GOAL 5: IMPROVE MATERNAL HEALTH
NATIONAL TARGET SIX: REDUCE BY THREE-QUARTERS, BETWEEN 1990 AND 2015, THE MATERNAL MORTALITY RATE
Status and Trends
Statistically, maternal mortality contributes to only 2.3 per cent of the total mortality. Still births make up 6.7 per cent of total mortality. There are also causes of mortality that are related to poor health including malnutrition. Over half of expectant women deliver at home and not at health facilities and as such may not be attended by skilled personnel or have access to Emergency Obstetrics Care (EmOC). Most recent DHS (DHS 2010) data show that maternal mortality situation has improved somewhat from a deteriorating trend observed in the mid 2000s in Tanzania.
Figure 5: Progress in achieving MDG5 Target 6
Source: TDHS 2010
The estimated maternal mortality rate in 2010 at 454 is an improvement from 578 in 2005 and 529 in 1999 (TRCHS data). Even with this turnaround the challenges of reducing maternal mortality to the targeted levels under MDGs are enormous. Improvements have also been made in the proportion of births attended by skilled health personnel (41 per cent in 1999, 46 per cent in 2004 and 51 per cent in 2010), and births taking place in health facilities (44 per cent in 1999, 47 per cent in 2004 and 50 per cent in 2010). The slow progress in reducing maternal mortality on Mainland is compounded by the impact of the HIV and AIDS epidemic. Most of the maternal deaths are preventable, hence the need to ensure continuum of care from the community level such as through instituting Emergency Obstetric Care (EmOC).
The approach of focusing on the unborn child and stopping treatment of the mother immediately after delivery under PMTCT was changed to PMTCT+ to now address post delivery time as well.
Major Challenges and Priorities
Reduction in maternal mortality requires urgent scaling up of actions in the following areas: EmOC; making voluntary counselling and testing for HIV and AIDS a routine for expectant mothers; establishing maternal obstetric theatres and surgical interventions in remote and more disadvantaged areas (at the Health Centre level) and upgrading the skills of Assistant Medical Officers to enable them handle maternal operations at the health centre levels. Provision of incentives for the skilled staff to work at those stations. Other includes improving the referral system to be more responsive to emerging challenges; increasing health and reproductive health facilities in order to minimize distance for travel to increase accessibility; and addressing the human resource crisis by deployment of skilled staff with the correct skills mixes.
Other challenges include addressing infrastructure problems and increasing working space to meet the needs of rural areas; improving women’s access to quality health and reproductive services; and improving the status of women in society e.g. education, property rights and decision-making. Other areas include improving training to impart the required skills (obstetrics); improving motivation in order to retain human resources in the health sector; decentralizing decision making to the lower level; and involving communities to participate in health services management and ownership and accelerating PMTCT programme.
Quick Impact Interventions
- Provision of Emergency Obstetric care at Health center level;
- Fast tracking the employment of skilled staff at all levels with specific focus to the remote rural areas;
- Enhancing access to obstetric services by making the services a public good and thus to be provided free at the time of use. These services cover ante natal and post natal services up to 42 days after delivery;
- Ensuring that ITNs are accessed by voucher prepaid by the government; and
- Providing expecting mothers with free anti-malaria drugs during pregnancy (presumptive treatment).
Likelihood of achieving MDG5
The very slow progress in reducing maternal mortality in the past means Tanzania is off track in achieving MDG5 and unlikely to be achieved by 2015.
Ministry of Planning, Economy & Empowerment (MPEE). Millennium Development Goals, Progress Report. December 2006. Available at http://www.povertymonitoring.go.tz