COOPERATION
STRATEGY
2016‒2020
TANZANIA
COOPERATION
STRATEGY
2016‒2020
United Republic of Tanzania
WHO Country Cooperation Strategy
AFRO Library Cataloguing-in-Publication Data
United Republic of Tanzania WHO Country Cooperation Strategy 2016-2020
1. Health planning — organization and administration 2. Health Priorities — organization and administration 3. Achievement
4. Health Planning Technical Assistance — organization and administration 5. International Cooperation
6. Tanzania
, :RUOG+HDOWK2UJDQL]DWLRQ5HJLRQDO2I¿FHIRU$IULFD ,,7LWOH
ISBN: … 978-929023346-6«1/0&ODVVL¿FDWLRQWA 540 HT3)
:+25HJLRQDO2I¿FHIRU$IULFD2016
Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights UHVHUYHG&RSLHVRIWKLVSXEOLFDWLRQPD\EHREWDLQHGIURPWKH/LEUDU\:+25HJLRQDO 2I¿FH IRU $IULFD 32 %R[ %UD]]DYLOOH 5HSXEOLF RI &RQJR 7HO )D[ (PDLO DIUJRDIURERRNV#ZKRLQW 5HTXHVWV IRU SHUPLVVLRQ to reproduce or translate this publication – whether for sale or for non-commercial distribution – should be sent to the same address.
The designations employed and the presentation of the material in this publication do QRWLPSO\WKHH[SUHVVLRQ RIDQ\RSLQLRQ ZKDWVRHYHURQWKHSDUWRIWKH:RUOG+HDOWK 2UJDQL]DWLRQFRQFHUQLQJWKHOHJDOVWDWXVRIDQ\FRXQWU\WHUULWRU\FLW\RUDUHDRURILWV DXWKRULWLHVRUFRQFHUQLQJWKHGHOLPLWDWLRQRILWVIURQWLHUVRUERXQGDULHV'RWWHGOLQHVRQ PDSVUHSUHVHQWDSSUR[LPDWHERUGHUOLQHVIRUZKLFKWKHUHPD\QRW\HWEHIXOODJUHHPHQW
7KH PHQWLRQ RI VSHFL¿F FRPSDQLHV RU RI FHUWDLQ PDQXIDFWXUHUV¶ SURGXFWV GRHV QRW imply that they are endorsed or recommended by the World Health Organization in SUHIHUHQFHWRRWKHUVRIDVLPLODUQDWXUHWKDWDUHQRWPHQWLRQHG(UURUVDQGRPLVVLRQV H[FHSWHGWKHQDPHVRISURSULHWDU\SURGXFWVDUHGLVWLQJXLVKHGE\LQLWLDOFDSLWDOOHWWHUV
Contents
Map of Tanzania iv
Acronyms v
Preface vi
([HFXWLYHVXPPDU\ YLL
Chapter 1: Introduction 1
Chapter 2: Health and development situation 3
3ROLWLFDOPDFURHFRQRPLFDQGVRFLDOFRQWH[WV
2.2 Social determinants of health 4
2.3 Health status of the population 5
'HYHORSPHQWFRRSHUDWLRQDQGWKH8QLWHG5HSXEOLFRI
7DQ]DQLD¶VUROHLQWKHJOREDOKHDOWKDJHQGD
2.5 Health sector challenges 13
Chapter 3: Review of the WHO cooperation in the last CCS cycle 14
Chapter 4: Strategic agenda for WHO cooperation with the United Republic
RI7DQ]DQLD
4.1 CCS III strategic priorities and focus areas 18
4.2 Strategic actions for the implementation of CCS III 25
Chapter 5: Implementing the strategic agenda 30
5.1 Implications for the entire WHO Secretariat 30
,PSOLFDWLRQVIRUWKHFRXQWU\RI¿FH
,PSOLFDWLRQVIRUWKH:+25HJLRQDO2I¿FHIRU$IULFD
,PSOLFDWLRQVIRU:+2KHDGTXDUWHUV
5.5 Monitoring and evaluation 31
...
...
...
...
...
...
... ...
... ...
...
...
... ...
... ...
...
...
...
...
Acronyms
CCS Country Cooperation Strategy
&'& 8QLWHG6WDWHV&HQWHUVIRU'LVHDVH&RQWURO
CSSC Christian Social Services Commission
CSO Civil Society Organization
'),' 'HSDUWPHQWIRU,QWHUQDWLRQDO'HYHORSPHQW '3* 'HYHORSPHQW3DUWQHUV*URXS
)<'3 )LYH<HDU'HYHORSPHQW3ODQ *%9 *HQGHU%DVHG9LROHQFH *'3 *URVV'RPHVWLF3URGXFW *3: *OREDO3URJUDPPHRI:RUN
*6+6 *OREDO6FKRRO%DVHG6WXGHQW+HDOWK6XUYH\
HMIS Health Management Information System
HRH Human Resources for Health
HSSP Health Sector Strategic Plan IHR International Health Regulations
0'*V 0LOOHQQLXP'HYHORSPHQW*RDOV
0.8.87$ .LVZDKLOL$FURQ\PIRUWKH1DWLRQDO6WUDWHJ\IRU*URZWKDQG5HGXFWLRQ
of Poverty
MKUZA Kiswahili Acronym of the Zanzibar Poverty Reduction Plan
02+&'*(& 0LQLVWU\RI+HDOWK&RPPXQLW\'HYHORSPHQW*HQGHU(OGHUO\DQG
Children
1&' 1RQFRPPXQLFDEOH'LVHDVHV 17'V 1HJOHFWHG7URSLFDO'LVHDVHV
307&7 3UHYHQWLRQRI0RWKHUWR&KLOG7UDQVPLVVLRQRI+,9
PPP Public-Private Partnership
501&$+ 5HSURGXFWLYH0DWHUQDO1HZERUQ&KLOGDQG$GROHVFHQW+HDOWK 6'*V 6XVWDLQDEOH'HYHORSPHQW*RDOV
67(36 67(3ZLVHDSSURDFKWRVXUYHLOODQFH
SWAp Sector-Wide Approach
7'+6 7DQ]DQLD'HPRJUDSKLFDQG+HDOWK6XUYH\ 7)'$ 7DQ]DQLD)RRGDQG'UXJV$XWKRULW\
7+0,6 7DQ]DQLD+,9$,'6DQG0DODULD,QGLFDWRU6XUYH\
UN United Nations
81'$3 8QLWHG1DWLRQV'HYHORSPHQW$VVLVWDQFH3ODQ
UNFPA United Nations Population Fund
81,&() 8QLWHG1DWLRQV&KLOGUHQ¶V)XQG
86$,' 8QLWHG6WDWHV$JHQF\IRU,QWHUQDWLRQDO'HYHORSPHQW :$6+ :DWHU6DQLWDWLRQDQG+\JLHQH
Preface
The implementation period for this Country Cooperation Strategy (CCS) will coincide with major developments not only in the United Republic of Tanzania but also globally. At WKHJOREDOOHYHODUHWKH6XVWDLQDEOH'HYHORSPHQW*RDOV6'*VDGRSWHGLQ6HSWHPEHU DWWKH8QLWHG1DWLRQV*HQHUDO$VVHPEO\RQHRIZKLFKLVRQKHDOWK6'*IRFXVHV RQHQVXULQJKHDOWK\OLYHVDQGSURPRWLQJZHOOEHLQJIRUDOODWDOODJHV+HDOWKLVOLQNHGWR RWKHU6'*V7KH6'*VDUHLQWHJUDWHGDQGLQGLYLVLEOH
Universal Health Coverage is both a goal in itself and the means of achieving the overall KHDOWK JRDO RI HQVXULQJ HTXLWDEOH DFFHVV WR HYHU\RQH WKH KHDOWK VHUYLFHV WKH\ QHHG ZLWK ¿QDQFLDO SURWHFWLRQ 8QLYHUVDO KHDOWK FRYHUDJH QHHGV WR EH VHHQ DV KDYLQJ DQ LQWHJUDWLQJUROHXQGHUSLQQLQJWKHDFKLHYHPHQWRIWKHRWKHUKHDOWKWDUJHWVDQGFUHDWLQJ a balance among them.
Another important development is that the general elections in the United Republic RI7DQ]DQLDLQ2FWREHUXVKHUHGLQDQHZKHDGRIVWDWHZLWKH[FHSWLRQDOYLJRXU to improve the well-being of all Tanzanians. Health service provision was a common thread in the goals of all the political parties involved in the elections. With the country recording relatively strong economic growth and transitioning into a lower middle income VWDWXVLQGLFDWLRQVDUHWKDWH[WHUQDOGHYHORSPHQWDVVLVWDQFHLVOLNHO\WRGHFOLQH7KHQHZ JRYHUQPHQWZLOOEHH[SHFWHGWRUDLVHLWVFRQWULEXWLRQIRUKHDOWKVHUYLFHV7KH8QLWHG 1DWLRQV'HYHORSPHQW$VVLVWDQFH3ODQ,,81'$3,,KDVDOUHDG\VKLIWHGLWVSURJUDPPH IRFXVJLYHQWKHGZLQGOLQJRIUHVRXUFHVIURPLWVPDLQVRXUFHRIIXQGLQJIRU81'$3,
7KH6'*VFRYHUDOOWKHSULRULWLHVLQWKH:RUOG+HDOWK2UJDQL]DWLRQ:+2WK*HQHUDO 3URJUDPPHRI:RUN±,QWKDWFRQWH[WVRPHRIWKHSULRULWLHVIRUHVHHQIRU WKHZRUNRI:+2LQWKH8QLWHG5HSXEOLFRI7DQ]DQLDDUHVWUHQJWKHQLQJRIWKHFDSDFLW\ IRUHDUO\ZDUQLQJULVNUHGXFWLRQDQGPDQDJHPHQWRIQDWLRQDODQGJOREDOKHDOWKULVNVLQ NHHSLQJZLWKWKHSURYLVLRQVRIWKH,QWHUQDWLRQDO+HDOWK5HJXODWLRQV,+5WDFNOLQJ QRQFRPPXQLFDEOH GLVHDVHV DQG WKH XQ¿QLVKHG 0LOOHQQLXP 'HYHORSPHQW *RDOV¶ DJHQGDDQGIDFLOLWDWLQJEHWWHUFRRUGLQDWLRQRIWKHZRUNRQWKHVRFLDOGHWHUPLQDQWVRI health.
This&&6ZLOOWDNHDGYDQWDJHRIDOOWKHVHGHYHORSPHQWVWRHQVXUHWKDW:+2FRQWULEXWHV to the achievement of the health development objectives of the United Republic of Tanzania.
'U0DWVKLGLVR0RHWL
Executive Summary
7KH ± &RXQWU\ &RRSHUDWLRQ 6WUDWHJ\ RU &&6 ,,, IRU WKH 8QLWHG 5HSXEOLF RI7DQ]DQLD RXWOLQHV WKH YLVLRQ RI WKH :+2 IRU LWV ZRUN LQ WKH FRXQWU\ RYHU WKH QH[W ¿YH\HDUV,WDUWLFXODWHVKRZ:+2ZLOOFRQWULEXWHWRWKHFRXQWU\¶VDFKLHYHPHQWRILWV objectives for improved health outcomes.
The process for developing this CCS was participatory and was led by the WHO country RI¿FHDQGVXSSRUWHGE\WKH:+25HJLRQDO2I¿FHIRU$IULFDDQG:+2KHDGTXDUWHUV,W LQYROYHGDGHVNUHYLHZRINH\QDWLRQDOGRFXPHQWVWRGHWHUPLQHWKHSURJUHVVLQWKHKHDOWK VHFWRUDQGFRQVXOWDWLRQPHHWLQJVZLWKVHOHFWHGPLQLVWULHVGHSDUWPHQWVDQGDJHQFLHV ZLWKLQWKHJRYHUQPHQWWKH8QLWHG1DWLRQVFRXQWU\WHDPGHYHORSPHQWSDUWQHUVDQG NH\ DFDGHPLF LQVWLWXWLRQV7KH SURFHVV ZDV XQGHUSLQQHG E\ WKH SULQFLSOH RI FRXQWU\ RZQHUVKLSWRUHÀHFWWKHH[SHFWDWLRQVRIWKHJRYHUQPHQWDQGRWKHUVWDNHKROGHUVLQWKH KHDOWKVHFWRUDQG:+2DQGZDVJXLGHGE\WKH*XLGHIRUWKHIRUPXODWLRQRID:+2 &RXQWU\&RRSHUDWLRQ6WUDWHJ\
Several achievements were made during the implementation of CCS II such as the VLJQL¿FDQWUHGXFWLRQLQPDODULDSUHYDOHQFH±DQGFRQVHTXHQWO\PRUELGLW\DQGPRUWDOLW\ UHGXFWLRQ LQ FKLOG PRUWDOLW\ ZLWK WKH 8QLWHG 5HSXEOLF RI 7DQ]DQLD DPRQJ WKH IHZ FRXQWULHV LQ $IULFD WR DWWDLQ WKH 0LOOHQQLXP 'HYHORSPHQW *RDO 0'* H[SDQVLRQ RI URXWLQH LPPXQL]DWLRQ FRYHUDJH WR DERYH IRU WKH RUDO SROLR SHQWDYDOHQW DQG PHDVOHVYDFFLQHVDQGGHFOLQHLQ+,9SUHYDOHQFHDPRQJDGXOWVDJHG±\HDUVIURP LQWR
'HVSLWHWKHVHDFFRPSOLVKPHQWVPDQ\KHDOWKREMHFWLYHVDUHIDUIURPDFFRPSOLVKPHQW PDWHUQDOPRUWDOLW\KDVQRWVKRZQJRRGSURJUHVVDQGDWLWVFXUUHQWOHYHORIGHDWKV SHUOLYHELUWKVLWLVIDUIURPWKH0'*WDUJHWRIGHDWKVSHUOLYHELUWKV WKHUHLVDVKRUWDJHRIKHDOWKZRUNHUVWKURXJKRXWWKHFRXQWU\DQGWKHFRUHFDSDFLWLHV for the implementation of the International Health Regulations (IHR) 2005 have not EHHQDWWDLQHGUDWLRQDOXVHRIPHGLFLQHVDQGHQVXULQJDGHTXDWHVXSSOLHVRIPHGLFLQHV UHPDLQFKDOOHQJHVQRQFRPPXQLFDEOHGLVHDVHV1&'VDUHDPDMRUFDXVHRILOOQHVV DQGGHDWKDGH¿QLWHVKRUWDJHRIIXQGVH[LVWVIRUWKHKHDOWKVHFWRUDQGWKHDOORFDWLRQWR WKHKHDOWKVHFWRURI±RIWKHJRYHUQPHQWEXGJHWLVEHORZWKH$EXMDWDUJHWRI
The agenda for this CCS consists of a set of strategic priorities and focus areas for :+2FRRSHUDWLRQZLWKWKH8QLWHG5HSXEOLFRI7DQ]DQLD7KHIRFXVDUHDVGHWDLOH[DFWO\ what WHO will do within each strategic priority. The following are the strategic priorities:
(a) Reducing the morbidity and mortality caused by communicable diseases through DSSURSULDWH DQG HIIHFWLYH LQWHUYHQWLRQV LQFOXGLQJ VWUHQJWKHQLQJ KHDOWK V\VWHPV DQGDGGUHVVLQJHQYLURQPHQWDOLVVXHV
(b) 5HGXFLQJWKHEXUGHQRI1&'VWKURXJKKHDOWKSURPRWLRQDQGUHGXFWLRQSUHYHQWLRQ WUHDWPHQWDQGPRQLWRULQJRIWKHLUULVNIDFWRUV
(c) &RQWULEXWLQJ WR UHSURGXFWLYH PDWHUQDO QHZERUQ FKLOG DQG DGROHVFHQW KHDOWK (RMNCAH) and well-being and promotion of health through addressing the social GHWHUPLQDQWVRIKHDOWK
(d) 6WUHQJWKHQLQJKHDOWKV\VWHPVWRLPSURYHWKHTXDOLW\HTXLW\LQDFFHVVDQGXWLOL]DWLRQ RIKHDOWKVHUYLFHV
(e) Providing support for developing the minimum IHR (2005) core capacities and VWUHQJWKHQLQJWKHFDSDFLW\WRLPSOHPHQWGLVDVWHUULVNPDQDJHPHQW
Chapter 1: Introduction
The World Health Organization 1&RXQWU\&RRSHUDWLRQ6WUDWHJ\±&&6,,, RXWOLQHVWKHPHGLXPWHUPIUDPHZRUNIRU:+2FRRSHUDWLRQZLWKWKH*RYHUQPHQWRIWKH 8QLWHG5HSXEOLFRI7DQ]DQLD7KHSUHYLRXVWZR&&6¶VFRYHUHGWKHSHULRG±1
and 2010–20152.
7KLV&&6DUWLFXODWHVWKHYLVLRQRI:+2UHJDUGLQJKRZLWVZRUNLQWKHFRXQWU\ZLOOEH conducted to best contribute to the improvement of the health status of the population LQNHHSLQJZLWKWKHQDWLRQDOKHDOWKGHYHORSPHQWJRDOV,WSUHVHQWVDQDQDO\VLVRIWKH KHDOWK FKDOOHQJHV WKH FRXQWU\ LV IDFLQJ WKH VROXWLRQV DV LGHQWL¿HG E\ WKH QDWLRQDO authorities and partners and the health priorities that guide WHO support within the IUDPHZRUNRILWVPDQGDWHDQGFRUHIXQFWLRQV
'XULQJ WKH GHYHORSPHQW RI &&6 ,,, WKH *RYHUQPHQW ZDV ZRUNLQJ RQ WKH VHFRQG QDWLRQDO )LYH<HDU 'HYHORSPHQW 3ODQ )<'3 ,, IRU ± ZKRVH WKHPH is “nurturing industrialization for economic transformation and human development”. )<'3 ,, VXFFHHGV )<'3 , RI ± DQG WKH 1DWLRQDO 6WUDWHJ\ IRU *URZWKDQG5HGXFWLRQRI3RYHUW\0.8.87$,,FRYHULQJ±WKDW focused more on the growth of infrastructure and social services. CCS III is in line ZLWKWKHIRFXVRI)<'3,,ZKLFKKDVQLQHREMHFWLYHVRQHRIZKLFKLVWRLPSURYHWKH TXDOLW\RIOLIHDQGKXPDQZHOOEHLQJ)<'3,,DLPVDPRQJRWKHUWKLQJVWRORZHUWKH XQGHU¿YHPRUWDOLW\UDWHWRDERXWGHDWKVSHUOLYHELUWKVPDWHUQDOPRUWDOLW\WR EHORZGHDWKVE\DQGWKHSUHYDOHQFHRI+,9DQG$,'6WRDQGWRUDLVHOLIH H[SHFWDQF\DWELUWKWR\HDUV,WZLOODOVRHQVXUHWKDWE\DFFHVVWRFOHDQDQGVDIH ZDWHUUHDFKHVLQWKHUXUDODUHDVDQGLQWKHXUEDQDUHDV&&6,,,ZLOOVXSSRUW the country through the 0LQLVWU\ RI +HDOWK &RPPXQLW\ 'HYHORSPHQW *HQGHU (OGHU DQG&KLOGUHQ02+&'*(&WRLPSOHPHQWWKHNH\LQWHUYHQWLRQVDLPLQJDWUHDFKLQJWKH health objectives.
&&6 ,,, LV DOLJQHG ZLWK WKH +HDOWK 6HFWRU 6WUDWHJLF 3ODQ ,9 ± +663 ,93 DQG81'$3±81'$3,,,QDGGLWLRQLWUHÀHFWVWKHSULRULWLHVLGHQWL¿HGLQ WKHWK*3:±4 approved by the 66th World Health Assembly in 2013. The DFWLYLWLHV PRQLWRULQJ LQGLFDWRUV DQG UHTXLUHG UHVRXUFHV IRU LPSOHPHQWLQJ WKH SULRULWLHV LGHQWL¿HGIRU&&6,,,DUHGHWDLOHGLQWKH:+2ELHQQLXPZRUNSODQVDSSURYHGMRLQWO\E\ WHO and national authorities.
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ÀHFW WKH H[SHFWDWLRQV RI WKH JRYHUQPHQW DQG RWKHU VWDNHKROGHUV LQ WKH KHDOWK VHFWRU DQG WHO. It was guided by the Guide for the formulation of a WHO Country Cooperation Strategy, 2014.
1:+2&RXQWU\&RRSHUDWLRQ6WUDWHJ\±7DQ]DQLD:+2 2:+2&RXQWU\&RRSHUDWLRQ6WUDWHJ\±7DQ]DQLD:+2
7KH &&6 ,,, SURFHVV ZDV OHG E\ WKH :+2 FRXQWU\ RI¿FH ,W FORVHO\ IROORZHG WKH GHYHORSPHQW RI +663 ,9 DQG 81'$3 ,, ZKLFK WRRN SODFH IURP WKH ODVW TXDUWHU RI WR-XQH2Q-DQXDU\WKH:+2FRXQWU\RI¿FHPDGHDSUHVHQWDWLRQ RQ WKH &&6 ,,, SURFHVV DW WKH VWDNHKROGHUV¶ FRQVXOWDWLRQ PHHWLQJ RQ WKH GUDIWLQJ RI +663,97KHPDLQREMHFWLYHVRIWKHPHHWLQJZHUHWRLQWHJUDWHLQSXWVIURPGLIIHUHQW VRXUFHV LPSURYH V\QHUJLHV DPRQJ DFWLYLWLHV LQ WKH KHDOWK DQG VRFLDO ZHOIDUH VHFWRU DQG¿OODQ\JDSVLQWKHGHYHORSPHQWRI+663,9,WDOVRDLPHGWRIXOO\LQWHJUDWHWKH planned strategies of the Big Results Now initiative into the strategic plan. The CCS ,,,SUHVHQWDWLRQKLJKOLJKWHGLWVGHYHORSPHQWSURFHVVWKHUROHRILWVVWDNHKROGHUVLQWKH SURFHVVDQGLWVDOLJQPHQWZLWK+663,97KHFRXQWU\RI¿FHSDUWLFLSDWHGLQVXEVHTXHQW FRQVXOWDWLRQPHHWLQJVLQFOXGLQJ+663,97DVN)RUFHPHHWLQJVDQGWKH6HFWRU:LGH $SSURDFK6:$SWHFKQLFDOZRUNLQJJURXSVWRHQVXUHWKDWWKH&&6ZDVLQOLQHZLWKWKH KHDOWKVHFWRUSULRULWLHVRXWOLQHGLQ+663,9
7KH FRXQWU\ RI¿FH ZDV LQYROYHG LQ DOO WKH FRQVXOWDWLRQ PHHWLQJV IRU IRUPXODWLQJ 81'$3 ,, IURP -DQXDU\ ,W SDUWLFLSDWHG LQ WKH HYDOXDWLRQ RI 81'$3 , ZKLFK DVVHVVHG WKH GHOLYHU\ RI WKH 81'$3 RXWFRPHV DQG WKHLU EURDGHU FRQWULEXWLRQ WR WKH UHOHYDQW 0.8.87$ ,, DQG 0.8=$ ,, JRDOV DV ZHOO DV WKH DGYDQFHPHQW RI KXPDQ ULJKWV LQ WKH FRXQWU\ 7KH SURFHVV LQYROYHG QDWLRQDO VWDNHKROGHUV ZLWKLQ WKH JRYHUQPHQW FLYLO VRFLHW\ RUJDQL]DWLRQV &62V DQG GHYHORSPHQW SDUWQHUV 7KH FRXQWU\ RI¿FH ZDV LQFOXGHG LQ WKH VLWXDWLRQDO DQDO\VLV LQ VXSSRUW RI 81'$3 ,, LQ 0DUFK ZKLFK KDG WKH RYHUDOO SXUSRVH RI LGHQWLI\LQJ DQG GRFXPHQWLQJ VLJQL¿FDQW DFKLHYHPHQWV DQG NH\ GHYHORSPHQW FKDOOHQJHV DQG WKHLU XQGHUO\LQJ FDXVHVLQFOXGLQJFDSDFLW\JDSVWRIDFLOLWDWHDJUHHPHQWRQWKHSRWHQWLDODUHDVIRU81 VXSSRUW7KH¿QDOUHSRUWHQWLWOHGTanzania situation analysis in support of UNDAP II5
is available for distribution.
2Q0DUFKWKHFRXQWU\RI¿FHZRUNHGZLWKRWKHUVWDNHKROGHUVLQWKH81DQG WKHQDWLRQDODXWKRULWLHVZKLFKZHUHJRYHUQPHQWPLQLVWULHVGHSDUWPHQWVDQGDJHQFLHV WR IRUPXODWH WKH SULRULWLHV IRU 81'$3 ,, (LJKWHHQ GHYHORSPHQW FKDOOHQJHV LQ WKH sectors that are priority for the UN in the United Republic of Tanzania were presented VRDVWRLGHQWLI\SULRULW\DUHDVIURPHDFKVHFWRU7KHFRXQWU\RI¿FHSDUWLFLSDWHGZLWK other UN implementing partners in identifying development challenges in health and QXWULWLRQ+,9$,'6ZDWHUDQGVDQLWDWLRQVRFLDOSURWHFWLRQDQGGLVDVWHUULVNUHGXFWLRQ and emergency preparedness sectors. A number of consultation meetings were then FRQGXFWHGWRDJUHHRQWKHSULRULW\DUHDVDQGVWUDWHJLFLQWHUYHQWLRQVIRU81'$3,,$OO these processes fed into the development of CCS III.
)ROORZLQJLWVSDUWLFLSDWLRQLQWKH+663,9DQG81'$3,,SURFHVVHVDQGWKHGUDIWLQJ RI WKH &&6 ,,, GRFXPHQW WKH FRXQWU\ RI¿FH FRQGXFWHG D VWDNHKROGHUV¶ FRQVXOWDWLRQ meeting on 11 August 2015 that involved the ministries of health for the mainland and =DQ]LEDU JRYHUQPHQW GHSDUWPHQWV DQG DJHQFLHV GHYHORSPHQW SDUWQHUV DQG &62V WR DJUHH RQ WKH VWUDWHJLF SULRULWLHV DQG IRFXV DUHDV VR WKDW WKH FRXQWU\ RI¿FH FRXOG PRYH WR WKH QH[W VWHS LQ WKH GHYHORSPHQW RI WKH &&6 7KH KHDOWK 6'* VXEJRDOV +663 SULRULWLHV DQG 81'$3 RXWFRPHV ZHUH XVHG LQ WKH PHHWLQJ DV D UHIHUHQFH WR GHWHUPLQH&&6,,,¶VVWUDWHJLFSULRULWLHVZKLOHWKH:+2WK*3:RXWFRPHVZHUHXVHG to determine the focus areas.
Chapter 2:
Health and development situation
2.1
Political, macroeconomic and social contexts
The United Republic of Tanzania comprises Tanzania mainland and Zanzibar. The WRWDO VXUIDFH DUHD LV NP2 7KH SRSXODWLRQ LV HVWLPDWHG WR EH 6 RIZKLFKDUHIHPDOHDQGDUHUXUDO7KHVHFWRUVWKDWIDOOXQGHUWKHPDQDJHPHQW RIWKHXQLRQKDYHRQHPLQLVWU\ZKLOHWKRVHVXFKDVKHDOWKWKDWDUHFRQVLGHUHGDVQRQ XQLRQKDYHWZRPLQLVWULHVRQHHDFKIRUWKHPDLQODQGDQG=DQ]LEDU7KH:+2FRXQWU\ RI¿FHZRUNVZLWKWKHWZRPLQLVWULHVWKDWLVWKH02+&'*(&RQWKHPDLQODQGDQGWKH Ministry of Health in Zanzibar.
The administration and management structure of the health services on the mainland follows the geographical boundaries of the regions and districts. The decentralization of the functions through devolution allocates the regions and local government authorities power over decisions on the management of resources within their areas RIUHVSRQVLELOLW\7KLVLQFOXGHVIRUVWDIIUHFUXLWPHQWSURFXUHPHQWSODQQLQJEXGJHWLQJ DQG ¿QDQFLDO PDQDJHPHQW ,Q =DQ]LEDU IRU KHDOWK VHUYLFHV PDQDJHPHQW RQO\ WKH DGPLQLVWUDWLYHDXWKRULW\KDVEHHQGHFHQWUDOL]HGWKURXJKGHFRQFHQWUDWLRQDOOWKHRWKHU decisions are made at the ministerial level.
The United Republic of Tanzania is a member of African Union and other regional SROLWLFDOERGLHVVXFKDVWKH6RXWKHUQ$IULFDQ'HYHORSPHQW&RRSHUDWLRQDQGWKH(DVW $IULFDQ&RPPXQLW\ERWKRIZKLFKKDYHDKHDOWKGHVN,WLVDOVRDPHPEHURIWKH(DVWHUQ Central and Southern Africa Health Community.
The United Republic of Tanzania is among the least developed countries EXW QRZ KDV D KLJK *'3 DQQXDO JURZWK UDWH DYHUDJLQJ DQG RYHU WKH SDVW ¿YH \HDUV KDV UHFRUGHG UHODWLYHO\ VWURQJ HFRQRPLF JURZWK 7KH SHU FDSLWD LQFRPH LV 86 DQG WKH *LQL LQGH[ LV HVWLPDWHG DW . 7KH SRYHUW\ OHYHO LV HVWLPDWHG DW IRU UXUDO DUHDV DQG IRU XUEDQ DUHDV RWKHU WKDQ 'DU HV 6DODDP ZKHUH LW LV 8.The country has a human GHYHORSPHQW LQGH[ RI UDQNLQJ RXW RI FRXQWULHV :LWK WKH GLVFRYHU\ RI JDV GHSRVLWV DQG WKH FXUUHQW IDYRXUDEOH *'3 JURZWK WKH FRXQWU\¶V FKDQFHV RI EHFRPLQJ D PLGGOH LQFRPH FRXQWU\ DUH KLJK +RZHYHU DERXW RI WKH HFRQRPLF WUDQVDFWLRQV WDNH SODFH RXWVLGH WKH IRUPDO VHFWRU PHDQLQJ WKDW WKH FRXQWU\IDFHVFKDOOHQJHVLQUDLVLQJDGHTXDWHUHYHQXHWRPHHWJRYHUQPHQWH[SHQGLWXUH including provision of health services.
2.2
Social determinants of health
Social determinants of health are the conditions under which people live that shape WKHLUGDLO\OLIH7KHVHLQFOXGHIDFWRUVVXFKDVLQFRPHDQGZHDOWKDQGWKHLUGLVWULEXWLRQ HDUO\FKLOGKRRGFDUHHGXFDWLRQZRUNLQJFRQGLWLRQVMREVHFXULW\IRRGVHFXULW\JHQGHU DVVRFLDWHGLQÀXHQFHVVRFLDOVDIHW\QHWVDQGKRXVLQJLQFOXGLQJDFFHVVWRVDIHZDWHU DQGVDQLWDWLRQ*HQGHUDQGHGXFDWLRQLQHTXLWLHVJUHDWO\LQÀXHQFHWKHKHDOWKRIZRPHQ DQG FKLOGUHQ ,Q WKH 8QLWHG 5HSXEOLF RI 7DQ]DQLD RI ZRPHQ KDYH QR IRUPDO HGXFDWLRQDOPRVWWZLFHWKHOHYHOIRUPHQRI3UHYDOHQFHIRUVH[XDODQGSK\VLFDO violence against women and children are alarming10.
:KLOHWKH8QLWHG5HSXEOLFRI7DQ]DQLDLVVDLGWREHRQWUDFNWRDFKLHYHWKH0LOOHQQLXP 'HYHORSPHQW*RDORQHQUROPHQWLQSULPDU\VFKRROVIRUER\VDQGJLUOVZLWKDQHWSULPDU\
6*OREDO+HDOWK2EVHUYDWRU\:RUOG+HDOWK2UJDQL]DWLRQ
7KH:RUOG%DQN,%5','$7DQ]DQLD(FRQRPLF8SGDWH-XO\
87DQ]DQLD+RXVHKROG%XGJHW6XUYH\
HQUROPHQWUDWHRIWKHVFKRROV\VWHPVWLOOVWUXJJOHVWRGHOLYHUTXDOLW\HGXFDWLRQ 7KHFRXQWU\KDVPDGHOLWWOHSURJUHVVLQUHGXFLQJH[WUHPHKXQJHUDQGPDOQXWULWLRQ7KH *OREDO+XQJHU,QGH[FRQVLGHUVWKHVLWXDWLRQDVDODUPLQJChildren in rural areas VXIIHUVXEVWDQWLDOO\KLJKUDWHVRIPDOQXWULWLRQDQGFKURQLFKXQJHUDOWKRXJKXUEDQ±UXUDO GLVSDULWLHVKDYHQDUURZHGIRUERWKVWXQWLQJDQGXQGHUZHLJKW7KH:RUOG%DQNKHDOWK statistics for 2013 indicate that stunting and under-weight have declined only marginally VLQFH IURP WR DQG WR UHVSHFWLYHO\ 7KH FKDOOHQJH RI SURYLGLQJFOHDQZDWHUSHUVLVWVDQGRIWKHSRSXODWLRQODFNVDFFHVVWRFOHDQZDWHU11. 7KHXQHPSOR\PHQWUDWHFXUUHQWO\LV
2.3
Health status of the population
2.3.1 The health system
Health services are organized in a pyramidal structure with the primary care facilities at WKHEDVHWKHGLVWULFWKRVSLWDOVDWWKHQH[WOHYHODQGWKHUHIHUUDOKRVSLWDOVZKLFKLQFOXGH UHJLRQDODQGQDWLRQDOWHUWLDU\KRVSLWDOVDWWKHDSH[7KHPDQDJHPHQWRIWKHSULPDU\ care services and district hospitals is devolved to the local government authorities ZKLOHUHJLRQDODQGQDWLRQDOWHUWLDU\KRVSLWDOVDUHXQGHUWKHFHQWUDOJRYHUQPHQW3XEOLF DQGSULYDWHKHDOWKFDUHSURYLGHUVDUHUHVSRQVLEOHIRUGLVSHQVDULHVFOLQLFVDQGKHDOWK FHQWUHV'LVSHQVDULHVSURYLGHSUHYHQWLYHDQGFXUDWLYHRXWSDWLHQWVHUYLFHVZKLOHKHDOWK centres also admit patients and might provide minor surgical services.
At the community level the health services are provided by vertical programmes. Nongovernmental organizations and community-based organizations also are involved LQRXWUHDFKVHUYLFHV7KH02+&'*(&LV¿QDOL]LQJDWUDLQLQJFXUULFXOXPDQGWUDLQLQJ PDWHULDOV IRU FRPPXQLW\ KHDOWK ZRUNHUV EDVHG RQ WKH FRPPXQLW\ KHDOWK VHUYLFHV guidelines developed in 201312.
2.3.2 Disease burden
The health status of Tanzanians resembles that of their counterparts in most developing FRXQWULHV/LIHH[SHFWDQF\DWELUWKLVHVWLPDWHGWREH\HDUV&RPPXQLFDEOHGLVHDVHV DQGPDWHUQDOQHZERUQDQGFKLOGKRRGLOOQHVVHVDUHWKHPDLQFDXVHVRIPRUELGLW\DQG PRUWDOLW\2WKHUFRPPRQFRQGLWLRQVDUHQHJOHFWHGWURSLFDOGLVHDVHV17'V1&'VDQG malnutrition.
The United Republic of Tanzania is among the 22 countries in the world with a high WXEHUFXORVLVEXUGHQDQGLWUDQNVVL[WKLQ$IULFDZLWKFDVHQRWL¿FDWLRQUHDFKLQJ in 201313.
7KHFRXQWU\¶V7%+,9FRLQIHFWLRQUDWHLVHVWLPDWHGWREH±$ERXWPLOOLRQ SHRSOH LQ 7DQ]DQLD DUH OLYLQJ ZLWK +,9 RI ZKRP DUH DJHG ± \HDUV DQG DUH ZRPHQ 7KHUH KDV EHHQ D VWHDG\ GHFOLQH LQ +,9 SUHYDOHQFH IDOOLQJ IURP WR DPRQJ DGXOWV DJHG ± \HDUV EHWZHHQ DQG *HQHUDOO\ +,9 SUHYDOHQFH DPRQJ ZRPHQ DW LV KLJKHU WKDQ DPRQJ PHQ DW 14. 7KHOHDGLQJURXWHRI+,9WUDQVPLVVLRQLVKHWHURVH[XDOLQWHUFRXUVHDFFRXQWLQJIRURYHU RIWKHQHZLQIHFWLRQV
7KH EXUGHQ RI PDODULD KDV GHFOLQHG VXEVWDQWLDOO\ ZLWK VHURSUHYDOHQFH GHFUHDVLQJ IURP WR EHWZHHQ DQG ,QFLGHQFH UDWHV RQ WKH PDLQODQG KDYH DOVR GHFOLQHG JRLQJ IURP WR SHU SRSXODWLRQ =DQ]LEDU
101%67DQ]DQLD'HPRJUDSKLF+HDOWK6XUYH\ 111%6+RXVH+ROG%XGJHW6XUYH\
KDV UHWDLQHG D PDODULD SUHYDOHQFH RI OHVV WKDQ RYHU WKH ODVW ¿YH \HDUV DQG KDV VHHQ D VLJQL¿FDQW GHFUHDVH LQ WKH QXPEHU RI FDVHV DQG GHDWKV15.
The incidence rates on the island decreased from 8 to 2 per 1000 population between 2005 and 2015. The decline has been associated with the unprecedented scaling up RI ORQJODVWLQJ LQVHFWLFLGHWUHDWHG QHWV LQGRRU UHVLGXDO VSUD\LQJ XVH RI DUWHPLVLQLQ FRPELQDWLRQ WKHUDSLHV DQG FRQWLQXDO WUDLQLQJ RI KHDOWK FDUH ZRUNHUV RQ SURSHU FDVH management. A main challenge for Zanzibar is to prevent the resurgence of malaria.
The present maternal mortality ratio of 410 per 100 000 live births is far too high for WKH DFKLHYHPHQW RI 0'* 7KH PDLQ FDXVHV RI PDWHUQDO PRUWDOLW\ DUH SRVWSDUWXP KDHPRUUKDJH HFODPSVLD SXHUSHUDO VHSVLV DQG DQWHSDUWXP KDHPRUUKDJH /DERXU REVWUXFWLRQXWHUXVUXSWXULQJDQGXQVDIHDERUWLRQVDUHFRQWULEXWLQJIDFWRUV6LJQL¿FDQW JDLQVKDYHEHHQPDGHLQUHGXFLQJLQIDQWDQGXQGHU¿YHPRUWDOLW\EXWQRWLQQHRQDWDO PRUWDOLW\ 7KH PRUWDOLW\ UDWHV IRU XQGHU¿YHV DQG LQIDQWV DUH DW DQG SHU OLYHELUWKVUHVSHFWLYHO\0DODULDPDOQXWULWLRQSQHXPRQLDGLDUUKRHD+,9DQGQHRQDWDO FRQGLWLRQVDFFRXQWIRURYHURIDOOFKLOGKRRGGHDWKV1HRQDWDOGHDWKVDUHPDLQO\ DVVRFLDWHGZLWKORZELUWKZHLJKWSUHPDWXUHELUWKVELUWKLQMXULHVDQGELUWKDVSK\[LD
$FKROHUDRXWEUHDNWKDWKDVEHHQDFWLYHVLQFH$XJXVWKDVVSUHDGWRUHJLRQV RIUHJLRQVLQWKHFRXQWU\DIIHFWLQJPRUHWKDQSHRSOHDQGFDXVLQJKXQGUHGV RIGHDWKV7KHRXWEUHDNLVXQXVXDOEHFDXVHLWKDVRFFXSLHGDYDVWJHRJUDSKLFDODUHD ZLWKLQDVKRUWSHULRG7KHSDWWHUQRIWKHFXUUHQWRXWEUHDNLVVLPLODUWRWKDWRIWKH RXWEUHDNDVVRFLDWHGZLWK(O1LxRUDLQVGXULQJZKLFKWKHFRXQWU\¶VFDVHIDWDOLW\UDWHRI GHDWKVIURPFDVHVZDVDPRQJWKHKLJKHVWLQ(DVW$IULFD
5RDGWUDI¿FLQMXULHVKDYHEHHQRQWKHLQFUHDVHDQGFRQWLQXHWRWDNHOLYHV'DWDIURP WKH7UDI¿F'HSDUWPHQWLQGLFDWHWKDWIURP-DQXDU\WR-XQHWUDI¿FDFFLGHQWV FODLPHGOLYHVDQGFDXVHGLQMXULHV3ROLFHGDWDLQGLFDWHWKDWURDG WUDI¿FGHDWKVRFFXUUHGGXULQJEXWWKHLUDFFXUDF\LVLQGRXEWVLQFHWKHGlobal road safety status report shows these to have been 16 000.
The United Republic of Tanzania has hosted hundreds of thousands of refugees for GHFDGHVSULPDULO\IURP%XUXQGLDQGWKH'HPRFUDWLF5HSXEOLFRIWKH&RQJREXWDOVR from Somalia and other countries. This has posed serious challenges in providing them KHDOWKFDUHHGXFDWLRQIRRGZDWHUDQGVDQLWDWLRQVKHOWHUDQGVHFXULW\
According to the World Health Statistics 2015 reportWKH8QLWHG5HSXEOLFRI7DQ]DQLD KDV UHFRUGHG VXEVWDQWLDO VXFFHVVHV LQ VHYHUDO SURJUDPPDWLF DUHDV EXW ZLOO UHTXLUH VXVWDLQHGHIIRUWVWRPDLQWDLQWKHQHZOHYHOV6XFKDUHDVLQFOXGHPDWHUQDOKHDOWKZKHUH WKHUHKDVEHHQDVXEVWDQWLDOUHGXFWLRQLQLQIDQWPRUWDOLW\DQGQHRQDWDOPRUWDOLW\UDWLRV +,9DQGPDODULD7KHQHRQDWDOLQIDQWDQGXQGHU¿YHPRUWDOLW\UDWHVRIDQG SHUOLYHELUWKVUHVSHFWLYHO\VXUSDVVHGWKH$IULFDDYHUDJHVRIDQGSHU OLYHELUWKVUHVSHFWLYHO\*DSVVWLOOUHPDLQIRUH[DPSOHLQDFFHVVWRGULQNLQJZDWHU DQGVDQLWDWLRQIDFLOLWLHVLQUHGXFLQJPDOQXWULWLRQZKLFKLVUHVSRQVLEOHIRUUHVXOWLQJLQ VWXQWLQJ DQG XQGHUZHLJKWLQHVV DQG LQ HOLPLQDWLQJ WXEHUFXORVLV (IIRUWV QHHG WR EH stepped up to increase access to and utilization of health services to address the high PDWHUQDOPRUWDOLW\UDWLR7KHGHQVLWLHVRISK\VLFLDQVDQGQXUVHVDQGPLGZLYHVUHPDLQ ORZDWDQGSHUSRSXODWLRQUHVSHFWLYHO\DQGDUHZRUVHWKDQWKHUHJLRQDO DYHUDJHVRIDQGUHVSHFWLYHO\7KHDQQXDOJRYHUQPHQWH[SHQGLWXUHRQKHDOWK UHPDLQVEHORZWKHJOREDOQRUP2XWEUHDNVRIGLVHDVHVXFKDVFKROHUDPHDVOHVDQG GLDUUKRHD UHPDLQ D WKUHDW RZLQJ WR WKH SUHVHQFH RI WKHLU ULVN IDFWRUV VXFK DV SRRU DFFHVVWRLPSURYHGGULQNLQJZDWHUDQGVDQLWDWLRQPDOQXWULWLRQSRRUDQWHQDWDOFDUHDQG poor access to insecticide-treated nets.
2.3.3 Progress in the six WHO leadership priorities
Universal health coverage
7KH8QLWHG5HSXEOLFRI7DQ]DQLD¶VKHDOWKVHUYLFHVDUHEXLOWXSZDUGIURPWKHJUDVVURRWV OHYHO ZLWK FRPPXQLW\ KHDOWK FDUH SURYLGHUV GLVSHQVDULHV DQG KHDOWK FHQWUHV WKHQ ¿UVWOHYHO KRVSLWDOV DQG ¿QDOO\ UHJLRQDO UHIHUUDO ]RQDO DQG QDWLRQDO KRVSLWDOV ZLWK WKHVHUYLFHVSURYLGHGE\HDFKOHYHOZHOOGH¿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¿QDQFLQJ VWUDWHJ\ DOO DLP WR LPSURYH WKH SRSXODWLRQ¶V DFFHVVWRJRRGTXDOLW\HTXLWDEOHDIIRUGDEOHVXVWDLQDEOHDQGJHQGHUVHQVLWLYHKHDOWK services.
8Q¿QLVKHG0'*VDQGWKH6XVWDLQDEOH'HYHORSPHQW*RDOV6'*V
7KH 0'*V KDYH UHPDLQHG D KLJK SULRULW\ LQ WKH QDWLRQDO GHYHORSPHQW DJHQGD including in the health sector strategies. There has been good progress in the DFKLHYHPHQW RI KHDOWKUHODWHG 0'*V HVSHFLDOO\ 0'* RQ FKLOG VXUYLYDO 7KH 8QLWHG 5HSXEOLF RI 7DQ]DQLD LV DPRQJ WKH FRXQWULHV WKDW KDYH DWWDLQHG WKH 0'* WDUJHW IRU XQGHU¿YH PRUWDOLW\ RI GHDWKV RU ORZHU SHU OLYH ELUWKV. +RZHYHU SURJUHVV KDV EHHQ OLPLWHG LQ DFKLHYLQJ 0'* RQ WKH UHGXFWLRQ RI PDWHUQDO PRUWDOLW\ ZKLFK FXUUHQWO\ LV HVWLPDWHG DW SHU OLYH ELUWKV18 DQG 0'* RQ WKH UHGXFWLRQ RI FKLOGKRRG VWXQWLQJ ZKLFK UHPDLQV DW . *RRG SURJUHVV KDV EHHQ PDGH LQ WKH UHGXFWLRQ RI PDODULD SUHYDOHQFH LQ FKLOGUHQ DJHG±PRQWKVZKLFKIHOOIURPLQWRLQ7+0,6LQWKH UHGXFWLRQ RI +,9 SUHYDOHQFH LQ WKH JHQHUDO SRSXODWLRQ ZKLFK GHFOLQHG IURP LQ WRLQDQGLQWKHLPSURYHPHQWRIDFFHVVWRDQWLUHWURYLUDOVE\SHRSOH OLYLQJZLWK+,9
Noncommunicable Diseases
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¿YH VHUYLQJV RI IUXLW DQGRU YHJHWDEOHV RQ DYHUDJH SHU GD\ )XUWKHUPRUH ZHUH RYHUZHLJKWKDGUDLVHGIDVWLQJEORRGJOXFRVHRUZHUHRQPHGLFDWLRQIRULWDQG ZHUHK\SHUWHQVLYHEXWPRUHWKDQDKDOIRIWKHZHUHXQDZDUHRIWKLV
,QWHUQDWLRQDO+HDOWK5HJXODWLRQV
$QDVVHVVPHQWRIWKHFRXQWU\¶VFRUHFDSDFLWLHVIRUVXUYHLOODQFHDQGUHVSRQVHFRYHULQJ
even the points of entry was conducted in 2010 and was followed with the development of annual action plans for core capacity strengthening guided by the annual monitoring UHSRUWV7KLVZDVGRQHLQOLQHZLWKWKHSURYLVLRQRI$UWLFOHVDQGDQG$QQH[RI IHR (2005).
,QWKH8QLWHG5HSXEOLFRI7DQ]DQLD,+5LVLPSOHPHQWHGWKURXJKWKH,QWHJUDWHG 'LVHDVH6XUYHLOODQFHDQG5HVSRQVH,'65IUDPHZRUN7KHFRXQWU\LVQRZHPEDUNLQJ RQ UROOLQJ RXW DQ HOHFWURQLF ,'65 LQLWLDWLYH ZKLFK ZLOO IDFLOLWDWH WLPHO\ UHSRUWLQJ Improvements have been made in the laboratory capacity to handle IHR (2005) implementation. The national laboratory capacity has been strengthened to facilitate FRQ¿UPDWLRQIRU(ERODYLUXVGLVHDVHDQG0LGGOH(DVWUHVSLUDWRU\V\QGURPHFRURQDYLUXV LQFOXGLQJ SDQGHPLF LQÀXHQ]D SUHSDUHGQHVV $GKHUHQFH WR ELRVDIHW\ DQG ELRULVN PHDVXUHVLVHQIRUFHGDWQDWLRQDO]RQDODQGUHJLRQDOOHYHOVWKURXJKWKHLPSOHPHQWDWLRQ RIWKHVWHSZLVHODERUDWRU\TXDOLW\LPSURYHPHQWSURFHVVHV
$WWKHHQGRIWKH8QLWHG5HSXEOLF RI7DQ]DQLDLQFROODERUDWLRQ ZLWK:+2DQG XVLQJWKHDGDSWHG:+2WRROFRQGXFWHGDQDVVHVVPHQWRIWKHFRUHFDSDFLWLHVDWWKH SRLQWVRIZKLFKZHUHLQ=DQ]LEDUDQGRQWKHPDLQODQG7KHDVVHVVPHQWUHYHDOHG that the core capacities at all the entry points were below the recommended average of 7KLVLVDVHULRXVJDSDQGZLOOQHHGWREHDGGUHVVHG7KHFRXQWU\KDGQRWDWWDLQHG WKH UHTXLUHG IXQFWLRQDO FDSDFLWLHV IRU LPSOHPHQWLQJ ,+5 E\ WKH WDUJHW GDWH RI $IRUPDOUHTXHVWWR:+2IRUH[WHQVLRQRIWKHSHULRGWRZDVJUDQWHG
Increasing access to essential, high-quality, effective and affordable
medical products
=DQ]LEDU¶V0LQLVWU\RI+HDOWKUHYLVHGWKHQDWLRQDOPHGLFLQHSROLF\LQRUGHUWRDGGUHVVWKH SKDUPDFHXWLFDOVHFWRU¶VLVVXHVXQGHUDFRPPRQIUDPHZRUN7KHVWDQGDUGWUHDWPHQW guidelines and the national essential medicines lists for the mainland and Zanzibar also were revised to promote the rational use of medicines. The electronic logistic PDQDJHPHQWLQIRUPDWLRQV\VWHPEHLQJGHYHORSHGLVH[SHFWHGWRLQFUHDVHHI¿FLHQF\ LQSURFXUHPHQWDQGGLVWULEXWLRQRIPHGLFLQHVUHGXFHZDVWDJHDQGLPSURYHDYDLODELOLW\ RIPHGLFLQHVDWWKHJRYHUQPHQWKHDOWKIDFLOLWLHV+RZHYHUDFFHVVRIPHGLFLQHVIURP WKH 0HGLFDO 6WRUHV 'HSDUWPHQW LV LPSDLUHG E\ WKH GHSDUWPHQW¶V OLTXLGLW\ FKDOOHQJHV DVVRFLDWHG ZLWK WKH GHSOHWLRQ RI LWV ZRUNLQJ FDSLWDO 7KH *RYHUQPHQW LV ZRUNLQJ RQ PHDVXUHVWRDGGUHVVWKLVSUREOHPDVVSHFL¿HGLQWKH%LJ5HVXOWV1RZLQLWLDWLYH
7KHUHJXODWRU\IUDPHZRUNIRUPHGLFLQHVFRVPHWLFVDQGPHGLFDOGHYLFHVKDVLPSURYHG RYHU WKH \HDUV HVSHFLDOO\ LQ UHJLVWUDWLRQ RI PHGLFLQHV OLFHQVLQJ DQG LQVSHFWLRQ RI PDQXIDFWXUHUV WKH GLVWULEXWLRQ SURFHVV FRQWURO RI LPSRUWDWLRQ DQG H[SRUWDWLRQ RI PHGLFLQHVDXWKRUL]DWLRQRIFOLQLFDOWULDOVDQGSKDUPDFRYLJLODQFH&KDOOHQJHVVWLOOH[LVW KRZHYHUZLWKFRXQWHUIHLWSURGXFWVVWLOOEHLQJPDUNHWHGDQGWKHFDSDFLW\RIWKH4XDOLW\ Control Laboratory being low on both the mainland and Zanzibar.
Social, economic and environmental determinants of health
7KH 8QLWHG 5HSXEOLF RI 7DQ]DQLD KDV D 1DWLRQDO +HDOWK 3URPRWLRQ 3ROLF\ *XLGHOLQH (2014) and its implementation strategy (2015–2020) that outline the actions to address WKHVRFLDOGHWHUPLQDQWVRIKHDOWK+663,9DGYRFDWHVIRUHYLGHQFHEDVHGLQWHUYHQWLRQV DQGDSSURDFKHVLQDGGUHVVLQJWKHVRFLDOGHWHUPLQDQWVRIKHDOWK7KH*RYHUQPHQWKDV recently renewed its efforts to address the challenges in the education sector and to improve access to clean and safe water through the Big Results Now initiative.
/HYHOVDQG7UHQGVLQ&KLOG0RUWDOLW\81,QWHUDJHQF\*URXSIRU&KLOG0RUWDOLW\(VWLPDWLRQ
187UHQGVLQ0DWHUQDO0RUWDOLW\(VWLPDWHVE\:+281,&()81)3$7KH:RUOG%DQNDQGWKH8QLWHG1DWLRQV3RSXODWLRQ'LYLVLRQ
2WKHU*RYHUQPHQWDFWLRQVWRVXSSRUWKHDOWKVHUYLFHV
7KH %LJ 5HVXOWV 1RZ LQLWLDWLYH LV D *RYHUQPHQW SURJUDPPH DLPHG DW HVWDEOLVKLQJ D VWURQJ DQG HIIHFWLYH V\VWHP WR RYHUVHH PRQLWRU DQG HYDOXDWH WKH LPSOHPHQWDWLRQ RI WKH¿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wanza and Kigoma. These are considered the most underserved regions. The programme will be rolled out to the other regions gradually.
$SDUWIURPWKHIRXU%LJ5HVXOWV1RZLQLWLDWLYHNH\DUHDV+663,9KDVSULRULWL]HGWKH following strategic directions:
(a) Investing in health promotion interventions that give emphasis to multisectoral DSSURDFKHV
(b) 6WUHQJWKHQLQJ UHSURGXFWLYH PDWHUQDO QHRQDWDO FKLOG DQG DGROHVFHQW KHDOWK 501&$+VHUYLFHVWKURXJKDVWUHQJWKHQHGKHDOWKV\VWHP
(c) Maintaining a high level of performance for disease control programmes and LPSURYLQJWKHLULQWHJUDWLRQ
(d) )RFXVLQJ RQ FRPPXQLW\EDVHG LQWHUYHQWLRQV KHDOWK SURPRWLRQ DQG VFUHHQLQJ HDUO\WUHDWPHQWDQGUHKDELOLWDWLRQIRUWKHFRQWURORI1&'V
(e) Advocating for intersectoral action and active engagement in partnerships in DGGUHVVLQJWKHVRFLDOGHWHUPLQDQWVRIKHDOWK
(f) &ROODERUDWLQJZLWKRWKHUPLQLVWULHVGHSDUWPHQWVDQGDJHQFLHVLQSXWWLQJLQSODFH systems and structures for facilitating immediate response to crises using the PRGHUQPHDQVRIFRPPXQLFDWLRQ
(g) )XUWKHU GHFHQWUDOL]LQJ VRFLDO ZHOIDUH E\ HVWDEOLVKLQJ D IXOOÀHGJHG GHSDUWPHQW under the local government authorities.
2.4
Development cooperation and the United Republic of
Tanzania’s role in the global health agenda
2.4.1 Development cooperation and partnerships
7KH-RLQW$VVLVWDQFH6WUDWHJ\IRU7DQ]DQLDLVWKHQDWLRQDOPHGLXPWHUPIUDPHZRUNIRU PDQDJLQJFROODERUDWLRQEHWZHHQWKH*RYHUQPHQWDQGGHYHORSPHQWSDUWQHUVWRDFKLHYH WKHQDWLRQDOGHYHORSPHQWDQGSRYHUW\UHGXFWLRQJRDOV7KHVWUDWHJ\DOVRGH¿QHVWKH UROHVRIQRQVWDWHDFWRUV,WLVKDUPRQL]HGZLWKWKHFRXQWU\¶VLQWHUQDWLRQDOFRPPLWPHQWV DQGLQLWLDWLYHVLQDLGHIIHFWLYHQHVVVXFKDVWKH3DULV'HFODUDWLRQ
IURP WKH 02+&'*(& WKH 3ULPH 0LQLVWHU¶V 2I¿FH UHJLRQDO DXWKRULWLHV WKH ORFDO JRYHUQPHQW WKH 0LQLVWU\ RI )LQDQFH GHYHORSPHQW SDUWQHUV WKH &KULVWLDQ 6RFLDO 6HUYLFHV &RPPLVVLRQ WKH $VVRFLDWLRQ RI 3ULYDWH +HDOWK )DFLOLWLHV LQ 7DQ]DQLD DQG representatives from CSOs. The implementation milestones are determined by the SWAp technical committee and approved by the SWAp policy meeting held once a \HDUDWZKLFKWKHVHQLRURI¿FLDOVIURPWKHWHFKQLFDOPHPEHULQVWLWXWLRQVSDUWLFLSDWH7KH 6:$SWHFKQLFDOZRUNLQJJURXSVPRQLWRUWKHLPSOHPHQWDWLRQRIWKHSURJUDPPHVDQG identify new areas for interventions. Annual and mid-term reviews evaluate progress WRZDUGVWKHPLOHVWRQHVDQG+663UHVSHFWLYHO\7KHRXWFRPHVIURPPLGWHUPUHYLHZV DUHXWLOLVHGWRGHYHORSWKHVXEVHTXHQW+663
7KHGHYHORSPHQWSDUWQHUVXVHVHYHUDOPHFKDQLVPVWRIXQGWKHKHDOWKVHFWRUVRPH of them going directly through general budget support and others through the Health %DVNHW)XQGRUSURMHFWV*OREDOKHDOWKLQLWLDWLYHVVXFKDVWKH*$9,$OOLDQFHWKH*OREDO )XQGIRU$,'67XEHUFXORVLVDQG0DODULDDQGWKH8QLWHG6WDWHV*RYHUQPHQWSURYLGH IXQGLQJIRULPPXQL]DWLRQ+,9$,'6WXEHUFXORVLVDQGPDODULDSURJUDPPHVDVZHOODV supporting health systems strengthening. Funding by WHO is delivered to programmes DQGWRKHDOWKV\VWHPVVWUHQJWKHQLQJ7KH:+2FRXQWU\RI¿FHSDUWLFLSDWHVLQWKHNH\ GHFLVLRQPDNLQJ ERGLHV¶ DFWLYLWLHV VXFK DV WKH WHFKQLFDO ZRUNLQJ JURXS PHHWLQJV H[WHQGHG 02+&'*(& PDQDJHPHQW PHHWLQJV MRLQW DQQXDO KHDOWK VHFWRU UHYLHZV WHFKQLFDOFRPPLWWHHIRU6:$SPHHWLQJV6:$SSROLF\PHHWLQJVDQGWKH'HYHORSPHQW 3DUWQHUV *URXS IRU KHDOWK¶V '3*+HDOWK DFWLYLWLHV (YHQ WKRXJK WKH GHYHORSPHQW SDUWQHUVFROODERUDWHWKURXJKWKH6:$SIUDPHZRUNHDFKRIWKHPRSHUDWHVLQVSHFL¿F SURJUDPPDWLFDUHDVDFFRUGLQJWRWKHLUVSHFL¿FQLFKHFDSDFLW\DQGPDQGDWHVHH$QQH[ 0RUH SDUWQHUV VXSSRUW SURJUDPPHV VXFK DV PDODULD +,9 501&$+ +5+ DQG KHDOWK¿QDQFLQJWKDQRWKHUDUHDV1&'VDQGHPHUJHQF\SUHSDUHGQHVVKDYHUHFHLYHG OLWWOHDWWHQWLRQDQGDGYRFDF\DQGUHVRXUFHPRELOL]DWLRQZLOOEHUHTXLUHGWRHQVXUHWKH\ receive funding support.
:+2¶VFRPSDUDWLYHDGYDQWDJHLVLQSURYLGLQJWHFKQLFDODVVLVWDQFHDQGSROLF\DGYLFH /DWHO\VXSSRUWIRULPSOHPHQWLQJ,+5KDQGOLQJGLVHDVHHSLGHPLFVDVVHVVLQJ WKHQDWLRQDOFDSDFLWLHVIRUGLVDVWHUULVNUHGXFWLRQDQGGHYHORSLQJDURDGPDSIRUWKHLU LPSURYHPHQWDGYRFDWLQJIRU1&'VDQGPRELOL]LQJUHVRXUFHVWKURXJKWKHJOREDOKHDOWK LQLWLDWLYHVKDVFRPHWRWKHIRUH:+2LVDVRXUFHRILQIRUPDWLRQRQJOREDOKHDOWKLVVXHV EHVW SUDFWLFHV KHDOWK ¿QDQFLQJ KXPDQ UHVRXUFH SODQQLQJ DQG DYDLODELOLW\ RI KHDOWK H[SHUWLVHLQWHUQDWLRQDOO\
2.4.2 Collaboration with the UN system
7KH GHYHORSPHQW RI 81'$3 ,, GUHZ OHVVRQV IURP WKH HYDOXDWLRQ RI 81'$3 , 2QH critical recommendation from that evaluation was for the UN to use its resources to demonstrate to the local government authorities how to solve problems using evidence and to plan for long-term sustainability. This was the basis for the inception by WHO of WKH3HHU/HDUQLQJ'LVWULFWVLQLWLDWLYHZKLFKKDVKHOSHGGLVWULFWVUHDOL]HSRVLWLYHUHVXOWV WKURXJKVXSSRUWLYHVXSHUYLVLRQDQGSHHUOHDUQLQJ81'$3,,IRFXVHVRQIRXUWKHPDWLF DUHDVLQFOXVLYHJURZWKGHPRFUDWLFJRYHUQDQFHKHDOWK\QDWLRQDQGUHVLOLHQFH
2.4.3 The United Republic of Tanzania’s contribution to the global
health
agenda
The United Republic of Tanzania actively participates in many global health governance IRUXPVVXFKDVWKH:+25HJLRQDO&RPPLWWHHIRU$IULFDWKH:RUOG+HDOWK$VVHPEO\ DQG WKH $IULFDQ 8QLRQ KHDOWK PLQLVWHUV¶ FRQIHUHQFHV ,W KDV D KHDOWK DWWDFKp LQ LWV *HQHYDHPEDVV\WRFORVHO\IROORZLVVXHVUHODWHGWRKHDOWKDW:+2
7KH8QLWHG5HSXEOLFRI7DQ]DQLDZDVLQYROYHGLQWKHGHYHORSPHQWRIWKH81*OREDO 6WUDWHJ\RQ:RPHQ¶VDQG&KLOGUHQ¶V+HDOWKDQGLWV3UHVLGHQWDQGWKH3ULPH0LQLVWHURI Canada were appointed co-chairs of the Commission on Information and Accountability IRU:RPHQ¶VDQG&KLOGUHQ¶V+HDOWKHVWDEOLVKHGE\WKH816HFUHWDU\*HQHUDOIROORZLQJ WKHDGRSWLRQRIWKHVWUDWHJ\7KHFRPPLVVLRQZKRVHZRUNZDV¿QDOL]HGLQ0D\ FDPHXSZLWKNH\UHFRPPHQGDWLRQVIRULPSURYLQJWKHKHDOWKRIZRPHQDQGFKLOGUHQ It emphasized that countries should develop effective ways of gathering important KHDOWK GDWD WR EH XVHG IRU LQIRUPHG GHFLVLRQPDNLQJ DQG D FRRUGLQDWHG V\VWHP IRU WUDFNLQJKHDOWKVSHQGLQJRQZRPHQDQGFKLOGUHQ,WUHFRPPHQGHGHVWDEOLVKLQJQDWLRQDO DQGJOREDORYHUVLJKWVWUXFWXUHVWRVWUHQJWKHQWKHIHHGEDFNPHFKDQLVPVWKDWVXSSRUW continuous improvement in the delivery of health services for women and children.
The President of the United Republic of Tanzania was appointed by the UN Secretary- *HQHUDOWRFKDLUWKH+LJKOHYHO3DQHORQ*OREDO5HVSRQVHWR+HDOWK&ULVHV+HDOVR FKDLUHGWKH$IULFDQ/HDGHUV0DODULD$OOLDQFHDQGVXEVHTXHQWO\'DUHV6DODDPSURYLGHG DKRPHIRUWKHRI¿FHVRIWKHDOOLDQFH¶VVHFUHWDULDW
2.5
Health sector challenges
7KH8QLWHG5HSXEOLFRI7DQ]DQLD¶VKHDOWKVHFWRULVVHYHUHO\XQGHUIXQGHG7KHFRXQWU\ VSHQGVDERXW86SHUFDSLWDLQKHDOWKFDUHZKLFKLVORZFRPSDUHGZLWKWKH86 SHU FDSLWD UHFRPPHQGHG IRU GHYHORSLQJ FRXQWULHV E\ WKH KLJK OHYHO 7DVNIRUFH RQ ,QQRYDWLYH ,QWHUQDWLRQDO )LQDQFLQJ IRU +HDOWK 6\VWHPV $ERXW RI WKH WRWDO H[SHQGLWXUHRQKHDOWKLVGRQRUVXSSRUW7KHIUDJPHQWDWLRQRIKHDOWK¿QDQFLQJZLWKRXW PDQGDWRU\SUHSD\PHQWPHFKDQLVPVFRQWULEXWHVWRWKHKLJKRXWRISRFNHWH[SHQGLWXUH impeding progress towards universal health coverage. The utilization of funds during WKH LPSOHPHQWDWLRQ RI &&6 ,, ZDV ORZ DYHUDJLQJ ± 7KLV UHVXOWHG IURP WKH FKDQJHVLQ¿QDQFLDOPDQDJHPHQWLQVWLWXWHGE\:+2RQWKHXVHRIWKH*OREDO6\VWHP 0DQDJHPHQWWKDWWRRNWLPHIRUWKH*RYHUQPHQWWRJHWXVHGWR
7KHUH LV D ZLGHVSUHDG VKRUWDJH RI TXDOL¿HG KHDOWK ZRUNHUV RI DERXW ± DW DOO OHYHOV ZKLFK LV PRUH VHYHUH LQ UXUDO GLVWULFWV DQG LV H[DFHUEDWHG E\ WKH LQFUHDVLQJ EXUGHQ RI GLVHDVH 6LPLODUO\ GLVSDULWLHV H[LVW LQ WKH GLVWULEXWLRQ RI KXPDQ UHVRXUFHV between urban and rural areas.
(VVHQWLDOPHGLFLQHVDQGKHDOWKWHFKQRORJLHVDUHIUHTXHQWO\RXWRIVWRFNDWWKH0HGLFDO 6WRUHV'HSDUWPHQWRQWKHPDLQODQGWKH&HQWUDO0HGLFDO6WRUHVLQ=DQ]LEDUDQGWKH KHDOWKIDFLOLWLHV7KHORFDOSKDUPDFHXWLFDOPDQXIDFWXULQJEDVHLVZHDN7KHPHGLFLQHV¶ UHJXODWRU\IUDPHZRUNVDOWKRXJKLPSURYLQJIDFHFKDOOHQJHVZLWKUHJDUGWRWKHKXPDQ UHVRXUFHFDSDFLW\DQGWKHTXDOLW\RIPHGLFLQHVDQGRWKHUKHDOWKSURGXFWV
7KH 8QLWHG 5HSXEOLF RI 7DQ]DQLD LV VWLOO IDU IURP DFKLHYLQJ 0'* DQG LW KDV WR VXVWDLQ WKH JDLQV LQ 0'* DQG DGGUHVV WKH LQHTXLWLHV DW WKH GLVWULFW OHYHO LQ FKLOG KHDOWKLQWHUYHQWLRQV7KH0'*VDUHVWLOOUHOHYDQWDQGWKHUHLVDFULWLFDOQHHGWRJHWZHOO SUHSDUHGIRUWKH6'*V$OVRWKHLQWHJUDWLRQRIJHQGHUHTXDOLW\DQGKXPDQULJKWVLQWR KHDOWKSURJUDPPHVLVZHDN7KLVPD\PDQLIHVWLQGLVHDVHWUHQGVDPRQJVWZRPHQDQG other vulnerable groups including socioeconomically disadvantaged people.
&DSDFLW\IRULPSOHPHQWLQJ,+5KDVQRWEHHQIXOO\EXLOW)RUH[DPSOHFDSDFLW\ IRURUJDQL]HGTXLFNUHVSRQVHWRHPHUJHQFLHVDQGHSLGHPLFVLVQRWTXLWHLQSODFH7KH WKUHDWRIWKHHPHUJLQJHSLGHPLFVDQGWKHUHHPHUJHQFHRIGLVHDVHVVXFKDVLQÀXHQ]D (ERODGHQJXHIHYHUDQGRWKHUKDHPRUUKDJLFIHYHUVUHTXLUHWKLV&&6WRWDNHWKDWLQWR account to ensure that the country has the capacity to respond to such emergencies. 7KHFRXQWU\KDVFRPPLWWHGWRZRUNZLWKWKH:+2FRXQWU\RI¿FHDQGRWKHUSDUWQHUV WR VWUHQJWKHQ ,+5 FRUH FDSDFLWLHV KXPDQLWDULDQ HPHUJHQF\ UHVSRQVH DQG LPSOHPHQWDWLRQRIWKH$IULFD5HJLRQDO'LVDVWHU5LVN0DQDJHPHQW6WUDWHJ\
The growing double burden of communicable and noncommunicable diseases poses DVHULRXVWKUHDWDQGDEXUGHQWRWKHKHDOWKVHFWRU7KLV&&6LVH[SHFWHGWRHQVXUHWKDW FDSDFLW\LVEXLOWDQGDGYRFDF\LVFDUULHGRXWIRUHIIHFWLYH1&'SUHYHQWLRQDQGFRQWURO VWUDWHJLHVLQFOXGLQJWKRVHUHODWHGWRWKHVRFLDOGHWHUPLQDQWVRIKHDOWK
Chapter 3: Review of the WHO cooperation in the last CCS cycle
7KH FRRSHUDWLRQ EHWZHHQ WKH :+2 FRXQWU\ RI¿FH DQG WKH FRXQWU\ GXULQJ WKH &&6 ,, F\FOH ZDV HIIHFWLYH LQ VXSSRUWLQJ WKH FRXQWU\ LQ LWV TXHVW WR DFKLHYH WKH 0'*V ,W involved the implementation of the four strategic agenda priorities and ten strategic SULRULWLHVGH¿QHGLQWKDW&&67KHUHYLHZRIWKH&&6,,F\FOHZDVXQGHUWDNHQWKURXJKD FRQVXOWDWLRQSURFHVVZLWKJRYHUQPHQWRI¿FLDOVIURPWKH02+&'*(&WKH3UHVLGHQW¶V 2I¿FH 5HJLRQDO $GPLQLVWUDWLRQ DQG /RFDO *RYHUQPHQW DQG RWKHU JRYHUQPHQW GHSDUWPHQWVGHYHORSPHQWSDUWQHUVDQG81DJHQFLHV7KHUHYLHZXVHGNH\LQIRUPDQW LQWHUYLHZV VWDNHKROGHU FRQVXOWDWLRQ VHVVLRQV PLGWHUP UHYLHZ RI +663 ,,,20 RXWFRPHV :+2 FRXQWU\ RI¿FH DQQXDO UHSRUWV DQG WKH UHOHYDQW QDWLRQDO GRFXPHQWV 7KH FRXQWU\ RI¿FH DOVR DFWLYHO\ SDUWLFLSDWHG LQ 81'$3 , HYDOXDWLRQ ZKLFK LQFOXGHG D UHYLHZ RI :+2 ZRUN GXULQJ WKDW SHULRG 7KH UHSRUW HQWLWOHG Tanzania situation analysis in support of UNDAP II21 SURYLGHVGHWDLOHGLQIRUPDWLRQRQWKLV7KH¿QGLQJVRI&&6,,UHYLHZLQFOXGLQJWKHNH\ DFKLHYHPHQWVWKHOHVVRQVOHDUQWDQGWKHFKDOOHQJHVKDYHEHHQXVHGDVLQSXWVIRUWKH development of the strategic agenda for 2016–2020.
The strategic priorities were implemented in accordance with the WHO programme and EXGJHW F\FOHV IRU ± ,Q WKH ELHQQLXP WKHUH ZHUH VWDII PHPEHUV LQ WKH FRXQWU\ RI¿FH DPRQJ ZKRP ZHUH SURIHVVLRQDO ZLWK H[SHUWLVH RQ SXEOLF KHDOWK GLVHDVH FRQWURO DQG PDQDJHPHQW KHDOWK V\VWHPV GHYHORSPHQW PRQLWRULQJ DQG HYDOXDWLRQ HWF $GPLQLVWUDWLYH DQG PDQDJHPHQW VXSSRUW ZDV SURYLGHG E\ WKH WUDQVIRUPHGFRXQWU\VXSSRUWXQLWZKLFKHQDEOHGWKHFRXQWU\RI¿FHWRSURYLGHHIIHFWLYH WHFKQLFDOVXSSRUWIRUWKHVWUDWHJLFSULRULWLHVIRU&&6,,2YHUDOODFWXDOH[SHQGLWXUH WRWDOOHGRIWKHIXQGVDOORFDWHG7KHUHZHUHGHOD\VLQIXQGVGLVEXUVHPHQWRZLQJWR 02+&'*(&¶VIDLOXUHWRVXEPLW'LUHFW)LQDQFLDO&RRSHUDWLRQUHSRUWVRQWLPH7HFKQLFDO H[SHUWLVHIURPWKH:+25HJLRQDO2I¿FHIRU$IULFDDQGWKHKHDGTXDUWHUVZDVFDOOHG XSRQDVQHFHVVDU\WR¿OOJDSV
Several achievements were realized with regard to Strategic agenda 1: Strengthening WKHKHDOWKV\VWHPDQGVHUYLFHGHOLYHU\7HFKQLFDOVXSSRUWZDVSURYLGHGWRGHYHORSNH\ national documents to strengthen the capacity of the health system. These included the
Human Resources for Health Production Plan, 2014–2024; Tanzania Health Financing Strategy; Monitoring and evaluation framework of the Health Sector Strategic Plan III, 2014–2019 for Zanzibar; National medicine policy; Tanzania Pharmaceutical Manufacturing Plan of Action, 2014–2018 for the Mainland; Community health workers’ policy guideline and the Health Sector Strategic Plan IV.
:LWKUHJDUGWR6WUDWHJLFDJHQGD6XSSRUWLQJQDWLRQDOSULRULW\SURJUDPPHVWKHFRXQWU\ RI¿FH VXSSRUWHG WKH GHYHORSPHQW RI WKH 501&$+ URDG PDS DQG WKH 6KDUSHQHG 2QH SODQ IRU DFFHOHUDWLQJ WKH UHGXFWLRQ RI PDWHUQDO QHZERUQ DQG FKLOG PRUWDOLW\ ,W FRQWULEXWHG WR WKH DFKLHYHPHQW RI 0'* RQ UHGXFWLRQ RI FKLOG PRUWDOLW\ WKURXJK VXSSRUWLQJLPPXQL]DWLRQLQWHJUDWHGPDQDJHPHQWRIFKLOGKRRGLOOQHVVHVSUHYHQWLRQRI PRWKHUWRFKLOGWUDQVPLVVLRQ307&7RI+,9DQGUHGXFWLRQRIPDODULDPRUELGLW\DQG mortality by deployment of correct interventions and supporting emergency obstetric and neonatal care services.
7KH 1DWLRQDO &RPSUHKHQVLYH DQG ,QWHJUDWHG 17' 0DVWHU 3ODQ ± ZDV developed and launched with a good partnership involving the government and LQWHUQDWLRQDODQGQDWLRQDOVWDNHKROGHUVLQYROYHGLQ17'V7KHFRXQWU\RI¿FHVXSSRUWHG epidemic preparedness and response efforts through developing the second generation
Integrated disease surveillance and response guidelines. Support was provided in building core capacities for implementing IHR (2005) and developing IHR (2005) action SODQ IRU ± DV ZHOO DV IRU GLVHDVH RXWEUHDN SUHSDUHGQHVV SUHYHQWLRQ DQG control.
The achievements in implementing Strategic agenda 3: Supporting actions on VRFLDO GHWHUPLQDQWV RI KHDOWK LQFOXGH WKH SURPRWLRQ RI IRRG VDIHW\ DQG UHGXFWLRQ RI malnutrition through developing a national nutrition strategy and a national food safety SROLF\ 6XSSRUW ZDV SURYLGHG DOVR WR WKH 02+&'*(& WR DVVHVV WKH PDJQLWXGH RI 1&'V LQ WKH FRXQWU\ WKURXJK IDFLOLWDWLRQ RI 67(36 DQG JOREDO VFKRROEDVHG VWXGHQW KHDOWK VXUYH\V 7KH 02+&'*(& ZDV VXSSRUWHG WR LQWHJUDWH JHQGHU HTXDOLW\ DQG human rights aspects into health programmes through developing the national clinical PDQDJHPHQWJXLGHOLQHVIRUWKHKHDOWKVHFWRU¶VUHVSRQVHWRJHQGHUEDVHGYLROHQFH
,QLPSOHPHQWLQJ6WUDWHJLFDJHQGD6XSSRUWLQJSDUWQHUVKLSIRUKHDOWKGHYHORSPHQW WKH FRXQWU\ RI¿FH DV D PHPEHU RI WKH 81 FRXQWU\ WHDP DQG D EURNHU IRU KHDOWK GHYHORSPHQW FROODERUDWHG HIIHFWLYHO\ ZLWK 81 DJHQFLHV WR OHDG DQG FRRUGLQDWH WKH RSHUDWLRQ RI WKH 81'$3 +HDOWK DQG 1XWULWLRQ 3URJUDPPH :RUNLQJ *URXS IRU ± LQKHDOWKUHODWHGRXWFRPHV7KHFRXQWU\RI¿FHDOVRFRQWULEXWHGWRWKHFRRUGLQDWLRQ RI'3*+HDOWKDVLWVVHFUHWDULDWWRVXSSRUWWKHKHDOWKVHFWRUSULRULWLHVRXWOLQHGLQ+663 ,,,DQGWKHGHYHORSPHQWRI+663,9
7KH FRXQWU\ RI¿FH PRELOL]HG UHVRXUFHV LQGLYLGXDOO\ DQG LQ FRRSHUDWLRQ ZLWK RWKHU partners and UN agencies to support the implementation of the health sector priorities. 7KHVH LQFOXGHG UHVRXUFHV IRU VFDOLQJ XS QXWULWLRQ LQWHUYHQWLRQV VWUHQJWKHQLQJ VXUYHLOODQFH V\VWHPV DQG LPSOHPHQWLQJ 81'$3 , 7KH RI¿FH FRRSHUDWHG ZLWK '3* +HDOWK WR PRELOL]H UHVRXUFHV IRU LPSOHPHQWLQJ +663 ,,, DQG GHYHORSLQJ +663 ,9 ,W SOD\HGDVWURQJUROHLQHQDEOLQJWKHFRXQWU\WRJHWDFFHVVWRIXQGLQJWKURXJKWKH*OREDO )XQG*$9,$OOLDQFHDQG501&$+)XQGDVZHOOWRPDQDJHDQGLPSOHPHQWJUDQWV
$ELGLQJ E\ WKH SULQFLSOHV RI WKH 3DULV 'HFODUDWLRQ RQ$LG (IIHFWLYHQHVV WKH FRXQWU\ RI¿FH FROODERUDWHG ZLWK WKH 02+&'*(& DQG SDUWQHUV LQ KDUPRQL]LQJ WKH ZRUN RI WKHKHDOWKVHFWRUXQGHUWKH6:$SIUDPHZRUNFRQWULEXWLQJWRWKHZRUNRIWKH6:$S WHFKQLFDO ZRUNLQJ JURXSV WR UHDFK WKH DJUHHG DQQXDO KHDOWK VHFWRU PLOHVWRQHV DQG
establish monitoring and evaluation targets for HSSP III through mechanisms such as WKHMRLQWDQQXDOKHDOWKVHFWRUUHYLHZPLGWHUPUHYLHZDQGH[WHUQDOMRLQWHYDOXDWLRQ
Chapter 4: Strategic agenda for WHO cooperation with the United
Republic of Tanzania
The strategic agenda consists of a set of priorities and CCS III focus areas for WHO cooperation with the country. The CCS strategic priorities constitute what will be the medium-term priorities for the cooperation. WHO will concentrate most of its resources over the CCS III cycle to support these areas. The strategic priorities will contribute WRWKHDFKLHYHPHQWRIWKH+663,9REMHFWLYHV7KH&&6IRFXVDUHDVFRQWDLQGHWDLOV RQ ZKDW H[DFWO\ :+2 ZLOO GR ZLWKLQ HDFK VWUDWHJLF SULRULW\ %HVLGHV +663 WKH\ ZLOO DOVRFRQWULEXWHWR81'$36'*VWKH6HQGDL)UDPHZRUNIRU'LVDVWHU5LVN5HGXFWLRQ ±WKHJOREDOOHYHORXWFRPHVLQWKHWK*3:DQGWKHVL[:+2OHDGHUVKLS priorities (see Figure 1).
Figure 1: Inputs for CCS III strategic agenda
4.1
CCS III strategic priorities and focus areas
)LYH VWUDWHJLF SULRULWLHV ZHUH LGHQWL¿HG DQG DJUHHG RQ IRU &&6 ,,, E\ WKH QDWLRQDO VWDNHKROGHUVWREHDGGUHVVHGGXULQJWKHLPSOHPHQWDWLRQRI=DQ]LEDU¶V+663,,,DQG WKHPDLQODQG¶V+663,96HYHUDOFKDOOHQJHVZLWKLQWKHKHDOWKVHFWRULGHQWL¿HGLQWKH PLGWHUPUHYLHZRIWKHPDLQODQG¶V+663,,,DQGGXULQJWKHGHYHORSPHQWRI+663,9OHG WRWKHGH¿QLWLRQRIWKHSULRULWLHVZKLFKDUHDVIROORZV
(a) Reducing the morbidity and mortality caused by communicable diseases through DSSURSULDWH DQG HIIHFWLYH LQWHUYHQWLRQV LQFOXGLQJ VWUHQJWKHQLQJ KHDOWK V\VWHPV DQGDGGUHVVLQJHQYLURQPHQWDOLVVXHV
CCS strategic priority
CCS focus areas
GPW/Programme budget outcome UNDAP
12th GPW
HSSP SDGs, other global
commitments and agreements
National development plan
Key health and development
challenges
Contribution of other development partners
,QWKHSURFHVVRIGHYHORSLQJ&&6,,,ZHUHFRJQL]HGWKDW6'*ZDVVSHFL¿FDOO\UHODWHG WRKHDOWKDQGLWVWDUJHWVZHUHFORVHWRWKH&&6¶VVWUDWHJLFSULRULWLHV6'*VDQG DUHUHODWHGWR&&6,,,¶VVWUDWHJLFSULRULW\RQ501&$+DQGHQYLURQPHQWDOKHDOWKDQG 6'*LVUHODWHGWRWKH&&6¶VVWUDWHJLFSULRULW\RQ1&'V7KHOLQNDJHEHWZHHQ&&6 ,,,¶VVWUDWHJLFSULRULWLHVDQGWKH6'*WDUJHWVLVVKRZQLQWKH7DEOH
(b) 5HGXFLQJWKHEXUGHQRI1&'VWKURXJKKHDOWKSURPRWLRQDQGUHGXFWLRQSUHYHQWLRQ WUHDWPHQWDQGPRQLWRULQJRIWKHLUULVNIDFWRUV
(c) &RQWULEXWLQJ WR 501&$+ DQG ZHOOEHLQJ DQG SURPRWLRQ RI KHDOWK WKURXJK DGGUHVVLQJWKHVRFLDOGHWHUPLQDQWVRIKHDOWK
(d) 6WUHQJWKHQLQJKHDOWKV\VWHPVWRLPSURYHWKHTXDOLW\HTXLW\LQDFFHVVDQGXWLOL]DWLRQ RIKHDOWKVHUYLFHV
(e) Providing support for developing the minimum IHR (2005) core capacities and VWUHQJWKHQLQJWKHFDSDFLW\WRLPSOHPHQWGLVDVWHUULVNPDQDJHPHQW
Table 1 shows how the CCS III strategic priorities are related to the WHO leadership priorities.
Table 1: CCS III strategic priorities’ linkage with the WHO leadership priorities
CCS strategic priorities WHO leadership priorities
Reducing the morbidity and mortality caused by communicable diseases through appropriate and effective
LQWHUYHQWLRQV LQFOXGLQJ VWUHQJWKHQLQJ KHDOWK V\VWHPV DQG
addressing environmental issues
8Q¿QLVKHG KHDOWKUHODWHG 0'*V DQG 6'*V
5HGXFLQJWKHEXUGHQRI1&'VWKURXJKKHDOWKSURPRWLRQ DQGUHGXFWLRQSUHYHQWLRQWUHDWPHQWDQGPRQLWRULQJRIWKHLU ULVNIDFWRUV
1&'V
Contributing to RMNCAH and well-being and promotion of health through addressing the social determinants of health
8Q¿QLVKHG KHDOWKUHODWHG 0'*V DQG 6'*V
$FWLRQ RQ VRFLDO HFRQRPLF DQG
environmental determinants of health
6WUHQJWKHQLQJ KHDOWK V\VWHPV WR LPSURYH TXDOLW\ HTXLW\ LQ
access and utilization of health services
Universal health coverage Providing support for developing the minimum IHR (2005)
core capacities and strengthening the capacity to implement
GLVDVWHUULVNPDQDJHPHQW
7DEOH&&6,,,VWUDWHJLFSULRULWLHV¶OLQNDJHZLWK6'*V
6'*WDUJHWV CCS strategic priorities
%\ HQG WKH HSLGHPLFV RI$,'6 WXEHUFXORVLV PDODULD DQG 17'V DQG FRPEDW KHSDWLWLV ZDWHUERUQH GLVHDVHV DQG RWKHU
communicable diseases
Reducing the morbidity and mortality caused by communicable diseases through appropriate and effective
LQWHUYHQWLRQVLQFOXGLQJVWUHQJWKHQLQJ
health systems and addressing environmental issues
%\UHGXFHE\RQHWKLUGSUHPDWXUHPRUWDOLW\IRUP1&'V
through prevention and treatment and promote mental health and well-being
6WUHQJWKHQWKHSUHYHQWLRQDQGWUHDWPHQWRIVXEVWDQFHDEXVH
including narcotic drug abuse and harmful use of alcohol
5HGXFLQJWKHEXUGHQRI1&'V WKURXJKKHDOWKSURPRWLRQDQG UHGXFWLRQSUHYHQWLRQWUHDWPHQWDQG PRQLWRULQJRIWKHLUULVNIDFWRUV
%\UHGXFHWKHJOREDOPDWHUQDOPRUWDOLW\UDWLRWROHVVWKDQ
per 100 000 live births
%\ HQG SUHYHQWDEOH GHDWKV RI QHZERUQV DQG FKLOGUHQ XQGHU\HDUVRIDJHZLWKDOOFRXQWULHVDLPLQJWRUHGXFHQHRQDWDO
mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births
%\ HQVXUH XQLYHUVDO DFFHVV WR VH[XDO DQG UHSURGXFWLYH KHDOWKFDUH VHUYLFHV LQFOXGLQJ IRU IDPLO\ SODQQLQJ LQIRUPDWLRQ DQG HGXFDWLRQ DQG WKH LQWHJUDWLRQ RI UHSURGXFWLYH KHDOWK LQWR
national strategies and programmes.
%\KDOYHWKHQXPEHURIJOREDOGHDWKVDQGLQMXULHVIURPURDG WUDI¿FDFFLGHQWV
%\VXEVWDQWLDOO\UHGXFHWKHQXPEHURIGHDWKVDQGLOOQHVV IURP KD]DUGRXV FKHPLFDOV DQG DLU ZDWHU DQG VRLO SROOXWLRQ DQG
contamination
Contributing to RMNCAH and well-being and promoting health through addressing the social determinants of health
$FKLHYH XQLYHUVDO KHDOWK FRYHUDJH LQFOXGLQJ ¿QDQFLDO ULVN SURWHFWLRQ DFFHVV WR TXDOLW\ HVVHQWLDO KHDOWKFDUH VHUYLFHV DQG DFFHVV WR VDIH HIIHFWLYH TXDOLW\ DQG DIIRUGDEOH HVVHQWLDO
medicines and vaccines for all
Strengthening health systems to
LPSURYHWKHTXDOLW\HTXLW\LQDFFHVV
and utilization of health services
6WUHQJWKHQWKHFDSDFLW\RIDOOFRXQWULHVLQSDUWLFXODUGHYHORSLQJ FRXQWULHV IRU HDUO\ ZDUQLQJ ULVN UHGXFWLRQ DQG PDQDJHPHQW RI QDWLRQDODQGJOREDOKHDOWKULVNV
Providing support for developing the minimum IHR (2005) core capacities and strengthening the capacity to
LPSOHPHQWGLVDVWHUULVNPDQDJHPHQW
Table 3: CCS III strategic priorities’ linkage with UNDAP outcomes
UNDAP outcomes CCS strategic priorities
,PSURYHG VFDOHG XS DQG HTXLWDEOH XVH RI SURYHQ +,9 SUHYHQWLRQWUHDWPHQWFDUHDQGVXSSRUWLQWHUYHQWLRQV
Reducing the morbidity and mortality caused by communicable diseases through
DSSURSULDWHDQGHIIHFWLYHLQWHUYHQWLRQV
including strengthening health systems and addressing environmental issues
,QFUHDVHG FRYHUDJH RI HTXLWDEOH TXDOLW\ DQG HIIHFWLYH QXWULWLRQVHUYLFHVDPRQJZRPHQDQGFKLOGUHQXQGHU¿YH 5HGXFLQJWKHEXUGHQRI1&'VWKURXJK KHDOWKSURPRWLRQDQGUHGXFWLRQSUHYHQWLRQ WUHDWPHQWDQGPRQLWRULQJRIWKHLUULVNIDFWRUV ,PSURYHGDFFHVVWRHTXLWDEOHDFFHSWDEOHDQGDIIRUGDEOH TXDOLW\KHDOWKVHUYLFHV
Strengthening health systems to improve
TXDOLW\ HTXLW\ LQ DFFHVV DQG XWLOL]DWLRQ RI
health services Increased coverage of comprehensive and integrated
social protection (interventions and services) for the poor and vulnerable
9XOQHUDEOH JURXSV KDYH LQFUHDVHG DFFHVV WR VDIH DQG
affordable water supply sanitation and hygiene
Contributing to RMNCAH and well-being and promoting health through addressing the social determinants of health
,PSURYHGHQYLURQPHQWDOQDWXUDOUHVRXUFHVDQGGLVDVWHU ULVNPDQDJHPHQW
Providing support for developing the minimum IHR (2005) core capacities and strengthening
WKH FDSDFLW\ WR LPSOHPHQW GLVDVWHU ULVN
management
7KH+663SULRULWLHVDUHUHODWHGWR6'*VWKH\LQÀXHQFHGWKHGH¿QLWLRQRIWKH81'$3 RXWFRPHVDQGWKH\DUHOLQNHGWRWKH&&6,,,VWUDWHJLFSULRULWLHV7DEOH
Table 4: CCS III strategic priorities’ linkage with HSSP priorities
HSSP priorities CCS III strategic priorities
The health system will maintain the high level of performance
RI GLVHDVH FRQWURO SURJUDPPHV UHGXFH PRUELGLW\ DQG
mortality caused by infectious diseases while increasing
HI¿FLHQF\WKURXJKLPSURYHGLQWHJUDWLRQRIDFWLYLWLHV
Reducing the morbidity and mortality caused by communicable diseases through appropriate and effective
LQWHUYHQWLRQVLQFOXGLQJVWUHQJWKHQLQJ
health systems and addressing environmental issues
2Q 1&'V WKH FRXQWU\ ZLOO IRFXV RQ FRPPXQLW\EDVHG SUHYHQWLRQKHDOWKSURPRWLRQVFUHHQLQJDQGHDUO\WUHDWPHQW
as well as rehabilitation.
5HGXFLQJWKHEXUGHQRI1&'VWKURXJK KHDOWKSURPRWLRQDQGUHGXFWLRQ SUHYHQWLRQWUHDWPHQWDQGPRQLWRULQJRI WKHLUULVNIDFWRUV
7KH KHDOWK V\VWHP ZLOO EH VWUHQJWKHQHG WR SURYLGH TXDOLW\ VHUYLFHVZKLFKZLOOFRQWULEXWHWRDFKLHYLQJWKHJRDORIHQGLQJ SUHYHQWDEOHPDWHUQDOQHZERUQDQGFKLOGGHDWKVDQGHQVXUH XQLYHUVDODFFHVVWRVH[XDODQGUHSURGXFWLYHDQGDGROHVFHQW KHDOWK VHUYLFHV DQG WKH KHDOWK VHFWRU ZLOO DGYRFDWH IRU
intersectoral action and actively engage in partnerships
LQ DGGUHVVLQJ WKH VRFLDO GHWHUPLQDQWV RI KHDOWK LQFOXGLQJ
implementation of the approach.
&RXQFLO KHDOWK VHUYLFHV ZLOO FRQVWLWXWH WKH EDFNERQH RI WKH KHDOWKVHUYLFHVDQGZLOOSURYLGHWKHQDWLRQDOHVVHQWLDOKHDOWK FDUH LQWHUYHQWLRQ SDFNDJH 1(+&,3 ZKLOH JXDUDQWHHLQJ TXDOLW\VWDUUDWLQJDQGWUDQVSDUHQF\VRFLDODFFRXQWDELOLW\
and will sensitize the population to enrol in the single national
KHDOWK LQVXUDQFH DQG WDNH SDUW LQ PDQDJHPHQW RI FRXQFLO
health services.
Strengthening the health system to
LPSURYH TXDOLW\ HTXLW\ LQ DFFHVV DQG
utilization of health services
02+&'*(& LQ FROODERUDWLRQ ZLWK RWKHU PLQLVWULHV
departments and agencies) will put systems and structures in place to be able to respond immediately to health related
FULVHVDQGHSLGHPLFVXVLQJPRGHUQPHDQVRIFRPPXQLFDWLRQ
to ensure global health
Providing support for developing the minimum IHR (2005) core capacities and strengthening the capacity to implement
GLVDVWHUULVNPDQDJHPHQW
7KH&&6,,,VWUDWHJLFSULRULWLHVDUHFRQVLVWHQWZLWKWKH:+2WK*3:DQGLWVIRFXV DUHDVKDYHDRQHWRRQHOLQNZLWKWKH*3:¶VRXWFRPHV7DEOH
Table 5: CCS III strategic priorities and focus areas with its linkage to WHO
*HQHUDO3URJUDPPHRI:RUN
Reducing the morbidity andmortality caused by communi-cable diseases through appropriate and effective interventions, including strengthening the health systems and addressing environmental issues
Strengthened intersectoral capacities for the management of environmental threats to health
Increased access to prevention, diagnostics, care, treatment and interventions for tuberculosis, HIV and malaria
Increased access to key interventions for people living with HV
Increased number of successfullly treated tuberculosis patients
Increased access to first-line antimalarial treatment for confirmed malaria cases
Increased and sustained access to essential medicines for NTDs
Increased vaccination coverage for hard-to-reach populations and communities
Category 1
Increased and sustained access to safe and quality essential medicines for NTDs
Reducing the burden of NCDs through health promotion, and reduction, prevention, treatment and monitoring of their risk factors
Increased evidence to use for advocacy, leadership and multisectoral response on injuries, with a focus on risk factors, road safety, child injuries, and violence against children women and youth
Increased access to interventions to prevent and manage NCDs and monitoring of their risk factors
Increased access to interventions to prevent and manage NCDs and their risks
Increased access to services for mental health and substance use disorders
Reduced nutritional risk factors
Increased access to services to people with disabilities Reduced risk factors for violence and injuries with a focus on road safety, child injuries and violence against children, women and youth
Category 2
Improved capacity for surveillance and interventions for reduction of nutritional risk factors
Country Cooperation Strategy Strategic priorities Focus areas
Contributing to RMNCAH and well-being and promoting health through addressing the social determinants of health
Increased access to high quality, reproductive, maternal, newborn, child and adolescent health interventions
Increased vaccination coverage for hard-to-reach
populations and communities
Country Cooperation Strategy Strategic priorities Focus areas
WHO General Programme of Work Results Chain GPW/ Programme budget outcomes
Increased access to interventions for improving health of women newborns, children and adolescents
Increased proportion of older people who can maintain an independent life
Gender, equity and human rights integrated into the Secretariat’s and countries’ policies and programmes
Increased intersectoral policy coordination to address the social determinants of health
Reduced environmental threats to health
Category 3
Enhanced capacity for intersectoral collaboration to address the social determinants of health
Strengthening the health system to improve quality, equity in access and utilization of health services
Strengthened capacity to develop and implement appropriate policies and legislation for HRH planning, management, production and retention, and to adopt innovative health financing that ensures increased quality, access and equity of health services
Built capacity of the civil registration and vital statistics systems, including to support the strengthening of HMIS reviews, assessments, research and evaluation, to generate evidence for policy
All countries have comprehensive national health policies, strategies and plans updated within the last five years
Policies, financing and human resources are in place to increase access to people-centered, integrated health services
All countries have properly functioning civil registration and vital statistics system
Increased access to and rational use of safe, efficacious and quality medicines
and heath technologies
Category 4
Increased access to, and rational use of, safe, efficacious and quality medicines and health technologies
Providing support for developing the minimum IHR (2005) core capacities and strengthening the capacity to implement disaster risk management
Built core capacities required for IHR (2005) in MOHSW and the local government authorities for all-hazard alert and response
Increased capacity to manage health risks of emergencies and build resilience, including and preparedness for rapid and effective response to health-related disasters and emergencies and major epidemics and pandemics using the One Health approach
All countries are adequately prepared to prevent and mitigate risks to food safety
No cases of paralysis due to wild or type-2 vaccine related poliovirus globally
Countries have the capacity to manage public health risks associated with emergencies
All countries have the minimum core capacities required by IHR (2005) for all-hazard alert and response
Increased capacity of countries to build resilience and adequate preparedness to mount a rapid, predictable and effective response to major epidemics and pandemics
Category 5
4.2 Strategic actions for the implementation of CCS III
)RU:+2WRUHVSRQGWRWKHFRXQWU\¶VSULRULWLHVDQGQHHGVWKHDJUHHGVWUDWHJLFSULRULWLHV and focus areas will need to be accomplished through strategic actions. These strategic DFWLRQVZLOOOHDGWRWKHRXWFRPHVVWDWHGLQWKHIRFXVDUHDVZKLFKLQWXUQZLOOFRQWULEXWH to the achievement of the strategic priorities.
Strategic priority 1: Reducing the morbidity and mortality caused by communicable diseases through appropriate and effective interventions, including strengthening the health system and addressing environmental issues
Focus area 1: Strengthened intersectoral capacities for the management of environmental threats to health
&RXQWU\RI¿FHVWUDWHJLFDFWLRQV
D 'HYHORSDQGLPSOHPHQWQDWLRQDOSROLFLHVSODQVDQGVWUDWHJLHVIRUWKHSUHYHQWLRQ mitigation and management of the health impacts of environmental and occupational ULVNV
(b) Strengthen the capacity to prevent and manage the health impacts of poor water VDQLWDWLRQDQGK\JLHQH
(c) Monitor the status of water supply and sanitation to enable better planning and management of WASH interventions.
Focus area 2: Increased access to prevention, diagnostics, care and treatment and interventions for tuberculosis, HIV and malaria
&RXQWU\RI¿FHVWUDWHJLFDFWLRQV
D $GDSWDQGLPSOHPHQWJOREDOSROLFLHVVWUDWHJLHVJXLGHOLQHVDQGUHFRPPHQGDWLRQV RQ+,9WXEHUFXORVLVDQGPDODULDWRHQVXUHHTXLWDEOHFRYHUDJHRIWKHSUHYHQWLRQ WUHDWPHQWFDUHDQGVXSSRUWVHUYLFHV
(b) 6WUHQJWKHQFDSDFLW\LQ+,9WXEHUFXORVLVDQGPDODULDFDVHGLDJQRVLVPDQDJHPHQW PRQLWRULQJDQGHYDOXDWLRQ
(c) Coordinate proposal development and local resource mobilization initiatives for +,9WXEHUFXORVLVDQGPDODULDSURJUDPPLQJ
Focus area 3: Increased and sustained access to safe and quality essential medicines for NTDs
&RXQWU\RI¿FHVWUDWHJLFDFWLRQV
(b) )DFLOLWDWH PRQLWRULQJ DQG UHSRUWLQJ LQ SUHYHQWLYH FKHPRWKHUDS\ DQG LQWHQVL¿HG 17'PDQDJHPHQWLQWHUYHQWLRQVDQGDVVHVVWKHLULPSDFW
(c) ,QQRYDWHDQGFUHDWHHYLGHQFHRQEHVWSUDFWLFHVUHODWHGWRLQWHJUDWHG17'FRQWURO and elimination to inform programme management and planning.
Strategic priority 2: Reducing the burden of NCDs through health promotion, prevention, treatment and monitoring of their risk factors
Focus area 1: Increased evidence to use for advocacy, leadership and multisectoral response on injuries, with a focus on risk factors, road safety, child injuries and violence against children, women and youth
&RXQWU\RI¿FHVWUDWHJLFDFWLRQV
(a) Support evidence generation and dissemination for advocacy on a multisectoral UHVSRQVHWRSUHYHQWLQMXULHVDQGYLROHQFH
(b) Support capacity building and implementation of multisectoral plans and SURJUDPPHVWRSUHYHQWLQMXULHVZLWKDIRFXVRQDFKLHYLQJWKHWDUJHWVRIWKH8QLWHG 1DWLRQV'HFDGHRI$FWLRQIRU5RDG6DIHW\
Focus area 2: Increased access to interventions to prevent and manage NCDs and monitoring of their risk factors
&RXQWU\RI¿FHVWUDWHJLFDFWLRQV
(a) Convene multisectoral dialogues on policy options for the prevention and control RI1&'VLQOLQHZLWKWKH:+2*OREDO$FWLRQ3ODQIRUWKH3UHYHQWLRQDQG&RQWURORI 1&'V±DQGWKHUHJLRQDOVWUDWHJLHVSODQVDQGIUDPHZRUNV
(b) 'HYHORS DQG LPSOHPHQW QDWLRQDO SODQV VWUDWHJLHV DQG JXLGHOLQHV WR UHGXFH PRGL¿DEOHULVNIDFWRUVIRU1&'VZKLFKDUHWREDFFRXVHGLHWSK\VLFDOLQDFWLYLW\ DQGWKHKDUPIXOXVHRIDOFRKRODVZHOODVSURPRWLQJPHQWDOKHDOWK
(c) 6WUHQJWKHQKHDOWKFDUHVHUYLFHVIRUWKHPDQDJHPHQWRIFDUGLRYDVFXODUGLVHDVHV FDQFHUGLDEHWHVDQGFKURQLFUHVSLUDWRU\GLVHDVHV
(d) )DFLOLWDWHPRQLWRULQJRI1&'WUHQGVDQGUHODWHGULVNIDFWRUVLQFOXGLQJLPSOHPHQWDWLRQ RIWKH:+267(36JOREDODGXOWWREDFFRJOREDO\RXWKWREDFFRDQGJOREDOVFKRRO based student health surveys.
Focus area 3: Improved capacity for surveillance and interventions for reduction of nutritional risk factors
&RXQWU\RI¿FHVWUDWHJLFDFWLRQV
(b) $GDSWQRUPVVWDQGDUGVDQGSROLF\RSWLRQVIRUSURPRWLQJFRVWHIIHFWLYHLQWHUYHQWLRQV WRDGGUHVVWKHGRXEOHEXUGHQRIPDOQXWULWLRQ
(c) Build capacity for nutrition surveillance and monitoring.
Strategic priority 3: Contribute to RMNCAH and well-being and promote health through addressing the social determinants of health
Focus area 1: Increased access to high quality, reproductive, maternal, newborn, child and adolescent health interventions
&RXQWU\RI¿FHVWUDWHJLFDFWLRQV
(a) Build the capacity for coordination and planning of RMNCAH interventions and for PRQLWRULQJWKHLUSURJUHVVLQFOXGLQJIRUWKHLUDQQXDOUHYLHZV
(b) 6WUHQJWKHQ WKH LPSOHPHQWDWLRQ RI SROLFLHV QRUPV VWDQGDUGV DQG JXLGHOLQHV IRU 501&$+
(c) %XLOGWKHFDSDFLW\IRUSURYLVLRQRITXDOLW\501&$+VHUYLFHVLQVHOHFWHGGLVWULFWV WKURXJK WUDLQLQJ VXSHUYLVLRQ PHQWRUVKLS DQG SURYLVLRQ RI HVVHQWLDO HTXLSPHQW and supplies.
(d) 6WUHQJWKHQWKHFDSDFLW\IRUPDLQVWUHDPLQJJHQGHUHTXLW\DQGKXPDQULJKWVLQWR KHDOWKSURJUDPPHVSODQVDQGVHUYLFHV
Focus area 2: Increased vaccination coverage for hard-to-reach populations and communities
&RXQWU\RI¿FHVWUDWHJLFDFWLRQV
(a) ,PSOHPHQWDFWLYLWLHVUHODWHGWRWKH5HDFKLQJ(YHU\&KLOGDSSURDFKWRHQVXUHWKDW DOOHOLJLEOHFKLOGUHQKDYHDFFHVVWRDQGXWLOL]HLPPXQL]DWLRQVHUYLFHV
(b) Strengthen the capacity in surveillance for vaccine-preventable diseases and in WKHXVHRILPPXQL]DWLRQGDWDIRUSURJUDPPHPRQLWRULQJUHSRUWLQJDQGUHVSRQVH
Focus area 3: Enhanced capacity for intersectoral collaboration to address the social determinants of health
&RXQWU\RI¿FHVWUDWHJLFDFWLRQV
(a) Convene intersectoral dialogues to advocate for the implementation of social determinants to health approaches that promote governance in other sectors that SRVLWLYHO\LPSDFWRQKXPDQKHDOWK
Strategic priority 4: Strengthening health systems to improve quality, equity in access and utilization of health services
Focus area 1: Strengthened capacity to develop and implement appropriate policies and legislation for HRH planning, management, production and retention, DQGWRDGRSWLQQRYDWLYHKHDOWK¿QDQFLQJWKDWHQVXUHVLQFUHDVHGTXDOLW\DFFHVV and equity of health services
&RXQWU\RI¿FHVWUDWHJLFDFWLRQV
(a) Adapt and implement the WHO global strategy on people-centred and integrated KHDOWK VHUYLFHV WDNLQJ LQWR DFFRXQW WKH JOREDO VWUDWHJ\ RQ KXPDQ UHVRXUFHV IRU KHDOWK
(b) %XLOGSURFHVVHVIRUHTXLWDEOHVWDIIGLVWULEXWLRQDQGUHWHQWLRQDQGIRUPDLQWHQDQFH RI KLJK SHUIRUPDQFH VWDQGDUGV IRU VNLOOHG VWDII WR LPSURYH WKH TXDOLW\ RI KHDOWK VHUYLFHV
(c) Provide support for the implementation of the Human Resources for Health 6WUDWHJLF3ODQ±DQGWKH+XPDQ5HVRXUFHVIRU+HDOWK3URGXFWLRQ3ODQ 2014–2024.
(d) $GYRFDWHIRUKHDOWK¿QDQFLQJSROLFLHVWRHQVXUHSURJUHVVWRZDUGVXQLYHUVDOKHDOWK FRYHUDJH ZLWK D IRFXV RQ ¿QDQFLDO SURWHFWLRQ LQFOXGLQJ IRU WKH DGRSWLRQ RI WKH KHDOWK¿QDQFLQJVWUDWHJ\
(e) 3URYLGHVXSSRUWIRUWKHLPSOHPHQWDWLRQRIWKHKHDOWK¿QDQFLQJVWUDWHJ\LQFOXGLQJ HIIRUWVWRLQVWLWXWLRQDOL]HKHDOWK¿QDQFLQJUHIRUPVWKURXJKDOLJQLQJKHDOWK¿QDQFLQJ ZLWKWKHQDWLRQDOSXEOLF¿QDQFHPDQDJHPHQWDQGEXGJHWSURFHVVHV
(f) 6WUHQJWKHQ WKH LQVWLWXWLRQDO FDSDFLW\ WR DQDO\VH GHYHORS DQG LPSOHPHQW KHDOWK ¿QDQFLQJSROLFLHVWKDWLQFRUSRUDWHOHVVRQVOHDUQWIURPRWKHUFRXQWULHV
Focus area 2: Built capacity of the civil registration and vital statistics systems, including to support the strengthening of HMIS reviews, assessments, research and evaluation, to generate evidence for policy
&RXQWU\RI¿FHVWUDWHJLFDFWLRQV
(a) $GYRFDWHIRUWKHSURYLVLRQRIHIIHFWLYHWRROVDQGDOORFDWLRQRIVXI¿FLHQWUHVRXUFHV WRVWUHQJWKHQWKHQDWLRQDOUHJLRQDODQGGLVWULFWKHDOWKLQIRUPDWLRQV\VWHPV
(b) 'HYHORS DQG LPSOHPHQW VWUDWHJLHV DQG DFWLRQ DQG LQYHVWPHQW SODQV IRU KHDOWK LQIRUPDWLRQFLYLOUHJLVWUDWLRQDQGYLWDOVWDWLVWLFV
(d) Identify capacity strengthening needs and provide support in areas of governance IRUKHDOWKUHVHDUFKKHDOWKV\VWHPVUHVHDUFKDQGUHVHDUFKHWKLFV
)RFXV $UHD ,QFUHDVHG DFFHVV WR DQG UDWLRQDO XVH RI VDIH HI¿FDFLRXV DQG quality medicines and health technologies
&RXQWU\RI¿FHVWUDWHJLFDFWLRQV
(a) 5HYLVH DQG LPSOHPHQW WKH QDWLRQDO SROLFLHV RQ FRQWHPSRUDU\ WUDGLWLRQDO DQG complementary medicines and other health technologies and foster their rational XVH DV ZHOO DV RSWLPL]H WKH XVH RI DQWLPLFURELDOV DQG FRPEDW DQWLPLFURELDO UHVLVWDQFH
(b) Build the capacity of the procurement and supply management systems and for the implementation and monitoring of the global strategy and plan of action on SXEOLFKHDOWKLQQRYDWLRQDQGLQWHOOHFWXDOSURSHUW\ULJKWV
(c) 6WUHQJWKHQ WKH QDWLRQDO UHJXODWRU\ DXWKRULWLHV IRU PHGLFLQHV PHGLFDO GHYLFHV biologicals and other health technologies.
6WUDWHJLF SULRULW\ 3URYLGLQJ VXSSRUW IRU GHYHORSLQJ WKH PLQLPXP ,+5
core capacities and strengthening the capacity to implement disaster risk management
)RFXVDUHD%XLOWFRUHFDSDFLWLHVUHTXLUHGIRU,+5LQ02+&'*(&DQG local government authorities for all-hazard alert and response
&RXQWU\RI¿FHVWUDWHJLFDFWLRQV
(a) 'HYHORSDQGLPSOHPHQWDIUDPHZRUNIRUWKHQDWLRQDOIRFDOSRLQWDQGHQKDQFHLWV FDSDFLW\WRFRRUGLQDWHDQGGHYHORSDJXLGLQJGRFXPHQWIRUVWDNHKROGHUVWRSOD\ WKHLUUROHVHIIHFWLYHO\
(b) (VWDEOLVKDV\VWHPRIVXUYHLOODQFHIRUKRVSLWDODFTXLUHGLQIHFWLRQVDQGDQWLPLFURELDO UHVLVWDQFH
(c) ,PSURYHWKHGLDJQRVWLFDQGFRQ¿UPDWLRQFDSDFLW\DWQDWLRQDODQG]RQDOODERUDWRULHV DQGLQLGHQWL¿HGUHJLRQVDQGGLVWULFWOHYHOV
(d) 'HYHORSFRPSUHKHQVLYHJXLGHOLQHVIRUVXUYHLOODQFHRISXEOLFKHDOWKWKUHDWVDWWKH SRLQWVRIHQWU\DQGSUHSDUHGQHVVDQGHPHUJHQF\FRQWLQJHQF\SODQVIRUWKHSRLQWV of entry.