Stagnating maternal mortality in Tanzania: what went wrong and what can be done

Background: This paper presents and analyses the trend of maternal mortality ratio in Tanzania against major events, policy, economic and political decisions which may have influenced this trend. The impact of several initiatives related to Health Systems Strengthening are discussed and alternative strategies for effective maternal mortality reduction in Tanzania are proposed.
Methods: We reviewed data and information published on maternal mortality and relevant political decisions, policies programmes and guidelines on maternal and new-born for Tanzania from 1990 to 2016. We examined the timeline of economic development, political decisions and other major events going back 5-10 years before the possible stagnation of maternal mortality decline.
Results: This period coincides with the Health Sector Reforms which included among other things the introduction of user fees, reintroduction of private practice, staff retrenchment, widening inequalities and growing poverty. Health service factors include persistent low coverage and utilization of basic emergency obstetric care services. To address these gaps, we propose strengthening rights-based approaches in maternal health programming with political, financial and performance accountabilities at all levels. Introducing these will themselves help with improvement of the quality of care and address the issues of equity by reaching even the poorest households. We further propose application of process indicators to monitor maternal care services. Skilled care should be adopted as the single most important indicator for improving emergency obstetric care. There is need to review the legal and policy framework on task shifting to allow nurses to deliver the seven signal functions and Assistant Medical Officers to deliver Comprehensive Emergency Obstetric Care.
Conclusion: We conclude that greater effort needs to be put in designing heath strengthening systems that address more the demand side of health systems strengthening as opposed to current efforts which are largely supply oriented.

Keywords
maternal mortality; sector reforms; health systems; emergency obstetric care; Tanzania