title: Tanzania's countdown to 2015: an analysis of two decades of progress and gaps for reproductive, maternal, newborn, and child health, to inform priorities for post-2015.
abstract: BACKGROUND
  Tanzania is on track to meet Millennium Development Goal (MDG) 4 for child survival, but is making insufficient progress for newborn survival and maternal health (MDG 5) and family planning. To understand this mixed progress and to identify priorities for the post-2015 era, Tanzania was selected as a Countdown to 2015 case study.
  
  
  METHODS
  We analysed progress made in Tanzania between 1990 and 2014 in maternal, newborn, and child mortality, and unmet need for family planning, in which we used a health systems evaluation framework to assess coverage and equity of interventions along the continuum of care, health systems, policies and investments, while also considering contextual change (eg, economic and educational). We had five objectives, which assessed each level of the health systems evaluation framework. We used the Lives Saved Tool (LiST) and did multiple linear regression analyses to explain the reduction in child mortality in Tanzania. We analysed the reasons for the slower changes in maternal and newborn survival and family planning, to inform priorities to end preventable maternal, newborn, and child deaths by 2030.
  
  
  RESULTS
  In the past two decades, Tanzania's population has doubled in size, necessitating a doubling of health and social services to maintain coverage. Total health-care financing also doubled, with donor funding for child health and HIV/AIDS more than tripling. Trends along the continuum of care varied, with preventive child health services reaching high coverage (≥85%) and equity (socioeconomic status difference 13-14%), but lower coverage and wider inequities for child curative services (71% coverage, socioeconomic status difference 36%), facility delivery (52% coverage, socioeconomic status difference 56%), and family planning (46% coverage, socioeconomic status difference 22%). The LiST analysis suggested that around 39% of child mortality reduction was linked to increases in coverage of interventions, especially of immunisation and insecticide-treated bednets. Economic growth was also associated with reductions in child mortality. Child health programmes focused on selected high-impact interventions at lower levels of the health system (eg, the community and dispensary levels). Despite its high priority, implementation of maternal health care has been intermittent. Newborn survival has gained attention only since 2005, but high-impact interventions are already being implemented. Family planning had consistent policies but only recent reinvestment in implementation.
  
  
  CONCLUSIONS
  Mixed progress in reproductive, maternal, newborn, and child health in Tanzania indicates a complex interplay of political prioritisation, health financing, and consistent implementation. Post-2015 priorities for Tanzania should focus on the unmet need for family planning, especially in the Western and Lake regions; addressing gaps for coverage and quality of care at birth, especially in rural areas; and continuation of progress for child health.
  
  
  BACKGROUND
  Government of Canada, Foreign Affairs, Trade, and Development; US Fund for UNICEF; and the Bill & Melinda Gates Foundation.
authors.affiliation: MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Hoviyeh
authors.initials: H
authors.lastname: Afnan-Holmes
authors.affiliation: Evidence for Action, Dar es Salaam, Tanzania.
authors.forename: Moke
authors.initials: M
authors.lastname: Magoma
authors.affiliation: World Health Organization, Dar es Salaam, Tanzania. Electronic address: kabutenit@who.int.
authors.forename: Theopista
authors.initials: T
authors.lastname: John
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Francis
authors.initials: F
authors.lastname: Levira
authors.affiliation: Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
authors.forename: Georgina
authors.initials: G
authors.lastname: Msemo
authors.affiliation: MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK; Evidence for Action, Dar es Salaam, Tanzania.
authors.forename: Corinne E
authors.initials: CE
authors.lastname: Armstrong
authors.affiliation: MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Melisa
authors.initials: M
authors.lastname: Martínez-Álvarez
authors.affiliation: Save the Children, Edmonton, AB, Canada; University of the Western Cape, Bellville, South Africa.
authors.forename: Kate
authors.initials: K
authors.lastname: Kerber
authors.affiliation: Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
authors.forename: Clement
authors.initials: C
authors.lastname: Kihinga
authors.affiliation: Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Makuwani
authors.affiliation: Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
authors.forename: Neema
authors.initials: N
authors.lastname: Rusibamayila
authors.affiliation: UNICEF, Dar es Salaam, Tanzania.
authors.forename: Asia
authors.initials: A
authors.lastname: Hussein
authors.affiliation: MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Joy E
authors.initials: JE
authors.lastname: Lawn
mesh_terms: D002648:Child; D000067576:Child Health; D046688:Child Mortality; D003695:Delivery of Health Care / Q000592:standards* / Q000639:trends; D036861:Delivery, Obstetric; D005193:Family Planning Services; D005260:Female; D006801:Humans; D007114:Immunization; D007223:Infant; D000068104:Infant Health; D007226:Infant Mortality; D007231:Infant, Newborn; D057148:Insecticide-Treated Bednets; D000068097:Maternal Health; D008428:Maternal Mortality; D000068101:Maternal-Child Health Services / Q000592:standards*; D009026:Mortality; D011247:Pregnancy; D060728:Reproductive Health; D012923:Social Class; D012959:Socioeconomic Factors; D013636:Tanzania / Q000453:epidemiology