Background: This paper presents and analyses the trend of maternal mortality ratio in Tanzania against
major events, policy, economic and political decisions which may have influenced this trend. The impact
of several initiatives related to Health Systems Strengthening are discussed and alternative strategies for
effective maternal mortality reduction in Tanzania are proposed.
Methods: We reviewed data and information published on maternal mortality and relevant political
decisions, policies programmes and guidelines on maternal and new-born for Tanzania from 1990 to 2016.
We examined the timeline of economic development, political decisions and other major events going
back 5-10 years before the possible stagnation of maternal mortality decline.
Results: This period coincides with the Health Sector Reforms which included among other things the
introduction of user fees, reintroduction of private practice, staff retrenchment, widening inequalities and
growing poverty. Health service factors include persistent low coverage and utilization of basic
emergency obstetric care services. To address these gaps, we propose strengthening rights-based
approaches in maternal health programming with political, financial and performance accountabilities at
all levels. Introducing these will themselves help with improvement of the quality of care and address the
issues of equity by reaching even the poorest households. We further propose application of process
indicators to monitor maternal care services. Skilled care should be adopted as the single most important
indicator for improving emergency obstetric care. There is need to review the legal and policy framework
on task shifting to allow nurses to deliver the seven signal functions and Assistant Medical Officers to
deliver Comprehensive Emergency Obstetric Care.
Conclusion: We conclude that greater effort needs to be put in designing heath strengthening systems
that address more the demand side of health systems strengthening as opposed to current efforts which
are largely supply oriented.