C ommo nwe a l t h memb e r c o u n t r i e s Health MDGs: The Millennium Development Goals (MDGs) mature in 2015, but monitoring of progress is ongoing due to the time it takes to collect and analyse data from each country. For Tanzania to achieve its targets for the reduction of child mortality, which form MDG 4, it should have reduced under-five deaths per 1,000 live births to 56 and increased measles immunisation to 100 per cent when the 2015 data is analysed. In 2013 under-five mortality stood at 52 deaths per 1,000 live births and measles immunisation at 99 per cent. So the country has already met part of this goal. The global MDG 5 target for maternal health is to reduce the number of women who die in pregnancy and childbirth by threequarters between 1990 and 2015. For Tanzania, the maternal mortality ratio should fall to 228 cases per 100,000 live births. In 2013 it had an adjusted maternal mortality ratio of 410 deaths per 100,000 live births (this figure was estimated at 460 deaths per 100,000 by UN agencies/World Bank in 2010). Although the maternal mortality rate is falling, Tanzania is unlikely to meet this target. Part of the goal also stipulates that 100 per cent of births must be attended by a skilled health professional. In 2010 this figure stood at 49 per cent, so achievement of this target is also looking unrealistic. A report by the United Nations Development Programme has suggested that Tanzania’s slow progress towards MDG 5 is exacerbated by the impact of HIV and AIDS. MDG 6 aims for a reduction in the prevalence of HIV, malaria and other diseases. Tanzania has shown an encouraging reduction in HIV prevalence since 1996, although the current degree of prevalence is still higher than it was in 1990. The incidence of malaria declined significantly since 2006, from 1,928,296 confirmed cases down to just 40 in 2009. However, in 2012 there were 1,986,955 cases of malaria. The estimated incidence of and mortality (when mortality data excludes cases comorbid with HIV) from tuberculosis fell significantly in the period 1990–2012. The rate of improvement for the prevalence of this disease in Tanzania is promising, showing that it could possibly achieve MDG 6. For definitions, sources and explanations on the Millennium Development Goals see page 314. Universal health coverage Just under two-fifths of health care in Tanzania (39 per cent) was government funded in 2012. The remaining 61 per cent was paid for by patients or funded by other non-governmental entities, such as private insurers, charities or employers. Total health expenditure constituted seven per cent of GDP in 2012. Expenditure by government amounts to US$16 per capita. The WHO reported in 2010 that Tanzania’s health status is continually improving, despite the challenges provided by AIDS, TB and various tropical diseases. However, fees are generally payable for health services, which puts even basic health care beyond the reach of some Tanzanians. The National Health Insurance Fund, established in 1999, is funded by compulsory payments made by public servants and covers up to five dependents, but this only caters to five per cent of the population. There is also a small private insurance industry, mainly linked to private sector employers. An alternative type of health insurance for those working in the informal sector in rural areas, the Tanzanian Community Health Fund, was launched in 2001. The equivalent for urban areas is Tiba kwa Kadi. Only a small number of people pay into it, however. The WHO Country Cooperation Strategy (2010–15) focuses on strengthening the capacity of health systems and services, as well as scaling up health service delivery. Tanzania was not an original signatory to the International Covenant on Economic, Social and Cultural Rights, but acceded to it in 1976 and has written the covenant into law. It includes ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The covenant commits signees to providing healthy and hygienic environmental conditions, controlling epidemic diseases, improving child health and facilitating access to health services without discrimination. Care of the elderly: Around 1.5 million people in Tanzania are over the age of 65 – three per cent of the total population (2013). At the age of 60 a person living in Tanzania can be expected to live for an additional 18 years, on average (2013). Overall, public pension spending is equivalent to 0.8 per cent of the country’s total economic output (2008). The over-60s can usually get free health care. Charities such as HelpAge International are active in Tanzania, educating older people about health concerns and establishing support groups. The Tanzania Development Trust has established several old people’s homes for the most needy. Further information Ministry of Health and Social Welfare: www.moh.go.tz Commonwealth Health Online: www.commonwealth health.org/health/africa/united_republic_of_tanzania 294 Commonwealth Health Partnerships 2015 Population over 65 3%
Commonwealth Health Partnerships 2015
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