Tanzania's Countdown to 2015: an analysis of two decades of progress and gaps for reproductive, maternal, newborn, and child health, to inform priorities for post-2015
Tanzania's Countdown to 2015: an analysis of two decades of progress and gaps for reproductive, maternal, newborn, and child health, to inform priorities for post-2015
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DOI：
10.1016/s2214-109x(15)00059-5
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发表时间：
2015-07-01
影响因子：
34.3
通讯作者：
Lawn, Joy E.
中科院分区：
文献类型：
--
作者：
Afnan-Holmes, Hoviyeh;Magoma, Moke;Lawn, Joy E.
背景坦桑尼亚正在按部就班地实现关于儿童生存的千年发展目标4，但在新生儿生存和产妇保健(千年发展目标5)和计划生育方面进展不足。为了理解这一喜忧参半的进展，并确定2015年后时代的优先事项，坦桑尼亚被选为2015年倒计时案例研究。方法我们分析了坦桑尼亚在1990年至2014年期间在孕产妇、新生儿和儿童死亡率方面取得的进展，以及未得到满足的计划生育需求，其中我们使用卫生系统评估框架来评估保健、卫生系统、政策和投资连续体系中干预措施的覆盖率和公平性，同时也考虑了背景变化(如经济和教育)。我们有五个目标，对卫生系统评估框架的每一级进行评估。我们使用拯救生命工具(LIST)并进行多元线性回归分析，以解释坦桑尼亚儿童死亡率的下降。我们分析了孕产妇和新生儿存活率和计划生育变化较慢的原因，以便为到2030年结束可预防的孕产妇、新生儿和儿童死亡的优先事项提供信息。过去20年来，坦桑尼亚的人口规模翻了一番，需要将卫生和社会服务翻一番，以保持覆盖范围。卫生保健资金总额也翻了一番，捐助者为儿童健康和艾滋病毒/艾滋病提供的资金增加了两倍多。连续照料的趋势各不相同，预防性儿童保健服务达到高覆盖率(85%)和公平(社会经济地位差异13-14%)，但儿童治疗服务(覆盖率71%，社会经济地位差异36%)、设施交付(覆盖率52%，社会经济地位差异56%)和计划生育(覆盖率46%，社会经济地位差异22%)的覆盖率较低，不平等程度更大。清单分析表明，大约39%的儿童死亡率下降与干预措施覆盖面的扩大有关，特别是免疫接种和杀虫剂处理蚊帐的覆盖面。经济增长还与儿童死亡率的降低有关。儿童健康方案侧重于卫生系统较低级别(如社区和药房级别)选定的高影响力干预措施。尽管产妇保健是高度优先事项，但它的实施一直是断断续续的。新生儿存活率自2005年以来才受到关注，但高影响力的干预措施已经在实施。坦桑尼亚在生殖、孕产妇、新生儿和儿童健康方面的进展喜忧参半，这表明政治优先、卫生筹资和持续执行之间存在复杂的相互作用。坦桑尼亚2015年后的优先事项应侧重于未得到满足的计划生育需求，特别是在西部地区和湖泊地区；解决特别是在农村地区的出生保健覆盖率和质量方面的差距；以及继续在儿童健康方面取得进展。
Background Tanzania is on track to meet Millennium Development Goal (MDG) 4 for child survival, but is making insufficient progress for newborn survival and maternal health (MDG 5) and family planning. To understand this mixed progress and to identify priorities for the post-2015 era, Tanzania was selected as a Countdown to 2015 case study.Methods We analysed progress made in Tanzania between 1990 and 2014 in maternal, newborn, and child mortality, and unmet need for family planning, in which we used a health systems evaluation framework to assess coverage and equity of interventions along the continuum of care, health systems, policies and investments, while also considering contextual change (eg, economic and educational). We had five objectives, which assessed each level of the health systems evaluation framework. We used the Lives Saved Tool (LiST) and did multiple linear regression analyses to explain the reduction in child mortality in Tanzania. We analysed the reasons for the slower changes in maternal and newborn survival and family planning, to inform priorities to end preventable maternal, newborn, and child deaths by 2030.Findings In the past two decades, Tanzania's population has doubled in size, necessitating a doubling of health and social services to maintain coverage. Total health-care financing also doubled, with donor funding for child health and HIV/AIDS more than tripling. Trends along the continuum of care varied, with preventive child health services reaching high coverage (>= 85%) and equity (socioeconomic status difference 13-14%), but lower coverage and wider inequities for child curative services (71% coverage, socioeconomic status difference 36%), facility delivery (52% coverage, socioeconomic status difference 56%), and family planning (46% coverage, socioeconomic status difference 22%). The LiST analysis suggested that around 39% of child mortality reduction was linked to increases in coverage of interventions, especially of immunisation and insecticide-treated bednets. Economic growth was also associated with reductions in child mortality. Child health programmes focused on selected high-impact interventions at lower levels of the health system (eg, the community and dispensary levels). Despite its high priority, implementation of maternal health care has been intermittent. Newborn survival has gained attention only since 2005, but high-impact interventions are already being implemented. Family planning had consistent policies but only recent reinvestment in implementation.Interpretation Mixed progress in reproductive, maternal, newborn, and child health in Tanzania indicates a complex interplay of political prioritisation, health financing, and consistent implementation. Post-2015 priorities for Tanzania should focus on the unmet need for family planning, especially in the Western and Lake regions; addressing gaps for coverage and quality of care at birth, especially in rural areas; and continuation of progress for child health.