| Author(s) |
Ministry of Health and Social Welfare, Dar es Salaam Ministry of Health, Zanzibar National Bureau of Statistics, Dar es Salaam Office of Chief Government Statistician, Zanzibar ICF International, Rockville, Maryland USA |
| Table of contents |
TABLES AND FIGURES ........................................................................................................................................ vii
FOREWORD ............................................................................................................................................................. xv
ACKNOWLEDGMENTS ...................................................................................................................................... xvii
ABBREVIATIONS AND ACRONYMS ................................................................................................................. xix
MAP OF TANZANIA ............................................................................................................................................ xxii
1 OVERVIEW OF THE HEALTH AND SOCIAL SYSTEM IN TANZANIA .......................................... 1
1.1 Demography and Structures of Health and Social Welfare Services ................................................ 1
1.2 Health Status in Tanzania ................................................................................................................. 1
1.3 Enabling Policies and Strategies to Improve Health Status .............................................................. 1
1.3.1 Tanzania Development Vision 2025 ................................................................................... 2
1.3.2 MKUKUTA and Five Year Development Plan 2011/12–2015/16 ..................................... 2
1.3.3 Big Results Now ................................................................................................................. 3
1.4 Organisation of the Health Care System ........................................................................................... 3
1.4.1 Health and Social Welfare Service Structure (Tanzania Mainland) ................................... 3
1.4.2 Administrative Structure of the Ministry of Health in Zanzibar ......................................... 5
1.4.3 Organisation of the Health Care System in Zanzibar .......................................................... 5
1.4.4 Management of Health and Social Welfare Services in Tanzania Mainland ...................... 7
1.5 Service Delivery of the Health and Social Welfare Sector in Tanzania Mainland ............................ 9
1.5.1 Services in Community ....................................................................................................... 9
1.5.2 Services Provided by Institutions........................................................................................ 9
1.6 Health Care Support Systems in Tanzania Mainland ...................................................................... 11
1.6.1 Human Resources for Health ............................................................................................ 11
1.6.2 Essential Medicines and Health Products ......................................................................... 12
1.6.3 Capital Investment ............................................................................................................ 13
1.6.4 Monitoring and Evaluation ............................................................................................... 13
1.6.5 Health Financing ............................................................................................................... 13
2 METHODOLOGY ...................................................................................................................................... 15
2.1 Overview ......................................................................................................................................... 15
2.2 Institutional Framework and Objectives of the 2014-15 TSPA ...................................................... 15
2.2.1 Institutional Framework .................................................................................................... 15
2.2.2 Objectives of the 2014-15 TSPA ...................................................................................... 15
2.3 Data Collection Methods ................................................................................................................ 16
2.4 Sampling ......................................................................................................................................... 17
2.4.1 Sample of Health Facilities ............................................................................................... 17
2.4.2 Sample of Health Service Providers ................................................................................. 18
2.4.3 Sample for Observations and Exit Interviews ................................................................... 19
2.5 Implementation ............................................................................................................................... 19
2.5.1 Questionnaire Adaptation ................................................................................................. 19
2.5.2 Pre-test .............................................................................................................................. 20
2.5.3 Main Training ................................................................................................................... 20
2.5.4 Data Collection ................................................................................................................. 21
2.5.5 Data Management and Report Writing ............................................................................. 21
2.5.6 Data Analysis .................................................................................................................... 22
2.6 Response Rates ............................................................................................................................... 22
2.6.1 Facility Response Rate...................................................................................................... 22
2.6.2 Provider Interview ............................................................................................................ 25
2.6.3 Client Observation and Interview ..................................................................................... 26
3 FACILITY-LEVEL INFRASTRUCTURE, RESOURCES, MANAGEMENT, AND SUPPORT ...... 29
3.1 Background ..................................................................................................................................... 30
3.2 Availability of Services ................................................................................................................... 30
3.2.1 Overall Availability of Specific Client Services ............................................................... 30
3.2.2 Availability of Basic Client Services ................................................................................ 32
3.3 Service Readiness: Basic Facility Infrastructure to Support Quality Service Provision ................. 34
3.3.1 Basic Amenities ................................................................................................................ 34
3.3.2 Basic Equipment to Support Quality Health Services ...................................................... 36
3.3.3 Standard Precautions for Infection Control in Service Delivery Area .............................. 38
3.3.4 Capacity for Adherence to Standards for Quality Sterilisation or High-level Disinfection Processes ...... 40
3.3.5 Diagnostic Capacity .......................................................................................................... 42
3.3.6 Availability of Essential Medicines .................................................................................. 44
3.4 Management Systems to Support and Maintain Quality Services and Appropriate Client Utilisation ...... 46
3.4.1 Management Meetings, Quality Assurance, and Client Opinion ...................................... 46
3.4.2 Supportive Management for Providers ............................................................................. 49
3.5 Availability of Human Resources for Health .................................................................................. 51
4 CHILD HEALTH SERVICES ................................................................................................................... 53
4.1 Background ..................................................................................................................................... 54
4.1.1 Health Situation of Children in Tanzania ......................................................................... 55
4.2 Availability of Child Health Services ............................................................................................. 56
4.2.1 Outpatient Curative Care, Child Growth Monitoring, and Child Vaccination.................. 56
4.2.2 Vitamin A Supplementation ............................................................................................. 58
4.2.3 Frequency of Availability ................................................................................................. 59
4.3 Service Readiness ........................................................................................................................... 62
4.3.1 Guidelines, Trained Staff, and Equipment for Sick Child Care ........................................ 62
4.3.2 Infection Control in Sick Child Services .......................................................................... 65
4.3.3 Laboratory Diagnostic Capacity ....................................................................................... 67
4.3.4 Medicines and Commodities for Sick Child Care ............................................................ 67
4.3.5 Guidelines, Trained Staff, and Equipment for Vaccination Services ................................ 69
4.3.6 Infection Control in Vaccination Services ........................................................................ 73
4.4 Sick Child Care Practices................................................................................................................ 75
4.4.1 Full Assessment ................................................................................................................ 75
4.4.2 Diagnosis-Specific Assessments and Treatment ............................................................... 78
4.5 Client Opinion ................................................................................................................................. 80
4.6 Basic Management and Administrative Systems ............................................................................ 80
4.6.1 Supervision ....................................................................................................................... 80
4.6.2 Training ............................................................................................................................ 82
5 FAMILY PLANNING SERVICES ............................................................................................................ 85
5.1 Background ..................................................................................................................................... 85
5.1.1 TSPA Approach to Collection of Family Planning Service Information .......................... 85
5.1.2 Family Planning Services in Tanzania .............................................................................. 86
5.2 Availability of Family Planning Services ....................................................................................... 89
5.2.1 Contraceptive Method Mix and Method Availability ....................................................... 89
5.2.2 Frequency of Family Planning Services ........................................................................... 91
5.2.3 Specific Methods Offered ................................................................................................. 92
5.2.4 Availability of Family Planning Methods on the Day of the Assessment ........................ 93
5.3 Service Readiness ........................................................................................................................... 95
5.3.1 Service Guidelines, Trained Staff, and Equipment ........................................................... 95
5.3.2 Infection Control ............................................................................................................... 97
5.4 Adherence to Standards for Quality Service Provision ................................................................... 99
5.4.1 Counselling and Client Assessment at First Family Planning Visits ................................ 99
5.4.2 Counselling at All Family Planning Visits ..................................................................... 102
5.5 Client Opinion and Knowledge ..................................................................................................... 103
5.5.1 Major Problems .............................................................................................................. 103
5.5.2 Clients’ Knowledge about Methods ................................................................................ 103
5.6 Basic Management and Administrative Systems .......................................................................... 105
5.6.1 Supervision ..................................................................................................................... 105
5.6.2 Training .......................................................................................................................... 106
6 ANTENATAL CARE................................................................................................................................ 109
6.1 Background ................................................................................................................................... 109
6.1.1 Use of ANC Services ...................................................................................................... 110
6.2 Availability of ANC Services ....................................................................................................... 111
6.3 Service Readiness ......................................................................................................................... 113
6.3.1 Service Guidelines, Trained Staff, and Equipment ......................................................... 113
6.3.2 Infection Control ............................................................................................................. 115
6.3.3 Laboratory Tests ............................................................................................................. 117
6.3.4 Medicines ........................................................................................................................ 119
6.4 Adherence to Standards ................................................................................................................ 120
6.4.1 Characteristics of ANC Clients ....................................................................................... 120
6.4.2 Components of ANC Consultations ................................................................................ 121
6.5 Client Opinion ............................................................................................................................... 128
6.5.1 Health Education ............................................................................................................ 128
6.5.2 Major Problems Perceived by Clients ............................................................................. 129
6.6 Basic Management and Administrative Systems .......................................................................... 129
6.6.1 Supervision ..................................................................................................................... 129
6.6.2 Training .......................................................................................................................... 131
6.7 Prevention of Mother-to-Child Transmission of HIV ................................................................... 132
6.8 Malaria in Pregnancy .................................................................................................................... 136
6.8.1 Availability of Guidelines, Trained Staff, Medicines, and Diagnostics .......................... 136
6.8.2 Malaria-related Interventions During ANC Visits .......................................................... 138
6.8.3 Malaria-related Training ................................................................................................. 139
7 DELIVERY AND NEWBORN CARE .................................................................................................... 141
7.1 Background ................................................................................................................................... 142
7.1.1 Maternal Health Status and Health Care Utilization ....................................................... 142
7.2 Availability of Delivery and Newborn Care Services ................................................................... 143
7.3 Service Readiness ......................................................................................................................... 145
7.3.1 Service Guidelines, Trained Staff, and Equipment for Delivery Services ...................... 145
7.3.2 Medicines and Commodities for Delivery and Newborn Care ....................................... 148
7.3.3 Infection Control ............................................................................................................. 149
7.4 Newborn Care Practices ................................................................................................................ 151
7.4.1 Signal Functions for Emergency Obstetric and Newborn Care ...................................... 151
7.4.2 Routine Newborn Care ................................................................................................... 153
7.5 Basic Management and Administrative Systems .......................................................................... 154
7.5.1 Supervision ..................................................................................................................... 154
7.5.2 Training .......................................................................................................................... 155
8 HIV/AIDS AND SEXUALLY TRANSMITTED INFECTIONS .......................................................... 159
8.1 Background ................................................................................................................................... 159
8.1.1 The HIV/AIDS Situation in Tanzania ............................................................................. 160
8.1.2 National Response to the HIV Epidemic ........................................................................ 161
8.1.3 Service Utilisation .......................................................................................................... 161
8.1.4 Definitions of HIV/AIDS Services ................................................................................. 161
8.2 HIV Testing and Counselling ........................................................................................................ 161
8.2.1 Service Availability ........................................................................................................ 162
8.2.2 Service Readiness ........................................................................................................... 166
8.2.3 Infection Control ............................................................................................................. 166
8.2.4 Basic Management and Administrative Systems for HIV Testing and Counselling ...... 168
8.3 HIV Care and Support Services .................................................................................................... 170
8.3.1 Specific Care and Support Services ................................................................................ 173
8.4 Antiretroviral Therapy .................................................................................................................. 174
8.4.1 Service Availability ........................................................................................................ 175
8.4.2 Service Readiness ........................................................................................................... 175
8.5 Services for Sexually Transmitted Infections ............................................................................... 177
8.5.1 TSPA Approach to Collection of Information on Sexually Transmitted Infections ....... 177
8.5.2 Health Situation Regarding STIs and RTIs in Tanzania ................................................. 177
8.5.3 Service Availability ........................................................................................................ 178
8.5.4 Service Readiness ........................................................................................................... 179
9 NON-COMMUNICABLE DISEASES .................................................................................................... 181
9.1 Background ................................................................................................................................... 181
9.2 Health Situation Regarding Major Non-communicable Diseases in Tanzania ............................. 182
9.2.1 Diabetes .......................................................................................................................... 183
9.2.2 Cardiovascular Diseases ................................................................................................. 183
9.2.3 Chronic Respiratory Diseases ......................................................................................... 183
9.3 Diabetes: Service Availability and Readiness ............................................................................... 183
9.3.1 Availability of Services for Diabetes .............................................................................. 183
9.3.2 Service Readiness for Diabetes ....................................................................................... 184
9.4 Cardiovascular Diseases: Service Availability and Readiness ...................................................... 188
9.4.1 Service Availability for Cardiovascular Diseases ........................................................... 188
9.4.2 Service Readiness for Cardiovascular Diseases .............................................................. 188
9.5 Chronic Respiratory Diseases: Service Availability and Readiness ............................................. 192
9.5.1 Service Availability for Chronic Respiratory Diseases .................................................. 192
9.5.2 Service Readiness for Chronic Respiratory Diseases ..................................................... 192
10 TUBERCULOSIS ...................................................................................................................................... 197
10.1 Background ................................................................................................................................... 197
10.1.1 Global Burden of Tuberculosis ....................................................................................... 198
10.1.2 Health Situation Regarding Tuberculosis in Tanzania .................................................... 198
10.1.3 Response of the Tanzania National Tuberculosis and Leprosy Programme ................... 199
10.2 Availability of TB Services ........................................................................................................... 200
10.2.1 TB Diagnostic Services .................................................................................................. 200
10.2.2 TB Treatment and/or Follow-up Services ....................................................................... 200
10.3 Service Readiness ......................................................................................................................... 200
10.3.1 Guidelines and Trained Staff .......................................................................................... 200
10.3.2 Diagnostic Capacity ........................................................................................................ 203
10.3.3 Treatment and Availability of Medicines ....................................................................... 205
10.3.4 Infection Control ............................................................................................................. 205
10.4 Basic Management and Administrative Systems .......................................................................... 207
11 MALARIA ................................................................................................................................................. 211
11.1 Background ................................................................................................................................... 211
11.1.1 Health Situation Regarding Malaria in Tanzania ............................................................ 212
11.1.2 Malaria Control Strategy ................................................................................................ 213
11.2 Availability of Services for Malaria .............................................................................................. 214
11.3 Service Readiness ......................................................................................................................... 214
11.3.1 Guidelines, Trained Staff, and Diagnostics .................................................................... 214
11.3.2 Medicines and Commodities for Malaria Services ......................................................... 217
11.4 Malaria Services in Facilities Offering Curative Care for Sick Children ...................................... 221
11.4.1 Diagnosis Readiness ....................................................................................................... 221
11.4.2 Treatment ........................................................................................................................ 222
REFERENCES ........................................................................................................................................................ 227
APPENDIX A ADDITIONAL TABLES ............................................................................................................ 231
APPENDIX B PERSONNEL .............................................................................................................................. 301
APPENDIX C QUESTIONNAIRES AND SUPPORTING DOCUMENTS ................................................... 305 |
