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Campaign on Safe Motherhood & Child Survival: Experience from Tanzania

By Emmanuel Kihaule Communications Advisor-Plan International Tanzania Friday March 12, 2010 At the 3rd Forum on the African Charter on the Rights and Welfare of the Child, Addis Ababa-Ethiopia
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Plan at a glance
Who we are
‡ Plan is an international child-centred development organization without religious, political or governmental affiliation.

When we started
‡ Founded over 70 years ago, one of the oldest and largest international development agencies in the world working in 66 countries across the globe.

Our Primary Partners
‡ Plan works with and for children, their families, communities and governments to implement programmes at grassroots level in health, education, water and sanitation, income generation and building relationships across cultures.

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Our Vision
‡ Our vision is of a world in which all children realize their full potential in societies which respect people¶s rights and dignity and therefore empower children to realize their basic rights including survival, development, protection and participation.

Where we work in Tanzania
‡ In Tanzania Plan started implementing its programmes in 1991 and has projects in Dar es Salaam (Ilala), Kisarawe, Kibaha, Ifakara, Mwanza and Geita.

Our Programmes in Tanzania
-Sauti ya Watoto (Children¶s Voice) -Community Health Promotion -Enabling Children to Learn -Water and Environmental Health -Sustainable Family Livelihoods

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A grim picture
‡ Tanzania is among the top ten sub-Saharan African countries contributing to 61% of global maternal deaths and 66% of all newborn deaths (One Plan, 2008). ‡ The country loses 8000 women annually due to maternal health complications (TDHS 2004/2005) ‡ The Maternal Mortality Ratio (MMR) has remained consistently high over the past ten years currently estimated to be 578 per 100000 live births. ‡ Only 46% of births are attended by a skilled birth attendant meaning that 54% give birth at home with assistance of traditional birth attendants (TDHS 2004/2005) ‡ The country only has 32% of the qualified staff needed (TDHS 2004/2005)

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grim picture contd.
‡ Children below five years constitute about 16% of the population, however, they account for 50 percent of the total mortality burden for all ages. ‡ In Plan supported areas the maternal mortality rates are also high and range between 217/100,000 in Mwanza and 578/100,000 in Kisarawe. ‡ Infant and under five mortality rates are also high whereby the under five mortality rate ranges from 99/1000 in Ifakara to 145/1000 in Kisarawe. ‡ Poor budget allocation/prioritization (the available budget could have been distributed better) ‡ Low education among the public (infant and child mortality is highest in women without education) ‡ © Plan Traditional beliefs and practices e.g. on malnutrition

, immunisation among others.

Causes 
Major direct causes of maternal mortality include obstetric hemorrhage, obstructed labour and pregnancy induced hypertension. 

Most of these deaths are due to preventable diseases like malaria, pneumonia, diarrhea, HIV/AIDS, malnutrition and neonatal conditions. 

According to annual Health Statistical Abstract Tanzania mainland 2008, severe malaria is the main killer disease and in 2006 alone it accounted for 33% of all under five deaths, followed by pneumonia 13%, anemia 13% and diarrhea 5%. 

Malnutrition is a contributory factor to about 50 percent of all deaths.

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Safe motherhood and child survival campaign in Tanzania
Background
‡Born in March 2004 the White Ribbon Alliance of Tanzania resulted from the attendance of some of its founding members to; -The International Conference on Safe Motherhood Best Practices organized by Global White Ribbon Alliance-October 2002 (India) and -a workshop on the same that was held in Lusaka, Zambia

Objective
To advocate for maternal, newborn and child health in Tanzania in response to high maternal, infant and child mortality rates.

Membership
In March 2004 (when launched) WRATZ had 13 members only but now it has 2500 individual members and 107 member organizations both local and international. Fast growing.
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The campaign¶s front
‡ Awareness creation campaigns throughout the country including mass and community media, communications support materials, community dialogues, house to house visits, dialogues with Govt officials, among others. ‡ Community mobilization against bad traditional and cultural beliefs/practices ‡ Advocacy e.g. for policy change/enforcement, more budgetary allocation, improvement of healthcare service delivery to mothers and children, the rolling-out of IMCI (Integrated Management of Childhood Illnesses), and c-IMCI ‡ Training of CORPs to work as Voluntary Health Workers right at village level ‡ Facilitating access to health services to mothers, newborns and children including PMTCT (by some members). ‡ Annual celebrations to mark the Safe Motherhood and Child Survival Day (see advocacy package)
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Achievements
‡ Infant mortality rate improved from 68 in 2004 (TDHS 2004/2005) to 58 per 1,000 live births in 2008 and the under-five mortality has declined from 112 in 2004 to 91 per 1000 live births in 2008 (HIV/AIDS and Malaria Survey 2007/2008 by TACAIDS) ‡ Prevention of Mother to Child Transmission of HIV (PMTCT) services have been rolled out in all district hospitals, all health centers and some dispensaries. ‡ Enhanced political will on the country¶s leadership e.g. full support and participation of top most Government officials i.e. Presidents, Prime Ministers, Ministers, First Ladies etc. ‡ Enhanced public awareness ‡ Ever expanding membership base with commitments to take the work to higher levels

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Challenges
‡ Maternal (neonatal) mortality has remained the same in the past 10 years ‡ Though slightly dropped, infant and under five mortality rates still unacceptably high ‡ Poor budgeting from family to national level ‡ Traditional and cultural beliefs/practices are die hard elements in our society ‡ Low education level among the public ‡ Poor infrastructure and equipment ‡ Low number of qualified staff ‡ Unreliable power supply ‡ Long distance to health centres/facilities especially in remote rural areas

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Hope/commitments by Government
‡ The National Road Map Strategic Plan to accelerate Reduction of maternal, Newborn and Child Deaths in Tanzania 2008-2015 ‡ Plan by the Government under the Primary Health Services Development Program (PHSDP) 2007-2017 to construct 3088 dispensaries, 19 district hospitals, 95 maternity waiting homes and 2,074 health centers. ‡ Under the Plan, services provided by health centers and district hospitals focusing on maternal health will be improved through strengthening 2555 health centers and 62 district hospitals. ‡ This has already begun in several parts of the country starting with those in dire need.

‡ Will we reach there? MDG 4. Reduce child mortality MDG 5. Improve maternal health
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Reduce by two-thirds the mortality rate of children under five Reduce by three-quarters the maternal mortality ratio

THANK YOU FOR LISTENING

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