[A] Reviewing the PAST
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Transcript of [A] Reviewing the PAST
Countdown to 2015 In-Depth Case Study: United Republic of Tanzania
Feedback from the HSP & Finance WorkshopNairobi, Kenya
3 March 2014
[A] Reviewing the PAST1. One Plan MTR Quantitative & Qualitative Analysis
2. HSSP III MTR of the HSSP III
3. Tanzanian Countdown Country Case Study
[B] Planning for the future1. Sharpened plan (2014 – 2015) and costing
2. One Plan (2016 – 2020) and costing (inline with the HSSP IV)
[C] Tracking progress1. Scorecards
Overview
Evaluation Framework for Countdown Country Case Study
Contextual factors including non-health system determinants- Economic growth, education, transport & communication -
NMR
MMR
Under 5 Mortality Rate
Total Fertility RateCoverage along the continuum of care
- Demand for family planning- Antenatal care visits - Delivery in a health facility- Caesarean section rate- Postnatal care- Exclusive breastfeeding- Vaccine coverage
Equity- Urban/rural residence- Socioeconomic status- Maternal education
Stillbirth Rate
INPUTS OUTPUTS OUTCOMES IMPACT
Health service readiness
Health service quality
Health service utilisation
Health Information Systems
Legislative framework
Health workforce
Infrastructure & commodities
Health system financing
Governance & leadership
WHO
Hea
lth S
yste
m B
uild
ing
Bloc
ks
Evaluation Framework for Countdown Country Case Study
Contextual factors including non-health system determinants- Economic growth, education, transport & communication -
NMR
MMR
Under 5 Mortality Rate
Total Fertility RateCoverage along the continuum of care
- Demand for family planning- Antenatal care visits - Delivery in a health facility- Caesarean section rate- Postnatal care- Exclusive breastfeeding- Vaccine coverage
Equity- Urban/rural residence- Socioeconomic status- Maternal education
Stillbirth Rate
INPUTS OUTPUTS OUTCOMES IMPACT
Health service readiness
Health service quality
Health service utilisation
Health Information Systems
Legislative framework
Health workforce
Infrastructure & commodities
Health system financing
Governance & leadership
WHO
Hea
lth S
yste
m B
uild
ing
Bloc
ks
Impact
Progress on MDG 4Reduce the under-five mortality rate by two-thirds
Absolute # of deaths
1990 2010
U5MR 170 035 179 286
NMR 43 436 52 337
Source: IHME
Impact
Progress on MDG 5.A.Reduce the maternal mortality ratio by three quarters
220
0
200
400
600
800
1000
1200
1400
1600
MM
R(D
eath
s/10
0 00
0 liv
e bi
rths)
1990 1995 2000 2005 2010 2015
Year
United Nations IHME DHS MDG 5
Maternal Mortality Ratio
MMR Average annual rate of
reduction (%)
2000 - 2010 4.6
Source: Countdown to 2015 Report (2012)
Absolute # of deaths
2010
MMR 8500
Source: Countdown Report
Global goal = <50 by 2035
One Plan Goal= 193 by 2015
Impact
Progress on MDG 5.B. – FAMILY PLANNINGAchieve universal access to reproductive health
0
20
40
60
80
100
Mar
ried
wom
en 1
5-49
(%)
1991 1996 1999 2004 2010
DHS Survey
Traditional Method CPR Modern Method CPR Unmet need
Source: DHS; (CPR: Contraceptive Prevalence Rate)
(Contraceptive prevalence plus unmet need for family planning)Demand for family planning
DHS Survey
Modern Methods
CPR
Unmet need
1991 7 27
1996 13 26
1999 19 22
2004 20 24
2010 27 25
One Plan CPR Goal= 60% by 2015
Impact
0
1
2
3
4
5
6
7
8
TFR
(chi
ldre
n/w
oman
)
1985 1990 1995 2000 2005 2010Year
UN Estimates DHSCensus
(TFR)Total Fertility Rate
Source: United Nations, Department of Economic and Social Affairs, Population Division (2011). World Population Prospects: The 2012 Revision, CD-ROM Edition; Demographic and Health Surveys; Tanzania census 1988 & 2002.
London School Analysis for Tanzanian Countdown
Total Fertility RateImpact
Evaluation Framework for Countdown Country Case Study
Contextual factors including non-health system determinants- Economic growth, education, transport & communication -
NMR
MMR
Under 5 Mortality Rate
Total Fertility RateCoverage along the continuum of care
- Demand for family planning- Antenatal care visits - Delivery in a health facility- Caesarean section rate- Postnatal care- Exclusive breastfeeding- Vaccine coverage
Equity- Urban/rural residence- Socioeconomic status- Maternal education
Stillbirth Rate
INPUTS OUTPUTS OUTCOMES IMPACT
Health service readiness
Health service quality
Health service utilisation
Health Information Systems
Legislative framework
Health workforce
Infrastructure & commodities
Health system financing
Governance & leadership
WHO
Hea
lth S
yste
m B
uild
ing
Bloc
ks
Outcomes
Demand for family 1991planning satisfied 1999
2010
Antenatal care 1991(4+ visits) 1999
2010
Births in a 1991health facility 1999
2010
Measles 1991immunisation 1999
2010
0 10 20 30 40 50 60 70 80 90 100
Coverage (%)
Poorest 20% Richest 20%
Trend in Coverage along theContinuum of Care
Source: DHS
Coverage along the Continuum of Care& identifying health gaps
Source: Demographic and Health Surveys, Tanzania London School Analysis for Tanzanian Countdown
Demand for family 1991planning satisfied 1999
2010
Antenatal care 1991(4+ visits) 1999
2010
Births in a 1991health facility 1999
2010
Measles 1991immunisation 1999
2010
0 10 20 30 40 50 60 70 80 90 100
Coverage (%)
Poorest 20% Richest 20%
Trend in Coverage along theContinuum of Care
Source: DHS
Focus of In depth Country Case Study
Family Planning
Care at Birth
Focus of the Tanzanian In-Depth Country Case Study
1. Family Planning
Better understand why the unmet need for family planning has remained constant between 1990 and the current year, and explore which women are not being reached and why?
2. Coverage and Quality of Care at Birth
Further explore which women and children are not receiving the necessary care at birth, how to bridge the inequities and to improve quality of care.
Family PlanningFamily Planning Who is being left behind?
Equity gaps: Who’s being left behind?
RURAL
POOR
LEAST EDUCATED
FROM THE WESTERN
& LAKE ZONE
MWANZA, MARA & SHINYANGA
W O M E N
LAKE
WESTERN
Care at BirthWho is being left behind?
Equity gaps: Who’s being left behind?
RURAL
POOR
LEAST EDUCATED
W O M E N
BIRTH IN A HEALTH FACILITY
BIRTH BYCASEAREAN
WHY?
Focus of this Tanzania Country Case Study
Evaluation Framework for Countdown Country Case Study
Contextual factors including non-health system determinants- Economic growth, education, transport & communication -
NMR
MMR
Under 5 Mortality Rate
Total Fertility RateCoverage along the continuum of care
- Demand for family planning- Antenatal care visits - Delivery in a health facility- Caesarean section rate- Postnatal care- Exclusive breastfeeding- Vaccine coverage
Equity- Urban/rural residence- Socioeconomic status- Maternal education
Stillbirth Rate
INPUTS OUTPUTS OUTCOMES IMPACT
Health service readiness
Health service quality
Health service utilisation
Health Information Systems
Legislative framework
Health workforce
Infrastructure & commodities
Health system financing
Governance & leadership
WHO
Hea
lth S
yste
m B
uild
ing
Bloc
ks
Health System and Policy and Finance Workshop
(Nairobi 25 – 28 Feb)
Objectives
• Build capacity for analysis of health system and health policy- related factors that have an impact on progress in reducing maternal, newborn and child mortality
• Build capacity for analysis of health financing for maternal, newborn and child health through tracking of resource flows
Specific objectives
• Health system and policy analysis– Assess adoption of technical, health sector, and multi-
sectoral policies and contextual factors that have an impact of RMNCAH and develop a policy timeline
– Assess adoption of Countdown policy tracer indicators and develop a dashboard
– Assess the extent to which policies have been translated into effective programmes
– Assess key health system characteristics and identify facilitating factors and bottlenecks for access, quality and coverage of interventions
Specific objectives
• Health financing analysis– Review types of analysis for resource tracking relevant to
country case studies– Discuss resource tracking efforts underway in countries– Refine the analysis plans
• Work in teams to familiarize with the proposed tools and methods and conduct analysis
• Develop a plan of action for the country case study and identify needs for technical assistance
Team members present at the workshop
1) Moke Magoma – E4A
2) Clement Kihinga – MoHSW
3) Theopista John – WHO
4) Melisa Martinez-Alvarez – LSHTM
5) Arin Dutta – Futures Group/USAID
6) Joy Lawn – LSHTM
7) Hoviyeh Afnan-Holmes – LSHTM
Other Countries present: Afghanistan,
Ethiopia, Kenya, Malawi, Pakistan, Peru,
Rwanda
.
What the Tanzanian team aimed to get out of this workshop?
1. Describe the overall story of policy change for women, newborns and children in Tanzania between 1990 and the current year.
2. Explore reasons for the inequity present in the provision of family planning and care at birth, understand why specific women are missing out on these essential services and how to address this need.
3. Further inform where to focus attention and resources needed for the Tanzanian Sharpened Plan.
4. Documentation of the Countdown HSP Analysis Tools 1 – 3 and further progress on the health finance analysis & scientific journal article.
5. Further plan for the National RMNCH Event (Technical products etc)
1. Describe the overall story of policy change for women, newborns and children in Tanzania between 1990 and the current year.
Accomplished this week: A better understanding of previous progress in country for MDG 4 and 5 and what needs to be done differently for the future.
Progress Made in the Workshop - HSP analyses -
Progress Made in the Workshop - HSP analyses -
2. Explore reasons for the inequity present in the provision of family planning and care at birth, understand why specific women are missing out on these essential services and how to address this need.
Accomplished this week: Further explored the qualitative data collected at a district level to answer why the inequities are present in country.
(Further analyses still to be completed.)
Progress Made in the Workshop - HSP analyses -
3. Further inform where to focus attention and resources needed for the Tanzanian Sharpened Plan.
Accomplished this week: Agreed on resources and further analyses required to inform the Tanzanian Sharpened Plan.Developed a timeline. (See later slide)
Progress Made in the Workshop - HSP analyses -
4. Documentation of the Countdown HSP Analysis Tools 1 – 3 and further progress on the scientific journal article.
Accomplished this week: Completed Tool 1 and Tool 2. Identified the demand and supply bottlenecks specific to the focus of the case study (Tool 3). Created an E-Library in Dropbox with all policy documents.
(Still to finalise the graphics to be includedin the scientific journal article.)
Progress Made in the Workshop - Finance analyses -
Accomplished this week: Reviewed the current information
Identified new data sources that need further analysis – to inform the gap analysis
Feb1 2 3 4
March1 2 3 4
April1 2 3 4
May1 2 3 4
June1 2 3 4
July1 2 3 4
RMNCH EVENT
Products
Analysis
Process
Policy BriefReport CardSharpened Plan One RMNCH Plan to 2020
HSSP (IV)
Partners Forum Meeting
Analysis completed- Impact, Coverage, Equity
Analysis to be finalised- Finance analysis – Gap Analysis- LiST – a) Short term (2015); b) Medium term (2020); c) Universal coverage- One Health Costing – Short Term (by April); Medium Term (post April)- Qualitative analysis of district performance
PLANNING MEETINGS
Details of roles and responsibilities to be drafted into a Gantt Chart
Timeline
FINALISE SCIENTIFIC ARTICLE
Next Steps• What?
– Policy Brief– Report Card– Sharpened Plan (Priority actions and Costing)– Finalize the analysis (LiST, Financial)
• Who?– Case study Team– Core team for the RMNCH Event
• When?– By End of March /First week of April ready for RMNCH Event– May for the Case study
Only 632 days left to achieve the MDG’s
Only 36-40 days to the National RMNCH Event
We need to start sprinting rather than running normally!
Kazi ni Kwetu!
Asanteni!
Dr Theopista – please change this photo to be Tanzania specific.
Timeline for In-Depth Case Study1. Start date: July 2013
2. End date: July 2014
3. Proposed products: - PPT library of slides and policy brief;- Scientific journal article; - Scorecards
4. Is a Country Countdown event planned? Yes – April 2014 (Guest of honor: President JM
Kikwete)
5. Is the in-depth case study linked to other processes in-country? Yes Please specify. - HSSP III MTR and The One Plan MTR- Sharpened RMNCH Plan (2008 – 2015); Second RMNCH Plan (2015 - 2020) which will be in line with the HSSP IV- Costed priorities for both a) Sharpened Plan (2014-2015); & b) Second RMNCH Plan (2015 – 2020)
- A Promised Renewed Campaign and The Every Newborn Action Plan- National RMNCH Scorecards