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HIGHLIGHTS OF MDGs & MKUZA II IN ZANZIBAR

HEALTH SYSTEM OPPORTUNITIES & CHALLENGES

Presented by : Dr. Mkasha Hija Mkasha (On behalf of Acting DG)

Introduction

• Eight Goals were set during 1990 Millennium Development Declaration to guide the development process with defined targets for each goal which are to be achieved by 2015 or earlier

• Goal 4, 5 and 6 are directly related to

health and the remaining are indirectly related

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Intro. Cont……

• To reach the desired targets Zanzibar developed its national strategy (MKUZA- ZSGRP),

• While at Ministerial level - Health Policy which is translated into sector Strategies and annual plan of action

• Robust Health systems are required to meet the MDGs in each of the six building blocks.

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Goal 1: Eradicate extreme poverty and hunger (Indirect)

Zanzibar has shown an improvement in reducing malnutrition 4

Indicator Target 2015 Status

Reduce % of underweight for children Under 5 years

19.9% 13.9% (2014 National Nutrition Survey – Preliminary results)

Reduce % of stunting for children Under 5years

23.8% 24.4% (2014 National Nutrition Survey – Preliminary results)

Goal 4: Reduce child mortality Progress has been made in reducing infant and child mortality

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Indicator Target 2015 Status

Reduce Under-five mortality rate (U5MR)

67/1,000 live births

66/1,000 live births (2012 census preliminary results)

Reduce infant mortality rate (IMR)

40/1,000 live births

46/1,000 live births (2012 census preliminary results)

Increase Proportion of children vaccinated against measles

100% >100% (HMIS Bulletin ,2013)

Reduce Neonatal mortality rate (NMR)****MKUZA

15/1,000 live births

29/1,000 live-births (2009/10 TDHS)

Goal 5: Improve maternal health

1. Reduce Maternal Mortality

MMR 2015 target = 170 /100,000 live births.

Remains a challenge

Joints efforts are needed to reduce

Trend of MMR

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Improve maternal health cont...Indicator Target

2015Status

2. Proportion of births attended by skilled health personnel

90% 60% (HMIS Bulletin, 2013)

3. Increase percentage of birthsdelivered in health facilities*** MKUZA

60% 56.6% (HMIS Bulletin, 2013

4. Contraceptive prevalence rate*** MKUZA20% 12.4% (TDHS 2009/10)

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Goal 6: Combat HIV/AIDS, malaria and other diseases HIV: Indicator Target 2015 Status

HIV prevalence among general population*** MKUZA

< 1% 1.1% (2012 THMIS)

HIV prevalence among pregnant women aged 15 -24 years

0.3% 0.6% (2014 ANC surveillance)

HIV Prevalence among CSW reduced *** MKUZA

5.4% 8.6% (IBBSS, 2012)

HIV Prevalence among MSM*** MKUZA

6.1% 2.6% (IBBSS, 2012)

HIV Prevalence among IDUs reduced *** MKUZA

7.5% 11.3% (IBBSS, 2012)

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HEALTH SYSTEM OPPORTUNITIES & CHALLENGES

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Opportunities• Political stability and commitment• Availability of national plans to support MDGs

implementations (Vision 2020, MKUZA and sector policy and strategies

• Government commitment in health issues• Partners financial and technical support to the health

sector• Extensive health system in Zanzibar• Health management information system (HMIS) uses

(DHIS2)

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Challenges Governance• Implementation of the health policy• Inadequate monitoring and follow up

Human Resource• Inadequate skills in caring neonates• Treatment according to guidelines is a

challenge at all levels

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Challenges ….Human Resource cont...

• Shortage of medical specialist (high number of support staff) –Gynecologist: none available vs.

minimum staff requirement = 12–Anesthetic nurses and doctors are not

available all maternity emergencies in all hospitals

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Challenges ….

Logistic, Drugs and Medical Supplies• Inadequate medical equipment, drugs and

supplies

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Challenges ….

Finance• Underfunding of the health sector (per capita

expenditure is ($23) which is lower than that recommended by WHO of $ 60

• Donor - driven support• Sustainability of Malaria financing• Imbalance funding from vertical programmes (lots of

fund are allocated to vertical programs than other areas)

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Challenges …Service delivery• Negative attitudes in provision of health

services (YFS and condom)• No referral guidelines at all levels• Low health education in the community• In adequate interventions on neonatal

death

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Challenges ….Health Information • Incomplete data for neonatal deaths at

community • High stigma for PLHIV• Insufficient of vital data on civil registration• Causes of morbidity and mortality are not

classified using ICD 10

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Thank you

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