CHALLENGES TO PRIMARY HEALTH CARE:

TANZANIA MAINLAND CASE STUDY

Prof Joas B Rugemalila

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Tanzania Geographical Location

Tanzania

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Tanzania Mainland

Latitude 1 - 11 S
Longitude 30 - 40 E
Surface area 945 087 Sq km
Great Lakes
Mt Kilimanjaro 5 895 m
Tourism spots:
Ngorongoro, Serengeti,
Spice Islands of Zanzibar
and Pemba etc

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 Population Structure

SN Age Male (%) Female (%) Total (%)

1 00-11 Mos 578 283 581 197 1 159 480 (03.5)

2 01- 04 Yrs 2 174 765 2 176 820 4 351 585 (13.0)

3 05 - 14 4 666 094 4 626 564 9 292 658 (27.8)

4 15 - 49 7 313 319 (21.9) 8 003 907 (23.9) 15 317 226 (45.8)

5 50 - 64 977 944 1 045 019 2 022 963 (06.0)

6 65+ 638 610 679 327 1 317 937 (03.9)

Total 16 349 015 (48.9) 17 112 834 (51.1) 33 461 846 (100)

Source: Ministry of Planning, Economy and Empowerment (2006); Progress Report on Millennium Development

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TANZANIA POPULATION AGE AND GENDER STRUCTURE

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 Demographic Profile Period 1994 - 2004
SN Indicator Value
Tanzania USA
1 Total Population in 000, 000 37.627 295.410
2 Pop Density per Km2 43 37
3 % Annual Growth Rate 2.3 1.0
4 Dependency Ratio per 100 86 50
5 % Population Aged 60 Years+ 5.0 16.5
6 Total Fertility Rate 4.9 2.0
7 Life Expectancy at Birth Years 48 78
Male 46 75
Female 47 80

Source: WHO 2006. The World Health Report for 2006, Statistical Annex

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 Socio-Economic Indicators Period Preceding 2003

SN Indicator Value Year

1 Adult Literacy Rate (%) 70 2002

2 Primary School Enrolment (%) 95 2002
3 %Pupils Completing Grades 1-7 79 2002
4 % Population Rural/Urban 80/20 2002
5 Total Heath Budget TZS, 000,000 210,280 2001/02
6 % External Assistance 50 2001/02
7 Per Capita on Public Health US$ 6 2001/02

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 Population Socio-Economic Indicators

SN Indicator Value
Tanzania USA
1.0 Annual GDP per Capita in 2009 (US$) 509 46 436
2.0 Annual GDP Growth Rate in 2009 (%) 6.6 -2.4
3.0 Annual Inflation, GDP Deflator (%) 8.9 1.7
4.0 National Budget Expenditure on Health 11.0 --
5.0 (%) Population Below National
5.1 Basic Needs Poverty Line ($1/day) 39 19.5
5.2 Food Poverty Line 19 -
6.1 % rural pop access potable water 42 74
6.2 % urban pop access potable water 85 84
7.0 % Adult (15 years+) Literacy 73 --
Source: World Bank (2010): worldbank.org/indicator/NYGDP.MKTP.KD.2G; 13 Nov 2010

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 Health Status Indicators for Year 2005
Value
SN Indicator Current 2015 Target
1.0 % Under-five (U5) Under-weight 21.9 14.4
2.0 % U5 Under-height (Stunted) 38 23.3
3.0 Rate/Ratio per 1 000 Live Births
3.1 Infant Mortality Rate 83 40
3.2 U5 Mortality Rate 133 67
3.3 Maternal Mortality Ratio 578 133
4.0 % Births Attended by Skilled Staff 46 90
5.0 % Children Vaccinated (Measles) 80 95
6.0 % Family Planning Coverage 20 ---

Source: Ministry of Planning, Economy and Empowerment (2006); Progress Report on Millennium Development

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 Population Coverage by Health Professionals Year 2005

Coverage/Pop000
SN Frontline Health Professionals Current 2015 Target
1 Medical Doctor (Physician) 138 ??
2 Assistant Medical Officer 67 ??
3 Clinical Officer 14 ??
4 Nursing Officer 5 ??
5 Dental Surgeon 1 021 ??
6 Assistant Dental Officers 356 ??

Source: Ministry of Health (2006); Annual Health Statistical Abstract

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 Public Health Services and Population Coverage

SN Admin Level Health Sector Pop /Unit

1 National Ministry of Health 40 000 000
Tertiary Health Facilities
2 National National Hospital: Muhimbili 40 000 000
3 Zonal Zonal Consultant Hospitals ~ 5 Regional Hospitals
Bugando, Mbeya, KCMC, Singida (underconstruction)
4 Special Hospitals Special Hospitals: Mirembe (Psychiatric), Kibongoto (Tb), Chazi (Leprosy)

Secondary Health Facilities

5 Regions (21) Regional Hospitals ~5 District Hospitals
Primary Health Facilities
6 Districts (121) District Hosp 250 000
7 Divisions (512 ) Health Centre 50 000
8 Wards (2,400) Dispensary 6 000 10 000
9 Villages (10,075) Village Health Post

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 Health Facilities by Ownership

Facility Level
SN Ownership Hospitals Health Centres Dispensaries
1 Government 87(40) 331(69) 3 038(65)
2 Voluntary 87(40) 101(21) 0 763(16)
3 Parastatal 08(04) 010(02) 0 145(03)
4 Private 37(16) 039(08) 0 733(16)
5 Total 219(100) 481(100) 4 679(100)

Source: Ministry of Health (2006); Annual Health Statistical Abstract

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 Administrative Responsibilities

1. MoHSW supervises
i. National Hospital
ii. Zonal Consultant Hospitals
iii. Special Hospitals
iv. Training Institutions
v. Executive Agencies: NIMR
vi. Regulatory Authorities: TFDA
2. Regional Administration

With technical guidance from the Regional
Health Management Team supervises district
health services and programs

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 Administrative Responsibilities (contd)

3. District Councils empowered to constitute

i. Health Service Board
ii. Facility Committees
iii. District Health Management Teams

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 Responsibilities by Administrative Levels

1. Central Level ~ MoHSW

i. Policy, legislation, regulation and control
ii. Resources mobilization and allocation,
iii. Coordination of inter-sectoral linkages
iv. Public health interventions eg NACP,
NMCP
v. Management support of tertiary hospitals
vi. Supervision & monitoring of NGO
owned special & referral hospitals

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 Responsibilities by Administrative Levels

1. Central Level ~ MoHSW

vii. Provision of feedback to other levels
viii. Training key health professionals

ix. M & E quality of health services &

training
x. Supervision & inspection of public and
private health services
xi. Health research
xii. Management of executive agencies

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Responsibilities by Administrative Levels (contd)

2. Regional
i. Mobilizes resources
ii. Interprets policies into actions
iii. Provides technical support to districts
iv. Supports supervision & inspection of
district health services
v. Links districts & MoH regarding
standards & quality of public/private
health care

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Responsibilities by Administrative Levels (contd)

3. District
i. Provides health services at primary level
ii. Prepares comprehensive district health
plans and implementation reports
iii. Provides feedback to other levels and the
community
iv. Coordinates, supports supervision,
monitoring & inspection of district health
facilities

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Responsibilities by Administrative Levels (contd)

3. District (contd)
v. Mobilizes resources for services and
management
vi. Ensures communities take responsibilities
for their own health

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 Top Ten OPD Diagnoses in U5s

SN Diagnosis %age
1 Malaria 39.4
2 Acute Respiratory Infection 16.5
3 Pneumonia 9.6
4 Diarrhoea Diseases 7.1
5 Intestinal Worms 4.6
6 Eye Infections 3.9
7 Skin Infections 3.4
8 Anaemia 2.5
9 Minor Surgical Conditions 2.0
10 Ill-Defined Conditions 2.0
Source: MoH 2006: Annual Health Statistical Abstract

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 Top Ten Causes for U5 Admissions
SN Diagnosis %age
1 Malaria - Uncomplicated 33.4
2 Acute Respiratory Infections 22.1
3 Malaria - Complicated 11.4
4 Diarrhoea Diseases 8.4
5 Pneumonia 5.5
6 Intestinal Worms 4.9
7 Anaemia 3.4
8 Other Respiratory Diseases 1.6
9 Tuberculosis 1.0
10 Ill-Defined Conditions 0.8
Source: MoH 2006: Annual Health Statistical Abstract

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 Top Ten Causes for U5 Deaths

SN Diagnosis %age
1 Malaria - Uncomplicated 28.0
2 Malaria - Complicated 20.0
3 Anaemia 10.0
4 Pneumonia 9.0
5 Diarrhoea Diseases 5.0
6 HIV/AIDS 3.0
7 Perinatal Conditions 3.0
8 Severe Malnutrition 3.0
9 Other Respiratory Diseases 2.0
10 Acute Respiratory Infections 1.0
Source: MoH 2006: Annual Health Statistical Abstract

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 Top Ten OPD Diagnoses in Pops 5 Yrs+

SN Diagnosis %age
1 Malaria 48
2 ARI 11
3 Intestinal Worms 5
4 Pneumonia 5
5 Diarrhoea Diseases 5
6 Ill-Defined Conditions 3
7 Minor Surgical Conditions 3
8 Eye Infections 2
9 Anaemia 2
10 Urinary Tract Infections 2
Source: MoH 2006: Annual Health Statistical Abstract

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 Top Ten In-Patient Diagnoses in Pops 5 Yrs+
SN Diagnosis %age
1 Malaria - Uncomplicated 42.1
2 ARI 13.3
3 Severe Malaria 10.3
4 Diarrhoea Diseases 7.2
5 Intestinal Worms 4.3
6 Pneumonia 3.4
7 Anaemia 2.2
8 HIV/AIDS 1.1
9 Tuberculosis 0.99
10 Ill-Defined Symptoms 0.84
Source: MoH 2006: Annual Health Statistical Abstract

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 Top Ten Causes of Deaths in Pops 5 Yrs+
SN Diagnosis %age
1 Severe Malaria 19.0
2 HIV/AIDS 12.0
3 Uncomplicated Malaria 6.9
4 Pneumonia 6.4
5 Typhoid Diseases 6.2
6 Tuberculosis 5.9
7 Anaemia 5.0
8 Diarrhoea Diseases 2.9
9 Neoplasms 2.8
10 Cardiac Failure 2.6
Source: MoH 2006: Annual Health Statistical Abstract

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 Leading Causes of Maternal Deaths Year 2004

SN Diagnosis %age
1 Post-Partum Haemorrhage (PPH) 15
2 Anaemia 13
3 Eclampsia 12
4 Sepsis 11
5 Malaria 9
6 HIV/AIDS 7
7 Ruptured Uterus 6
8 Ante-Partum Haemorrhage (APH) 3
9 Abortion 2
10 All Others 19
Source: MoH 2006: Annual Health Statistical Abstract
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 Sectoral Cross Cutting Challenges

Equity with reference to

 Age
 Gender

 Socio-economic status eg income, education,

rural/urban communities

Population coverage by health professionals
 Low ratios for professionals to service pops

 Training required to produce sufficient professionals

 Motivation required to

 retain the professionals in the country

 provide services to rural communities

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 Cross Cutting Challenges

Inter-sectoral collaboration for enhancing

 Production of adequate food supplies

 GDP national/household incomes

 Health services accessibility, affordability and

sustainability
 Education for assimilation of health education

messages
 Public private partnerships for provision of health

services

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 Age and Gender Equity Challenges

High U5 morbidity and mortality
 Constitute 16.5% national population

 Communicable diseases

 malaria, respiratory infections, GIT

infections
 Non-communicable disease

 anaemia, under-nutrition
 Enhance program effectiveness and
efficiency for U5 nutrition monitoring

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 Age Gender Equity Challenges

High maternal mortality

 Reproductive age women constitute 23.9%
national pop
 High general fertility rate of 6.5

 Low coverage by programs for

 Family Planning

 Pregnancy Monitoring

 Detection and Management of HIV/AIDS

and other STIs

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 Age Gender Equity Challenges

Epidemiological transition

Pop 60 yrs+ constituting ~10% national
pop

Have increased risk for
 cardiovascular diseases

 diabetes mellitus

 geriatric conditions

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 END

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