulative deficient growth and is Total <5 yr 46.7 43.8 19.8 17.1
associated with chronic insufficient Female 45.3 42.7 18.7 17.3
dietary intake, frequent infections, Male 48.1 44.9 21 16.9
and poor feeding practices over a Rural 48.1 47.6 21.1 19.1
long period. Wasting is usually the Urban 44.8 26.1 15.5 7.7
Mainland 46.6 44 19.7 17.2
result of recent nutritional
Zanzibar 47.9 35.8 25.7 12.2
deficiency.
Wasting
Data on malnutrition is coming Total <5 yr 5.6 5.4 1.2 0.6
Female 5.1 5.3 1.2 0.1
from the national household survey Male 6.2 5.4 1.2 1.2
Rural 5.6 5.3 1.3 0.7
38
Urban 4.4 5.9 0.6 0.4
Mainland 5.5 5.3 1.2 0.6
Zanzibar 11 6.3 1.5 0.5
s conducted in the 1990’s which all applied the international definitions
based on standard deviation cut-off points.
Data presented in the table and graphs below indicate that the
prevalence of malnutrition has stayed more or less at the same level
throughout the 1990s. Comparing data from 1991/92 and 1999 surveys
show that for all three indicators there has only been a minor decrease
in the malnutrition prevalence, with moderate underweight even
recording a slight increase in the prevalence. Thus, the efforts to reduce
malnutrition have not reach the target set in 1990. Still almost a third of
all under-five children are moderate underweight, and the critical severe
underweight continues to be relatively high. Stunting reflects the long-
term chronic malnutrition that might not be life threatening but reduces
the physical condition of the child which again can have negative
influence on the health and productivity of the person during adulthood.
It continues to be high (43.8%) despite a small improvement during the
decade. The only major improvement recorded is for severe wasting.
However, measuring trends for wasting is problematic as the indicator
may exhibit significant seasonal shifts associated with changes in the
availability of food or disease prevalence. The actual timing of the
fieldwork for the survey might influence the prevalence of wasting.
Looking at the disparity by gender and rural/urban there are no
significant discrepancies apart for the stunting prevalence in urban
settings which has seen a clear drop for both moderate and severe
stunting, indicating that the nutritional intake and health status has
improved for children in urban areas. Malnutrition data from
respectively the 1991/92 and the 1999 survey show an interesting
trend, namely that Zanzibar has seen a dramatic drop in malnutrition
rates. For instance, children being moderate underweight has declined
from 39.9% to 25.8% during the decade and the critical severe stunting
has dropped from 25.7% to 12.2%. Having had higher prevalence of
malnutrition for all categories compared to Mainland, the situation has
improved considerably in Zanzibar in the 1990s.
Malnutrition, Moderate
50
45
40
35
30
Percent
25 Stunting
20
Underw eight
15
Wasting
10
5
0
1991/1992 1999
39
Malnutrition, Severe
25
20
15 Stunting
Percent
Underw eight
10 Wasting
5
0
1991/1992 1999
40
Goal 4: Universal access to safe drinking water
Use of improved drinking water sources Proportion of population who use
any of the following types of water supply for
drinking: (1) piped water to household; (2)
public standpipe/tap; (3) borehole/pump; (4)
protected well; (5) protected spring; (6)
rainwater
Source of data: Tanzania Reproductive and Child Health Survey 1999
The exact measurement of access to safe water has posed major
problems during the last two decades. Tanzania has collected
administrative data for coverage of safe drinking water in the last
decades but the reliability and quality of the data has often been
questioned. Partly because no consistent definition of safe drinking
water was applied and because the flow of data from districts and
regions to the national level was not consistent enough to produce the
reliable estimates needed. Internationally some efforts have been made
to formulate a uniform definition and recently one was presented for
use of improved drinking water source. This approach recognizes that
the assessment must focus on the source of water, and it also marks a
shift from a provider base to a user base for the data. A list of improved
source was identified (see above definition) making it possible through
household surveys to obtain data that can give an indication of the
access to improved sources for drinking water.
In the latest household survey, the TRCHS99, the definition was for the
first time applied in a national survey. In monitoring the population who
use safe drinking water, reference will only be made to data from this
survey, hence not making it possible to present trends in the coverage
during the decade. Data show that 2/3 of the population in Tanzania use
any of the following types of water supply for drinking: piped water into
household; public standpipe/tap;
borehole/pump; protected well; Safe drinking water, 1999
protected spring. The below table and
graph display the huge disparity between
rural and urban in the access to
100
Rural
improved drinking water sources. In
90
Urban
Total
urban settings data from the survey
80
estimates that more than 90% of the
70
population have access to safe drinking
60
Per cent
50
water coming close to the target of 40
universal access. Looking at data for 30
rural areas approximately half of the 20
population have access to improved 10
0
41
Use of safe drinking water
drinking water sources, falling far short of the target of universal
access.
Access to safe water, 1999
(percent)
Urban Rural Total
Piped into residen. 9.0 1.0 3.1
Piped into yard 39.2 3.1 12.6
Public tap 31.9 18.2 21.8
Protected well 5.2 18.5 15.0
Borehole/tubewell 6.0 10.4 9.2
Protected spring 0.8 5.1 4.0
Total 92.1 56.3 65.7
42
Goal 5: Universal access to sanitary means of excreta disposal
Use of improved sanitary Proportion of population who use any of the
following types of sanitation facilities
means of excreta disposal (1) toilet connected to sewage system; (2) toilet connected to
septic system; (3) pour-flush system; (4) improved pit latrine; (4)
Traditional pit latrine
Sources of data Tanzania Demographic and Health Survey 1992
Tanzania Demographic and Health Survey 1996
Tanzania Reproductive and Child Health Survey 1999
The measurement of access to sanitary means of excreta disposal
suffers from the same lack of quality data as described above for safe
drinking water. Those administrative data that are available is
considered to be incomplete and misleading, because service providers
are often unaware of self-built facilities, or even systems installed by
small local communities. For access to safe sanitation an international
definition has been formulated which focus on types of sanitation. Types
of sanitation facilities considered being of a certain hygienic quality
were identified (see above definition) and, so far, Tanzania has manily
relied on household surveys as the source of data for measuring access
to safe sanitation. To have a more precise estimate of good quality
sanitation, the next step will be to assess the adequacy of each type of
facility. None of the conducted household surveys included that quality
aspect.
The three household surveys conducted in the 1990’s have all collected
data on people’s access to sanitary means of excreta disposal. From the
data it is seen that an already high coverage of safe sanitation in the
beginning of the decade has been further improved. In urban areas the
national target of universal
access has almost been meet Access to safe sanitation
with coverage of approximately
99%. In rural settings the 100
coverage is likewise relatively 95 Urban
high. As mentioned above one Total
thing is to measure the access Rural
Percent
90
to improved sanitation facilities, 85
but the adequacy of the facility
is important to assess as well if 80
quality data for safe sanitation
is to be collected.
75
1992 1996 1999
Access to safe sanitation
percent 43
1991/92 1996 1999
44
Goal 6: Universal access to basic education and achievement of primary education
by at least 80 per cent of primary school-age children through formal schooling or
non-forma education of comparable learning standards, with emphasis on
reducing the current disparities between boys and girls.
Children reaching standard 5 Proportion of children entering first grade of
primary school who eventually reach standard 5
Net primary school Proportion of children of primary school age enrolled
in primary school
enrolment ratio
Net primary school Proportion of children of primary school age
attending primary school
attendance rate
Sources of data Administrative records, Basic Statistics in Education, Ministry
of Education and Culture
Education for All - 2000 Assessment, Ministry of Education,
Zanzibar
Tanzania Reproductive and Child Health Survey 1999
Education data are widely available from school records being compiled
at district, regional and national level. The data flowing from
administrative records are considered to be of a reasonable quality. The
Ministry of Education and Culture submit several publications every year
providing data on education. However, a problem faced in calculating
estimates for the often used net enrolment ratio is to obtain reliable
estimate of the population of primary school age. Population estimates
for calculation net enrolment ratio have been based on the 1988 census
making the figures less accurate. Data from the latest household survey,
on the attendance of children in school, are also used, and while surveys
cannot easily provide small area information, they can obtain data on
children who are not in school.
For children reaching standard 5 the data show a minor decrease from
81.5% in 1992 to 76.5 % in 1998. The proportion of children that
eventually reach standard 5 is relatively high during the decade and only
small changes in the survival rate is recorded from year to year. The
target of 80% survival rate is almost achieved. Data for survival rate do
not indicate the quality of the provided education – an important aspect
to consider when monitoring the education sector.
Looking at disparities between boys and girls it is apparent that slightly
more girls than boys reaches standard 5. The tendency of a higher
survival rate for
girls is consistent Children reaching standard V
through out the Per cent
1992 1993 1994 1995 1996 1997 1998
Mainland 45
81.5 83.2 78.7 78.4 77 81.3 76.5
Female 81.6 85.5 81 79.4 78.7 84 78.6
Male 81.3 81.1 76.6 77.4 75 78.7 74.6
1990’s. The data indicate that girls are not being excluded from
attending primary education, rather they are doing slightly better than
the boys.
Another key indicator to
monitor the achievements Children reaching standard V
in primary education is the
net primary school 95
enrolment ratio. Often this 90
indicator is being referred 85
80
to when the standard of
Per cent
75
education is measured. 70
However, net primary 65
Total
school enrolment is 60
Female
suffering from the same 55 Male
weakness as the survival 50
rate as the figures for net 1992 1993 1994 1995 1996 1997 1998
enrolment do not give any
indication of the actual
quality of the education. With reference to data coming from school
records and published by the Ministry of Education and Culture, the net
enrolment ratio for each year in the 1990s is shown in the below table
for both Mainland and Zanzibar. As seen, the net enrolment ratio in
Mainland has recorded an upward trend moving from 54.2% in 1990 to
57.1% in 1999. This positive trend should however be seen against the
very low enrolment ratio with only slightly more than half of children
between 7-13 years enrolled in primary school. The data also show that
slightly more girls than boys are enrolled, but in general there are no
real discrepancy recorded between girls and boys. Zanzibar has during
the 1990s seen a remarkable increase in net enrolment of primary
school aged children increasing from 50.9% in 1990 to 67% in 1997.
The data should however be interpreted rather cautiously as this ‘boom’
in net enrolment is normally difficult to accommodate over these
relatively few years.
Net primary school enrolment ratio
percent
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
Mainland 54.2 53.8 54.2 53.7 55.2 54.7 56.3 56.7 57 57.1
Female 55.4 56.1 56.2 55.7 55.9 56.3 57.2 57.4 57.8
Male 54.9 55.8 55.4 54.4 54.7 55.2 55.9 56.1 56.4
Zanzibar 50.9 49.3 49.8 50.7 59.3 65.4 65.9 67
46
It is possible to present the Net Primary School Enrolment Ratio
net enrolment ratio for each
80
district. On the next page a
map is drawn showing the net
75
Mainland
enrolment by districts in 70 Zanzibar
mainland Tanzania. The map 65
Per cent
displays the high disparity 60
between districts, with many 55
falling below 50% enrolment 50
ratio. The fact that almost 45
half of the districts have an 40
enrolment ratio below 50% 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
indicates the urgent need for
measures to reverse the
situation in particular areas of the country. Net primary school attendance rate
percent
To complement the indicator for net 1999
enrolment, the net primary school Total (7-13 years) 53.5
attendance rate is included. It gives a one- Female 55.6
point-in-time measure of the proportion of Male 51.4
Rural 49.4
school aged children attending school, and
Urban 71.1
hence are not dependent on the uncertain Mainland 53.1
population denominator required for the Zanzibar 66.9
enrolment ratio. National data on
attendance rate has only been collected once in the last decade, namely
in the latest household survey (TRCHS99). Data from the1999 survey
show that 53.5% of the 7-13 years old children covered in the survey
were attending school. If net enrolment data from 1999 (57.1%) are
compared to data for attendance rate, the number of children that are
enrolled in primary school but not attending school is relatively low,
standing at 3.6%. The disparity by gender and urban/rural highlights
that more girls attend primary school, but the biggest disparity is
recorded for urban/rural. Just below 50% of school-aged children in
rural areas attend school whereas more than 70% of school aged
children show up in primary school in urban areas. For Zanzibar the
attendance rate is also much higher than in Mainland standing at 67%
which do support the high enrolment rates listed above.
Primary school net enrolment ratio by districts, 1998
47
Goal 7: Reduction of adult illiteracy rate to at least half its 1990 level, with
emphasis on female literacy
Literacy rate Proportion of population aged 15 years and older who are
able, with understanding, to both read and write a short
simple statement on their every day life
Source of data Administrative records, Ministry of Education and Culture
Tanzania Reproductive and Child Health Survey 1999
Data concerning adult literacy rate are almost non-existing. Censuses
are the usual source of data for literacy rate, but the last census was
conducted in 1988 providing highly out dated estimates. In the 1990s
the Ministry of Education and Culture only published one figure on
literacy rate going back to 1992. Another indication of the literacy level
comes from the 1999 Tanzania Reproductive and Child Health Survey
that asked respondents to read a sentence. The survey did not include
writing skills in question on literacy.
1992 data from the Ministry of Education show that 84% of the adult
population (15 years and older) were literate. A total of 88% of men
could read and write and for women the rate was 81%.
The latest data on literacy rate coming from the TRCHS99 estimates that
63.9% of women can read, with 57.1% being able to read whole
sentence and 6.8% reading part of sentence. For men the figure comes
48
to 77.5%, and of those 70.6% can read whole sentence and 6.9% only
a part of the sentence.
It’s difficult to compare the two data sets, but they indicate a
substantial fall in adult literacy rate and a growing disparity between
men and women, with women having a much higher illiteracy rate than
men.
Goal 8: Provide improved protection of children in especially difficult circumstances and
tackle the root causes leading to such situations
Total child disability rate Proportion of children aged less than 15 years with
some reported physical or mental disability
No data available (See indicators for monitoring children’s rights)
49
Goal 9: Special attention to the health and nutrition of the female child and to
pregnant and lactating women
See goals 1, 3, 11 (disaggregated by gender)
Goal 10: Access by all couples to information and services to prevent pregnancies that are
too early, too closely spaced, too late or too many
Contraceptive prevalence Proportion of women aged 15-49 who are using (or
whose partner is using) a contraceptive method
(either modern or traditional)
Fertility rate for women Number of live births to women aged 15-19 per 1000
women aged 15-19
15 to 19
Total fertility rate Average number of live births per woman who has
reached the end of her childbearing period
Sources of data Tanzania Demographic and Health Survey 1991/92
Knowledge, Attitudes & Practices Survey 1994
Tanzania Demographic and Health Survey 1996
Tanzania reproductive and Child Health Survey 1999
During the 1990’s the source for national data on contraception and
fertility has been the national household surveys. In the below tables
data for contraceptive prevalence are presented showing that the use of
contraceptives has increased in the period 1994 to 1999 for both men
and women. A 4-5 % increase can be recorded but in general the
contraceptive prevalence rate is still
relatively low. By the end of the decade Contraceptive prevalence
per cent 1994 1999
only ¼ of all married women were All women 17.8 22.3
currently using contraception, and the Currently married women 20.4 25.4
figure for all women is even lower. For All men 24.7 29.3
men the rate is higher especially among Currently married men 33.5 37
those being married.
For women the preferred type of contraceptive method falls increasingly
under the category ‘modern methods’ with injectables being more
frequently used as well as condoms.
Contraceptive prevalence
type of method - women
Any Pill IUD Inject- Condom Sterialisa- Any Periodic With- Other
modern ables tion traditional absinence drawal methods
method method
1999 15.6 4.6 0.5 5.4 50 3.5 1.5 6.7 2.2 2.5 2.2
1994 11.3 4.5 0.7 1 2.4 1.6 6.4 2.5 2.2 1.6
Looking at fertility rate for women aged 15-19 it is Fertility rate for women
seen that the rate has dropped during the decade aged 15 to 19
from 144 per 1000 women in 19/1992 to 138 per per cent
1000 women in 1999. Despite the small decrease the 1991/92 1996 1999
fertility rate for adolescents is still to be considered Total 144 135 138
Rural 149 143 154
relatively high. The disparity between rural and urban
shows that where the fertility rate has dropped rather
drastic in urban areas it has increased during the
decade in rural areas. Total fertility rate
women aged 15-49
per cent
Data for total fertility rate show a steady decline 1991/92 1996 1999
in number of live births per women aged 15-49. Total 6.3 5.82 5.55
The total rate drops from 6.3 live births in 1992 to Rural 6.6 6.33 6.48
5.55 live births in 1999. However as also seen Urban 5.6 4.09 3.16
Mainland 6.2 5.81 5.55
from the graph the decline has almost only
occurred in urban areas where a remarkable drop has been recorded
from 5.6 to 3.16 at the end of the decade. On the other hand hardly any
drop in total fertility rate is recorded in rural areas that has even seen a
small increase in the second half of the 1990s.
Total fertility rate
7
6
5
Number
4
Total
3
Rural
2
Urban
1
0
1992 1996 1999
51
Goal 11: Access by all pregnant women to pre-natal care and trained attendants
during childbirth
Antenatal care Proportion of women aged 15-49 attended at least once
during pregnancy by skilled health personnel
Childbirth care Proportion of births attended by skilled health personnel
Sources of data Tanzania Demographic and Health Survey 1991/92
Tanzania Demographic and Health Survey 1996
Tanzania Reproductive and Child Health Survey 1999
In monitoring the situation of pregnant women the national household
surveys are key sources for information and data. In goal 2, the high
maternal mortality ratio was presented, and a likely reason for the many
women dying from pregnancy related was said to be the deteriorating
situation in access provided to women during and immediately after
termination of pregnancy.
Antenatal care is one indicator to monitor the situation. It measures the
proportion of women who have been attended at
Antenatal care
least once during pregnancy by ‘skilled health
per cent
personnel’. In Tanzania, skilled health personnel,
1991/92 1996 1999
refers to; doctor, nurse and trained midwife. From Total 62.2 49.5 48.8
data collected during the 1990s, it becomes apparent Rural 56.8 44.1 40.6
that the proportion of women offered antenatal care Urban 79 77.4 76.2
has dropped significantly in the last ten years. Mainland 62.1 49.9 49.4
Zanzibar 66.2 37.4 21.3
According to data from the national household
surveys the decrease in coverage of antenatal care took place in the first
half of the 1990s, recording a drop from 62.2% in 1991/92 to 49.5% in
1996.
This dramatic fall
in services Antenatal care
provided for 90
pregnant women
has mainly 80
happened in
rural areas as 70
seen from the Rural
per cent
graph. At the end
Total
60 Urban
of the decade
only 40% of 50
pregnant women
in rural areas 40
were offered
antenatal care by 30
1992 1996 1999
52
a doctor or nurse/ trained midwife whereas the figure in urban areas
stands at a much higher 76%.
It is also clear from the recorded data that Zanzibar has seen an even
more dramatic drop in antenatal care coverage in the 1990s. The
proportion of women being attended by a doctor or nurse/trained
midwife during pregnancy on Zanzibar has dropped from 66% in
1991/92 to a very low attendance rate of just 21%.
Another key indicator in monitoring the situation of pregnant women is
to measure the proportion of births attended by skilled health personnel
(doctor, nurse, trained midwife). Data for childbirth care show the same
trend as for antenatal care with a significant drop
Childbirth care
during the 1990s. A low starting point in 1991/92 per cent
with only 44% of women attended by skilled 1991/92 1996 1999
health personnel has further dropped to 36% in Total 43.9 38.2 35.8
1999. Thus, the latest national data show that Rural 34.2 30.1 26.4
not more than 1/3 of pregnant women are Urban 80.7 78 66.7
attended by a doctor or nurse/trained midwife Mainland 44.3 38.4 35.8
Zanzibar 32.5 31.7 36.8
when giving birth. In rural areas it is only ¼
having used that service, but according to data from the household
surveys the biggest drop has taken place in urban areas. In 1991/92
80.7% of all births were attended by trained personnel but that figure
stands at 66.7% at the end of the decade.
Childbirth care
90
80
70
60 Rural
Total
Urban
Per cent
50
40
30
20
10
0
1992 1996 1999
53
54
Goal 12: Reduction of the low birth weight (less than 2.5 kg) rate to less than
10 per cent
Birth weight below 2.5 kg Proportion of live births that weight below 2500
gram
Source of data: Tanzania Demographic and Health Survey 1996
Tanzania Reproductive and Child Health Survey 1999
Data on low birth weight are almost non existing and for those data that
are available the quality is generally considered to be poor. Low birth
weight is a very important indicator to measure as it can give an
indication of the nutritional and physical status of both the newborn
child and the mother. But generally it is not well measured as very few
births are weighed. Data from hospital records if such are available are
generally not representative of the overall population, and data from
household surveys are also unreliable as they rely on mother’s reports of
children’s birth weight.
The data presented in the table is taken from the two latest Low birth weight
household surveys, but for reasons explained above the (less than 2.5 kg)
actual number of children with low birth weight are likely to
per cent 1996 1999
be much higher. For both household surveys more than half
of the women interviewed did not know the weight of their Total 5.2 3.8
Rural 4.7 3.2
newborn child and among those that did respond many had Urban 8.4 6.2
to recall years back, making the data less reliable.
Goal 13: Reduction of iron deficiency anemia in women by one third of the 1990 levels
Anemia Proportion of women aged 15-49 years with haemoglobin
levels below 12 grams/100 ml blood for non-pregnant
women, and below 11 grams/100 ml blood for pregnant
women
No data available
55
Goal 14: Virtual elimination of iodine deficiency disorders
Iodized salt consumption Proportion of households consuming adequately
iodized salt
Source of data: Tanzania Reproductive and Child Health Survey 1999
During the 1990s, hardly any data are available for monitoring the
consumption of adequately iodized salt which is believed to be the most
feasible way to control the elimination of iodine deficiency disorders.
However, the most recent household survey (TRCHS99) did include
national estimates on the consumption of adequately iodized salt. The
definition of ‘adequately iodized salt’ is salt containing 15 PPM (parts
per million) of iodine or more.
The national estimates from the survey show that a total of Iodised salt
66.7% of households use iodized salt containing 15 PPM of per cent
iodine or more. The consumption of iodized salt is much higher 1999
in urban areas estimated to be 86% than compared to the Total 66.7
Rural 60.0
recorded 60% for rural areas. Looking at regional differences Urban 86.1
there is a remarkable low consumption of iodized salt in Mainland 67.6
Zanzibar with only 33.5% of all households consuming iodized Zanzibar 33.5
salt. The consumption rate in mainland is twice as high
standing at 67.6% in 1999.
Goal 15: Virtual elimination of vitamin A deficiency and its consequences, including
blindness
Children receiving Proportion of children 6-59 months of age who have
received a high dose vitamin
Vitamin A supplements A supplement in the last 6 months
Mother receiving Proportion of mothers who received a high dose
vitamin A supplement before Vitamin A supplements infant was 8
weeks old
Vitamin A supplements
Source of data Tanzania Reproductive and Child Health children under 5
Survey 1999
per cent
1999
Total 13.8
56 Female 15.5
Male 12.2
Rural 12.9
Urban 17.8
Vitamin A deficiency is recognized as being a major public health
problem in Tanzania. Programs to eliminate vitamin A deficiency have
been implemented through nationwide distribution of vitamin A
capsules. National data to monitor the vitamin A coverage are scarce,
but the 1999 TRCHS did cover estimates on vitamin A supplementation.
Data from that survey indicate that coverage is still rather low with only
13.8% of all under-five children having received a high dose vitamin A
capsule in the last 6 months preceding the survey. It is likely that an
underestimation has occurred as interviewers did only present one of
the two distributed vitamin A capsules to the respondents.
Vitamin A supplements
The same picture is true for mothers who received a for mothers
high dose vitamin A supplement before infant was 8 per cent
weeks old. Among respondents in the household survey
1999
only 11.7% of mothers falling in the above category Total 11.7
received vitamin A supplements. No real discrepancy Rural 11.2
between rural and urban areas is recorded, but data Urban 13.9
show that on Zanzibar only two percent of mothers Mainland 12.0
Zanzibar 2.1
receive vitamin A supplements.
Goal 16: Empowerment of all women to breast-feed their children exclusively for four to six
months and to continue breastfeeding, with complementary food, well into the second year
Exclusive breastfeeding rate Proportion of infants less than 4 months of
age who are exclusively breastfeed
Timely complementary Proportion of infants 6-9 months of age who
are receiving breastmilk and
feeding rate complementary food
Continued breastfeeding rate Proportion of children 12-15 months and 20-
23 months of age who are breastfeeding
Source of data Tanzania Demographic and Health Survey 1996
Tanzania Reproductive and Child Health Survey 1999
Breastfeeding has been strongly promoted in the 1990s as an effective
means to boost the nutritional status of infant children. Data for
breastfeeding are unfortunately not ready available from the 1990s.
Estimates from different surveys are often not comparable because
slightly different definitions have been applied and the age groups also
differ between the surveys. Again reference will mainly be made to the
latest household survey (TRCHS99) which collected data following the
above definitions and age groups.
Exclusive breastfeeding
0-3 months
57 per cent
1996 1999
Total 40.3 41.4
The only trend that can be made is to compare data for exclusive
breastfeeding from 1996 and 1999. The breastfeeding rate for 0-3
months old babies has not changed significantly during the period, as it
continues to stand just above 40%. More detailed data from the 1999
survey indicate that most infant children are given breast milk and many
are still breastfeed when they reach the age of two years.
Breastfeeding rate, 1999
The girl child tends to be
per cent
breastfeed more often and
for longer time, but the 1999 Exclusive Timely Continued Continued
estimates do not show much 0-3 months 6-9 months 12-15 months 20-23 months
Total 41.4 64.1 88.2 48.0
discrepancy between
Female 45.2 63.2 95.5 50.2
girls/boys and urban/rural.
Male 37.6 65.3 82.3 45.7
Rural 41.7 63.7 89.0 53.9
Urban 39.8 66.3 84.3 26.3
Goal 17: Growth promotion and its regular monitoring to be institutionalized in all
countries by the end of the 1990s
Building on good experiences from the 1980s in monitoring the growth
of under-five children in selected communities, the system has since
been institutionalized in many more communities across the country.
Almost half of the districts (54) in the country are implementing regular
monitoring of its growth promotion initiative, collecting data from the
communities at a quarterly basis. A national growth chart has been
developed adopted by all communities involved in the initiative. Despite
gaps in growth promotion and its regular monitoring, with some
communities and districts allowing the recording of data to disintegrate,
the values of maintaining and further develop the monitoring of growth
promotion is widely recognised. In the NPA it is stated that growth
promotion and its regular monitoring is a key area for implementation,
but so far no measures has been taken to implement the initiative
nation wide.
Goal 18: Dissemination of knowledge and supporting services to increase food production
to ensure household food security
No specific indicator identified
58
Goal 19: Global eradication of poliomyelitis by the year 2000
Polio cases Annual number of cases of polio
Source of data National EPI Reports
During the 1990s the Expanded Program on Immunization (EPI) has
published yearly implementation reports and from these survey based
reports it is possible to obtain data on polio cases. The EPI reports is the
most reliable source and the frequent reporting of data from this source
makes it possible to provide the trend in number of polio cases. The
below table shows a low reporting of polio cases during the 1990s and
in recent years figures from EPI reports indicate a total elimination of
polio cases. Eradication of polio has been achieved when, after
comprehensive surveillance, no cases of polio have been reported for
three consecutive years (see also polio immunization rates, goal 22).
Polio cases
1991 1992 1993 1994 1995 1996 1997 1998 1999
4 9 1 6 3 9 0 0 0
Goal 20: Elimination of neonatal tetanus by 1995
Neonatal tetanus cases Annual number of neonatal tetanus cases
Source of data National EPI Reports
Data on neonatal tetanus cases are likewise coming from the yearly EPI
reports. Data from these reports should be interpreted with caution as
they are not likely to represent the whole population. Data recorded in
the 1990s indicate a sharp drop in cases of neonatal tetanus cases from
114 reported cases in 1991 to 23 cases in 1999. The decrease in tetanus
cases took place in the first half of the 1990s and in recent years a more
consistent (low) number of cases have been reported (see also tetanus
immunization rates, goal 22).
Neonatal tetanus cases
1991 1992 1993 1994 1995 1996 1997 1998 1999
114 91 53 25 27 19 12 17 23
59
Goal 21: Reduction by 95% in measles deaths and reduction by 90 per cent of measles cases
compared to pre-immunization levels by 1995
Under-five deaths from measles Annual number of under-five
deaths due to measles
Measles cases Annual number of cases of measles in
children under five years of age
Source of data National EPI Reports
There are no reliable data available for under-five deaths from measles.
What can be reported is the number of measles cases with data taken
from the annual EPI reports. The data obtained in the EPI report are not
representative for the whole population, but they can give an indication
of the trend in number of cases. Similar to the trend in neonatal tetanus
cases, there has been recorded a sharp drop in measles cases in the first
half of the 1990s. From 1996 the number of cases started to rise slightly
but no major change in cases is recorded (see also measles
immunization rates, goal 22).
Measles cases
1991 1992 1993 1994 1995 1996 1997 1998 1999
22,204 13,040 16,592 3,558 3,200 10,676 7,187 10,265 6,044
Goal 22: Maintenance of a high level of immunization coverage (at least 90 per cent of
children under one year of age by the year 2000)
DPT immunization coverage Proportion of one year old children immunized
against diphteria, pertussis and tetanus (DPT)
Measles immunization coverage Proportion of one year old children immunized
against measles
Polio immunization coverage Proportion of one year old children immunized
against poliomyelitis
Tuberculosis immunization Proportion of one year old children immunized
against tuberculosis
coverage
Children protected against Proportion of one year old children protected
against neonatal tetanus through neonatal tetanus immunization of
their mother
Sources of data Tanzania Demographic and Health Survey 1991/92
Tanzania Demographic and Health Survey 1996
Tanzania Reproductive and Child Health Survey 1999
60
Data on immunization coverage are available from Immunization Coverage
both routine reporting systems as well as from the per cent
national household surveys. Due to inconsistency
1991/92 1996 1999
in reporting of data the routine system is thought BCG immunization
to provide less reliable data compared to those Total 95.4 96.2 92.7
collected in household surveys. Female 95.4 95.1 94.0
Male 95.5 97.3 91.7
Rural 94.2 95.3 91.0
The high immunization rate recorded at the
Urban 99.5 99.6 100.0
beginning of the decade are still sustained, but it
is also clear from the gathered data that for most DPT immunization
antigens there have been a drop in the coverage. Total 79.8 85.2 81.0
Female 80.9 84.8 78.2
During the first half of the 1990s more one year Male 78.8 85.6 83.1
old children were being vaccinated against most of Rural 77.0 83.1 78.9
the diseases, though the improvement was Urban 89.4 94.6 89.9
modest. According to survey data only DPT Measles immunization
immunization saw a sharp increase in coverage. Total 81.2 80.9 78.1
The general positive trend observed in the period Female 81.1 81.0 76.0
1991/92-1996 has to some extent been Male 81.3 80.7 79.8
undermined in the last few years as a noticeable Rural 78.3 77.7 75.3
Urban 92.3 95.1 90.3
drop in coverage for most vaccines is recorded.
The vaccination that has sustained its coverage is Polio immunization
polio, backed by an international campaign for Total 77.1 79.6 79.9
Female 78.9 77.8 79.4
eradication of the disease. For other vaccinations
Male 75.2 81.3 80.4
like BCG, tuberculosis (DPT) and tetanus toxoid Rural 73.7 78.5 78.8
less children are today being immunized. Urban 88.1 83.7 84.8
Especially children protected against neonatal
Tetanus toxoid immunization
tetanus has seen a sharp fall in the last decade, as Total 71.5 74.3 61.1
still fewer mothers are receiving the required Rural 71.3 72.9 57.1
tetanus toxoid injections to protect their children. Urban 76.6 81.9 74.4
Children in urban areas are more likely to get Immunization Coverage
the required vaccinations. More access to health Mainland/Zanzibar
facilities and more reliable stocks of per cent
vaccinations are likely contributing factors to 1991/92 1996 1999
BCG immunization
the trend that urban children are better off Mainland 95.3 96.1 92.6
when it comes to immunization coverage. The Zanzibar 100.0 99.3 97.8
discrepancy between urban and rural areas is
DPT immunization
between 10-15% for most vaccines. The Mainland 90.2 85.2 80.9
disparity in male/female coverage show only Zanzibar 99.2 85.1 83.3
minor differences, but the general tendency is
Measles immunization
that boys are having slightly higher Mainland 81.0 80.9 78.2
immunization rates than girls when looking at Zanzibar 86.5 78.9 75.0
the latest data from 1999.
Polio immunization
Mainland 76.6 79.4 79.9
Zanzibar 92.6 85.1 82.8
Tetanus toxoid immunization
61 Mainland 72.5 74.5 61.5
Zanzibar 37.6 68.0 45.4
Data for Mainland/Zanzibar indicate that the decline in vaccination
coverage is most serious on Zanzibar. Compared to the very modest
decline in Mainland, the data show that for all vaccinations except BCG a
drop of 10% or more has occurred during the 1990s. For tetanus toxoid
immunization an even more drastic decline is recorded on Zanzibar in
the second half of the 1990s dropping from 68% in 1996 to 45% in
1999. On Mainland the immunization rate for tetanus toxoid stands at
62%.
Immunization coverage
120
100
80
Per cent
60 BCG immunization
DPT immunization
Measles immunization
40 Polio immunization
Tetanus toxoid immunization
20
0
1992 1996 1999
62
Goal 23: Reduction by 50 per cent in the deaths due to diarrhoea in children
under the age of five years and 25 per cent reduction in the
diarrhoea incidence rate
Under five deaths Annual number of under-five deaths due to diarrhoea
from diarrhoea
Diarrhoea cases Average annual number of episodes of diarrhoea per
child under five years of age
ORT use Proportion of children 0-59 months of age who had
diarrhoea in the last two weeks who were treated with oral
rehydration salts or an appropriate household solution
(ORT)
Home management of Proportion of children 0-59 months of age who had
diarrhoea in the last two weeks and diarrhoea received increased
fluids and continued feeding during the episode
Sources of data Tanzania Demographic and Health Survey 1991/92
Tanzania Demographic and Health Survey 1996
Tanzania Reproductive and Child Health Survey 1999
Data for under-five deaths from diarrhoea are not available from any
reliable source. For the other indicators identified to monitor goal 23,
reference will be made to data from the three household surveys.
The definition for diarrhoea cases used in the household surveys is
slightly different from the one stated above. In the three surveys, data
were collected for under-five years of age with Diarrhoea cases
diarrhoea during the two weeks preceding the survey. per cent
This definition has the weakness of not taking into 1991/92 1996 1999
account the pronounced seasonality of diarrhoea, as the Total 13.1 13.7 12.4
prevalence of diarrhoea is normally more epidemic Female 13.2 13.2 11.1
during the rainy season. From the figures in the table it Male 12.9 14.2 13.5
is noticed that the proportion of children 0-59 months Rural 12.6 13.9 12.9
Urban 15.9 11.9 9.8
with diarrhoea stands at around 13% in all three
surveys. The prevalence of diarrhoea cases has gone down slightly
between 1996 and 1999. Disparities between female/male and
rural/urban indicate that boys more frequently suffer from diarrhoea
and that the prevalence rate in urban areas has seen a noticeable drop
during the decade.
ORT use
In all three surveys the same definition for ORT use was per cent
applied similar to the one presented above. Data for ORT 1991/92 1996 1999
use show a minor drop in proportion of children treated Total 57.4 48.3 54.9
with oral rehydration salts or an appropriate household Female 59 45.6 54.4
Male 55.8 50.7 55.2
solution. A significant drop in the first half of the 1990s Rural 58.2 47.4 55.5
has been followed by an increase in ORT use in recent Urban 60.5 55 51
years. Only in urban areas the treatment with ORT
seems to have declined further in the second half of the 1990s.
63
For home management of diarrhoea, the proportion of Home management
children having received ‘increased fluids’(‘continued of diarrhoea
feeding’ not included in the question) during the per cent
diarrhoea episode has increased from 59% in 1991/92 1992 1996 1999
Total 59.5 56.3 63.2
to 63% in 1999The positive trend in home management Rural 55.9 54.0 62.0
of diarrhoea has taken place in rural areas to somehow Urban 71.9 70.0 70.1
narrow the gap between rural and urban areas.
64
Goal 24: Reduction by one third in the deaths due to acute respiratory infections in children
under five years
Under-five deaths from Annual number of under-five deaths due to
acute respiratory infections (ARI)
acute respiratory infections
Care seeking for acute Proportion of children 0-59 months of age
who had ARI in the last two weeks and respiratory infections were
taken to an appropriate health provider
Sources of data Tanzania Demographic and Health Survey 1991/92
Tanzania Demographic and Health Survey 1996
Tanzania Reproductive and Child Health Survey 1999
Figures for under-five deaths from respiratory infections are not
available. In monitoring measures to prevent fatal incidents of ARI the
proportion of under-five children who had ARI and were taken to an
appropriate health provider can be reported. The attempt to seek
professional care for treatment of ARI has not increased significantly
during the 1990s. Approximately 2/3 of all children with ARI are taken
to a health facility or provider, with boys more frequently taken for
treatment than girls. As seen from the below graph the proportion of
children with ARI taken to a health provider has not changed much, but
the gap between rural and urban areas is, despite some improvements
Care seeking for ARI
per cent
1992 1996 1999
Total 65.1 69.6 67.5
Female 64.6 69 65.7
Male 65.5 70.2 69.2
Rural 60.9 67.2 65.1
Urban 77.9 80.9 78.4
Mainland 64.8 69.5 67.3
Zanzibar 73.7 74.2 72.9
in rural area, still significant. In 1999 almost 80% of children suffering
from ARI were taken to a health provider, with the figure being 65% in
rural areas. Children from Zanzibar are more likely to be taken to a
health provider when developing ARI compared to children on Mainland,
but the discrepancy is minor.
Care seeking for ARI
90
Urban
85 Total
Rural
80
75
65
Per cent
70
66
Goal 25: Elimination of guinea-worm (dracunculiasis) by the year 2000
Dracunculiasis cases Annual number of cases of dracunculiasis (guinea-
worm) in the total population
Guinea-worm is considered eliminated in Tanzania.
Goal 26: Expansion of early childhood development activities, including appropriate low-cost
family and community based interventions
Preschool development Proportion of children aged 36-59 months who are
attending some form of organized early childhood
education programme
Source of data Tanzania Reproductive and Child Health Survey 1999
Data to monitor early childhood development activities are Preschool
difficult to obtain from administrative systems. A question on development
early childhood education was included in the 1999 TRCHS, per cent
providing data on the proportion of children aged 36-59
1999
months who are attending some form of organised early Total 2.4
childhood education. Data show that early childhood Female 3.1
education programmes are indeed very rare. According to data Male 1.8
from the survey as few as 2.4% of children aged 36-59 Rural 0.8
Urban 10.1
months attended preschool development programmes. To be Mainland 2.4
expected the disparity between rural/urban is high, with 10% Zanzibar 3
of children aged 36-59 months taking part in early childhood
development activities in urban areas, compared to less than 1% in
rural areas. Data show that more female children are enrolled in early
childhood education programme than boys. The proportion of children
attending early childhood education programme stands at almost the
same level in Mainland and Zanzibar.
Goal 27: Increased acquisition by individuals and families of the knowledge, skills and
values required for better living….
67
No specific indicator for reporting.
68
Indicators for monitoring children’s rights
Birth registration Proportion of children 0-59 months of age whose
births are reported registered
Children’s living Proportion of children 0-14 years of age in
households not living with biological
arrangements parent
Orphans in household Proportion of children 0-14 years of age who are
orphans living in households
Child labour Proportion of children 5-14 years of age who are
currently working (paid or unpaid; inside or outside
home)
Sources of data: Tanzania Demographic and Health Survey 1996
Tanzania Reproductive and Child Health Survey 1999
In addition to the above goals a few additional indicators have been
identified to monitor certain key issues, one being child rights. The focus
is on children who may be especially disadvantaged: children who are
not living with a biological parent or are orphans and children who are
working. In reporting on these indicators reference will once again be
made to data from the national household surveys conducted in the
1990s.
The first indicator to report on is ‘birth registration’. A fundamental right
for each and every child, is to have their birth registered, but for most
children that continues to be an unfulfilled right. Data from the latest
household survey clearly indicate that the majority of children are not
having their birth registered. Mothers were asked if the birth of their
under-five children was registered, and only 6.4% of the children
covered in the survey had a birth certificate. This very low figure is
recorded with noticable
disparity between rural and
Birth registration
urban areas. As few as 3% of 70
children in rural areas have 60
their birth registered compared
to almost 22% in urban 50
settings. Also boys are more 40
Per cent
Birth registration 30
per cent
20
1999
Total <5 yr 6.4 10
Female 5.4
0
Male 7.5
Total
Rural 2.9 Tanzania Female
Male
Rural S1
Urban 21.8 Urban
Total
Total
Mainland 4.7 Mainland
Zanzibar
Zanzibar 68.9
69
likely than girls to have their birth registered. The graph also clearly
show another disparity, namely between mainland and Zanzibar. The
birth registration rate stands at remarkable 69% on Zanzibar compared
to only 5% in mainland.
Children's living
Two other indicators to monitor children’s rights are arrangements
‘children’s living arrangements’ and ‘orphans in household’. per cent
The first estimates the proportion of children 0-14 years of 1996 1999
age in household not living with biological parent. In the two Total 13.7 13.7
Female 13.8 13.9
latest household surveys it was estimated that around 14% of Male 13.4 13.2
children 0-14 years of age are not living with either parent. Rural 13.2 13.3
Data from the two surveys show no major change in estimates Urban 15.7 15.5
over time, and also disparities by gender and rural/urban are
recording more or less same figures in 1996 and 1999.
Orphans in household likewise stands at the same rate
Orphans in household
when comparing data from 1996 and 1999 household
surveys. 6% of children are recorded to be orphans per cent
having lost its mother, father, or both parents. The 1996 1999
Total 5.8 5.5
figures for female/male and urban/rural show no major Female 5.7 5.4
discrepancy. In estimating the number of orphans it is Male 5.7 5.4
important to note that the proportion of children who are Rural 5.9 5.4
orphans living in households underestimates the true Urban 5.3 5.4
proportion of orphans since it excludes those who are
living in institutions or are homeless.
Apart from minor surveys and studies on child labour there is hardly any
national representative data available from the 1990s for this indicator.
Questions on working habits for children aged between 5-14 years were
included in the 1999 Tanzania Reproductive and Child Health Survey and
data from these questions will be referred to in the following. Caution
should be used in interpreting the data, as the rather lengthy questions
usually recommended by labour experts could not be accommodated in
the TRCHS.
The survey included both work in the Child labour, 1999
formal labour market and domestic per cent
work. In the table, data are reported Work Unpaid Domestic Currently
for pay work work > working (>4
separately for paid, unpaid, and 4 hours hours)
domestic work (for more than 4 hours
a day). In the last column the 5-14 years 1.6 21.9 25.3 40.5
proportion of children 5-14 years of 5-9 years 0.4 8.3 18.2 24.1
10-14 years 3.0 38.1 33.7 60.2
age who are currently working are
Female 1.2 20.1 24.8 38.4
reported. ‘Working’ means either
Male 2.0 23.6 25.8 42.6
doing paid or unpaid work or doing
Rural 1.5 24.1 27.1 43.6
70 Urban 1.9 12.6 17.8 28.0
Mainland 1.6 22.4 25.8 41.3
Zanzibar 3.8 3.4 8.3 13.4
domestic work for 4 or more hours a day. Recorded data show a high
rate of child labour with as many as 40% of children 5-14 years of age
working 4 or more hours a day. For the age group 10-14 years the
estimated figure is 60%. It is also clear from the data that most work
done by children is domestic work and that the majority of the children
are not paid for the work. Recorded data from the TRCHS99 show that
less than 2% of children are paid for the work. More children in rural
areas are likely to have a work day of 4 or more hours, and among the
total proportion of children working, boys are recorded to work slightly
more than girls. In the below graph it is also clear that child labour is
more common on mainland compared to the much lower rate (13.4%)
in Zanzibar.
Child labour
- Currently working
70
60
50
Per cent
40
30
20
10
0
Tanzania
5-14 yr
Tanzania
Tanzania
10-14 yr
5-9 yr
Female
Male
S1
Rural
Urban
Zanzibar
5-14 yr
Mainland
5-14 yr
Indicators for monitoring the Integrated Management of Child Illness (IMCI) and
malaria
Home management of illness Proportion of children 0-59 months of age
reported ill during the last two weeks who received
increased fluids and continued feeding
Care seeking knowledge Proportion of caretakers of children 0-59 months of
age who know a least 2 signs for seeking care
immediately
71
Bednets Proportion of children 0-59 months of age who slept
under an insecticide-impregnated bednet during the
previous night
Malaria treatment Proportion of children 0-59 months of age who were
ill with fever in the last two weeks who received
anti-malaria drugs
Sources of data Tanzania Reproductive and Child Health Survey 1999
During the decade special emphasis has been given to support
caretakers in management of illnesses among under-five children. For
the first indicator ‘home management of illness’ no reliable data are
available and as the three other indicators have only been monitored in
recent years data are not available from earlier surveys.
The proportion of caretakers who know at least 2 signs for seeking care
immediately are relatively high with 72% of the respondents knowing
at least two signs. Signs for seeking care were the following: drinking
poorly; becomes sicker; develops a fever, has fast breathing; has
Care seeking knowledge, 1999
78 77
76
74
72 72
72
Per cent
70
70
68 68
66
64
62
Tanzania Rural Urban Mainland Zanzibar
difficult breathing, has blood in stool. Data show that knowledge on
when to seek care is more widespread in urban areas.
Efforts have been made to monitor some of the Malaria, 1999
activities implemented to ‘roll back’ malaria. This
per cent
disease that kills thousand of under-five children every
Bednet Malaria
year is difficult to prevent, but use of bednets and treatment
timely treatment with drugs have proved to be the Tanzania 20.7 53.4
most effective way of bringing down the number of Female 52.4
under-five deaths due to malaria. Looking at data from Male 54.3
the TRCHS99, the proportion of under-five children Rural 13.0 51.6
sleeping under a bednet is still relatively low with 20% Urban 47.9 61.7
Mainland 20.3 53.0
Zanzibar 35.1 68.4
72
of children having slept under an insecticide-impregnated bednet during
the previous night. The number of under-five children sleeping under a
bednet is much higher in urban areas than in rural. Almost 50% of all
children use bednet in urban settings compared to 13% in rural areas.
Recorded data also show a more frequent use of bednets in Zanzibar
compared to mainland.
For treatment of malaria Malaria, 1999
more than 50% of
children 0-59 months of 80
Children sleeping under bednet
age who were ill with a 70 Mlaria treatment
fewer received anti
60
malaria drugs. There is
no real gender 50
discrepancy in the
Per cent
40
proportion of children
treated for malaria, but 30
children in urban areas 20
are more likely to be
given anti-malaria drugs
10
when having a fever. 0
The use of anti-malaria
Tanzania Female Male Rural Urban Mainland Zanzibar
drugs is also higher on
Zanzibar with almost 70% of children with fewer being treated
compared to 53% in mainland.
Indicators for monitoring HIV/AIDS
Knowledge of preventing HIV/AIDS Proportion of women who correctly
state three main ways of avoiding HIV
infection
Knowledge of misconceptions of HIV Proportion of women who correctly
identify three misconceptions about HIV/AIDS
Knowledge of mother to child Proportion of women who correctly identify
means of transmission of HIV
transmission of HIV from mother to child
Women who know where to be tested Proport ion of women who know where
to get a HIV test
Women who have been tested for HIV Proportion of women who have been
tested for HIV
Attitude toward condom use Proportion of women who state that it is
acceptable for women in their areas to ask a
man to use a condom
Sources of data Tanzania Demographic and Health Survey 1991/92
Tanzania Demographic and Health Survey 1996
Tanzania Reproductive and Child Health Survey 1999
73
To monitor the HIV/AIDS indicators the household surveys are the most
reliable source for data. Despite the fact that HIV/AIDS has evolved
from being a health crisis in the 1980s to become a developmental crisis
in the 1990s with a severe impact on human lives and properties,
knowledge about the many social, cultural and economic aspects of the
disease is still limited. For the indicators listed above several have only
been formulated in recent years and data are therefore not available
from the beginning of the 1990s.
The two indicators looking at the prevailing knowledge of HIV/AIDS,
show that many people still lack information about the disease.
Proportion of women who state three main ways of avoiding HIV
infections (one partner, use condom, abstain from sex) stands at 50%
according to data from the TRCHS99. This figure for the total population
involves a significant discrepancy between rural and urban respondents.
Almost 60% in urban areas could state three ways to avoid HIV/AIDS
whereas the figure in rural areas comes to 45%.
Knowledge of preventing HIV/AIDS
per cent Knowledge of HIV/AIDS, 1999
1999
Total 49.4 80
Rural 45.6 Preventing HIV/AIDS
70
Urban 59.3 Misconception of HIV/AIDS
Mainland 49.4 60
Zanzibar 51.7 50
Per cent
40
Knowledge of misconceptions of HIV
per cent 30
1999 20
Total 36.5 10
Rural 29.8
Urban 54.1 0
Total Rural Urban Mainland Zanzibar
Mainland 36.3
Zanzibar 43.9
For the proportion of women who can correctly state three
misconceptions about HIV/AIDS (sharing food, mosquito bites, health
person can’t be infected) the figure recorded is 36.5%. Again a huge
disparity between rural/urban is recorded with the proportion of women
living in rural areas knowing three misconceptions being as low as 30%
with the same indicator standing at 54 % in urban areas. For both
indicators the discrepancy between mainland and Zanzibar is not
significant.
Data for proportion of women who know that Mother to child transmission
per cent
HIV/AIDS can be transmitted from mother to child 1991/92 1996 1999
Total 58.9 77.1 81.5
74 Rural 71.3 82.7 87.8
Urban 53.9 75.4 79.2
Mainland 59 77.1 81.3
Zanzibar 56 76 89.2
are available from all three household surveys. The table and graph
indicate a steady increase in the number of women who are aware of
the risk of mother to child transmission. 60% responded positively to
that question in 1991/92 and at the end of the decade almost 82% of
the female respondents said they new about the risk. The rate is high
both in rural and urban areas, but the most significant increase is
recorded in Zanzibar growing from 56% in 1991/92 to almost 90% in
1999.
Knowledge of mother to child transmission
100
90
80
70
Per cent
60 Total
50 Rural
40
Urban
30
20
10
0
1991/92 1996 1999
In the latest household survey women were asked Attitude toward condom use
whether it is acceptable for women in their area to per cent
ask a man to use condom. 49% per cent of the 1999
interviwed women responded positively to the Total 49
Rural 41.6
question indicating that it would be possible for them Urban 68.2
to ask a man to use condom. The general attitude Mainland 48.9
toward condom use is crucial to monitor in the fight Zanzibar 50.5
against HIV/AIDS, and from the data recorded the
indication is that for almost half of the women condom is not a likely
prevention to use.
Finally, data are available for two other important indicators for
monitoring HIV/AIDS, namely knowledge about where to be tested for
HIV/AIDS and women who have been tested for HIV/AIDS.
Just above 50% of women are aware of a place to be tested and that
figure has stayed more or less at the same level in the 1996 and 1999
survey. Not surprisingly, more women in urban areas state that they
know a source for testing compared to women in rural areas.
75
For the indicator that measures the proportion of women who have got
a HIV/AIDS test, the figure has risen from 4% in 1996 to almost 7% in
1999. The highest increase has happend in urban areas that has seen an
increase from 7% to 13%. The prevalence of testing is still relatively
low but a positive trend is recorded, except from Zanzibar where the
proportion of women having had a HIV/AIDS test continues to stand
just below 4%.
Women who know where to be tested for HIV/AIDS
per cent
80
1996 1999 1996
70
Total 52.2 53.2 1999
60
Rural 47.7 46.1
Per cent
50
Urban 65.3 71
40
Mainland 52.1 53.3
30
Zanzibar 55 51.1 20
10
0
Total Rural Urban Mainland Zanzibar
Women who have been tested for HIV/AIDS
per cent
1996 1999 14
Total 4.1 6.7 12 1996
Rural 3.1 4.4 10 1999
Per cent
Urban 7.3 12.6 8
Mainland 4.1 6.8 6
Zanzibar 3.7 3.8 4
2
0
Total Rural Urban Mainland Zanzibar
76
