title: Regional Differences in Intervention Coverage and Health System Strength in Tanzania.
abstract: BACKGROUND
  Assessments of subnational progress and performance coverage within countries should be an integral part of health sector reviews, using recent data from multiple sources on health system strength and coverage.
  
  
  METHODS
  As part of the midterm review of the national health sector strategic plan of Tanzania mainland, summary measures of health system strength and coverage of interventions were developed for all 21 regions, focusing on the priority indicators of the national plan. Household surveys, health facility data and administrative databases were used to compute the regional scores.
  
  
  RESULTS
  Regional Millennium Development Goal (MDG) intervention coverage, based on 19 indicators, ranged from 47% in Shinyanga in the northwest to 71% in Dar es Salaam region. Regions in the eastern half of the country have higher coverage than in the western half of mainland. The MDG coverage score is strongly positively correlated with health systems strength (r = 0.84). Controlling for socioeconomic status in a multivariate analysis has no impact on the association between the MDG coverage score and health system strength. During 1991-2010 intervention coverage improved considerably in all regions, but the absolute gap between the regions did not change during the past two decades, with a gap of 22% between the top and bottom three regions.
  
  
  CONCLUSIONS
  The assessment of regional progress and performance in 21 regions of mainland Tanzania showed considerable inequalities in coverage and health system strength and allowed the identification of high and low-performing regions. Using summary measures derived from administrative, health facility and survey data, a subnational picture of progress and performance can be obtained for use in regular health sector reviews.
authors.affiliation: Policy and Planning Department, Ministry of Health and Social Welfare, Dar es Salaam, United Republic of Tanzania.
authors.forename: Claud J
authors.initials: CJ
authors.lastname: Kumalija
authors.affiliation: CTS Global, assigned to Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania.
authors.forename: Sriyanjit
authors.initials: S
authors.lastname: Perera
authors.affiliation: Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania.
authors.forename: Honorati
authors.initials: H
authors.lastname: Masanja
authors.affiliation: Policy and Planning Department, Ministry of Health and Social Welfare, Dar es Salaam, United Republic of Tanzania.
authors.forename: Josibert
authors.initials: J
authors.lastname: Rubona
authors.affiliation: World Bank, Dar es Salaam, United Republic of Tanzania.
authors.forename: Yahya
authors.initials: Y
authors.lastname: Ipuge
authors.affiliation: National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania.
authors.forename: Leonard
authors.initials: L
authors.lastname: Mboera
authors.affiliation: Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland.
authors.forename: Ahmad R
authors.initials: AR
authors.lastname: Hosseinpoor
authors.affiliation: Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland.
authors.forename: Ties
authors.initials: T
authors.lastname: Boerma
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D005260:Female; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000145:classification / Q000706:statistics & numerical data*; D008297:Male; D008427:Maternal Health Services / Q000458:organization & administration*; D008483:Medical Assistance; D008875:Middle Aged; D055815:Young Adult