Regional Differences in Intervention Coverage and Health System Strength in Tanzania.

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. 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. 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. 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

Indicators included in the Millennium Development Goals coverage score, with weighting.

<p>HMIS = health management information system (facility reports); THMIS = Tanzania Health and Malaria Indicator Survey; NACP = National AIDS Control Programme; NTPLCP = National Tuberculosis and Leprosy Control Programme</p><p>Indicators included in the Millennium Development Goals coverage score, with weighting.</p

Health MDG coverage score by health system strength score, Tanzania regions.

<p>Health MDG coverage score by health system strength score, Tanzania regions.</p

Inequalities in the Countdown MNCH coverage score (see text), based on survey data 1991–2010, national trend with three best and three poorest regions according to the 2010 survey.

<p>Inequalities in the Countdown MNCH coverage score (see text), based on survey data 1991–2010, national trend with three best and three poorest regions according to the 2010 survey.</p

Relative ranking of regions by level of socioeconomic development, Tanzania mainland, 2012.

<p>Relative ranking of regions by level of socioeconomic development, Tanzania mainland, 2012.</p

Relative ranking of regions by health MDG coverage score, Tanzania mainland, 2012.

<p>Relative ranking of regions by health MDG coverage score, Tanzania mainland, 2012.</p

Regional trends in the Countdown maternal, newborn and child health coverage score (%), based on demographic and health survey data 1991–2010, with average annual rate of relative change of the coverage rate during the whole period (1991–2010) and between the last two surveys (2004–2010).

<p>Regional trends in the Countdown maternal, newborn and child health coverage score (%), based on demographic and health survey data 1991–2010, with average annual rate of relative change of the coverage rate during the whole period (1991–2010) and between the last two surveys (2004–2010).</p

Relative ranking of regions on the health system strength, Tanzania mainland, 2012.

<p>Relative ranking of regions on the health system strength, Tanzania mainland, 2012.</p

Coverage score by region, 2010–12: ranking and scores, Tanzania mainland, 2012.

<p>MDG = Millennium Development goals; RMNCH = reproductive, maternal, newborn and child health; HTM = HIV, TB and malaria</p><p>Coverage score by region, 2010–12: ranking and scores, Tanzania mainland, 2012.</p