HIV prevalence in Tanzania has declined slightly since 2004, but the prevalence and extent of the decrease varies geographically and between different demographics. Conversely, Tanzania suffers high adverse sexual and reproductive health indicators including high levels of: maternal mortality, adolescent births, mother to child transmission of HIV, intimate partner violence, persistence of child and teenage marriages, girls forced to drop out of school due to pregnancy, and low contraceptive prevalence. Sexual and reproductive health programmes have limited orientation to key populations and there is little evidence of integration of sexual and reproductive health and HIV/AIDS interventions. Tanzania experiences a reducing under-five mortality rate that has been consistent and considerable since 1990, but new-born deaths are responsible for a significant proportion of current under-five death rates, and is an area for concern.
There exists extensive health infrastructure affording the vast majority of the population access to a health facility within five kilometres of their home. That notwithstanding, health facilities lack basic resources and are understaffed, the impacts of which mirror large inequities in health care access with the rural population being the worst affected.
Government expenditure on health has steadily declined with out-of-pocket expenditure increasing. Government expenditure on health has fluctuated between 11% and 20% of all government expenditure since 2001, with lower commitments being the trend since 2008 – increasingly falling short of the 15% pledged in the 2001 Abuja Declaration. Government health expenditure is not transparent, and relies heavily on development agencies to drive and finance sexual and reproductive health and HIV interventions.
Source: World Databank (2017) Health expenditure, public (% of government expenditure) https://data.worldbank.org/indicator/SH.XPD.PUBL.GX.ZS Accessed 01.03.2018
Maternal mortality remains high, though below the average for Sub-Saharan Africa. Contributing factors include: high fertility rates, high birth rates among adolescent girls, low socio-economic status of women, low prevalence of contraception, highly restrictive options for safe and legal abortion, high levels of sexual violence, persisting practices of female genital mutilation, and reports that user fees for maternal, newborn, and child health care constitutes the greatest proportion of household expenditure on health.
Source: World Databank (2017) Maternal mortality ratio (modeled estimate, per 100,000 live births) https://data.worldbank.org/indicator/SH.STA.MMRT Accessed 01.03.2018
HIV prevalence is high among injecting drug users, female sex workers, and men who have sex with men. Although the government funds a few methadone treatment centres and there is NGO-driven service provision for injecting drug users, drug use remains illegal which creates barriers to accessing sexual and reproductive health, increasing risk for this group. Female sex workers report high levels of both physical violence, and of forced sex by clients. This could reduce female sex workers’ ability to negotiate condom use, potentially contributing to the proportionately higher rates of HIV and Sexually Transmitted Infections than recorded in the general population.
There are high rates of adolescent pregnancy and marriage. Contributory factors to early sexual debut and high numbers of unplanned pregnancies may include a particularly low contraception prevalence for sexually active adolescents and young women, a legislative environment permitting girls to be married as young as 15 years, as well as limited provision of comprehensive sex education in schools resulting in little awareness around HIV, AIDS, and SRH.
A significant minority of females aged 18 to 24 report experiencing sexual violence before they were 18 years old. Legally, marital rape is only an offence in limited circumstances and gender based violence cases can remain ‘pending’ in the judicial system for years, undermining efforts for recourse and accountability. Customary practices of female genital mutilation amongst some ethnic groups persist despite criminalization.
Tanzania implemented a large body of progressive legislation to address the national health challenges, including strong policy supporting sexual and reproductive health and rights and HIV and AIDS, but implementation is variable. There is evidence of ongoing planning and revision of interventions but, seemingly, a lack of prioritization and review of performance and outcomes. There is an apparent disconnect between the government’s commitment to improving maternal, newborn and child health, and family planning services, government financing for this, and the fragmented nature of the government’s sexual and reproductive health interventions.
National Strategic Framework on HIV and AIDS and the Sexual Offences Special Provisions Act (SOSPA) and Penal Code specifically addresses gender based violence.
The HIV and AIDS Prevention and Management Bill (2011) in Zanzibar supports the rights of people living with HIV but this is not yet law.
The National Multi-Sectoral Strategic Framework on HIV and AIDS specifically seeks to address health challenges amongst key populations.
‘Tanzania Vision 2025’ has informed efforts to address maternal and child health challenges via the National Strategy for Growth and Reduction of Poverty (NSGRP-MKUKUTA) and the Primary Health Services Development Programme (PHSDP-MMAM) with a specific target to reduce infant and maternal mortality rates by three-quarters of current levels and achieve access to quality reproductive health services for all individuals of ‘appropriate ages’.
The National Road Map Strategic Plan to Improve Reproductive, Maternal, Newborn, Child & Adolescent Health in Tanzania (2016 – 2020) One Plan II follows on from the 2008–2015 (One Plan) of the same title. The One Plan II has five strategic objectives and several operational targets covering areas of Maternal Health; Newborn and Child Health; Adolescent Health; Family Planning; Prevention of Mother to Child Transmission; Immunization and Vaccine Development; Reproductive Health (RH) Cancer, Reproductive Health Gender and cross-cutting programmes. The overall goal is to accelerate reduction of preventable maternal, newborn, child and adolescent morbidity and mortality in line with the National Developmental Vision 2025.
Gender Operational Plan for the HIV and AIDS Response in Mainland Tanzania 2015-2018 follows on from the Gender Operational Plan for HIV and AIDS Response’ (2010-2012) and proposes activities that are to be undertaken by HIV & AIDS stakeholders in Tanzania Mainland with some gender sensitive programming that recognises the increase in vulnerability of women, and girls to being infected with or affected by HIV & AIDS.
Health Sector Strategic Plan 2015 – 2020 (HSSP IV) includes targets such as quality Reproductive, Maternal, Newborn, Child and Adolescent Health services to be within reach of the whole population in the country by 2020. Gender-sensitivity includes measures such as a focus on prevention of HIV amongst adolescent girls, and addressing violence against women, as well as a stated prioritisation of equal representation of women in committees and boards.
African Charter on Human and Peoples’ Rights (also known as the Banjul Charter)
United Nations Convention on the Rights of the Child (UNCRC)
Convention on the Elimination of All Forms of Discrimination against Women (CEDAW)
Protocol To The African Charter On Human and Peoples’ Rights On The Rights Of Women in Africa
African Charter on Democracy, Elections and Governance