Why inadequate contraceptive forecasting capacity?

By AJAAT

The State of the World’s Children Report of 2008, in the National Road Map Strategic Plan, 2008-2015, affirms that spacing interval between pregnancies could reduce 20-25% of all maternal deaths.

Additional statistics reveal that about one third of 536,000 maternal deaths each year could be averted if women had access to reliable family planning methods and at least one third of the 190 million unintentional pregnancies could be avoided with availability of FP methods.

It is believed that nearly 50 million women who resort to abortion, of which, 19 million are performed under unsafe conditions, could be prevented had the women been accessible to reliable reproductive health services.

Statistics prove that an estimated 68,000 women that die every year as a result of unsafe abortions and the millions more who suffer infections and complications such as infertility as a consequence of these abortions could be saved had there been sufficient supplies of reproductive health commodities.

In spite of their importance, sufficient evidence exists to suggest that there is limited supply of reproductive commodities in those countries.

While some 200 million women in resource-constrained countries would have liked to have an interval of two years before giving another birth, such wishes are hard to come-by because of these women not having access to modern contraception.

The World Health Organization (WHO), 1997 report states that over 99% of 585,000 women death during pregnancy or immediately after giving birth or after an induced abortion occur in low-income countries yearly where unsafe abortion is named as the major contributor to maternal mortality.

Abortion is a procedure performed either by a person lacking the necessary skills or in an environment lacking minimal medical standards or both – is a major contributor to maternal mortality.

The WHO 1994 report states that unsafe abortions are responsible for 50000–100000 preventable deaths each year world-wide and in addition there are millions of women who are suffering from chronic morbidities and disabilities as a consequence of unsafe abortions.

Roke and Rogerson (2008), defining What Are Essential Reproductive Health Supplies; showed that despite large efforts in enhancing the supplies of reproductive commodities in the Pacific region, end-users still reported receiving them inconsistently besides the goods being unsuitable and lacking quality.

The United Nations Population Fund (UNFPA), statement on RHCS Challenges in 19^th October, 2000, shows that not only have poor countries left the task of funding for these commodities to development partners, but also that international donor support has been declining.

There are numerous reasons that are attributable to the situation of reproductive health commodities being insufficient. One is that of funding.  Donor support in the commodities dropped from $560 million in 1995 to $460 million in 2003.

The Global Programme to Enhance Reproductive Health Commodity Security reveals the same trend between 2007 and 2013, the amount needed was $750,000,000 only $208,528,277 was receives while $170,041,267 was pledged and still $371,430,456 was needed.

Because of such shortage, ‘Tracking Donor Support’ notes that donor support would nearly need to double if the current unmet need is to be met by 2015.

But equally important is the question of supply of the commodities, which is dependent on a number of things, including forecasting, financing, procurement, and distribution capacities.

The Reproductive Health Supply Chain report states that for each of the goods to be well-forecasted, well-financed, well-procured, and well-distributed, good data are needed on consumption on how much is required of those commodities and on stock status to how much is left.

To have the right consumption data and the right knowledge on the stock status, it requires effective systems of collecting and storing information, which in a word may be referred to as effective Logistics Management Information System to facilitate better forecasting of future needs.

Accurate determination of funding requirements, improved establishment of the right quantities to be ordered and procured and enhancing management of distribution so as to avoid shortages.

Why should resources allocated for contraceptive be limited? Is it because contraceptives are not prioritized in our development plan? Why is there inadequate forecasting capacity? Why is it that the coordination system is not well organized?

The emerging question is: could the situation be the same for the reproductive health commodities such as EMOC drugs (Oxytocin, Ferrous/Zinc Sulphate, Ergometrine, Misoprostol, SP for pregnant women) and vaccines for children under Expanded Programme for Immunization (EPI), including BCG, TT, Measles, and Low Osmolarity ORS, as it is for FP commodities; COC, POP, Implants, IUCD, Injectables, and condoms?

This column is a contribution by Advance Family Planning (AFP), a coalition of 10 local Non-Governmental Organizations (NGOs) advocating for family planning access to Tanzania. The project’s thrust is to contribute towards strengthening investments in family planning as a way towards attaining national and Millennium Development Goals (MDGs) 4 and 5 in Acceleration of the Reduction of Maternal, Newborn and Child Mortality.

Tanzania’s elapsed national and MDGS

By AJAAT

Tanzania is one of the 189 nations, which endorsed the Millennium Development Goals (MDGs), in September 2000 as part of the internationally agreed-upon development goals at the General Assembly of the United Nations.

The MDGs initiative calls upon developed and developing countries to work in partnership towards a world with less poverty, hunger and disease, greater survival prospects for mothers and infants, guaranteeing basic education for children, equal opportunities for women, and a healthier environment in support of the Agenda 21 principles of sustainable development.

Family planning can contribute governments around the world are focused on combating poverty and achieving a range of health and development goals, such as those outlined in the United Nations and Millennium Development Goals (MDGs).

Although Africa has just 12% of the global population, it accounts half of all maternal deaths and half the deaths of children under five and to attain the MDGs 4 and 5 on maternal and child health are lagging far behind target.

The MDGs provide a framework of time-bound targets by which progress can be measured and commitment of all nations tracked. Statistical experts selected indicators to be used to assess progress over the period from 1990 to 2015, when targets are expected to be met.

The Tanzania Millennium Development Goals Report mid-way evaluation covering achievements in 2000 to 2008 report the Maternal Mortality Rate (MMR) is unlikely to be achieved by 2015.

MDG goal 5 is to improve maternal health with two targets; 5A to reduce by three quarters between 1990 and 2015, the MMR and it has two indicators for monitoring progress are 5.1 maternal mortality ratio and 5.2 Proportion of births attended by skilled health personnel.

The report conducted by the Poverty Eradication and Economic Empowerment Division at the Ministry of Finance highlighted the MMR target to have 133 per 100,000 live births is unlikely to be attain to met the target.

Computed as percentage passage time thus 2012 the equivalent to 22 years time that has elapsed, MMR according to Tanzania Demographic and Health Survey (TDHS) 2010 report shows it ranks 454 per 100,000 live births.

Maternal mortality rate remains high in Tanzania. About 7,000 women die every year due to pregnancy related complications. Other causes include underweight about 10 per cent of women in child bearing age, anemia 58% as well as long distances to health centres.

Indicator two for proportion of births attended by skilled health personnel is unlikely to be achieved has is shows insignificant improvements in both Tanzania Mainland and Zanzibar.

Births attended by skilled health personnel targeted to be 90% by 2015, computed percentage to passage time is beyond the 2008 expected of 77.1% to the time over and done.

The MDG 5B goal is to achieve universal access to reproductive health by 2015, the indicators are contraceptive prevalence rate (CPR), adolescent birth rate, antenatal care coverage at least one visit to at least four visits and unmet need for family planning.

Thus to attain the goal of reducing to 170 Maternal Mortality Rate and increasing the percentage of births attended by skilled health staff to 90 per cent as required by the MDG Goal more efforts are required.

The government has introduced new policy documents and guidelines in place to guide and mobilizing additional resources to support implementation through community participation at all levels by different stake holders to boost its responsibilities’.

Such policies are the Reproductive and Child Health (RCH) Policy guideline (2003), National Package of Essential RCH Interventions, RCHS strategy: 2005-2010, Adolescent Health and Development Strategy: 2004-2008 and the Adolescent Friendly Service Standards.

Others guidelines are the Road Map for Accelerating the Reduction of Maternal, Newborn and Child Morbidity and Mortality: 2008 -2015 and the National Plan of Action: 2001-2015 to accelerate the elimination of FGM and harmful traditional practices.

This column is a contribution by Advance Family Planning (AFP), a coalition of 10 local Non-Governmental Organizations (NGOs) advocating for family planning access to Tanzania. The project’s thrust is to contribute towards strengthening investments in family planning as a way towards attaining national and Millennium Development Goals (MDGs) 4 and 5 in Acceleration of the Reduction of Maternal, Newborn and Child Mortality.

Journalists Group Discussion at HAPCA (2008) Training

AJAAT builds capacity for journalists on HIV and AIDS Prevention and Control Act (HAPCA)-2008, Gender and Human Rights for MARPs

Journalists following up AFP training at UMATI, Dar es Salaam

Tanzania to Integrate Reproductive Health, Family Planning and HIV/AIDS

By AJAAT

Efforts are under way in Tanzania to integrate reproductive health, family planning and HIV/AIDS services to provide better, more comprehensive care and treatment at lower cost.

Speaking to journalists in Dar es Salaam recently, the Representative of Voice of America (VOA), Mwamoyo Hamza said often these services are offered at different facilities  by different providers, making it more time- consuming and expensive for women, who need family planning as well as HIV/AIDS services.

“Supporters say that integrating these services would help reduce vulnerability to HIV, reduce sexually transmitted infections, and provide information to men and women about preventing HIV and reproductive health as well as planning their families”, he added.

The process could help Tanzania achieve three of the Millennium Development Goals, which are reducing poverty, child deaths and improving maternal deaths. However, integration was not without challenges.

Mwamoyo said these include country’s lack of health professionals, resources to cross-train reproductive health and HIV/AIDS service providers. Currently, integration was being tried through various projects in Tanzania.” One question was whether these attempts have been successful enough to scale it up to a national level?”,  he asked.

Speaking in Dar es Salaam recently, Alisa Cameron, USAID/Tanzania Health Team Leader said the Global Health Initiative through the United States was investing US dollars 63 billion over six years to help partner countries strengthening their systems which would improve health outcomes.

She said there was a particular focus on bolstering the health of women, newborns and children by combating infectious diseases and providing quality health services. She added that for every US dollar invested in health systems, the Global Health Initiative (GHI) aims to maximize the health impact on citizens.

“In Tanzania the GHI builds on over four decades of partnership between the US government and the Republic of Tanzania. It represents an opportunity to contribute further to Tanzania’s development goals in health. The vision was to improve the health of all Tanzanians and especially the health of the most vulnerable groups of women, girls, newborns and children under the age of five” Lisa said.

The GHI was launched by President Barack Obama on May5, 2009. The GHI was a model that builds on the Bush Administration’s successful record in global health, notably as the President’s Emergence Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative.

Mass Media in Tanzania Promote Family Planning as an Economic Agenda

Advocacy Case Study

In December 2011, six media houses declared their firm support to family planning efforts. The committed from a predominantly private media houses is significant in terms of strengthening and expanding coverage of family planning issues as part of promoting policy dialogue and public education on the issues. The media houses namely;- Mwananchi Communications Ltd, New Habari (2006) Ltd., Tanzania Standard Newspapers and the Guardian Limited in print media while in electronic media were Sahara Communications Limited and Tanzania Broadcasting. Those are among the major media houses in the country with broad geographical reach, broad readership and listenership countrywide. All the six media houses committed to allocate space and air time as well to appoint two journalists in each institution to be focal persons for FP news coverage.

Background – Engaging the Media, an opportunity for sustaining advocacy

Historically, Tanzania’s mass media have been integral in promoting development through public education, leadership sensitization and mass mobilization. The mass media, especially radio and television has been the main source of information including that on family planning.[1] The DHS has shown that about 50% of women and 61% of men in the reproductive age (15-49) get family planning information and messages from radio, while television is the source of this kind of information to 19% women and 32% men. Media’s role in disseminating family planning information offers a great opportunity to engage leaders and the public in general in dialogue on pertinent issues around family planning services. These may range from access to contraceptives, method choice, and resources for improved family planning, to policy issues critical in creating enabling environment for service delivery. Therefore as agents of change, mass media’s participation in strengthening family planning advocacy is critical in Tanzania’s setting, and their contribution is undoubtedly invaluable. The fact that 95% of media houses are privately-owned makes their commitment to the family planning agenda a remarkable gesture that ought to be acknowledged.

The Strategy – Working with media structures to move the FP agenda

The Approach

The Association of Journalists Against AIDS in Tanzania (AJAAT) is one of the implementing partners of the Advance Family Planning (AFP) project in Tanzania that works with a number of local NGOs that formed the FP Coalition in November 2010. AFP’s lead partner – the Human Development Trust (HDT) coordinates the coalition with 11 member organisations including AJAAT. Using the Spitfire approach, AJAAT identified key media houses that are likely to support family planning, conducted a rapid assessment of media houses’ interest in FP issues, developed a policy brief on the significance of supporting these issues and shared results as part of soliciting media support to FP.

Key Activities: Soliciting Media Commitment to FP

The Association of Journalists Against AIDS in Tanzania (AJAAT) is one of the implementing partners of Advance Family Planning (AFP) Project in Tanzania. Between July and December 2011, AJAAT conducted four activities namely; an Assessment of Media House’s Interest in Supporting Family Planning Services in Tanzania, One – to- One Meeting with Managers from selected six national Media Houses and then disseminated and share findings of the report and finally a one day orientation workshop with media editors through the Editors’ Forum concerning family planning coverage and status in Tanzania.

A.     RAPID MEDIA ASSESSMENT FOR MEDIA HOUSES’ INTERESTED IN SUPPORTING FP

The assessment, explores the private sector playing its role in the provision of social services as outline in the Public Private Partnership Act, 2010 and the implementation of Corporate Social Responsibility policies. The rapid assessment main objective intended to set up the following; 

1. Gather information from media on the family planning coverage status; 

2. Capacity, interest and commitment from the media; and lastly

3. Challenges on family planning issues from the media.

The assessment was conducted using standard structured questionnaires with both closed-ended and open-ended questions to collect the desired information from respondents. The questionnaires were distributed to respondents to respond the questions privately and freely. Respondents were purposely selected; Media managers’ who hold positions of considerable influence in decision making were targeted.

B.     ONE – TO – ONE MEETINGS WITH MANAGERS OF THE SURVEYED MEDIA HOUSES

AJAAT started the process by preparing a policy brief, which pointed out the importance of family planning to support social and economical development in Tanzania. The aim was to enlighten the media houses on the importance of family planning advocacy.

One AJAAT staff visited one of the media houses to discuss how there media will support AFP partners in family planning advocacy, where awareness message in the policy brief were circulated. The media houses visited were; Sahara Corporation (Star Tv) and Tanzania Broadcasting Corporation (TBC) in the electronic media. In the print media were Swahili and English dailies newspapers from New Habari (2006) Ltd,. (Mtanzania and The African); Mwananchi

Communications (Mwananchi and The Citizen), The Guardian Ltd,. (Nipashe and The Guardian) and the Tanzania Standard Newspapers (The Daily News and Habarileo). All 12 media managers respond positively to support family planning coverage by providing space and air time. They also agreed to give priority in family planning news and features in their daily coverage’s.

C.      WORKSHOP ON SHARING MEDIA HOUSES ASSESSMENT REPORT

AJAAT organized a one day Media Meeting to disseminate the assessment report by inviting managers from the media surveyed; Sahara Corporation, Tanzania Broadcasting Corporation (TBC), New Habari (2006) Ltd,. Mwananchi Communications, The Guardian Ltd, and Tanzania Standard Newspapers.

D.     EDITOR’S FORUM ORIENTATION WORKSHOP ON FAMILY PLANNING

The Editors started arriving at the Lion Hotel, Sinza and 38 participants’ attendant the workshop, 30 were editors and senior journalists with four facilitators. Zacharia Ssebuyoya, ANAT programme coordinator was invited as amoung AFP lead implementing partner while Dr. Hellen Mrina from Medical Women of Tanzania Association (MEWATA) and Dr. Namala Mkopi from Paediatric Association of Tanzania (PAT) were two medical experts facilitate the workshop who come from AFP coalition.

The Workshops Outcome

1.       Media Managers and Editors react on the facts that because planning a family and deciding on the number of children and spacing impacts on individual economic situation; for those with more children, they endure greater burden in sustaining their families.

2.       At government level – it is critical for governments to plan well to meet the education, health and other needs of its population. The government doesn’t have sufficient resources for a growing population well equipped to fuel the economic engine.

3.      That the percentage of the labour forces in the population and how does this play out with dependency ratio? Governments see individuals as economic units – consume and produce – how big is this labour force and whether it is capable of promoting economic development.

4.      In the media, FP is almost a non-issue/agenda both as an issue for coverage, and for programming in media institutions. Media houses do not have family planning services and media managers have not seriously thought about this.

5.      The gender ratio in the media – fewer women than men; and the employers’ bias towards pregnant employees and those caring for children (seen sometimes as an opportunity loss – viewed as not as hardworking as male colleagues); FP as an issue of individual right – the media has a role in promoting the concept.

6.      Getting an interesting angle for FP issues – remains a challenge. The impacts on the narrow or inadequate coverage of FP issues.

7.      Media campaigns are critical in strengthening visibility of FP issues.

8.      Deteriorating mothers’ health due to frequent childbirth leads to declining family welfare and national economic growth.

9.      Big families – big money – secure future! Such attitudes and beliefs contribute to communities shying away from the use of contraceptives.

10.   The media managers’ request on the AFP coalition on-line internet hub as family planning archive to gather easy information’s and updated report concerning family planning status in Tanzania as well as the global ones.

Lessons Learnt and Next Steps

Why is FP not an agenda in the media when its contribution to reduction of maternal mortality rate and infant mortality rate is known?

It was highlighted that the media history – for many years media practitioners’ understanding on FP/RH and population issues has been skewed towards seeing these issues as externally-driven with foreign interests “harmful” to Tanzanians; the exception of the foreign actors wanting to exploit us and media structure – big names make news – as a guiding principle.

Media Assessment report Key findings;-

1. Workplace perceptions, policy implications and actions of the Media Houses on the subject.

Ø      None had guidelines for family planning in the workplace;

Ø      Only one Media House 7% – Mwananchi Communication - had a plan develop one or include family planning in existing policies.

Ø      Three Media Houses 21% – TBC, Mwananchi Communication, and Tanzania Standard Newspapers - consider family planning;

Ø      All of the rest 79% did not have policies considering family planning;

Ø      One 7% was not sure about the answer;

Ø      There was no particular type of contraceptives prescribed regarding family planning in workplace

2. Areas of interventions

1. Conduct media campaigns for family planning to increase awareness and expand networks of family planning stakeholders engaging the Media in family planning;

2. Media people have indicated their need for support from experts on family planning so they can work with them and collaborate with decision makers in order to properly align policies and practices.

WHAT SHOULD BE DONE?

Editors’ recommend that:-

Ø  Media should sensitize the society to see FP as an opportunity. (Packing the messages).

Ø   Increase FP coverage (make it an economic agenda).

Ø  Empower journalists with FP knowledge.

Ø  Experts in FP needed to be more accessible to journalists.

Ø  Harmonize information (operation system in media). – News story – Information for public knowledge.

Ø  Frequent survey should be done on the use of nets and its preventive ability.

Ø  Editors’ Forum should select a topic for discussion on AFP with view to building knowledge on these issues.

Ø  Editors from media outside the surveyed asked to be presented in the campaign and promise to provide space and air time for family planning coverage in the media.

Acknowledgements

Six media houses managers from the surveyed media houses as well as the editors through the Tanzania Editors Forum.

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[1] Tanzania Demographic and Health Survey 2010

MPs hail integration of Reproductive Health and HIV & AIDS

By AJAAT

The Chairperson of the Parliamentary Committee of Social Services, Margaret Sitta has said that integration of reproductive health, family planning and HIV/AIDS can enhance health services operations under one roof.

Hon. Sitta (pictured) said those were operational programmes that could be joined together to enhance outcomes. She said the importance of integration is to achieve multiple key goals.

Presenting the Rationale for Integration of Reproductive Health and HIV Services in Tanzania, James Mlali from Human Development Trust (HDT) said 80 per cent of HIV infections are sexually transmitted. Mlali said addressing reproductive health and HIV together can better serve both clients and providers comprehensively with less costs. 

Mlali who is also an Advocacy Officer of the Advanced Family Planning (AFP) at HDT was presenting the subject to the members of the Committee of Social Services and HIV and AIDS issues in Dodoma recently during the just ended parliamentary sessions. He said integration can prevent new HIV infections among women and girls as well. 

The Advocacy Officer said also Prevention of Mother to Child transmission (PMTCT) and supporting reproductive rights and fertility choices of People Living with HIV (PLHIV) were among the goals of the integration.

The one day workshop, brought together the two committees of HIV issues and the Social Services, was conducted at Dodoma Hotel. During the workshop the committee members were told that the importance of integration included reproductive health was essential for prevention, care and treatment of HIV/AIDS.

Mlali explained other important aspects of integration of reproductive health and HIV as to reduce costs of service provision. He said drop - out rates of clients caused by referrals would be reduced and also reduction of stigma, denial and discrimination which result from access to services in separate units. 

Speaking during the workshop, the Kigamboni MP, Hon. Dr. Faustine Ndugulile said the move was welcomed but the challenge is shortage of health personnel in most facilities in Tanzania. 

Dr. Ndungulile said Tanzania health sector has a shortage of 62 per cent of human resource needed in the sector currently including inadequate technical skills at facility level.

Contributing during integration workshop, the Parliament Chairperson Committee of HIV issues, Lediana Mung’ongo said family planning integrations to HIV has started in PMTCT, VCT, CTC and HBC just to mention a few. The workshop drew a total of 25 members from different constituencies.

Rapid Media Assessment on Family Planning

By AJAAT

Between July and September 2011 AJAAT conducted an assessment of Media House’s interest in supporting Family Planning services in Tanzania. The assessment, among other things, explored the possibility of the private sector to play its role in the provision of social services as outline in the Public Private Partnership Act, 2010 and the implementation of Corporate Social Responsibility policies.

The main objective of the assignment was to gather information from Media Houses on the status of coverage, capacity, interest/commitment and challenges on Family Planning issues by the media. Specifically, the assessment aimed at covering seven Media Houses; Mwananchi Communications (Mwananchi, The Citizen), The Guardian Limited (The Guardian, Nipashe), New Habari (2006) Ltd., (Mtanzania, The African), Tanzania Standard Newspapers (Daily News, Habari Leo), IPP Media (ITV and Radio One), TBC (TBC 1 and TBC Taifa) and Sahara Communications (Star TV and Radio Free Africa).  

One of the media Houses– IPP Media, was not reached, making the assessment covers six Media Houses only. The exercise targeted mainly senior media personnel: managers, managing editors, editors and news presenters from the selected Media Houses. 

The assessment was conducted using structured questionnaires of closed and open ended questions to solicit the desired information from respondents. 

The findings of the assessment show interesting facts about family planning issues in Media Houses. Respondents in the assessment were fairly distributed in the various Media Houses. Three Media Houses had high representations (21% each) while two Media Houses had middle representations (14% each) and one Media House had a low representation (7%).

Family Planning in Tanzania

Family planning saves the lives of women, newborns, and adolescents as well as contributes to the nation’s socioeconomic development. It prevents maternal mortality, one of the major concerns addressed by various global and national commitments and reflected in the targets of the Millennium Development Goals, Tanzania Vision 2025, the National Strategy for Growth and Reduction of Poverty, and the Primary Health Services Development Program.

Family planning reduces infant deaths from AIDS by preventing unintended pregnancies and hence mother-to-child transmission of HIV. It also helps governments achieve national and international development goals because it can contribute to the achievement of all of the United Nations’ Millennium Development Goals, including reducing poverty and hunger, promoting gender equity and empowering women, reducing child mortality, improving maternal health, combating HIV/AIDS, and ensuring environmental sustainability.

The Ministry of Health and Social Welfare (MOHSW) developed this National Family Planning Costed Implementation Program (NFPCIP) based on the goal of the One Plan to increase the contraceptive prevalence rate to a target of 60 percent by the year 2015. The NFPCIP is also guided by and links with the Health Sector Strategic Plan III (HSSPIII), the Human Resources for Health Strategy Plan (HRHSP), and the Primary Health Service Development Programme (PHSDP). Funds required to implement these NFPCIP activities will build on and augment the many investments called for in the HSSPIII, PHSDP, and HRHSP strategies by ensuring that essential resources for an effective family planning program are identified and that the activities are integrated and implemented within and throughout the overall health system.

The main objective of the NFPCIP is to reposition and reinvigorate access to and use of family planning services in Tanzania. The NFPCIP stipulates five strategic action areas for implementation that are needed to reposition family planning: contraceptive security, capacity building, service delivery, health systems management, and advocacy. Although all five components are needed for a thriving and effective program, emphasis will be given to two areas to prioritize fulfillment of the increasing demands for family planning services in the country. These two areas include ensuring contraceptive security and strengthening integrated service delivery of family planning in all aspects of the health sector, including HIV/AIDS, immunization services, postnatal care, and post abortion care.

Meeting the ‘One Plan’ Goal for Family Planning

Meeting the ‘One Plan’ Goal for Family Planning

By AJAAT

A continuing high rate of population growth is presenting major challenges to social and economic development in Tanzania. According to the National Bureau of Statistics (NBS), at the current annual rate of growth of 2.9 percent, Tanzania’s population is projected to reach 65 million by 2025, putting increased strain on already overstretched health and education services, infrastructure, food supply, and the environment.

Early initiation of childbearing and a high rate of fertility are the principal factors contributing to this rapid population growth, and they also have detrimental effects on the health of women and children.

Tanzania has among the highest rates of maternal, newborn, and child deaths in the world. Gender issues play important roles in both affecting access to health and economic resources for women and limiting the roles women can play in the country’s social and economic development.

Early childbearing usually curtails educational attainment for girls and constrains women’s participation in economic productivity.

Family planning (FP) has for several decades been well documented as a key strategy to promote social and economic development, and to improve the health of women and their children.

The National Road Map Strategic Plan to Accelerate Reduction of Maternal, Newborn and Child Deaths in Tanzania, 2008–2015 (One Plan) has set a goal to increase the contraceptive prevalence rate (CPR) from 20 percent to 60 percent by 2015, by making quality FP services more accessible to and equitable for all of Tanzania’s people.

Increased use of FP has a great potential to contribute to the One Plan target of reducing maternal mortality from 578 to 193 per 100,000 live births by 2015.

However, the Tanzania’s FP program has lost momentum over the past decade because of a number of factors. As a result, the national CPR for modern methods among married women of reproductive age at the time of the last Demographic and Health Survey (DHS) in 2004–2005 had reached only 20 percent, and the annual rate of growth in CPR had slowed from a high of 1.5 percentage points to 0.6 percentage points.

With the current level of investment in FP and the current rate of growth, the One Plan target will not be reached until 2030, with considerable negative consequences for the health and well-being of Tanzania’s people and increased challenges to the country’s economic development.

It was noted in a recent study on National Health Accounts that expenditures for FP had decreased drastically, from 54 percent of reproductive health (RH) spending in 2003 to 8 percent in 2006. Deliberate efforts must be taken to rectify the situation.

A renewed commitment to FP, a reinvigorated program, and significant investment of resources are thus required to achieve the One Plan target.

In recognition of the need to reinvigorate the national FP program, the Ministry of Health and Social Welfare (MOHSW) embarked on development of a costed implementation program for a ‘repositioned’ national FP program.

The National Family Planning Costed Implementation Program (NFPCIP) is guided by the vision and mission of the Reproductive and Child Health Policy Guidelines 2003 and the goals of the one plan, setting targets for increased use of all FP methods by all women of reproductive age.

The NFPCIP takes into consideration and builds on the substantial investments called for in other strategic plans and documents, namely the Health Sector Strategic Plan III (HSSPIII) July 2009–June 2015, the Primary Health Services Development Programme (PHSDP) 2007–2017, and the Human Resources for Health Strategic Plan (HRHSP) 2008–2013.

Through a collaborative, participatory, and consultative process involving a wide range of stakeholders, five strategic action areas (SAAs) have been defined, based on the issues and challenges that must be addressed to reposition FP successfully.

These are ensuring contraceptive commodities and logistics (adequate and timely supplies of contraceptive methods appropriate to meet individual needs); renewed efforts in capacity building to ensure that providers in the health sector have the skills required to provide and support integrated FP services; strengthened service delivery systems to increase access to quality, affordable, and sustainable services; a renewed focus on advocacy to increase visibility of and support for FP among development partners, program managers, service providers, and the public; and strengthening management systems, monitoring and evaluation (M&E) to ensure effective program implementation.

Background

The health benefits of Family Planning (FP) for women and their children have been well documented for several decades, as has its essential contributions to social and economic development. Limited FP services have been available in a few urban areas of Tanzania since the establishment of the family planning association of Tanzania (UMATI) in 1959.

Beginning in 1974, the Government of Tanzania allowed UMATI to expand FP services to public-sector maternal and child health (MCH) clinics throughout the country, but expansion was limited because of resource constraints, and levels of contraceptive use remained low.

Expansion of the program and growth in the contraceptive prevalence rate (CPR) were accelerated after a speech by the late first President Julius Kambarage Nyerere in 1989 that recognized the importance of FP to Tanzania’s development. In 1989, the Tanzanian government assumed responsibility for integrating FP into government MCH services from UMATI.

During the next few years—the ‘golden age’ of FP in Tanzania—the prevalence of modern FP method use more than doubled, increasing from 6.6 percent in 1992 to 13.3 percent in 1996, growing at an average of 1.5 percentage points per year.

Beginning in 2000, however, the increase in prevalence dropped to 0.6 percentage points per year, with contraceptive prevalence for all methods among married women of reproductive age reaching only 26.4 percent by the time of the last Demographic and Health Survey (DHS) in 2004–2005.

A number of factors contributed to the loss of momentum, including decentralization and integration of health programs and the shift in donor funding mechanisms and priorities.

As FP priority, visibility, and financial support declined, the fundamental elements needed to sustain a thriving FP program were also weakened at central, regional, and district levels.

These elements include a consistent and adequate supply of contraceptive commodities to meet increasing demand, capacity building to increase the number of skilled FP providers and ensure updated provider skills, well equipped and flexible service delivery systems, education and motivation to generate demand for services, advocacy to sustain support for FP from various funding sources, and effective management systems and leadership to guide program implementation.

Repositioning FP as a priority in the national agenda is a key strategy to improve maternal, newborn, and child health; to prevent mother-to-child HIV transmission; and to promote social and economic development. Renewed advocacy for FP and adequate funding for program implementation to meet these goals are therefore urgently needed.

Issues and Challenges of the Current Family Planning Program

The FP program faces a number of challenges and constraints that must be addressed for effective repositioning of FP to meet the country’s RH and development goals.

Five program areas or components are essential for implementing a successful FP program: a consistent and adequate supply of contraceptive commodities; sufficient numbers of health providers who have the necessary knowledge and the technical and client interactions skills to deliver FP services safely and effectively; appropriately equipped facilities with a flexible array of service delivery modalities and systems to meet the needs in different socio-cultural contexts and levels of development in Tanzania’s different regions; strong advocacy to increase visibility and support for the program and address the knowledge-use gap among FP clients; and strong management systems and leadership to ensure efficient and effective program implementation.

The issues and challenges for each area have been defined below based on a review of published literature and documents, through discussions with the National Family Planning Working Group and through a series of key informant interviews.

I.                   Contraceptives Commodities and logistics: Availability and Choices of Methods

Providing a choice of methods to meet the changing needs of clients throughout their reproductive lives increases overall levels of contraceptive use and enables individuals and couples to meet their reproductive goals.

The method mix available in a program influences not only successful client use and satisfaction, but also has implications for provider skills and the facilities and equipment needed to deliver certain methods.

All of these factors affect program cost and sustainability and, in turn, the amount of contraceptive protection that can be provided with various levels of financial support.

Maintaining an adequate supply of contraceptive commodities to meet clients’ needs, prevent stockouts and ensure contraceptive security is the most urgent issue facing the Tanzania’s FP program.

The inability to supply and sustain current users has considerable implications for expansion of the program to meet the CPR targets of the One Plan. Other key strategies (HSSPIII and PHSDP) recognize the importance of ensuring the availability of adequate contraceptive choices.

General strengthening of logistics systems planned in the PHSDP will benefit contraceptive security, but additional investments are needed to ensure adequate forecasting, budgeting, and tracking of supplies so that all contraceptive methods, especially those that are in greatest demand, are available when and where clients need them.

Funding allocations through the MTEF are not adequate to meet contraceptive commodity requirements because of competing priorities in the health sector. However, the government is progressing well towards meeting the Abuja declaration target of 15 percent of the total national budget to cover improvement in the health sector.

Furthermore, when requests for funding from the district level are prioritized and submitted for funding by the district-level health management teams, FP falls well below other health service priorities in some districts and is sometimes overlooked in these requests.

As a result, stock-outs of contraceptive commodities occur even when districts have returned unused funds to the Basket.

A key factor in ensuring contraceptive security, method-mix issues, has important implications for cost as well as for client acceptance and satisfaction needed to sustain successful use.

Short-acting methods are the most prevalent contraceptives in the current method mix, according to the 2004 DHS, which include pills, condoms, and, increasingly, injectable depotmedroxyprogesterone (DMPA).

Those methods require regular resupply; hence successful use must include access to a consistent supply of the product. Each ‘resupply’ visit to a service delivery point (SDP) entails additional costs.

Pills and condoms also require high levels of user adherence and motivation, with inconsistent and incorrect use leading to method failures and high rates of discontinuation.

Condoms protect not only against unintended pregnancy but also against STIs, including HIV. They have been widely promoted in HIV-prevention programs and, less often, as ‘dual protection’ against pregnancy and STIs/HIV.

Their association with STI and HIV prevention, however, means that for many couples, condoms are stigmatized as being associated with extramarital sex, and therefore partners may resist using condoms for pregnancy prevention.

Long-acting methods give contraceptive protection for a year or more. They include intrauterine devices (IUDs) and implants. These methods have higher initiation costs than short-acting methods, but because they can be used without resupply for several years, they are often less expensive per year of use.

 Initiation costs for those methods are higher because the costs of the commodities themselves are higher. In addition, they require providers to have special training and skills for insertion and removal as well as good counseling skills to ensure that clients can make informed choices about these long-acting methods.

Unlike short-acting methods, which can be discontinued simply by the user stopping the method, discontinuation of IUDs and implants requires removal by a trained provider.

Prevalence of IUD use in Tanzania is low, despite it being the most cost-effective form of reversible contraception, having a good safety record, and providing highly effective contraceptive protection for up to 10 years.

Expanding the use of IUDs will require considerable attention to addressing myths and misinformation about IUDs among both providers and clients. Hormone-releasing sub dermal implants provide safe, highly effective contraception and have been growing in popularity among Tanzanian women.

Permanent methods of contraception (sterilization) include tubal ligation for women and vasectomy for men. Worldwide, these two surgical methods account for the majority of contraceptive users and are highly effective and safe when provided by trained personnel with appropriate attention to infection control.

Although the prevalence of permanent methods is low in Tanzania, the use of tubal ligation is growing, especially for women who do not want more children, and a pilot program to provide vasectomy in the Kigoma region is meeting with considerable success.

Provision of permanent methods is limited both by weaknesses in health facilities as well as by lack of provider skills. Additionally, widespread rumours—for example, equating vasectomy with castration— undermine acceptance of these highly effective methods.

Because those methods limit future childbearing, client education and counseling to ensure informed choice and informed consent are essential parts of service provision. However, weaknesses exist in such client-provider interaction skills.

Expanded availability of permanent methods for those who do not want more children can help Tanzania achieve its CPR targets, but this will require significant investments in capacity building to ensure proficiency in surgical skills, counseling, and informed consent procedures.

Vision, Mission, Goals and Objectives of the NFPCIP

Vision

A healthy and well-informed Tanzanian population with access to quality reproductive and child health services that are acceptable, affordable, and sustainable and provided through efficient and effective support systems.

Mission

Promote, facilitate and support in an integrated manner the provision of reproductive and child health services to men, women, adolescents, and children in Tanzania.

Goal

Increase the CPR among women of reproductive age from 28 percent to 60 percent by 2015.

The denominator used for the CPR target is women of reproductive age and not married women of reproductive age (MWRA). This is to take into consideration all women of reproductive age regardless of their marital status.

Furthermore, the CPR target includes all methods and not just modern methods. According to the DHS 2004–2005, the CPR among MWRA for modern methods is 20 percent and the CPR among MWRA for all methods is 26.4 percent, while the CPR for women of reproductive age for all methods is 28 percent. The latter figure of 28 percent is thus used.

Although guidance is also provided by the HSSPIII, which has a goal CPR of 30 percent by 2015, the higher CPR goal of 60 percent specified by the One Plan was chosen so that repositioning FP can be addressed more aggressively and, as a result, will have greater potential impact on reducing maternal and newborn mortality and improving child survival.

Furthermore, there is a wide degree of variation across regions in current CPR as well as considerations of culture and context, such as the availability of infrastructure, human resources, service modalities, and current demand. These factors increase the challenges to be addressed and the level of resources that will be needed to reach the 60 percent CPR One Plan target by 2015.

The regional variations and the different scenarios for repositioning FP are discussed in more detail in the Analysis of Demographic Determinants of Resource Requirements section.

Strategic Action Area I: Contraceptive Security

This SAA refers to expanded availability and choices of safe, effective, acceptable and affordable contraceptive methods. It addresses contraceptive logistics and security, ensuring that supplies of all contraceptive commodities are adequate to meet the needs and preferences of family planning clients.