With its rugged plains, snow-capped Mt. Kilimanjaro, and beautiful coastline, Tanzania is one of Africa's natural gems. Yet, the country has been faced with significant sexual and reproductive health challenges over the last few decades, including elevated rates of HIV and AIDS and a total fertility rate that has remained high. While major investments by the US Government and the Global Fund for HIV and AIDS, TB, and malaria have led to improved access to anti-retrovirals, increased condom-use, and demand for HIV testing, serious gaps in care remain. More than 5.7 percent of the population is HIV-positive, more than half of whom are women. At the same time, maternal mortality in Tanzania is unacceptably high, as the lifetime risk of maternal mortality is one in 24.
Since 1984, Pathfinder has had a strong presence in Tanzania, working closely with the government and with local partners to improve access to reproductive health and HIV and AIDS services, while also building the capacity of local NGOs. Based on our experience delivering community home?based care for people living with HIV and AIDS, Pathfinder is continuously working to integrate family planning services at the community level. Through trainings and the creation of a distribution system, Pathfinder has equipped community health workers with supplies to deliver information and non?clinical contraceptive commodities, such as condoms, to people in their homes.
For much of the past decade, Pathfinder has focused on a community approach to providing services to people infected with and affected by HIV and AIDS. What started as an effort to provide nursing care for the terminally ill has evolved into providing a range of services that improve the health and extend the lives of the families and clients we serve. Home-based care, in concert with a two-way referral system between communities and health facilities, ensures linkages to a range of quality social and health services such as family planning, prevention of mother-to-child transmission, and support for orphans and other vulnerable children. In particular, strengthening the ties between HIV and family planning services at the community level gives families the information and options they need to make the best choices for their reproductive health.
Pathfinder recently engaged in a new initiative specifically focusing on the elimination of pediatric AIDS through community-based efforts and involvement of local partners. Other innovative projects have included work to combat the high rates of maternal mortality in refugee camps by training health providers to use a new technology to treat postpartum hemorrhage, as well strengthening health systems in one of the poorest and most remote regions of Tanzania by highlighting connections between reproductive health and natural resource management.
Evidence for Decision-Making
A key aspect of Pathfinder's approach to systems' strengthening is collecting evidence that enables public, private, and community partners to make informed health-related decisions. In Tanzania, examples of the kinds of evidence we collect to range from the "number of new or continuing patients, disaggregated by sex and age, who return for the results of an HIV test after counseling and testing." and the "number of women diagnosed with postpartum hemorrhaging who received treatment " to the "number of health facilities upgraded to provide family planning services." Some illustrative data from Pathfinder's work in Tanzania suggests that:
- As of December 2011, 1258 active home-based care providers are operating in the field.
- Between September 2009 and December 2011, 77,843 individuals were referred to HIV-related services, disaggregated by type of service.
- Between April 2009 and December 2011, 90,643 couple-years of protection were provided through contraception, disaggregated by method.
Building Capacity, Strengthening Systems
While there has been tremendous progress in delivering health services in Tanzania, many gaps remain. The country has less than 40 percent of the health personnel it needs to deliver planned services. People in rural communities have difficulties in accessing health services. As the population of the country grows, the health care delivery system is unable to cope with increasing demand for services. Therefore, in Tanzania, Pathfinder is partnering with the national government, local governments, and local civil society organizations to improve access to quality reproductive health services at the community level. To do this, Pathfinder works with the local partners to deliver home-based care services to people living with HIV and AIDS; family planning counseling and services for all potential clients in the community; home-based counseling and testing services to address stigma and reduce opportunity costs incurred; and, the establishment of systems to address gender-based violence. Pathfinder enables local organizations, such as the Tanzania Red Cross Society, to establish community-based services, while at the same time strengthening local government capacity to provide technical support, oversight, and overall management support to ensure that community-based services link strongly with the established network of government health facilities.
To support the delivery of health services at the community level, Pathfinder is also working to:
- Advocate for greater allocation of financial and human resources for health care at national and local government levels;
- Increase community engagement in health service delivery; and,
- Increase support for mechanisms to enable communities to hold their governments accountable for the delivery of reproductive health services.
In order to institutionalize capacity, Pathfinder works with the Ministry of Health and Social Welfare to establish in-service training materials for community-based health workers on the delivery of family planning services, the establishment of youth-friendly reproductive health services, home-based care for people living with HIV and AIDS, community-based integration of family planning and HIV services, and on improving health worker response to survivors of gender-based violence. Pathfinder is also collaborating with the Ministry to integrate and prioritize family planning in the local government budgeting process. Finally, Pathfinder is working with the Muhimbili University Health and Allied Sciences School of Public Health to establish a graduate degree program in behavior change, in order to enable Tanzanians to better understand and therefore better develop programs that support individuals, families, communities, and societies seeking to change key behaviors.
An Effective Response
Among the health and development priorities for Tanzania are maternal and newborn health and the HIV and AIDS epidemic. These two areas of concern contribute not only to high morbidities and mortalities, but also to an overall impediment in the socio-economic development of the country. Only 27 percent of married women use modern contraceptive methods and the unmet need for family planning has increased from 22 percent in 2004 to 25 percent in 2010. And while Tanzania has successfully scaled the provision of anti-retrovirals to HIV-positive people, the HIV prevalence rate is currently at 5.6 percent . It is for these reasons that national policies, frameworks, strategies, and plans have been developed and implemented to address both maternal and newborn health and the HIV epidemic. The country's target is to increase the current contraceptive prevalence rate to 60 percent by the year 2015.
In Tanzania, Pathfinder works to prevent violence against children and adolescents at the household and community level.
Pathfinder, Vodafone Foundation and Touch Foundation have come together to reduce maternal mortality and morbidity in Tanzania. The project expands availability of comprehensive emergency obstetric care and implements community level activities to reduce maternal mortality during delivery and childbirth.
In Nigeria, Tanzania, and Uganda, Pathfinder aims to improve the capacity of community-based organizations to better prevent mother-to-child transmission of HIV.
With the human population in the Greater Mahale Ecosystem growing rapidly, in conditions of extreme poverty and ill health, this project used a model of population, health, and environment to address reproductive health and natural resource management.
Putting Reproductive Health Back on the Map: A Demand Driven Approach for Increased Funding for Family Planning
In Tanzania, Pathfinder promoted a more efficient and higher quality service delivery system by increasing national focus on family planning and combining efforts with AIDS initiatives.
This project provides community-home-based-care for people living with HIV and AIDS and their families. Pathfinder also works in the community to reduce the stigma and increase the voice and visibility of people living with HIV and AIDS.
Pathfinder’s mHealth in Tanzania began in 2008 with funding from the Center for Disease Control. The project uses mobile technology to improve communication and reporting between health clinics, home-based care providers and clients.
This article retrospectively analyzes the scale up of adolescent-friendly contraceptive services in five countries and draws lessons learned to inform implementation and sustainable scale up of HIV and other services for adolescents.
The purpose of the Working Paper Series is to disseminate work in progress by Pathfinder International staff on critical issues of population, reproductive health, and development.
This study examined the experiences of adolescents living with HIV in Tanzania in order to identify ways to improve home based care to better meet their needs.
Right now, communities face two interconnected crises—how to protect their health and the environment they depend on. The problems are complex. And Pathfinder is up to the challenge.