Family Planning in Tanzania: Executive Summary. A Review of National and District Policies and Budgets
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1 A Family Planning in Tanzania: Executive Summary Family Planning in Tanzania: A Review of National and District Policies and Budgets
2 Family Planning in Tanzania: A Review of National and District Policies and Budgets
3 2 Family Planning in Tanzania: Published by: DSW Deutsche Stiftung Weltbevoelkerung P.O. Box 14279, Arusha, Tanzania Tel: Internet: Authors: Elinami Mungure and Peter Owaga Layout and Design: Sprint Design www. sprintdesign.com.pk DSW (Deutsche Stiftung Weltbevoelkerung) All forms of copies, reproductions, adaptations, and translations through mechanical, electrical, or electronic means, should acknowledge DSW (Deutsche Stiftung Weltbevoelkerung as the source. May 2014
4 A Review of National and District Policies and Budgets 3 Contents List of abbreviations 5 Acknowledgement 6 Executive summary Introduction Tanzania country context Family planning in Tanzania Fertility and contraceptive use in Tanzania Euroleverage project Objective of this study Methodology Data collection Document Review RH/FP Budget tracking Key Informant Interviews Focused group discussions Facility assessment Data Analysis District sampled for gathering community perspectives Handeni district Shinyanga district Community perspectives FP awareness and attitude FP method Availability Challenges of accessing FP Causes of unmet need Views of policy makers on addressing unmet need for FP Findings from facility assessment Findings from policy Review The national health policy 20
5 4 Family Planning in Tanzania: 4.2 The population policy National Youth development Policy (Ministry of Labor and Youth Development) MKUKUTA II (National Strategy for Growth and Reduction of Poverty (NSGRP) Health Sector Strategic Plan III (HSSP III) Human resource for health strategic plan The national road map strategic plan to accelerate reduction maternal, newborn and child deaths in Tanzania National Family Planning Costed Implementation Program (NFPCIP) Key policy and programme priorities and policy implementation challenges and responses Findings from Budget Analysis National Budgeting process Health budget trends Sexual Reproductive Health budget trends Family planning budget trends Proportion of budget allocation for Reproductive health and Family planning Health budget Vs Expenditure Family Planning Budget Vs Expenditure Sources of funds for SRH and FP Budgets Conclusion and recommendations Conclusion Recommendations 53 References 54 Appendix 55 Appendix 1: Data collection tools 55
6 A Review of National and District Policies and Budgets 5 Acronyms CCHP Council Comprehensive Health Plans CDHP Council Development Health Plan CHMT Council Health Management Team CPAC Comprehensive Post Abortion Care CPR Contraceptive prevalence rate DED District Executive Director DHMT District Health Management Team DHS Demographic and Health Survey DRCHO District Reproductive and Child Health Coordinator FBO Faith Based Organization FP Family Planning GoT Government of Tanzania HMIS Health Management Information system HSSPIII Health Sector Strategic Plan III IMCI Integrated Mother and Child I nterventions LAPMs Long acting and permanent methods LGA Local Government Authority MCH Mother and Child Health MDG Millennium Development Goals MKUKUTA Mkakati wa KukuzaUchuminaKu punguzaumaskini Tanzania MMR Maternal Mortality Rate MoFEA Ministry of Finance and Economic Affairs MoHSW Ministry of Health and Social Welfare MTEF Medium Term Expenditures Framework NHP National Health Policy NFPCIP National Family Planning Costed Implementation Program NPEFPI National Package of Essential Family Planning Interventions NSGRP National Strategy for Growth and Reduction of Poverty RCH TFR USAID UNFPA ZHMT Administration and Local Government Reproductive and Child Health Total Fertility Rate United States Agency for International Development United Nations Population Fund Zonal Health Management Team
7 6 Family Planning in Tanzania: Acknowledgements
8 A Review of National and District Policies and Budgets 7 Executive Summary DSW Tanzania as part of the Euroleverage 2 project conducted a study to establish the level of policy engagement and budget commitment at national and district/sub national level that address unmet needs of family planning. The and district level information on access and budgets. service providers. vulnerable groups. 3 3
9 8 Family Planning in Tanzania: development agenda.
10 A Review of National and District Policies and Budgets Introduction 1.1. Tanzania country context 1.1. Family planning in Tanzania It is noted that family planning is critical for preventing unintended pregnancies and unsafe abortions ultimately con 1.2. Fertility and contraceptive use in Tanzania recognizes the need to improve provision of family planning services and ensure that the services are fully integrated
11 10 Family Planning in Tanzania: to allocate resources for family planning in the district plans Euroleverage project 1.5. Objective of this study level of policy engagement and budget commitment at national and sub national levels that address unmet needs for
12 A Review of National and District Policies and Budgets Methodology 2.1. Data collection Document Review the policies.
13 12 Family Planning in Tanzania: RH/FP Budget tracking Key Informant Interviews Focused group discussions planning in this community? prefer to use most? planning methods they use? challenges Facility assessment
14 A Review of National and District Policies and Budgets Data Analysis
15 14 Family Planning in Tanzania: 3.1. District sampled for gathering community perspectives Handeni district Vital health statistics Characteristics Data by Shinyanga district Dispensaries
16 A Review of National and District Policies and Budgets 15 Vital health statistics Characteristics Data by Community perspectives FP awareness and attitude Family planning is about deciding the size of your family how many children do you want to have and when to get them.family planning is about the size of the family you want to have how many children and ability to decide an average space from one child to another.we wants to plan for our families so that our women have time to rest and spend their time in economic activities. Family planning help our wives remain health and beautiful.god has given you the ability to reproduce children and this is a gift from him, we cannot in any way prevent pregnancy. There are people who work day and night to get pregnant, now since God has given us ability to have children
17 16 Family Planning in Tanzania: Myths and misconception about FP. Service providers are not professional. not inserted properly resulting in a health problem and the family incurred cost for treatment. FP is perceived by men as a woman s business. FP is women business they are told to use them when they go for clinics, they come home and start using them but Youth view FP as a practice for people who already have children. Those commodities are good for people who already have children for us if we use condom is for protecting us from STIs only but those other methods is not for young people like me FP method Availability.if you want to plan your family, pills and injectable are all over when you approach the health facilities. Only when you want implant and IUD you may need to wait for those people who come from the district hospital during mobile clinics have district hospital Challenges of accessing FP
18 A Review of National and District Policies and Budgets Causes of unmet need Widespread myths and misconceptions on FP commodities. Mistrust of quality of service. Fear of side effects Socio-cultural beliefs and practices. Accessibility. seasons Views of policy makers on addressing unmet need for FP need District key informants is being done due to budget limitations. subject and the doctors are not also motivating.
19 18 Family Planning in Tanzania: National key informants (MOHSW) comments Widespread community misconceptions and false beliefs associated with the use of modern contraceptives: training facilities Findings from facility assessment Availability of family planning methods in Health facilities have a district hospital. Availability of Youth Friendly services FP stock and stock out
20 A Review of National and District Policies and Budgets 19 Supervisory visits IEC material for FP awareness
21 20 Family Planning in Tanzania: 4.0. Findings from policy Review In this section various relevant key policies which responds to reproductive health and family planning are reviewed and analyzed to see to what extent those policies responds to RH/FP issues. We also assess the extent the primary objectives of the policy review component of this project were to; development and health policies and strategies; that are considered critical for the achievement of the objectives of the policies; in the policies The national health policy Responsiveness of national health policy to International Commitments National Health Policy commitment to the international SRH principles delivered for the achievement of improved health status. It is also not clear if the national health policy articulated individuals have the basic right to decide freely and responsibly the number and spacing of their children and to have the information and means to do so. to improve the health sector as expected by the international principle. The facts on the ground also indicates that improvement compared to the last ten years
22 A Review of National and District Policies and Budgets 21 a) Safe abortion child health and family planning under the primary health care but does not come out clearly on safe abortion. b) Adolescent SRH information and services also recommends Equity and accessibility to health care by ensuring that every individual has the right to health care c) Contraception d) Sexual rights This is not included in the national health policy. It is conspicuously missing though education is mentioned as part of 4.2. The population policy Responsiveness of the population policy to International Commitments Population Policy commitment to the international SRH principles population issues
23 22 Family Planning in Tanzania: pressure interact at all these levels. the vulnerable groups. of their children and to have the information and means to do so. This is partially highlighted in the population policy a) Safe abortion
24 A Review of National and District Policies and Budgets 23 b) Adolescent SRH information and services c) Contraception d) Sexual rights 4.3. National Youth development Policy (Ministry of Labour and Youth Development) Responsiveness of the National Youth development Policy to International Commitments planners in various sectors of development in Tanzania. to develop relevant strategies and programmes for youth. in an elaborate sense. Ibid. Ibid.
25 24 Family Planning in Tanzania: National Youth development Policy commitment to the international SRH principles recognizes the importance of youth in social and economic development of a nation and hence allocates adequate funds for youth programmes. Incorporate the programme of implementation for the youth development plans and to educate communities and sensitize them on implementation of the youth programmes. There is no special mention that all couples and individuals have the basic right to decide freely and responsibly the number and spacing of their National Youth development Policy commitment to the international SRH principles gender discrimination. Within
26 A Review of National and District Policies and Budgets 25 nizes the importance of youth in social and economic development of a nation and hence allocates adequate funds for youth programmes. sure that it is implemented. cate communities and sensitize them on implementation of the youth programmes. There is no special mention that all couples and individuals have the basic right to decide freely and responsibly the number and spacing of their chil provide family life education to youths at all levels of education a) Safe abortion boys and girls. b) Adolescent SRH information and services grammes geared to promote youth health c) Contraception d) Sexual rights Tanzania Ibid.
27 26 Family Planning in Tanzania: 4.4. MKUKUTA II (National Strategy for Growth and Reduction of Poverty (NSGRP) Responsiveness of the MKUKUTA II to International Commitments MKUKUTA II commitment to the international SRH principles population gender reduced. a) Safe abortion the primary health care but does not come out clearly on safe abortion. b) Adolescent SRH information and services mends promoting adequate child spacing by enhancing access to modern contraceptive use for all sexually active
28 A Review of National and District Policies and Budgets 27 c) Contraception methods and options. d) Sexual rights 4.5. Health Sector Strategic Plan III (HSSP III) Responsiveness of the HSSP III to International Commitments health parameters HSSP III commitment to the international SRH principles in all health parameters The population issues highlighted in this strategic plan touches on economic and social development. The plan em 32 development 32
29 28 Family Planning in Tanzania: a) Safe abortion b) Adolescent SRH information and services The document is not clear on adolescent sexual reproductive health information c) Contraception d) Sexual rights 4.6. Human resource for health strategic plan Responsiveness of the human resources for health strategic plan to International Commitments
30 A Review of National and District Policies and Budgets 29 Human resource for health strategic plan commitment to the international SRH principles economic and social development. It is indicated that increase in social problems is due to uncontrolled population poverty levels. The dictum that all couples and individuals have the basic right to decide freely and responsibly the number and spac ing of their children and to have the information and means to do so is not included in the document. This leaves a gap building. a) Safe abortion the causes. b) Adolescent SRH information and services c) Contraception d) Sexual right
31 30 Family Planning in Tanzania: 4.7. The national road map strategic plan to accelerate reduction of maternal, new-born and child deaths in Tanzania Responsiveness of the national road map strategic plan to accelerate reduction of maternal, newborn and child deaths in Tanzania to International Commitments health interventions National road map strategic plan to accelerate reduction of maternal, newborn and child deaths in Tanzania commitment to the international SRH principles 33 The population issues are considered in this document as an important social development item. It is used as a fam be emphasized. The target is to mobilize resources from internal and external sources in order to complement the 33
32 A Review of National and District Policies and Budgets 31 a) Safe abortion several attempts have been made to document the severity of the issue. provide this service. about the dangers of unsafe abortion. b) Adolescent SRH information and services c) Contraception misconceptions about modern family planning methods. d) Sexual rights This is not very explicit in the document. The overall picture portrayed is human rights and gender and health National Family Planning Costed Implementation Program (NFPCIP) Responsiveness of the NFPCIP to International Commitments
33 32 Family Planning in Tanzania: NFPCIP commitment to the international SRH principles be able to meet the demand of the people thus maintaining sustainable development clearly. Though the policy proposes providing a choice of methods to meet the changing needs of clients throughout their reproductive lives increases overall levels of contraceptive use and enables individuals and couples to meet their reproductive goals percent of the total national budget to cover improvement in the health sector. a) Safe abortion b) Adolescent SRH information and services
34 A Review of National and District Policies and Budgets 33 c) Contraception d) Sexual rights In this document positions that many gaps still remain in terms of fostering implementation of existing supportive 4.9. Key policy and programme priorities and policy implementation challenges and responses Prioritization of FP population in such a short period of time has serious implications for the national vision to achieve a high quality of life and eliminate severe poverty.
35 34 Family Planning in Tanzania: affordability of family planning services Challenges for implementing the FP policy in Tanzania Strategies for addressing the FP policy implementation challenges agenda.
36 A Review of National and District Policies and Budgets 35 Main causes of Unmet Need for FP Sustainability of FP Programmes
37 36 Family Planning in Tanzania: 5.0. Findings from Budget Analysis 5.1. National Budgeting process The Personnel involved in developing the RH/FP budget in the MoHSW Professional backgrounds of personnel involved in the RH/FP budget development
38 A Review of National and District Policies and Budgets 37 Reviewing and approving the budget The budget process essentially involves the determination of resources and their uses for attainment of government
39 38 Family Planning in Tanzania: Cabinet Approval of the Estimates: Parliamentary Social Services Committee Public Debate and Authorization speech have committed to.
40 A Review of National and District Policies and Budgets 39 pervision of programs and projects. This involves a continuous monitoring of the plans and budget in order to identify administration. The monitoring and evaluation mechanisms or tools used for tracking allocated resources to the MoHSW Guiding documents (policies, strategies, sector plans) used by the MoHSW in preparing budgets
41 40 Family Planning in Tanzania: Needed initiatives in order to increase budget allocation for Reproductive Health and Family Planning Health budget trends Figure 1: Overall national health budget trends from the year 2010/ /1 (Tshs) Tanzania National Health Budget FY2010/11 FY2011/12 FY2012/13 FY2013/14 Data source: MOHSW
42 A Review of National and District Policies and Budgets 41 Figure 2: Overall District Health budget trends (Figures in 000 Tshs) 6,000,000 5,000,000 4,000,000 3,000,000 2,000,000 1,000,000 - Handeni DC 1 Handeni DC 2 Source: Handeni and Shinyanga DC CCHP Sexual Reproductive Health budget trends Figure 3: Overall national SRH budget trends SRH Budget Trend FY2010/11 FY2011/12 FY2012/13 FY2013/14 Data source: MOHSW
43 42 Family Planning in Tanzania: DC Handeni DC Shinyanga DC FY 2010/ / / / / / / /14 Total Source: Handeni and Shinyanga DC CCHP Family planning budget trends Figure 4: Overall national Family planning budget trends Family Planning Budget Trend FY2010/11 FY2011/12 FY2012/13 FY2013/14 Data source: MOHSW
44 A Review of National and District Policies and Budgets , FY2010/11 FY2011/12 FY2012/13 FY2013/14 Source: Handeni and Shinyanga DC CCHP Proportion of budget allocation for Reproductive health and Family planning We also assessed the percentage of health budget that is allocated for reproductive health and ultimately family plan Figure 6: Proportion of SRH, Family Planning and HIV/AIDS Budget in the Total National Health Budget 40% 38% 35% 30% 25% 20% 15% 16% 16% 16% 10% 5% 0% 2% 1% 1% 2% 1% 1% 1% 1% FY2010/11 FY2011/12 FY2012/13 FY2013/14 Data Source: MOHSW
45 44 Family Planning in Tanzania: Figure 7: Proportion of Handeni DC Health budget allocation for SRH and FP 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% 21.99% 7.88% 2.23% 26.38% 6.06% 21.24% 24.80% 16.75% 14.40% 1.85% 1.21% 0.52% Health percentage share of District budget RH percentage share of district health budget FP percentage share of district RH budget FY2010/11 FY2011/12 FY2012/13 FY2013/14 Source: Handeni DC CCHP Figure 8: Proportion of Shinyanga DC Health budget allocation for SRH and FP 40.00% 36.10% 35.00% 30.00% Health percentage share of District budget 25.00% 20.00% 24.31% 21.48% 16.70% RH percentage share of district health budget 15.00% 10.00% 12.33% 11.46% 9.89% FP percentage share of district RH budget 5.00% 0.00% 2.92% 1.73% 4.80% 6.15% 1.05% FY2010/11 FY2011/12 FY2012/13 FY2013/14 Source: Shinyanga DC CCHP
46 A Review of National and District Policies and Budgets Health budget Vs Expenditure Figure 9: National Health Budget vs Expenditure billions Health Budget Health Expenditure FY 2010/11 FY 2011/2 FY 2012/13 Data Source: MOHSW Figure 10: % of Expenditure over Health Budget Health Budget billions % 52% 85% Health Expenditure FY2010/11 FY2011/12 FY2012/13 FY2013/14 Data Source: MOHSW
47 46 Family Planning in Tanzania: the three years. Figure 11: SRH Budget vs Expenditure % 50% 93% billions SRH Budget SRH Expenditure FY2010/11 FY2011/12 FY2012/13 FY2013/14 Data Source: MOHSW The analysis of the district health budget from FY 2010/11 to FY 20012/13 as presented in table 2 and 3 below remain erratic. Table 2: Handeni DC Reproductive health budget vs expenditure FY FY2010/11 FY2011/12 FY2012/13 Allocation Exp Allocation Exp Allocation Exp Source: Handeni DC CCHP Table 3: Shinyanga DC Reproductive health budget Vs expenditure FY FY2010/11 FY2011/12 FY2012/13 Allocation Exp Allocation Exp Allocation Exp Source: Shinyanga DC CCHP
48 A Review of National and District Policies and Budgets Family Planning Budget Vs Expenditure Figure 12: Family Planning Budget vs Expenditure FY2013/14 Family Planning Budget FY2012/13 53% FY2011/12 100% Family Expenditure Budget FY2010/11 95% Data Source: MOHSW Table 4: District family planning budget vs Expenditure District FY2010/11 FY2011/12 FY2012/13 Allocation Exp Allocation Exp Allocation Exp Source: Handeni and Shinyanga DC CCHP
49 48 Family Planning in Tanzania: Sources of funds for SRH and FP Budgets Sources of funds for SRH and FP at National levels their home country governments or other private sector agencies European countries health funds commitments Vs disbursement for the Tanzanian government Figure 13: European cuntries health commitment vs disbursements for the government of Tanzania ( Health Commitments Health Disbursements Data Source: Euroleverage project
50 A Review of National and District Policies and Budgets 49 European countries Reproductive health care funds commitments Vs disbursements Figure 14: Reproductive Health Care Funds Commitments vs Disbursements ( Commitment Disbursements Data Source: Euroleverage project Figure 15: Reproductive health care funds disbursements from European countries ( Data Source: Euroleverage project
51 50 Family Planning in Tanzania: European countries Family planning funds commitments Vs disbursement Figure 16: Family Planning funds Commitments vs Disbursements ( Commitment Disbursements Data Source: Euroleverage project Data Source: Euroleverage project
52 A Review of National and District Policies and Budgets 51 Sources of funds for SRH and FP at District levels Figure 13: Handeni DC Sources of Funds for SRH and FP budgets 14,000,000 12,000,000 10,000,000 FY 2010/11 8,000,000 6,000,000 FY 2011/12 4,000,000 2,000,000 FY 2012/13 - Council Contribution Government Contribution Government Contribution Development Grants Local Development Grants Foreign Source: Handeni and Shinyanga DC CCHP Figure 14: Shinyanga DC Sources of Funds for SRH and FP budgets 25,000,000 20,000,000 15,000,000 10,000,000 5,000,000 - FY 2010/11 FY 2011/12 FY 2012/13 FY 2013/14 Governement Funds Other Funds Foreign Funds Total domestic revenue Figures in 000 Tshs Source: Handeni and Shinyanga DC CCHP
53 52 Family Planning in Tanzania: 6.0. Conclusion and recommendations 6.1. Conclusion providers.
54 A Review of National and District Policies and Budgets Recommendations currently perceived. posting enough and competent health service providers in rural health facilities. up to date. agenda.
55 54 Family Planning in Tanzania: References National Package of Essential Family Planning Interventions for the Comprehensive District Plan 2. Comprehensive Council Health Plan, from Handeni and Shinyanga Districts (20010/11; 20011/12; 20012/2013; 2013/14). Comprehensive Council Health Planning Guideline. Human Resource for Health Strategic Plan
56 A Review of National and District Policies and Budgets 55 Appendix Appendix 1: Data collection tools A) POLICY REVIEW GUIDE FOR DSW PROJECT Responsiveness to International Commitments principles? Principle Summary/key points as an integral part of sustainable development spacing of their children and to have the information and means to do so. Safe abortion Sexual rights NOTE: account.
57 56 Family Planning in Tanzania: Policy Issue/ 3. Prioritization of FP a. To what extent is FP a development priority in the country? e. What is the level of political commitment and will in support of family planning at national and sub-national levels? f. To what extent is FP a priority within the Ministry of Health? hierarchy in other countries? 4. Policy Implementation challenges and responses 5. Sustainability of FP Programmes b. What is the magnitude and evidence of the issue in existing data at national level c. What responses are suggested for the issue in national policy and strategy documents d. What responses to the issue are suggested in operational policies or guidelines? b. What is the magnitude and evidence of the issue in existing data at national level c. What responses are suggested for the issue in national policy and strategy documents d. What responses to the issue are suggested in operational policies or guidelines? 7. Other pertinent policy issues advocacy opportunities Comments From Review opportunities for improving
58 A Review of National and District Policies and Budgets 57 B) DOCUMENTARY REVIEW Introduction is fully integrated in the development plans. NB: Use excel sheet of FP Budget analysis data collection tool 1
59 58 Family Planning in Tanzania: C) KEY INFORMANT INTERVIEW ON FP BUDGET ALLOCATION Health Management team Introduction and Informed consent family planning is fully integrated in the development plans through advocacy. appear in any reports or notes. collector...
60 A Review of National and District Policies and Budgets 59..
61 60 Family Planning in Tanzania: Questions emerged from FGD
62 A Review of National and District Policies and Budgets 61 What could be done by the district to help address those concerns? Policy analysis questions
63 DSW Deutsche Stiftung Weltbevoelkerung P.O. Box 14279, Arusha, Tanzania Tel: Internet:
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