Tanzania Maternal and Child Health Investment Program

active

Prospective

Over the last two decades, Tanzania has significantly reduced the disease burden and improved population health outcomes. The disease burden dropped from 88,225 to 41,047 disability adjusted life years (DALYs) per 100,000 population between 2000 and 2019. Over the same period, life expectancy increased from 51 to 65 years while under-five mortality and infant mortality dropped from 148 deaths and 98 deaths per 1,000 live births to 67 deaths and 43 deaths per 1,000 live births, respectively. The improvements are attributed to the control of major communicable diseases including vaccine preventable diseases, diarrheal diseases, malaria, and HIV/AIDS. Compared with mainland Tanzania, Zanzibar has low prevalence of communicable diseases of global public health significance. Despite the progress Tanzania has made, the disease burden remains high. Communicable diseases remain the major cause of morbidity and mortality. Neonatal disorders are the third key driver of the disease burden with newborn mortality rate of 27 deaths per 1000 live births. Maternal mortality ratio has stagnated at about 530 deaths per 100,000 live births in mainland Tanzania. The high total fertility rate (TFR, 5.2 per woman) together with early marriage and childbearing among adolescent girls are among the factors that partly drive the high maternal mortality. Moreover, stunting is persistently high affecting 34 percent of children under five years of age. In Zanzibar, neonatal mortality and acute malnutrition remain high. The burden of noncommunicable diseases (NCDs) is rapidly increasing and Tanzania is experiencing a double burden of disease from communicable diseases and NCDs. The operation will cover both mainland Tanzania and Zanzibar. The operation will use the PforR instrument for mainland Tanzania and an IPF for Zanzibar. The PforR Program in mainland Tanzania will finance essential RMNCAH-N services at the PHC level countrywide, selected regional referral hospitals, and activities to strengthen referral services at district and regional levels under the following five Key Result Areas: (i) maternal and child health services; (ii) Human resources for health; (iii) Emergency and referral services; (iv) health facility performance and functionality; and (v) management and accountability functions. The operation in Zanzibar using the IPF instrument will support two components (a) scale up provision of maternal and child health (MCH) services and (b) enhance institutional capacity to manage project supported activities. The primary beneficiaries of the program are women of reproductive age, adolescents, and children under the ages of five years including newborns and infants who will benefit from a package of high impact quality and cost-effective MCH interventions. Health is a nonunion matter, and mainland Tanzania and Zanzibar will each establish separate implementation arrangements. While some activities are to be implemented on a national scale, others will be focused to specific regions. The operation will contribute towards scaling up priority MCH -N interventions and addressing selected health systems bottlenecks relevant for the delivery of MCH services. The operation will prioritize obstetric and newborn care, family planning and adolescent health, emergency and referral services, quality of care, strengthening capacity for human resources for health management, ensuring functionality of the existing health infrastructure, scaling up use of electronic systems in the delivery of health services, and strengthening capacity of the community platform to deliver health services. The operation’s implementation will be mainstreamed, and part of its funding channeled through the Health Basket Fund (HBF) arrangement, which has worked well for the previous operations. The operation draws on lessons from the previous project (Strengthening Primary Health Care for Results Program, P152736), other programs in the country as well as global experiences.

FY17 - Health

World Bank Group

Project

Waste Processing and Treatment, Metal, Residential, Government, Commercial