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Effective Tanzanian health care management decreases child death rates by 40 per cent

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Fund health systems, not projects, say researchers

Katherine Nightingale, 14 April 2008

[LONDON] Investment in health systems — not just in specific health intervention projects — is key to achieving the Millennium Development Goals (MDGs) on maternal and child health, say experts. The 'Countdown to 2015' initiative — which tracks progress in reducing child and maternal deaths under the MDGs — cites Tanzania as an example of a country that manages its health investment well.

The initiative highlights a study published in a special issue of The Lancet last week (10 April) showing that Tanzania is on track to hit the fourth MDG — to reduce mortality in children under five years old by two-thirds from 1990 to 2015. Researchers in Tanzania calculated the annual death rates in children under five between 1990 and 2004, finding a decrease of 40%, with the sharpest decrease (24%) occurring between 2000 and 2004.

The heath service in Tanzania improved vastly between 1999 and 2004, they say. Policy changes led to a doubling of government spending on health. Donor and government funds were also pooled to create a 'basket fund' for redistribution in individual districts, providing additional funds per person. This decentralisation allowed the scaling up of key interventions such as provision of insecticide-treated bednets against malaria infection, vitamin A supplementation against blindness and oral rehydration therapy against diarrhoea.

Tanzania is one of only a handful of countries to request that donors give funds to their general budget rather than to specific health projects, such as immunisation programmes. The country itself can therefore decide how to spend the money. Only two per cent of donor money to maternal and child health is given in this way, according to the Countdown initiative.

"[Tanzania's success] is because the government has taken charge and changed their policies. Through this approach they've actually got a much more reliable source of support," said Liz Mason, director of the Department of Child and Adolescent Health and Development at the WHO, speaking at the launch of The Lancet special issue on maternal and child health in London, United Kingdom, last week (10 April).

"We need a balanced focus and effort in investment in what are sometimes called 'vertical interventions' — such as vaccination and immunisation — with investment in strengthening the health systems," said Ann Starrs, president of Family Care International, a US-based non-profit organisation working to improve maternal health. But, she adds, it's not a matter of diverting money away from projects. "We need the whole [financial] pie to grow. And then we need the investments in the projects to be met by the health system. Ask any minister of health and that's what they'll say."

Less than a quarter of priority countries — those that account for 97 per cent of all maternal and child deaths — are on track to meet the MDGs on maternal and child deaths, says Countdown to 2015. This will be discussed in their report, due to be launched in Cape Town, South Africa, this week (16 April).

Link to full paper in The Lancet*(Free registration is required to view this article)

This article was distributed by the Science and Development Network, SciDev Net, a not-for-profit organisation dedicated to providing reliable and authoritative information about science and technology for the developing world. Its website www.scidev.net gives policymakers, researchers, the media and civil society information and a platform to explore how science and technology can reduce poverty, improve health and raise standards of living around the world. SciDev Net also builds developing countries’ capacity for communicating science and technology through a regional networks of committed individuals and organisations, practical guidance and specialist workshops.

For a fascinating insight into how donor countries can support this approach, see Real Health News' interview with Tore Godal, Special Advisor on Maternal and Child Health to Norwegian prime minister Jens Stoltenberg. "On 26 September 2007, Stoltenberg announced plans for a radical transformation of international development funding, with a ‘Global Campaign for the Health MDGs’. Developing countries will prepare their own national plans to achieve Millennium Development Goals 4, 5 and 6 to reduce child and maternal mortality, and combat AIDS and other diseases, while donors will relate their support to the countries’ plans; and support will depend on measured results. The Campaign could be extended to the whole of health, and even development, and become each country’s truly Global Business Plan." The interview notes that Tanzania and Pakistan are two pilot countries for this approach.






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