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Measures to reduce the infant mortality rate in Tanmniu JANUARY

KARUNGULA,

R.N.(T).,

R.N.T.,

R.Psych.N.,

B.N.S.

Senior Nursing Officer, Department of Nursing Education, Facultv of .Vedicine. Muhimbili Medical Cenrre, P. 0. Box 65004. Dar-es-Salaam. Tanxznia

Abstract-Tanzanian health problems reflect those in other developing countries where the standard of living is low and housing and sanitation are inadequate. The major cause of infant mortality can be attributed to preventable diseases such as gastroenteritis, acute respiratory infections and malnutrition. In spite of the fact that various efforts have been made to extend primary health care coverage, particularly in rural areas, the scarcity of economic resources impedes the implementation of many health programmes. However, only by maintaining primary health care as a major part of the country’s development strategy can the needs of both rural and urban people be met.

Introduction

The Alma-Ata declaration of 1978 on Health for All by the year 2000, has had a fundamental impact on the form and content of worldwide health policies. Primary health care (PHC) was defined as: “an essential care based on practical, scientifically sound and socially acceptable methods and technologies made universally accessible to individuals and families in the community” (WHO, 1988).

Primary Health Care (PHC) addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services. Tanzania, as a developing country, has limited resources and unlimited health problems. In adapting to PHC strategies it was hoped that equity in health care delivery would become a reality. With this concept in mind, health care priorities had to be worked out carefully. The country’s socio-economic and technological development influenced these priorities. The targets which were spelled out by the Ministry of Health in the Syear development plan for 1983-1988 were based on the national long-term development plan for 1980-2000 which included the following objectives: 113

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raise the average life expectancy at birth to 55160 in 2000, by reducing the infant mortality rate to 50/1000 (2000). To provide primary health care to every village by the year 2000, every village will govern its health services independently with support in commodities by the government. To be self-sufficient in health manpower. To strengthen the management and supervision of the health services at different levels through training and retraining including the development of a viable health information system. To strengthen and improve the health services in all sectors. To involve people in implementation and management. To cooperate with the relevant parastatals and ministries. (In Tanzania, parastatals are non-profit making Government organizations, e.g. Muhimbili Medical Centre. The ministries include the Department of Health, Department of Education, etc.) To improve the drug supply system, to strive for self-reliance in it. To have an inventory and evaluation every 3 years (Ministry of Health Tanzania, 1984). To

This article highlights how Tanzania is attempting to meet the target, “IO raise the average life expectancy at birth to 55 to 60 years by reducing the infant rate to SO/l000

mortality

by the year 2000”.

The implcrnentation

of a primary

health care programme

In 1989, the Economist Intelligent Unit reported that: “The health infrastructure of the country reflects the demographic characteristics of Tanzania.” The population characteristics of Tanzania are: Table

I.

Demographic

characteristics

Total population Rate of growth Infant mortality rate per 1000 live births Life expectancy at birth Per capita income in U.S. %

of Tanzania 1978

1988

17.6m 3.2%

23.2m 2.8% 105 53 I80

135 45 200

These figures show that Tanzania is one of the countries in the world with a high infant mortality rate. This writer will outline how Tanzania is attempting to reduce the infant mortality rate. Two broad headings will be addressed: (i) action taken with regard to health policy; and (ii) action taken with regard to programmes for disease prevention. Action

taken with regard to health policy

Tanzania’s health policy during the colonial period had established and supported an urban-curative approach. As a result many people, especially in rural areas, had not had access to health care. Many of them, particularly children, were dying of preventable diseases. After the Arusha Declaration in 1967 (TANU, 1967) which proclaimed socialism and self-

reliance as the national policy, attention was focused on rural health development. The policy emphasized that: (i) Health care facilities should be provided free of charge to the people. (ii) Health care facilities should be delivered as close as possible to the place of residence of the people. In order to implement the policy, it was decided to decentralize health care planning so that people could participate in formulating health plans at a local level. For esample, in nearly all villages (95%), the village government makes decisions on health through village health committees (Ministry of Health Tanzania, 1984). In 1971 people who were scattered throughout the countryside were gathered together to form villages (“villagization programme”J. This made it easier for the state to provide the majority of the population with social facilities. Included in these were schools and dispensaries, and the provision of a clean water supply. To make self-reliance a reality, mass mobilization was used as a political tool to raise the consciousness of the people on health matters and to encourage participation in local self-help activities. The building of latrines, the development of systems of environmental cleanliness, and the provision of charcoal to enable sterilization are examples of activities undertaken by the people. In order to extend comprehensive health services and to make them available to all, the development of hospitals has been markedly contained. Small health care units such as health centres, dispensaries and village health posts have been encouraged. The following table demonstrates the intended development in these small units (Ministry of Health Tanzania, 1984): Table 2. Numbers of health facilities available in 1961 and 1981 and the numbers projected for the year Zoo0 1961

1981

?GiIo

120 22 839 -

123 239 2600 233

130 700 3500 5500

Hospitals Health centres Dispensaries Village health posts

To staff these health facilities, the number of locally trained health workers has been increased. These include rural medical aids, maternal and child health aids and rural health aids. This approach has enabled the application of the health care programme to the largest possible number of the population. The policy action aimed at providing essential health care within a five kilometre radius of the local population, i.e. l-hour walking distance. At present 72% of the total population live within this limit (Ministry of Health Tanzania, 1984). In making health care more available to the total population, a greater number of mothers and children are cared for. Action

taken

with regard to prograrnrnes

for

disease prevention

Programmes for disease prevention are organized at the national level and are then taken to the village. They are designed to reduce infant mortality especially when the cause can be attributed to preventable diseases. The programmes aim at preventing such conditions

116

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as mahrutrition, diarrhoea and malaria. Five major programmes are provided, and include: Maternal and child health (MCH)programme. This programme was launched to monitor the health of the mother and child before, during and after delivery. The target was aimed at reaching at least 90% of all mothers and children by 1988. Services are available daily at every health care facility, particularly dispensaries and health centres. Most of the workload at these health care facilities is carried out by nurses, Family planning, health education, immunization programmes are an integrated part of this programme. The percentage of mothers delivering their babies at health centres and hospitals rose from 53% in 1978 to 60% in 1984 (Ministry of Health Tanzania, 1984). Nutritionalprogramme. Agriculture has been given a high priority. Small-scale farmers are motivated to be self-sufficient in food production, The food and nutrition unit help to educate mothers about the daily nutritional needs of infants and children. It encourages mothers to breast feed for at least 2 years. Instruction is given on the elements of an adequate and balanced diet which are necessary for pregnant and nursing mothers. It is considered that improvement in nutrition would reduce the infant mortality by 10% if diseases related to nutrition were eliminated or controlled (Nhonoli, 1980). Control of communicable diseases. Common causes of morbidity and mortahty in infants are the communicable diseases and parasitic infections. The expanded programme of immunization includes the delivery, transport and care of supplies of vaccine and sera throughout the country. This necessitates the development of “cold chain” facilities. Ninety per cent vaccination coverage of the target population was achieved in 1983 (Ministry of Health Tanzania, 1984). Children were vaccinated against childhood diseases such as measles, tetanus and tuberculosis. The essential drug programme. The essential drug programme is aimed at counteracting the shortage of essential drugs in rural health care facilities. This means that children are able to get treatment for the three killing diseases, namely malaria, diarrhoea and respiratory infections. Health education programme. A health education programme is well developed in Tanzania. The use of mass media has helped to disseminate health information to target groups and to the general population. Emphasis is put on poor sanitation, lack of latrines and use of unsafe water and their association with diseases. The role of nurses in reducing

the infant

mortality

rate

Nursing personnel in Tanzania represent a potentially powerful force in the health care system. In contrast to other health care workers, they are the most widely distributed group of health care personnel throughout the country. Most of them work in rural health care facilities, i.e. dispensaries and health centres. Female nurses do most of the work in the maternal and child health programme. They are responsible for the health education of pregnant and nursing mothers. They monitor the health of the mother and child. They give advice to mothers on nutrition, child care and family planning. Eighty-five per cent of all deliveries at health centres, dispensaries and hospitals are conducted by nurse midwives. They are responsible for all immunizations and the storage of vaccines. They conduct mobile clinics and home visits. The goal set by the World Health Organization in the document “Health for All by the Year 2000”, may well prove to be the nursing profession’s greatest challenge. For Tanzanian nurses to meet this challenge and become efficient in the delivery of primary health care, a new direction is required in the scope of nursing practice and hence in the

,CtEA SURES

TO REDUCE

fNF,-l,VT

MOR 7-A LITY

I,L’ TA iVi_?-t.VlA

117

educational preparation of nurses. This involves a shift in emphasis, and a rearrangement and reorganization of both pre-service and in-service training, and in nursing curricula. Nurses can no longer be prepared exclusively for the care of the sick. The maintenance of good health and the prevention of illness will feature as major subjects in nursing education.

Conclusion

The remarkable progress achieved in the prevention of childhood diseases has benefited a good proportion of Tanzanian children. There has been an overall reduction of the infant mortality rate from 135 per 1000 in 1978 to 105 per 1000 in 1988. However, as there are regions which are considered to be under-served by the health care programme, the mortality and morbidity rates may be higher than those quoted. Several problems have been encountered in the implementation of the health care programme. Firstly, adequate supervision of the health services which are provided in rural areas is greatly impeded by lack of transport and the poor communication network. Secondly, the constant rise in inflation and the drop of income per capita are affecting programmes which require large financial investments. Among these are the provision of an adequate water supply and agricultural and technological development. In order to achieve the aims of “Health for All by the Year 2000”, Tanzania will have to considerably increase its economic growth. The development of the rural areas where most of the population live is a major concern. By addressing these problems, it is hoped that primary health care will be made available to the total population.

References Economist Intelligent Unit (1989). ~un:ania Counfry Profile: Annual

.Surve.v of Political

und Economic

Background,

pp. 3-22. Report No. 1988-89. Cure Review Tunxnia. Government Press, Ministry of Health Tanzania (1984). Join! frirr~ory Heulih Dar-es-Salaam. Nhonoli, A. M. (1980). frimory He&h Cure Delivery in Africa. University of Dar-es-Salaam. Dar-es-Salaam. TANU (1967). The Arushu Deckarution und TAAIL’Us Policy on Socialism und Self-reliance. Tanganyika African National Union. Dar-es-Salaam. United Nations. World Health Organization (1988). From A/mu-Afa fo [he Year 2000. WHO, Geneva. (Received

I7 Ju1.v I99 I ; accepted

for

publication

I 7 Ocrober

I99 1)

Measures to reduce the infant mortality rate in Tanzania.

Tanzanian health problems reflect those in other developing countries where the standard of living is low and housing and sanitation are inadequate. T...
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