For Tanzania, reaching MDG4 means a reduction in its mortality levels in children under five years old, which was 141 per 1000 live births in 1990. This must be reduced to 47 per 1000 by the year 2015, a two thirds reduction. Between 2000 and 2004, Tanzania achieved a reduction of 24%, with most of this success occurring after 1999. In the Article, Dr Hassan Mshinda, of the Ifakara Health Research and Development Centre, Tanzania, and colleagues examine how Tanzania made this remarkable progress, while considering if it can be sustained so the country can actually meet MGD4.
Between 1999 and 2004, the investigators found that Tanzania increased its public expenditure on health nearly twofold. They point out that an increase the budget in such a situation often correlates to positive results. "Such increased expenditure has been strongly correlated with increased survival in children younger than five years in developing countries, especially in poor people."Additionally, policy shifts occurred in 2000 in the government that leaned towards greater decentralization -- namely, grants were introduced that allowed individual districts financial resources. Thus, opportunities were opened for a local level of problem solving, and districts were selectively able to increase the resources for necessary interventions.
Alongside these funding improvements, several key child-survival interventions were given increased coverage. These include integrated management of childhood illness, insecticide-treated nets to prevent malaria, vitamin A supplemenation, immunization, and exclusive breastfeeding. Together, these funding modifications and local interventions reduced mortality in children under five by 24% between the years of 2000 and 2004.
There are a number of child health interventions that have only recently been implemented, whose effects have not yet been felt in the latest estimates, so there is significant optimism that Tanzania can maintain its progress in mortality reduction. One example of this is the increased funding to the nation from the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria. These grants were awarded in 2002 but only took effect in 2004. Another example is a larger scale of the Prevention of Mother to Child Transmission (HIV) program, and antiretroviral therapy which began in 2007. A third example is a set of programs for Zinc Supplementation and oral rehydration therapy introduced in 2007, which hopes to reduce deaths due to diarrheal illness. Finally, access to artemisinin combination therapy, an antimalarial treatment, also began in 2007.
Each of the above factors is expected to reduce child mortality in the remaining years of the Countdown. That said, the authors note that neonatal deaths, which occur in the first month of life, have not been reduced -- and these account for almost one third of child deaths in Tanzania. Additionally, material mortality has shown no progress so another of the MGDs, Millenium Development Goal 5, is not on track. It is imperative that more careful attention be paid to maternal and neonatal interventions.
The authors conclude with cautious optimism: "Broad, multifaceted progress in stewardship, public expenditure on health, decentralised financing, resource allocation, and better coverage of essential child-survival services can work synergistically to effect important progress towards MDG4 in low-income countries such as Tanzania. Increased health resources combined with strengthening of decentralised health systems to ensure that life-saving interventions reach those in need is a key child-survival strategy."
Child survival gains in Tanzania: analysis of data from demographic and health surveys
Honorati Masanja, Don de Savigny, Paul Smithson, Joanna Schellenberg, Theopista John, Conrad Mbuya, Gabriel Upunda, Ties Boerma, Cesar Victora, Tom Smith, Hassan Mshinda
Lancet 2008; 371: 1276-83
Written by Anna Sophia McKenney