Objective: To explore the region-level relationship between Tanzanian non-governmental organizations
(NGOs) and four maternal and child health (MCH) outcomes – stunting, child vaccination, antenatal care
(ANC) visits, and health facility delivery – at five time periods during the past twenty years.
Methods: Associations between five region-level NGO covariates and MCH outcomes were modeled
using cross-sectional and retrospective cohort designs. NGO, health, and additional covariates were
derived from a 2010 NGO survey conducted by the Foundation for Civil Society, Demographic and
Health Surveys (DHS), and government reports and published sources, respectively.
Findings: Cross-sectionally, regional NGO concentration was positively associated with multiple MCH
outcomes in 2010, with each increase of 1 NGO per 100,000 capita associated with a 3-6% increased
likelihood of full child vaccination, attending ≥4 ANC visits, or health facility delivery. Following regions
over time, NGO concentration in 2010 and 2000 were associated with change in MCH outcomes
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between DHS surveys, with each unit increase associated with a 3-10% reduction and 5% increase in the
prevalence of stunting and attending ≥4 ANC visits, respectively.
Conclusions: Both cross-sectionally on an individual-level and following regions over time, regional
concentration of NGOs was consistently and statistically significantly associated with improved MCH
outcomes in Tanzania, with similar but less consistent findings for NGO funding and staff concentration.
Population-level analysis shows great promise in assessing long-term health impacts of NGOs. A greater
understanding of robust indicators of population-level NGO influence may guide development of best
practices for monitoring and evaluation of NGOs.