National Family Planning Costed Implementation Program (NFPCIP) 2010-2015--without appendices

The United Republic of Tanzania

Ministry of Health and Social Welfare

Reproductive and Child Health Section. March 2010

2010 - 2015

National Family Planning

Costed Implementation Program

Reproductive & Child Health Section. March 2010

This publication is made possible by the generous support of the American people through the

United States Agency for International Development (USAID).

United Republic of Tanzania | National Family Planning Costed Implentantation Program

UNITED REPUBLIC OF TANZANIA

The National Family Planning

Costed Implementation Program

2010 - 2015

Ministry of Health and Social Welfare

United Republic of Tanzania | National Family Planning Costed Implentantation Program

Table of Contents

Abbreviations ...................................................................................................................................... i

Foreword ............................................................................................................................................ii

Acknowledgments ..............................................................................................................................iv

Executive Summary ............................................................................................................................ 1

Introduction ....................................................................................................................................... 4

National Family Planning Costed Implementation Program .................................................................. 13

Purpose of the NFPCIP ............................................................................................................ 13

Vision, Mission, Goals and Objectives of the NFPCIP .................................................................. 14

Analysis of Demographic Determinants of Resource Requirements ............................................. 16

Strategic Actions to Achieve Objectives ..................................................................................... 23

Institutional Arrangements for Implementation ................................................................................... 32

Resource Mobilization Framework ............................................................................................ 33

Monitoring and Evaluation of Plan Implementation ..................................................................... 34

Appendices .................................................................................................................................... 35

Appendix A: 2009–2010 Family Planning Partners and Implementers ..................................36

Appendix B: Summary Report of Key Informant Interviews and Advance Consultations ...........37

Appendix C: Summarized Process for Development of NFPCIP ..............................................42

Appendix D: Deﬁnition of Terms Used in the NFPCIP and Analytical Framework ......................45

Appendix E: Annual Resource Requirements by Strategic Action Area ...................................47

Appendix F: Bibliography ...................................................................................................66

United Republic of Tanzania | National Family Planning Costed Implentantation Program

Abbreviations

ADB Asian Development Bank

ADDOs Accredited drug dispensing outlets

ANC Antenatal care

ACQUIRE ACcess, Quality, and Use In REproductive

health

BCC Behaviour change communication

CBD Community-based distribution

CBOs Community-based organizations

CBS Community-based services

CCHP Council Comprehensive Health Plans

CHMT Council Health Management Team

CIDA Canadian International Development Agency

CMT Country Management Team

CPR Contraceptive prevalence rate

CSOs Civil society organizations

CTU Contraceptive technology update

DfID Department for International Development

(United Kingdom)

DHS Demographic and Health Survey

DMPA Depot-medroxyprogesterone acetate

DRCHCo District Reproductive and Child Health

Coordinator

FBOs Faith-based organizations

FHI Family Health International

FP Family planning

GTZ Gesellschaft für Technische Zusammenarbeit

HMIS Health management information system

HPI Health Policy Initiative

HRHSP Human Resources for Health Strategic Plan

HSSPIII Health Sector Strategic Plan III

IEC Information, education and communication

IPPF International Planned Parenthood Federation

IUDs Intrauterine devices

KfW Kreditanstalt für Wiederaufbau

LAPMs Long-acting and permanent methods

LGAs Local government authorities

M&E Monitoring and evaluation

MCH Maternal and child health

MDGs Millennium Development Goals

MoFEA Ministry of Finance and Economic Affairs

MoHSW Ministry of Health and Social Welfare

MSD Medical Stores Department

MTEF Medium-Term Expenditures Framework

MWRA Married women of reproductive age

NBS National Bureau of Statistics

NFPCIP National Family Planning Costed

Implementation Program

NGOs Non-governmental organizations

NORAD Norwegian Agency for Development

Cooperation

PAC Post abortion care

PHSDP Primary Health Services Development

Programme

PNC Postnatal care

POPC President’s Ofﬁce Planning Commission

PMO–RALG Prime Minister’s Ofﬁce–Regional

Administration and Local Government

PROGRESS Program Research for Strenghthening

Services

PSI Population Services International

PSU Pharmaceutical Support Unit

RCHCo Reproductive and Child Health Coordinator

RCHS Reproductive and Child Health Section

RH Reproductive health

RMO Regional Medical Ofﬁcer

RMT Regional Management Team

SAAs Strategic Action Areas

SAAWGs Strategic Action Area Working Groups

SDP Service delivery point

SIDA Swedish International Development

Cooperation Agency

SPAS Service Provision Assessment Survey

SRH Sexual and reproductive health

STIs Sexually transmitted infections

SWAps Sector-wide approaches

TACAIDS Tanzania Commission on AIDS

TFDA Tanzania Food and Drug Authority

T-MARC Tanzania Marketing and Communications

Company

THMIS Tanzania HIV/AIDS and Malaria Indicator

Survey

UMATI Chama Cha Malezi Bora Tanzania

UNFPA United Nations Population Fund

USAID United States Agency for International

Development

WHO World Health Organization

WRA Women of reproductive age

YFS Youth-friendly services

United Republic of Tanzania | National Family Planning Costed Implentantation Program

Foreword

Family planning saves the lives of women, newborns, and adolescents as well as contributes to

the nation’s socioeconomic development. Family planning prevents maternal mortality, one of the

major concerns addressed by various global and national commitments and reﬂected in the targets

of the Millennium Development Goals, Tanzania Vision 2025, the National Strategy for Growth

and Reduction of Poverty, and the Primary Health Services Development Program, among others.

Family planning also reduces infant deaths from AIDS by preventing unintended pregnancies

and hence mother-to-child transmission of HIV. Family planning also helps governments achieve

national and international development goals because it can contribute to the achievement of all

of the United Nations’ Millennium Development Goals, including reducing poverty and hunger,

promoting gender equity and empowering women, reducing child mortality, improving maternal

health, combating HIV/AIDS, and ensuring environmental sustainability.

Over the last decade, however, other competing health priorities, such as tuberculosis, malaria, and

HIV/AIDS have reduced the resources and visibility enabling Tanzania’s family planning program

to keep pace with unmet needs for these services. As such, the momentum of family planning

programs has slowed considerably since 1999. Whilst modern method prevalence increased from

6.6 percent in 1992 to 13.3 percent in 1999, the annual increase in prevalence has dropped by 0.2

percentage points per year since then, with prevalence reaching only 26.4 percent in 2004–2005.

At the same time, Tanzania has faced rising demands for family planning services, increasing from

38.3 percent in 1991–1992 to 49.5 percent in 2004–2005.

The Ministry of Health and Social Welfare (MOHSW) developed this National Family Planning

Costed Implementation Program (NFPCIP) based on the goal of the One Plan to increase the

contraceptive prevalence rate to a target of 60 percent by the year 2015. The NFPCIP is also guided

by and links with the Health Sector Strategic Plan III (HSSPIII), the Human Resources for Health

Strategy Plan (HRHSP), and the Primary Health Service Development Programme (PHSDP). Funds

required to implement these NFPCIP activities will build on and augment the many investments

called for in the HSSPIII, PHSDP, and HRHSP strategies by ensuring that essential resources

for an effective family planning program are identiﬁed and that the activities are integrated and

implemented within and throughout the overall health system.

The main objective of the NFPCIP is to reposition and reinvigorate access to and use of family

planning services in Tanzania. The NFPCIP stipulates ﬁve strategic action areas for implementation

that are needed to reposition family planning: contraceptive security, capacity building, service

delivery, health systems management, and advocacy. Although all ﬁve components are needed for a

thriving and effective program, emphasis will be given to two areas to prioritize fulﬁlment of the

increasing demands for family planning services in the country. These two areas include ensuring

contraceptive security and strengthening integrated service delivery of family planning in all aspects

of the health sector, including HIV/AIDS, immunization services, postnatal care, and postabortion

care.

Implementation of this plan requires that strategies and actions be integrated into the medium-

term expenditure frameworks of government ministries and into the budgets of local government

authorities. It is also the expectation of the Government, particularly the MoHSW, that development

partners and all stakeholders will make optimal use of this NFPCIP to support the implementation

of a reinvigorated family planning program and reach our target rate of contraceptive prevalence of

60 percent by 2015.

United Republic of Tanzania | National Family Planning Costed Implentantation Program

iii

Having developed the NFPCIP, the Government of Tanzania is strongly committed to its successful

implementation. All stakeholders have an obligation to participate to reposition and reinvigorate

access to and use of family planning services in Tanzania. We thank all stakeholders for working to

achieve the development of this plan. Together, we can improve the health of Tanzanian mothers,

babies, and children, and build a stronger and more prosperous nation.

Blandina S. J. Nyoni

Permanent Secretary

Ministry of Health and Social Welfare

United Republic of Tanzania | National Family Planning Costed Implentantation Program

Acknowledgments

The Ministry of Health and Social Welfare (MoHSW) would like to express sincere gratitude to

the many individuals and development partners who worked with the Ministry to develop the

National Family Planning Costed Implementation Program. The completion of this document is a

result of extensive consultations and collaboration with various stakeholders, including other sector

ministries, development partners, professional associations, and interested organizations as well as

committed individuals and under the guidance of the National Family Planning Working Group.

The Ministry acknowledges the ﬁnancial and technical support from the United States Agency for

International Development (USAID) for coordinating all activities that culminated in the NFPCIP

through the Program Research for Strengthening Services (PROGRESS) Project managed by Family

Health International (FHI) which provided secretariat support, technical guidance, and costing; and

through the Health Policy Initiative Project managed by the Futures Group which provided the

needed modeling and development of projections. Furthermore, the Ministry greatly appreciates

the technical support from EngenderHealth, John Snow Inc., Management Sciences for Health,

Marie Stopes Tanzania, Pathﬁnder International, Population Services International, T-MARC and

UNFPA for co-leading the development of strategic actions, together with Reproductive and Child

Health (RCHS) staff.

The Ministry recognizes and acknowledges the participation of many individuals from its development

partners (Donor Partners Group for Health and Gesellschaft für Technische Zusammenarbeit)

and from sectoral ministries (Ministry of Finance and Economic Affairs; Ministry of Community

Development, Gender and Children; President’s Ofﬁce Planning Commission; Medical Stores

Department; and the National Bureau of Statistics). The MoHSW also appreciates the participation

and contributions of regional and district representatives for their inputs in the NFPCIP.

Finally, the Ministry would like to acknowledge the RCHS for leading the coordination of all

stakeholders engaged in the development process of this document.

Dr. Deo M. Mtasiwa

Chief Medical Ofﬁcer

Ministry of Health and Social Welfare

United Republic of Tanzania | National Family Planning Costed Implentantation Program

Executive Summary

Meeting the ‘One Plan’ Goal for Family Planning

A continuing high rate of population growth is presenting major challenges to social and economic

development in Tanzania. According to the National Bureau of Statistics (NBS), at the current

annual rate of growth of 2.9 percent, Tanzania’s population is projected to reach 65 million by 2025,

putting increased strain on already overstretched health and education services, infrastructure, food

supply, and the environment. Early initiation of childbearing and a high rate of fertility are the

principal factors contributing to this rapid population growth, and they also have detrimental effects

on the health of women and children. Tanzania has among the highest rates of maternal, newborn,

and child deaths in the world. Gender issues play important roles in both affecting access to health

and economic resources for women and limiting the roles women can play in the country’s social

and economic development. Early childbearing usually curtails educational attainment for girls and

constrains women’s participation in economic productivity.

Family planning (FP) has for several decades been well documented as a key strategy to promote

social and economic development, and to improve the health of women and their children. The

National Road Map Strategic Plan to Accelerate Reduction of Maternal, Newborn and Child Deaths in

Tanzania, 2008–2015 (One Plan) has set a goal to increase the contraceptive prevalence rate (CPR)

from 20 percent to 60 percent by 2015, by making quality FP services more accessible to and

equitable for all of Tanzania’s people. Increased use of FP has a great potential to contribute to the

One Plan target of reducing maternal mortality from 578 to 193 per 100,000 live births by 2015.

However, the Tanzania’s FP program has lost momentum over the past decade because of a number

of factors. As a result, the national CPR for modern methods among married women of reproductive

age at the time of the last Demographic and Health Survey (DHS) in 2004–2005 had reached only

20 percent, and the annual rate of growth in CPR had slowed from a high of 1.5 percentage points

to 0.6 percentage points. With the current level of investment in FP and the current rate of growth,

the One Plan target will not be reached until 2030, with considerable negative consequences for

the health and well-being of Tanzania’s people and increased challenges to the country’s economic

development. It was noted in a recent study on National Health Accounts that expenditures for

FP had decreased drastically, from 54 percent of reproductive health (RH) spending in 2003 to 8

percent in 2006. Deliberate efforts must be taken to rectify the situation. A renewed commitment

to FP, a reinvigorated program, and signiﬁcant investment of resources are thus required to achieve

the One Plan target.

In recognition of the need to reinvigorate the national FP program, the Ministry of Health and

Social Welfare (MOHSW) embarked on development of a costed implementation program for

a ‘repositioned’ national FP program. The National Family Planning Costed Implementation

Program (NFPCIP) is guided by the vision and mission of the Reproductive and Child Health Policy

Guidelines 2003 and the goals of the one plan, setting targets for increased use of all FP methods by

all women of reproductive age. The NFPCIP takes into consideration and builds on the substantial

investments called for in other strategic plans and documents, namely the Health Sector Strategic

Plan III (HSSPIII) July 2009–June 2015, the Primary Health Services Development Programme

(PHSDP) 2007–2017, and the Human Resources for Health Strategic Plan (HRHSP) 2008–2013.

United Republic of Tanzania | National Family Planning Costed Implentantation Program

Through a collaborative, participatory, and consultative process involving a wide range of stakeholders,

ﬁve strategic action areas (SAAs) have been deﬁned, based on the issues and challenges that must

be addressed to reposition FP successfully. These are ensuring contraceptive commodities and

logistics (adequate and timely supplies of contraceptive methods appropriate to meet individual

needs); renewed efforts in capacity building to ensure that providers in the health sector have the

skills required to provide and support integrated FP services; strengthened service delivery systems

to increase access to quality, affordable, and sustainable services; a renewed focus on advocacy to

increase visibility of and support for FP among development partners, program managers, service

providers, and the public; and strengthening management systems, monitoring and evaluation

(M&E) to ensure effective program implementation.

Estimating the Level of Financial Support for Repositioning Family

Planning

Table 1 provides a summary of funding in Tanzanian shillings and U.S. dollars needed each year

through 2015, by Strategic Action Area (SAA), to reach a national average CPR target of 60 percent

for all methods for all women of reproductive age by 2015. Guided by an analytical framework

that projects needs based on the current population structure and growth rates, and considers the

diverse situations in mainland Tanzania’s 21 regions, these estimates were derived through an

iterative process to deﬁne and prioritize activities that will be required to achieve the objectives in

each of the ﬁve SAAs. Through this process, a total of 28 strategic actions were deﬁned across all ﬁve

areas. These were further broken down into speciﬁc activities, with timelines and inputs required

for implementation. Unit costs of the inputs were then used to estimate the cost for each activity

each year.

The activities and the costs of the inputs needed for each SAA serve as a platform for mobilizing

resources as well as for tracking implementation and measuring the impact of the NFPCIP. Careful

review of the HSSPIII, PHSDP, and HRHSP have been undertaken to ensure no duplication of the

investments and that the NFPCIP is integral of these strategic health programs. Although

investments in these strategic health programs will beneﬁt the entire health sector, including FP,

the resource needs identiﬁed in the ﬁve SAAs of the NFPCIP are the additional investments that

will be required speciﬁcally to strengthen FP through a coordinated approach to achieve the One

Plan target.

United Republic of Tanzania | National Family Planning Costed Implentantation Program

Table 1. Annual Funding Requirements, 2010–2015, by Strategic Action Area to Reposition Family Planning, with 60 percent CPR Target Achieved by 2015 (in Tshs/USD)

STRATEGIC ACTION AREA

FISCAL YEAR

TOTAL COST

ESTIMATE

FY 2010–2011 FY 2011–2012 FY 2012–2013 FY 2013–2014 FY 2014–2015 FY 2015–2016

I. Contraceptive security & logistics 16,282,691,047 17,592,358,355 18,700,234,439 20,617,616,767 22,733,318,127 25,403,005,311 121,329,224,046

II. Capacity building 1,211,037,000 1,619,613,533 913,909,250 730,794,500 604,212,000 604,112,000 5,683,678,283

III. Service delivery 465,895,283 917,230,750 570,577,000 96,353,750 99,935,000 64,000,000 2,213,991,783

IV. Advocacy 1,129,514,330 583,857,580 743,772,250 133,831,250 133,831,250 118,047,750 2,842,854,410

V. Management systems/M&E 549,527,800 202,613,800 134,500,300 77,746,300 72,346,300 84,496,300 1,121,230,800

Total (in Tshs) 19,638,665,461 20,915,674,018 21,062,993,239 21,656,342,567 23,643,642,677 26,273,661,361 133,190,979,323

Total (in USD$) 14,547,160 15,493,092 15,602,217 16,041,735 17,513,809 19,461,971 98,659,985

Exchange rate: 1 USD = 1,350 Tshs.

United Republic of Tanzania | National Family Planning Costed Implentantation Program

Introduction

Background

The health beneﬁts of Family Planning (FP) for women and their children have been well documented

for several decades, as has its essential contributions to social and economic development. Limited

FP services have been available in a few urban areas of Tanzania since the establishment of the

family planning association of Tanzania (UMATI) in 1959. Beginning in 1974, the Government of

Tanzania allowed UMATI to expand FP services to public-sector maternal and child health (MCH)

clinics throughout the country, but expansion was limited because of resource constraints, and levels

of contraceptive use remained low.

Expansion of the program and growth in the contraceptive prevalence rate (CPR) were accelerated

after a speech by the late ﬁrst President Julius Kambarage Nyerere in 1989 that recognized

the importance of FP to Tanzania’s development. In 1989, the Tanzanian government assumed

responsibility for integrating FP into government MCH services from UMATI. During the next

few years—the ‘golden age’ of FP in Tanzania—the prevalence of modern FP method use more than

doubled, increasing from 6.6 percent in 1992 to 13.3 percent in 1996, growing at an average of 1.5

percentage points per year. Beginning in 2000, however, the increase in prevalence dropped to 0.6

percentage points per year, with contraceptive prevalence for all methods among married women of

reproductive age reaching only 26.4 percent by the time of the last Demographic and Health Survey

(DHS) in 2004–2005.

A number of factors contributed to the loss of momentum, including decentralization and integration

of health programs and the shift in donor funding mechanisms and priorities. As FP priority,

visibility, and ﬁnancial support declined, the fundamental elements needed to sustain a thriving

FP program were also weakened at central, regional, and district levels. These elements include a

consistent and adequate supply of contraceptive commodities to meet increasing demand, capacity

building to increase the number of skilled FP providers and ensure updated provider skills, well-

equipped and ﬂexible service delivery systems, education and motivation to generate demand for

services, advocacy to sustain support for FP from various funding sources, and effective management

systems and leadership to guide program implementation.

Repositioning FP as a priority in the national agenda is a key strategy to improve maternal, newborn,

and child health; to prevent mother-to-child HIV transmission; and to promote social and economic

development. Renewed advocacy for FP and adequate funding for program implementation to meet

these goals are therefore urgently needed.

Health and demographic indicators are the widely accepted measures used to assess a country’s

health situation. Key indicators for Tanzania are shown in Table 2. Tanzania has a young population,

with early childbearing and high rates of fertility continuing throughout reproductive life. These

factors account for the projected near-doubling of the population by 2025, placing increasing stresses

on health and education systems, availability of food and clean water, natural resources and the

environment, and economic growth and development. All of the girls who will enter childbearing

age over the next decade have already been born, and with almost half of the country’s population

United Republic of Tanzania | National Family Planning Costed Implentantation Program

under age 15, Tanzania’s population growth will only accelerate. Early initiation of childbearing and

numerous, closely-spaced pregnancies throughout a woman’s reproductive life contribute not only

to rapid population growth but also to adverse social consequences such as gender inequity. Girls

who experience their ﬁrst pregnancy during adolescence often terminate their education, limiting

their future participation in positive social and productive economic activity. In addition, early and

frequent childbearing has serious health consequences for girls and women, contributing to higher

rates of complications such as eclampsia, obstructed labour, haemorrhage, anaemia, premature

delivery, and death.

Table 2. Tanzania Demographic and Health Indicators

INDICATOR

Population in millions, Tanzania mainland (2002 census) 34.4

Projected population in millions, 2004, Tanzania mainland (2004–2005 DHS) 36.0

Projected population, 2025, in millions (NBS) 65.3

Annual population growth rate (2002 census) 2.9

Percent of population under age 15 (2002 census) 47.0

Percent of women pregnant or with live birth by age 19 (2004–2005 DHS) 52.0

Total fertility rate (2004–2005 DHS) 5.7

CPR, modern methods (2004–2005 DHS) 20.0

Unmet need for FP (2004–2005 DHS) 21.8

Maternal mortality per 100,000 live births (2004–2005 DHS) 578

Infant mortality per 1,000 live births (2007 THMIS) 58

DHS = Demographic and Health Survey; NBS = National Bureau of Statistics; THMIS = Tanzania HIV/AIDS and

Malaria Indicator Survey.

Maternal mortality rates in Tanzania are among the highest in the world. Abortion is illegal in

Tanzania, and abortion complications are estimated to contribute to about 16 percent of maternal

deaths. Family planning services can signiﬁcantly reduce unintended pregnancies and maternal

mortality from unsafe abortions. Maternal mortality rates in Tanzania could be reduced by as much

as 35 percent if the One Plan FP goal is achieved.

High rates of infant and child deaths are another consequence of early and frequent childbearing

and of childbearing late in life (after age 35). Despite signiﬁcant progress in reducing the infant

mortality rate, this rate remains high in Tanzania. Signiﬁcant reductions in infant mortality can also

be realized by a reinvigorated FP program, saving the lives of half a million children over a 10-year

period.

Access to safe, effective, acceptable, and affordable FP methods and services is a key, highly cost-

effective intervention to save lives and reduce the adverse social and economic consequences of rapid

population growth. As shown in Table 2, at the time of the 2004–2005 DHS, more Tanzanian

women expressed an unmet need for FP than were actually using an FP method. An estimated

2.9 million unintended pregnancies could be averted over the next decade if the unmet need for

contraception were met. Although achieving the One Plan target will require increased demand for

FP, meeting the currently high level of unmet need alone would make a substantial contribution

toward achieving the goal.

United Republic of Tanzania | National Family Planning Costed Implentantation Program

Increased availability and use of FP is a key strategy for preventing HIV/AIDS. Consistent and

correct use of condoms is an important means of preventing transmission of HIV and other sexually

transmitted infections (STIs). Family planning is also a highly cost-effective means of preventing

mother-to-child transmission of HIV (PMTCT). Among infected women who do not wish to become

pregnant, providing effective contraception to prevent an unintended pregnancy costs a fraction of

providing antiretroviral drugs for PMTCT or of caring for AIDS orphans.

Investments in FP will contribute substantially to achievement of six of the eight Millennium

Development Goals (MDGs): reducing poverty and hunger, promoting gender equity and empowering

women, reducing child mortality, improving maternal health, combating HIV/AIDS, and ensuring

environmental sustainability. Family planning is a priority in the national development agenda, and

its visibility must be enhanced so that increased access to and use of FP methods and services can

make important contributions to achieving the country’s overall health and development goals.

An estimated 80 percent of FP services are provided by decentralized public-sector health facilities

through 133 local government authorities (LGAs). These include regional and district hospitals,

health centres, dispensaries, and community health services. In addition to the public-sector facilities,

a number of hospitals, health centres, and dispensaries managed by faith-based organizations

(FBOs) and standalone FP/RH clinics managed by nongovernmental organizations (NGOs) also

provide FP services. Further, all public, FBO, and NGO facilities obtain their FP commodities

through the national level Medical Stores Department (MSD). A limited number of private, for-

proﬁt clinics, pharmacies, and drug stores also provide some FP products and services, but data are

lacking on the numbers and distribution of such providers. Appendix A lists the planning partners

and implementers for the national FP program in the year 2009–2010.

An important step in implementing a reinvigorated FP program is to ensure that the process of

budgeting and ﬁnancing for RH services and contraceptive commodities are understood by the

Council Health Management Team (CHMT). Requests from the CHMT are forwarded, usually in

November, through the Regional Medical Ofﬁcer (RMO) to the Ministry of Finance and Economic

Affairs (MoFEA), which allocates governmental and Basket resources through the Medium-Term

Expenditures Framework (MTEF) in accordance with ceilings set through negotiations among the

MoHSW, MoFEA, President’s Ofﬁce Planning Commission (POPC), and the Prime Minister’s

Ofﬁce–Regional Administration and Local Government (PMO–RALG). At each level, additional

justiﬁcation or clariﬁcation may be required for the budget requests, until a ﬁnal approved budget is

submitted to Parliament in June. After approval by Parliament, the MTEF can dispense funds to the

CHMTs, usually on a quarterly basis. The process generally takes about nine months from initiation

until funds become available to support health services at the district and community levels.

The forecasting and quantiﬁcation exercise, as well as the development of budgets and procurement

plans for contraceptive commodities, are done at the central level. Then, funds are sent to the MSD

for procurement and distribution of FP commodities to facilities. For funds that are administered

through the Basket fund, an additional level of approval or no objection from the World Bank is

required before ordering of contraceptive commodities. The standard time from when funds are

released from the MoFEA until the commodities arrive at MSD is six to nine months.

The FP program faces a number of challenges and constraints that must be addressed for effective

repositioning of FP to meet the country’s RH and development goals. Five program areas or

components are essential for implementing a successful FP program: a consistent and adequate

United Republic of Tanzania | National Family Planning Costed Implentantation Program

supply of contraceptive commodities; sufﬁcient numbers of health providers who have the

necessary knowledge and the technical and client interactions skills to deliver FP services safely and

effectively; appropriately equipped facilities with a ﬂexible array of service delivery modalities and

systems to meet the needs in different sociocultural contexts and levels of development in Tanzania’s

different regions; strong advocacy to increase visibility and support for the program and address the

knowledge-use gap among FP clients; and strong management systems and leadership to ensure

efﬁcient and effective program implementation. The issues and challenges for each area have been

deﬁned below based on a review of published literature and documents, through discussions with

the National Family Planning Working Group and through a series of key informant interviews (see

Appendix B for a summary report of these interviews).

Providing a choice of methods to meet the changing needs of clients throughout their reproductive

lives increases overall levels of contraceptive use and enables individuals and couples to meet their

reproductive goals. The method mix available in a program inﬂuences not only successful client

use and satisfaction, but also has implications for provider skills and the facilities and equipment

needed to deliver certain methods. All of these factors affect program cost and sustainability and,

in turn, the amount of contraceptive protection that can be provided with various levels of ﬁnancial

support.

Maintaining an adequate supply of contraceptive commodities to meet clients’ needs, prevent stock-

outs and ensure contraceptive security is the most urgent issue facing the Tanzania’s FP program.

The inability to supply and sustain current users has considerable implications for expansion of

the program to meet the CPR targets of the One Plan. Other key strategies (HSSPIII and PHSDP)

recognize the importance of ensuring the availability of adequate contraceptive choices. General

strengthening of logistics systems planned in the PHSDP will beneﬁt contraceptive security, but

additional investments are needed to ensure adequate forecasting, budgeting, and tracking of

supplies so that all contraceptive methods, especially those that are in greatest demand, are available

when and where clients need them.

Funding allocations through the MTEF are not adequate to meet contraceptive commodity

requirements because of competing priorities in the health sector. However, the government is

progressing well towards meeting the Abuja declaration target of 15 percent of the total national

budget to cover improvement in the health sector.

Furthermore, when requests for funding from the district level are prioritized and submitted for

funding by the district-level health management teams, FP falls well below other health service

priorities in some districts and is sometimes overlooked in these requests. As a result, stock-outs of

contraceptive commodities occur even when districts have returned unused funds to the Basket.

A key factor in ensuring contraceptive security, method-mix issues, has important implications

for cost as well as for client acceptance and satisfaction needed to sustain successful use.

Short-acting methods are the most prevalent contraceptives in the current method mix,

according to the 2004 DHS, which include pills, condoms, and, increasingly, injectable depot-

medroxyprogesterone (DMPA). These methods require regular resupply, hence successful use must

include access to a consistent supply of the product. Each ‘resupply’ visit to a service delivery

point (SDP) entails additional costs. Pills and condoms also require high levels of user adherence

and motivation, with inconsistent and incorrect use leading to method failures and high rates of

discontinuation.

United Republic of Tanzania | National Family Planning Costed Implentantation Program

Condoms protect not only against unintended pregnancy but also against STIs, including HIV.

They have been widely promoted in HIV-prevention programs and, less often, as ‘dual protection’

against pregnancy and STIs/HIV. Their association with STI and HIV prevention, however, means

that for many couples, condoms are stigmatized as being associated with extramarital sex, and

therefore partners may resist using condoms for pregnancy prevention.

Long-acting methods give contraceptive protection for a year or more. They include intrauterine

devices (IUDs) and implants. These methods have higher initiation costs than short-acting methods,

but because they can be used without resupply for several years, they are often less expensive per year

of use. Initiation costs for these methods are higher because the costs of the commodities themselves

are higher. In addition, they require providers to have special training and skills for insertion and

removal as well as good counselling skills to ensure that clients can make informed choices about

these long-acting methods. Unlike short-acting methods, which can be discontinued simply by

the user stopping the method, discontinuation of IUDs and implants requires removal by a trained

provider.

Prevalence of IUD use in Tanzania is low, despite it being the most cost-effective form of reversible

contraception, having a good safety record, and providing highly effective contraceptive protection

for up to 10 years. Expanding the use of IUDs will require considerable attention to addressing myths

and misinformation about IUDs among both providers and clients. Hormone-releasing subdermal

implants provide safe, highly effective contraception and have been growing in popularity among

Tanzanian women.

Permanent methods of contraception (sterilization) include tubal ligation for women and vasectomy

for men. Worldwide, these two surgical methods account for the majority of contraceptive users

and are highly effective and safe when provided by trained personnel with appropriate attention

to infection control. Although the prevalence of permanent methods is low in Tanzania, the use of

tubal ligation is growing, especially for women who do not want more children, and a pilot program

to provide vasectomy in the Kigoma region is meeting with considerable success. Provision of

permanent methods is limited both by weaknesses in health facilities as well as by lack of provider

skills. Additionally, widespread rumours—for example, equating vasectomy with castration—

undermine acceptance of these highly effective methods. Because these methods limit future

childbearing, client education and counselling to ensure informed choice and informed consent are

essential parts of service provision. However, weaknesses exist in such client-provider interaction

skills. Expanded availability of permanent methods for those who do not want more children can

help Tanzania achieve its CPR targets, but this will require signiﬁcant investments in capacity

building to ensure proﬁciency in surgical skills, counselling, and informed consent procedures.

Human resources are the most costly recurring expense in the health care system, with ﬁnancial

resources needed not only to recruit and retain health care workers but also to ensure that they have

the knowledge, skills, and supervision to enable them to deliver safe, high-quality FP services.

For effective repositioning of FP to occur, health workers at all levels must see providing family

planning as their responsibility. National health-sector strategies (HSSPIII, HRHSP, and PHSDP)

include objectives to ensure sufﬁcient numbers of health care providers at all levels of the system.

The NFPCIP will therefore focus on ensuring that health providers already in service, as well as

those in training and those to be hired, have the appropriate knowledge, skills, supervision, and

support to provide safe, effective, acceptable FP services.

United Republic of Tanzania | National Family Planning Costed Implentantation Program

There is a critical shortage of skilled health care workers in Tanzania. Inadequate capacity for

planning, forecasting, and management of human resources are underlying factors affecting the

shortage. Distribution and retention of health care workers is also problematic. After almost a

decade-long employment freeze in the public sector during the Retrenchment Policy (1993–1999),

efforts to recruit health personnel have begun again. However, many posts, especially at rural

district levels, remain unﬁlled. Hardship living conditions in many districts, along with lack of

retention schemes, limited training opportunities, and overwhelming responsibilities, are major

factors undermining both recruitment and retention. According to a recent study, less than half of

Tanzania’s ﬁnal-year medical students were willing to accept rural postings.

Low health worker productivity also contributes to the provider capacity challenge. Currently

a ‘pay-for-performance’ initiative is underway to enhance health worker productivity, but it has

no indicator for FP. Inclusion of an indicator for FP must avoid any target-setting that could be

construed as coercive.

Capacity building of providers to ensure essential skills in FP is in critical need of focused attention.

The national training strategy for FP is due for revision. Many current providers have not had their

FP knowledge and skills updated in several years, undermining the quality of care they provide. A

baseline survey of FP services in 2004–2005 found low levels of provider knowledge, clinical skills,

and counselling capability needed to provide quality FP services for both short- and long-acting

methods.

Provider biases and misinformation persist about certain methods and the appropriateness of FP

methods and services for selected categories of clients (youth, HIV-infected, etc.). The six Zonal

Training Centres, are charged with maintaining the knowledge and skills of current health providers.

Pre-service training for health professionals in some 116 health training institutions (public and

private sectors) must be strengthened.

Supervision needs strengthening, a fact recognized in the HRHSP, the HSSPIII, and the PHSDP.

Among the reasons for low health worker morale and poor retention rates are the lack of structured

and supportive supervision, including lack of written or oral feedback from supervision visits.

Investments through other program initiatives can strengthen supervision capacity in general.

Investments through the NFPCIP will help supervisors play more active roles in identifying

providers who need FP skills updates and in ensuring that those who are trained are applying their

updated knowledge and skills appropriately.

Access to a SDP is an essential component of FP. According to the Tanzania DHS 2004–2005,

more than 90 per cent of Tanzanians live within 10 kilometres of a health facility. The Tanzania

Baseline Survey conducted by the ACcess, Quality, and Use In REproductive health (ACQUIRE)

project in 2004–2005 found major deﬁciencies in the abilities of both clinic and hospital sites to

provide FP services, especially for long-acting and permanent methods (LAPMs). In areas where

the nearest health care provider is an FBO, the availability of FP services depends on the religious

beliefs and attitudes of the organization with regard to FP and contraception methods.

Infrastructure limits the types of FP services that can be provided in many health facilities. Higher-

level facilities, such as regional and district hospitals, are better equipped and supplied than are

health centres, and dispensaries. Some dispensaries and health centres, lack an on-site clean water

source and electricity, both essential for providing quality services, including infection control, for

LAPMs. Other infrastructure weaknesses include lack of private space for providing FP counselling

United Republic of Tanzania | National Family Planning Costed Implentantation Program

or services involving pelvic examinations and inadequate storage space for contraceptive supplies.

As with other areas, the major investments in strengthening infrastructure are being made through

the PHSDP and HSSPIII. The NFPCIP gives attention to ensuring that they are incorporated in

planning for upgrading of health infrastructure and equipment.

Considerable progress has been made to ensure the availability of equipment and supplies, such

as examining and surgical tables, lamps, sterile gloves, disposable needles, syringes, and containers

for sharps disposal, that are needed to provide some FP methods safely. However, consistent supply

in facilities, especially in community health facilities, needs to be further strengthened.

Utilization of services is inﬂuenced both by proximity and physical access to an SDP and by

client perceptions about the quality of care they are likely to receive. Factors inﬂuencing client

perceptions include the availability of counselling, information, and support provided to those

seeking FP services and particularly the consistent supply of contraceptive methods.

Efforts are underway to foster the integration of FP with other sexual reproductive health services,

such as FP and HIV/AIDS, FP and gender-based violence, FP in postnatal care (PNC), and FP in

postabortion care (PAC). However, many missed opportunities remain to integrate, promote, and

provide FP as part of other health services, such as with child immunization services. Integration of

services will help to reach new populations who may need FP and who must be reached to achieve

One Plan targets. Studies in other East African countries have shown that, even when providers of

these services lack the time or skills to provide direct services, they can assess the need for FP and refer

clients to an appropriate source.

Young people also need special attention, both in increasing their access to information, education,

and friendly services and in helping them to choose and use contraceptive methods effectively.

With adolescents constituting almost a third of Tanzania’s population, early sexual debut, and high

rates of pregnancy and childbearing among teenage girls, the needs for contraception are clear.

The MoHSW/Reproductive and Child Health Section (RCHS) has developed a national strategy

on adolescent RH that outlines key strategic objectives to enable adolescents to cope with their

growing up in this transition period. Despite having the strategy, many gaps still remain in terms

of fostering implementation of existing supportive policies and laws for young people to exercise

their sexual and reproductive rights; access friendly RH information, education, and services;

human resource capacity for providing services; and parent and community support towards young

people.

Referral systems need strengthening by ensuring that the referring provider has knowledge of

what FP services are available at referral centres, and has a mechanism to link clients to those

centres,. This has also been emphasized in the PHSDP and HSSPIII. Closer linkages with private,

NGO, and FBO facilities can be encouraged as part of the referral system.

In addition to clinic-based services, there are other options to deliver FP services. The decentralization

of responsibility for health care to the community level in Tanzania opens the door for expansion

of community-based services (CBS). Community-based services includes community-based

distribution (CBD) of short-acting methods now underway in a limited number of regions in

Tanzania, as well as making some methods available through accredited drug dispensing outlets

(ADDOs) and through pharmacies. Several issues and challenges must be addressed in considering

expansion of CBS, however. The CBD workers, as well as distributors in ADDOs and pharmacies,

need training and supervision to provide contraception, and this can entail considerable costs. Also,

CBD workers work on a voluntary basis; long-term retention of CBD workers requires that some

attention be given to nonmonetary rewards or noncoercive incentives.

United Republic of Tanzania | National Family Planning Costed Implentantation Program

The basis of any strong program is a strong supportive policy framework, with high-level advocates

to maintain visibility and speak for the importance of the program. A supportive advocacy and

policy environment improves access to services and addresses normative barriers that restrict

provision of services. It mobilizes community and donor support for FP and is essential to secure

ﬁnancing for the program, a crucial component of maintaining contraceptive security. It is essential

in promoting awareness of the beneﬁts for FP and encouraging clients’ access to and use of services.

Strengthening capacity for advocacy called for in the PHSDP, and investments now underway to

expand information and communications technologies, will help to address the need for increased

advocacy for FP. The following paragraphs discuss the speciﬁc needs to be addressed through the

NFPCIP to strengthen advocacy for FP in Tanzania.

Sectoral reforms and decentralization, which began in the late 1990s and is still ongoing,

coincided with a slowing of the momentum achieved in the FP program in the mid- to late-

1990s. The sector-wide approach (SWAp) for health builds on the recommendations from the

1994 International Conference on Population and Development to integrate health services into

a comprehensive package that meets all client needs and reduces or eliminates vertical programs.

Because FP contributes to improvements in social and economic development, improvements in the

environment, and saving the lives of women, children, and adolescents, it is important to address FP

in a multisectoral approach.

Along with the SWAp, efforts to decentralize health care and promote community involvement

in and responsibility for health care were instituted. However, budget allocations still must be

increased for FP services at the district level. The MoHSW has developed a package of essential

interventions for empowering districts to include FP activities into Council Comprehensive Health

Plans (CCHP) guidelines.

Policy issues also directly affect the delivery of contraceptive methods and services. Although

policies set clear goals for making FP available to all who want and need services, without regard to

age, marital status, sex, or ability to pay, they are limited as to which categories of health personnel

are authorized to provide certain methods. These limitations must be reviewed according to the

local situation and needs and international norms and guidelines informed by recent research and

program evidence. Additionally, more effective dissemination of existing policies and guidelines, as

well as of updates and revisions, is needed so that all those implementing FP services are aware of

them.

Champions are important and needed to advocate for continued support and to promote use of

FP. There is a need to identify and recruit additional champions as well as orient and support their

activities at various levels.

Awareness levels of FP among Tanzanians are high. According to the 2004–2005 DHS, 96 percent

of all women and 97 percent of all men had heard of FP. However, knowledge does not equal

use of FP services. Obstacles that prevent adoption of FP among those who know about it include

actual or feared partner/spousal disapproval, myths, rumours and misinformation about FP and

speciﬁc methods, fears of side effects and health concerns, poor access to services and methods,

and concerns about costs. Public-sector facilities in Tanzania do not charge for FP methods and

services; however, poor infrastructure, shortage of skilled providers, and inconsistent availability of

contraceptive products all impede access to FP services by men, women, and adolescents.

In addition to those who fall within the traditional ‘unmet need’ category are all of those who remain

unaware of FP and its beneﬁts or of their eligibility to access and use FP. These may include women

United Republic of Tanzania | National Family Planning Costed Implentantation Program

in remote rural areas, youth, men, or groups with special needs, such as HIV-infected persons.

Bridging the gap between current use and unmet need to reach the One Plan target of 60 percent

CPR by 2015 will require expanded efforts to increase demand for and use of FP in these groups.

Along with increasing demand is the need to ensure that services and commodities are available

to meet it. Demand-generation activities must be paced so that new demand for methods and

services can be met while current needs are being sustained. Planned investments in information

and communications technologies in HSSPIII and PHSDP will be of great beneﬁt to activities that

aim to generate demand for FP.

Clear leadership and management responsibility and authority are essential for repositioning

FP overall and ensuring NFPCIP implementation. Increasing the number of RCHS staff and

management training is needed. The main challenges to achieving the goals of the NFPCIP are

that all of its elements must be fully funded and all recommended actions must be implemented

on schedule. For example, capacity building to ensure adequate human resources assumes sufﬁcient

numbers of health care workers can be hired and trained. This will require full funding and

implementation of the PHSDP and HRHSP as the platform upon which the NFPCIP is built.

Achieving the goal also assumes there will be no unforeseen circumstances that will sidetrack

implementation and that political and traditional leaders at the national and community levels will

recognize and give priority to FP as a basic human right of their people.

Management systems and existing tools must be strengthened for successful repositioning of FP.

Among the challenges that must be addressed are ensuring a clearer understanding, especially at the

CHMT level, of how to prioritize FP in the budgeting process for the basket funding. Coordination

among all of the different agencies and organization involved in FP, sharing operational information,

and tracking implementation of the NFPCIP will require investments in strengthening both systems

and management skills to accomplish these essential tasks, including increased attention to public-

private partnerships for FP.

Monitoring and evaluation (M&E) systems also need strengthening, as recognized in HSSPIII. The

‘way forward’ calls for investments in developing a comprehensive M&E and research strategy for

the health and social welfare sector that is integrated with the health management information

system (HMIS). For the NFPCIP, this includes having adequately trained personnel to collect,

report, analyze, and use FP data for oversight of plan implementation and to recognize needs for and

make decisions about midcourse corrections to the NFPCIP.

Health sector reform, especially as noted in the HSSPIII, emphasizes public-/private-sector

partnerships. However, such partnerships in the FP services area are weak and must be strengthened.

The private, NGO, and FBO sectors can play an increased role in repositioning FP. Currently, the

government of Tanzania accounts for almost 70 percent of FP services in the country. Increasing the

role of the other sectors can help reallocate limited governmental resources to meet the needs of the

poorest of Tanzania’s citizens. It can also help generate demand by reaching new groups who are not

yet users of FP or who do not yet perceive a need for FP.

United Republic of Tanzania | National Family Planning Costed Implentantation Program

National Family Planning Costed

Implementation Program

Purpose of the NFPCIP

Recognizing the need to reposition family planning in Tanzania, the MoHSW has developed the

NFPCIP. The development of the NFPCIP is guided by the vision and mission established in the

Reproductive and Child Health Policy Guidelines of 2003. Furthermore, the goal of the NFPCIP

is guided by the National Road Map Strategic Plan to Accelerate Reduction of Maternal, Newborn and

Child Deaths in Tanzania, 2008–2015 (One Plan) as well as by the HSSPIII. Both strategic plans

recognize family FP as essential to improving maternal, newborn, and child health. Although

the overall investments in the health sector called for in the HSSPIII, PHSDP, and HRHSP will

strengthen the foundation for FP, the speciﬁc aim of the NFPCIP is to identify the activities to

be implemented and additional resources that will be needed to make quality FP services more

accessible to and equitable for all of Tanzania’s people. Appendix C describes the process used to

develop the NFPCIP and provides a list of the individuals and organizations that participated in

this consultative, collaborative process.

The NFPCIP clearly deﬁnes priorities for strategic actions, delineates the activities and inputs needed

to achieve them, and estimates the costs associated with each as a basis for budgeting and mobilizing

resources required for implementation at different levels by organizations and institutions over the

2010–2015 period. In addition, the NFPCIP is intended to serve as a guide for development partners

and implementing agencies on areas of need to ensure the success of the national FP program.

More speciﬁcally, the NFPCIP will be used to:

Inform policy dialogue, planning and budgeting to strengthen FP as a priority area in the

National Development Agenda;

Prioritize FP program strategic actions and activities for implementation at different levels of

the health system;

Enable the MOHSW and other GoT sectors to understand the budgetary needs to implement

a FP program to reach projected targets, and to make projections for the future as new demand

for FP is generated;

Mobilize and sustain quality resources (human, ﬁnancial, technical, commodities and equipment)

that are essential for achieving cost-effective and scaled-up services for FP; and

Provide benchmarks and indicators that can be used by GoT and development partners to

monitor and support the FP program;

United Republic of Tanzania | National Family Planning Costed Implentantation Program

A healthy and well-informed Tanzanian population with access to quality reproductive and child

health services that are acceptable, affordable, and sustainable and provided through efﬁcient and

effective support systems.

Promote, facilitate and support in an integrated manner the provision of reproductive and child

health services to men, women, adolescents, and children in Tanzania.

Increase the CPR among women of reproductive age from 28 percent to 60 percent by 2015.

The denominator used for the CPR target is women of reproductive age and not married women

of reproductive age (MWRA). This is to take into consideration all women of reproductive age

regardless of their marital status. Furthermore, the CPR target includes all methods and not just

modern methods. According to the DHS 2004–2005, the CPR among MWRA for modern methods

is 20 percent and the CPR among MWRA for all methods is 26.4 percent, while the CPR for women

of reproductive age for all methods is 28 percent. The latter ﬁgure of 28 percent is thus used.

Although guidance is also provided by the HSSPIII, which has a goal CPR of 30 percent by 2015,

the higher CPR goal of 60 percent speciﬁed by the One Plan was chosen so that repositioning FP

can be addressed more aggressively and, as a result, will have greater potential impact on reducing

maternal and newborn mortality and improving child survival.

Furthermore, there is a wide degree of variation across regions in current CPR as well as considerations

of culture and context, such as the availability of infrastructure, human resources, service modalities,

and current demand. These factors increase the challenges to be addressed and the level of resources

that will be needed to reach the 60 percent CPR One Plan target by 2015. The regional variations

and the different scenarios for repositioning FP are discussed in more detail in the Analysis of

Demographic Determinants of Resource Requirements section.

The NFPCIP objectives reﬂect the ﬁve major program components that must be strengthened to

address the issues and challenges to reposition FP as a national priority for health and development.

Although all ﬁve components are needed for a thriving and effective program, emphasis will be given

to two areas to prioritize fulﬁlment of the increasing demand for FP services in the country. These

two areas include ensuring contraceptive security and strengthening integrated service delivery

of FP in all aspects of the health sector, including HIV/AIDS, immunization services, PNC, and

PAC.

United Republic of Tanzania | National Family Planning Costed Implentantation Program

The nation’s demographic proﬁle affects the ever-increasing need for resources for FP and hence is

taken into consideration to determine the resource requirements for the NFPCIP. Below are the

considerations and assumptions used for the NFPCIP to affect CPR projections and determine the

resources needed to meet the One Plan target of 60 percent CPR by 2015, assuming a growth rate

in CPR of ﬁve percentage points each year during 2010–2015. (Appendix D provides a deﬁnition

of the terms used in the NFPCIP and in the analysis):

The analysis that projects CPR and method-mix

targets for the NFPCIP is based on data from

the most recent DHS for Tanzania, conducted

in 2004–2005. To bring the CPR estimate to

2009, the growth in CPR has been assumed

to remained constant at 0.6 percentage points

annually since the last DHS, because that was

the rate of growth in CPR between 1999 and

2004–2005. A new DHS is currently ongoing

until late 2010. Findings from the new survey

may show this assumption to be incorrect because

of the loss in momentum in the FP program

discussed in the Introduction and the recent

and continuing stock-outs of contraceptives

discussed in the Issues and Challenges section.

If the growth in CPR is lower than has been

assumed, the challenges of meeting the One

Plan targets will be even greater.

An important factor in these projections is that the total number of women of reproductive age

(WRA) expands each year. This is because of the age structure of Tanzania’s population (the

Population Pyramid). As shown in Table 1 (see Introduction), 47 percent of the population was

under 15 years of age in 2004–2005. All of the girls who will reach reproductive age between

now and 2015 have already been born, and each year an ever-increasing number of girls will reach

reproductive age. A number of women will also ‘age out’ of reproductive age each year, but because

of the population pyramid (Figure 1), that number will always be smaller than the number of girls

entering reproductive age. This growing denominator further stresses the FP program to deliver

more services to achieve the 60 percent CPR goal by 2015. Assuming a CPR of 28 percent in 2008,

there are 2.02 million current users of all methods of FP. To reach the One Plan target, taking into

account the growing denominator, the number of FP users must more than double, to a total of 5.23

million users by 2015.

0-4

5-9

15-19

10-14

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80+

Male Female

-10% -8%-6% -4%-2% 0% 2% 4% 6% 8% 10%

Age in Years

Percent of the population

Figure 1. Polpulation Pyramid for Tanzania

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The map in Figure 2 shows the wide regional variations in CPR at the time of the last DHS. CPR

for all methods ranged from a low of 10.3 percent in Tabora region to a high of 49.5 percent in

Kilimanjaro region. Two thirds of the regions had a CPR of less than 40 percent. A number of

factors inﬂuence this variation in CPR, including availability of infrastructure and skilled providers,

social and cultural norms, and the relative level of priority given to FP by communities and local

governments. These factors, as well as the starting point of current CPR, will all inﬂuence whether

and how quickly each region can increase its CPR and contribute toward meeting the One Plan

target.

22%

35%

38%

30%

19%

35%

30%

26%

35%

26%

24%

17%

13%

12%

15%

11%

17%

Modern Contraceptive

Prevalence 2004

29%

Source: TDHS 2004

Figure 2. Modern Contraceptive Prevalence by Region, 2005–2005

Table 3 shows that the mix of FP methods also varied by region at the time of the 2004–2005 DHS.

The Kilimanjaro region, with relatively stronger infrastructure and more highly trained providers,

for example, had the highest rates of use for LAPMs, whereas pills and condoms were more likely

to make up the majority of the method mix in regions with less well-equipped facilities and less-

skilled staff. It also shows the relatively high demand for injectables and the very low use of IUDs.

United Republic of Tanzania | National Family Planning Costed Implentantation Program

Table 3. Contraceptive Method Mix by Region, DHS 2004–2005

Region

% Total

Population

Female

Sterilization Pill IUD Injectables Implant Condom LAPM

Kilimanjaro 0.062 10.2 6.8 1 17.2 1.6 1.5 0

Arusha 0.035 1.8 11.2 0.8 15.5 0.8 3 1.6

Mbeya 0.066 2 7 0 9.2 1 2.2 2

Dar es Salaam 0.07 3.7 11.6 0.9 13.7 1.5 3.4 0

Ruvuma 0.036 6.1 7.7 0 14.5 1.3 5.2 0

Tanga 0.053 1.8 6.3 0.5 15.5 0.9 4 0

Iringa 0.052 3.4 7.8 0 10.4 0 4.4 0.5

Morogoro 0.054 4.5 10.6 0 11.2 0.5 2.6 0.6

Lindi 0.026 3.5 18.3 0 6.1 0.4 1.8 0

Mtwara 0.034 2.2 13.6 0 9.2 0 0.9 0

Manyara 0.029 0.9 3.9 0 5.9 0 1.4 5.2

Dodoma 0.052 1 9.5 0 9.8 0 2 0

Coast (Pwani) 0.026 1.4 4.4 0 9.6 1.6 2.3 0

Kigoma 0.037 2.5 1.4 0.3 5.8 0 0.6 1

Singida 0.033 2.3 6.1 0.3 7.6 0 0.6 0

Rukwa 0.034 0.3 3.5 0.5 5.1 0 3.6 0

Kagera 0.059 3.4 3 0 7.5 0 1.1 0

Mara 0.042 1.8 1.1 0 6.7 0.3 0.6 0.3

Mwanza 0.08 2.2 2.2 0 3.2 0.3 0.6 0.7

Shinyanga 0.078 1.9 1.9 0 2.1 0.2 1.5 0

Tabora 0.043 1.2 0.5 0 4.5 0.3 1.3 0

Table 4 shows the projected total population for Tanzania in 2004 at 36 million, and the numbers

and percentages of the population residing in each region. It also shows the CPR, all methods, and

the total demand (CPR plus unmet need) in each region at the time of the DHS (2004–2005), with

an overall CPR of 28 percent. This table groups the regions into ﬁve strata based on the CPR. For

each stratum, it shows at the time of the last DHS the relative contribution that each stratum made

toward achieving a national CPR of 60 percent. The table also shows the stratum-speciﬁc CPR that

must be reached by 2015 to achieve the One Plan target. For example, Stratum 1 shows Kilimanjaro

and Arusha having the highest CPRs in 2004–2005. These two regions account for 9.7 percent of

Tanzania’s total population. For the country to reach 60 percent CPR overall, the regions in Stratum

1 will need to reach a CPR of 72 percent by 2015. The stratum with the lowest CPR, and with

almost a quarter of Tanzania’s population, will need to increase its CPR from around 11 percent

in 2004–2005 to 49 percent by 2015 for the country to reach its One Plan target. All regions will

need to increase demand to reach their targets, but meeting the current total demand in each region

would make a signiﬁcant contribution to reaching the targets.

United Republic of Tanzania | National Family Planning Costed Implentantation Program

Table 4. Population, CPR (2004–2005), and Total Demand with Regional Stratication and CPR Targets to Reach One

Plan Target

Region

2004–2005 DHS Stratum Analysis

Projected

population

CPR, all

methods

Total

demand

% Total

Population

2015 CPR

Target

% Total

Population

Relative

Contribution

Kilimanjaro 2,228,526 49.50% 69.60% 6.20%

72.00% 9.70% 0.07

Arusha 1,247,982 48.60% 65.50% 3.50%

Mbeya 2,369,368 45.10% 57.50% 6.60%

68.00% 22.50% 0.153

Dar es Salaam 2,522,531 44.60% 59.60% 7.00%

Ruvuma 1,280,113 41.60% 59.60% 3.60%

Tanga 1,922,318 40.20% 60.60% 5.30%

Iringa 1,871,754 35.10% 54.80% 5.20%

62.00% 27.20% 0.169

Morogoro 1,928,864 34.60% 50.20% 5.40%

Lindi 939,928 33.50% 55.20% 2.60%

Mtwara 1,225,136 26.80% 51.30% 3.40%

Manyara 1,041,894 26.50% 54.50% 2.90%

Dodoma 1,861,085 23.80% 52.20% 5.20%

Coast (Pwani) 935,906 22.20% 46.80% 2.60%

Kigoma 1,331,265 19.80% 52.80% 3.70%

55.00% 16.30% 0.09

Singida 1,204,090 18.30% 43.50% 3.30%

Rukwa 1,231,549 18.10% 35.50% 3.40%

Kagera 2,108,853 15.70% 38.80% 5.90%

Mara 1,530,609 13.00% 42.40% 4.20%

49.00% 24.30% 0.119

Mwanza 2,882,978 11.00% 38.90% 8.00%

Shinyanga 2,794,746 10.90% 42.60% 7.80%

Tabora 1,561,744 10.30% 34.80% 4.30%

Total 36,021,239 28.10% Total CPR 60.00%

Table 5 shows the annual CPR, all methods, that each region will need to reach to achieve the One

Plan target of 60 percent CPR by 2015. It assumes a 0.6 percentage point growth in CPR each year

since the last DHS. These projections serve as the basis for estimating the commodities and other

inputs that will be required to deliver the projected volume and mix of FP services. Although not

all of the regions will reach the One Plan target by 2015, the nation as a whole would meet the 60

percent target at this growth rate in CPR. In all, 13 regions will meet or exceed 60 percent CPR at

this rate of growth; the remainder will achieve lower CPRs.

United Republic of Tanzania | National Family Planning Costed Implentantation Program

Table 5. Growth in CPR, Assuming a 0.6 percent Increase from 2004 to 2009 and Reaching National Target in 2015

Region

2004–2005 DHS PROJECTIONS

CPR all

method

% Total

Population

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

Kilimanjaro 49.50% 6.20% 50% 51% 51% 52% 53% 56% 59% 62% 66% 69% 72%

Arusha 48.60% 3.50% 49% 50% 50% 51% 52% 55% 58% 62% 65% 69% 72%

Mbeya 45.10% 6.60% 46% 46% 47% 48% 48% 51% 55% 58% 61% 65% 68%

Dar es Salaam 44.60% 7.00% 45% 46% 46% 47% 48% 51% 54% 58% 61% 65% 68%

Ruvuma 41.60% 3.60% 42% 43% 43% 44% 45% 49% 52% 56% 60% 64% 68%

Tanga 40.20% 5.30% 41% 41% 42% 43% 43% 47% 51% 56% 60% 64% 68%

Iringa 35.10% 5.20% 36% 36% 37% 38% 38% 42% 46% 50% 54% 58% 62%

Morogoro 34.60% 5.40% 35% 36% 36% 37% 38% 42% 46% 50% 54% 58% 62%

Lindi 33.50% 2.60% 34% 35% 35% 36% 37% 41% 45% 49% 54% 58% 62%

Mtwara 26.80% 3.40% 27% 28% 29% 29% 30% 35% 41% 46% 51% 57% 62%

Manyara 26.50% 2.90% 27% 28% 28% 29% 30% 35% 40% 46% 51% 57% 62%

Dodoma 23.80% 5.20% 24% 25% 26% 26% 27% 33% 39% 44% 50% 56% 62%

Coast (Pwani) 22.20% 2.60% 23% 23% 24% 25% 25% 31% 37% 44% 50% 56% 62%

Kigoma 19.80% 3.70% 20% 21% 22% 22% 23% 28% 34% 39% 44% 50% 55%

Singida 18.30% 3.30% 19% 20% 20% 21% 21% 27% 33% 38% 44% 49% 55%

Rukwa 18.10% 3.40% 19% 19% 20% 21% 21% 27% 32% 38% 44% 49% 55%

Kagera 15.70% 5.90% 16% 17% 18% 18% 19% 25% 31% 37% 43% 49% 55%

Mara 13.00% 4.20% 14% 14% 15% 15% 16% 22% 27% 33% 38% 44% 49%

Mwanza 11.00% 8.00% 12% 12% 13% 13% 14% 20% 26% 32% 37% 43% 49%

Shinyanga 10.90% 7.80% 12% 12% 13% 13% 14% 20% 26% 31% 37% 43% 49%

Tabora 10.30% 4.30% 11% 12% 12% 13% 13% 19% 25% 31% 37% 43% 49%

National 28.1% 28.7 29.3 29.9 30.5 31.1 35.9 40.7 45.6 50.4 55.2 60

The next table, Table 6, sets the method-mix targets to be achieved in each region by 2015 to

meet the One Plan target. The analysis in this table, an important step in estimating the volume

of contraceptive commodities that must be available each year, is based on the use of each method

reported in the last DHS and on recent expansion in availability and demand for some methods.

The targets are shown are the percentage levels that each method is expected to reach in each region,

totalling to 100 percent in each region. The projections in this table take into account a variety of

contextual factors, including sociocultural considerations, availability of infrastructure, and provider

capacity, that are likely to inﬂuence provision and acceptance of each method. These targets also

take into consideration the recommendations of the National Family Planning Working Group to

shift use, wherever feasible, from less effective to more effective methods while maintaining the

widest possible range of method choices. For example, targets assume a shift of some users from

traditional to modern methods. Within temporary methods, some users are shifted from those

methods requiring high levels of personal adherence (pills and condoms) to injectables. An overall

shift to LAPMs is also assumed, especially in regions with better infrastructure and more highly

skilled providers.

United Republic of Tanzania | National Family Planning Costed Implentantation Program

Table 6. Contraceptive Method-Mix Targets, 2015, by Region, Based on Contextual Factors

Region

Female

Sterilization Pills IUD Injectables Implant Condoms Traditional

Kilimanjaro 16.0% 7.0% 9.0% 50.0% 10.0% 3.0% 5.0%

Arusha 3.0% 18.0% 3.0% 50.0% 9.0% 7.0% 10.0%

Mbeya 3.6% 14.0% 2.4% 34.0% 6.0% 5.0% 35.0%

Dar es Salaam 6.0% 22.0% 4.0% 40.0% 15.0% 8.0% 5.0%

Ruvuma 10.0% 14.0% 2.5% 40.0% 12.5% 13.0% 8.0%

Tanga 3.0% 23.0% 2.4% 45.0% 6.6% 10.0% 10.0%

Iringa 6.3% 25.0% 2.4% 35.0% 3.3% 13.0% 15.0%

Morogoro 8.5% 22.0% 3.0% 45.0% 8.5% 8.0% 5.0%

Lindi 6.6% 37.0% 3.6% 35.0% 7.8% 6.0% 4.0%

Mtwara 4.3% 40.0% 2.4% 45.0% 5.3% 3.0% 0.0%

Manyara 2.0% 30.0% 1.2% 30.0% 2.8% 6.0% 28.0%

Dodoma 2.2% 20.0% 1.6% 60.0% 4.2% 8.0% 4.0%

Coast (Pwani) 4.0% 10.0% 4.0% 55.0% 12.0% 10.0% 5.0%

Kigoma 5.7% 9.0% 4.0% 38.0% 10.3% 3.0% 30.0%

Singida 5.2% 15.0% 4.0% 60.0% 10.8% 3.0% 2.0%

Rukwa 2.3% 22.0% 1.4% 35.0% 3.0% 21.0% 15.3%

Kagera 7.8% 8.0% 6.0% 53.0% 16.2% 7.0% 2.0%

Mara 4.7% 5.0% 4.0% 60.0% 11.3% 5.0% 10.0%

Mwanza 6.5% 20.0% 6.0% 40.0% 17.5% 6.0% 4.0%

Shinyanga 6.0% 16.0% 6.0% 30.0% 18.0% 16.0% 8.0%

Tabora 4.0% 5.0% 4.0% 56.0% 12.0% 14.0% 5.0%

National 5.9% 17.5% 4.0% 44.0% 10.4% 8.4% 9.8%

Based on the method-mix targets in Table 6, Table 7 projects the annual rate of growth in each

method that will be required in all regions, starting in 2010 and reaching the One Plan target of 60

percent CPR by 2015. This table is used to project the absolute volume of commodities that will be

required each year to achieve the One Plan target.

United Republic of Tanzania | National Family Planning Costed Implentantation Program

Table 7. Annual Rate of Growth by Contraceptive Method, by Region, 2010–2015, to Achieve One Plan CPR Target

Method mix targets @ 60% CPR in 2015

Region 2010 2011 2012 2013 2014 2015

% Pop

Yrs to target

Fster

Pill

IUD

Inject

Implant

Cond

Trad

Fster

Pill

IUD

Inject

Implant

Cond

Trad

Fster

Pill

IUD

Inject

Implant

Cond

Trad

Fster

Pill

IUD

Inject

Implant

Cond

Trad

Fster

Pill

IUD

Inject

Implant

Cond

Trad

Fster

Pill

IUD

Inject

Implant

Cond

Trad

Kilimanjaro 0.062 6 0.11 0.07 0.02 0.22 0.03 0.02 0.10 0.11 0.07 0.03 0.25 0.04 0.02 0.08 0.11 0.06 0.04 0.27 0.04 0.02 0.07 0.11 0.06 0.05 0.30 0.05 0.02 0.06 0.11 0.05 0.06 0.33 0.06 0.02 0.05 0.12 0.05 0.06 0.36 0.07 0.02 0.04

Arusha 0.035 6 0.02 0.13 0.01 0.22 0.02 0.04 0.11 0.02 0.13 0.01 0.24 0.03 0.04 0.10 0.02 0.13 0.02 0.27 0.04 0.04 0.10 0.02 0.13 0.02 0.30 0.05 0.05 0.09 0.02 0.13 0.02 0.33 0.06 0.05 0.08 0.02 0.13 0.02 0.36 0.06 0.05 0.07

Mbeya 0.066 6 0.02 0.09 0.00 0.13 0.02 0.03 0.23 0.02 0.09 0.01 0.15 0.02 0.03 0.23 0.02 0.09 0.01 0.17 0.03 0.03 0.23 0.02 0.09 0.01 0.19 0.03 0.03 0.23 0.02 0.09 0.01 0.21 0.04 0.03 0.24 0.02 0.10 0.02 0.23 0.04 0.03 0.24

Dar es Salaam 0.070 6 0.04 0.13 0.01 0.17 0.03 0.04 0.09 0.04 0.13 0.02 0.19 0.04 0.04 0.08 0.04 0.14 0.02 0.21 0.06 0.05 0.07 0.04 0.14 0.02 0.23 0.07 0.05 0.06 0.04 0.15 0.02 0.25 0.09 0.05 0.05 0.04 0.15 0.03 0.27 0.10 0.05 0.03

Ruvuma 0.036 6 0.07 0.09 0.00 0.18 0.03 0.06 0.07 0.07 0.09 0.01 0.20 0.04 0.07 0.06 0.07 0.09 0.01 0.21 0.05 0.07 0.06 0.07 0.09 0.01 0.23 0.06 0.08 0.06 0.07 0.09 0.01 0.25 0.07 0.08 0.06 0.07 0.10 0.02 0.27 0.09 0.09 0.05

Tanga 0.053 6 0.02 0.08 0.01 0.19 0.02 0.05 0.11 0.02 0.10 0.01 0.21 0.02 0.05 0.10 0.02 0.11 0.01 0.24 0.03 0.06 0.09 0.02 0.13 0.01 0.26 0.03 0.06 0.09 0.02 0.14 0.01 0.28 0.04 0.06 0.08 0.02 0.16 0.02 0.31 0.04 0.07 0.07

Iringa 0.052 6 0.04 0.10 0.00 0.13 0.00 0.05 0.10 0.04 0.11 0.01 0.15 0.01 0.06 0.09 0.04 0.12 0.01 0.17 0.01 0.06 0.09 0.04 0.13 0.01 0.18 0.01 0.07 0.09 0.04 0.14 0.01 0.20 0.02 0.08 0.09 0.04 0.16 0.01 0.22 0.02 0.08 0.09

Morogoro 0.054 6 0.05 0.12 0.00 0.15 0.01 0.03 0.04 0.05 0.13 0.01 0.18 0.02 0.04 0.04 0.05 0.13 0.01 0.20 0.03 0.04 0.04 0.05 0.13 0.01 0.23 0.04 0.04 0.03 0.05 0.13

0.02 0.25 0.04 0.05 0.03 0.05 0.14 0.02 0.28 0.05 0.05 0.03

Lindi 0.026 6 0.04 0.22 0.00 0.10 0.01 0.02 0.02 0.04 0.22 0.01 0.12 0.02 0.03 0.02 0.04 0.22 0.01 0.14 0.03 0.03 0.02 0.04 0.22 0.01 0.17 0.03 0.03 0.02 0.04 0.23 0.02 0.19 0.04 0.03 0.02 0.04 0.23 0.02 0.22 0.05 0.04 0.02

Mtwara 0.034 6 0.03 0.17 0.00 0.13 0.01 0.01 0.00 0.03 0.19 0.01 0.16 0.01 0.01 0.00 0.03 0.20 0.01 0.19 0.02 0.01 0.00 0.03 0.22 0.01 0.22 0.02 0.02 0.00 0.03 0.23 0.01 0.25 0.03 0.02 0.00 0.03 0.25 0.01 0.28 0.03 0.02 0.00

Manyara 0.029 6 0.01 0.07 0.00 0.09 0.00 0.02 0.15 0.01 0.09 0.00 0.11 0.01 0.02 0.16 0.01 0.12 0.00 0.13 0.01 0.03 0.16 0.01 0.14 0.01 0.15 0.01 0.03 0.16 0.01 0.16 0.01 0.17 0.01 0.03 0.17 0.01 0.19 0.01 0.19 0.02 0.04 0.17

Dodoma 0.052 6 0.01 0.11 0.00 0.15 0.00 0.03 0.02 0.01 0.11 0.00 0.20 0.01 0.03 0.02 0.01 0.12 0.01 0.24 0.01 0.04 0.02 0.01 0.12 0.01 0.28 0.02 0.04 0.02 0.01 0.12 0.01 0.33 0.02 0.05 0.02 0.01 0.12 0.01 0.37 0.03 0.05 0.02

Coast (Pwani) 0.026 6 0.02 0.05 0.00 0.15 0.03 0.03 0.03 0.02 0.05 0.01 0.19 0.04 0.04 0.03 0.02 0.06 0.01 0.22 0.05 0.04 0.03 0.02 0.06 0.02 0.26 0.06 0.05 0.03 0.02 0.06 0.02 0.30 0.07 0.06 0.03 0.02 0.06 0.02 0.34 0.07 0.06 0.03

Kigoma 0.037 6 0.03 0.02 0.01 0.09 0.01 0.01 0.11 0.03 0.03 0.01 0.12 0.02 0.01 0.12 0.03 0.03 0.01 0.14 0.03 0.01 0.13 0.03 0.04 0.02 0.16 0.04 0.01 0.14 0.03 0.04 0.02 0.19 0.05 0.01 0.15 0.03 0.05 0.02 0.21 0.06 0.02 0.17

Singida 0.033 6 0.03 0.08 0.01 0.13 0.01 0.01 0.01 0.03 0.08 0.01 0.17 0.02 0.01 0.01 0.03 0.08 0.01 0.21 0.03 0.01 0.01 0.03 0.08 0.02 0.25 0.04 0.01 0.01 0.03 0.08 0.02 0.29 0.05 0.01 0.01 0.03 0.08 0.02 0.33 0.06 0.02 0.01

Rukwa 0.034 6 0.01 0.06 0.01 0.08 0.00 0.06 0.06 0.01 0.07 0.01 0.11 0.01 0.07 0.06 0.01 0.08 0.01 0.13 0.01 0.08 0.07 0.01 0.09 0.01 0.15 0.01 0.09 0.07 0.01 0.11 0.01 0.17 0.01 0.10 0.08 0.01 0.12 0.01 0.19 0.02 0.12 0.08

Kagera 0.059 6 0.04 0.04 0.01 0.12 0.01 0.02 0.01 0.04 0.04 0.01 0.16 0.03 0.02 0.01 0.04 0.04 0.02 0.19 0.04 0.03 0.01 0.04 0.04 0.02 0.22

0.06 0.03 0.01 0.04 0.04 0.03 0.26 0.07 0.03 0.01 0.04 0.04 0.03 0.29 0.09 0.04 0.01

Mara 0.042 6 0.02 0.02 0.00 0.12 0.01 0.01 0.03 0.02 0.02 0.01 0.15 0.02 0.01 0.04 0.02 0.02 0.01 0.19 0.03 0.02 0.04 0.02 0.02 0.01 0.22 0.04 0.02 0.04 0.02 0.02 0.02 0.26 0.05 0.02 0.05 0.02 0.02 0.02 0.29 0.06 0.02 0.05

Mwanza 0.080 6 0.03 0.04 0.01 0.07 0.02 0.01 0.02 0.03 0.05 0.01 0.10 0.03 0.02 0.02 0.03 0.06 0.01 0.12 0.05 0.02 0.02 0.03 0.08 0.02 0.15 0.06 0.02 0.02 0.03 0.09 0.02 0.17 0.07 0.03 0.02 0.03 0.10 0.03 0.20 0.09 0.03 0.02

Shinyanga 0.078 6 0.03 0.04 0.01 0.05 0.02 0.03 0.03 0.03 0.05 0.01 0.07 0.03 0.04 0.03 0.03 0.05 0.01 0.09 0.05 0.05 0.03 0.03 0.06 0.02 0.11 0.06 0.06 0.03 0.03 0.07 0.02 0.13 0.07 0.07 0.04 0.03 0.08 0.03 0.15 0.09 0.08 0.04

abora 0.043 6 0.02 0.01 0.00 0.10 0.01 0.03 0.02 0.02 0.01 0.01 0.13 0.02 0.04 0.02 0.02 0.02 0.01 0.17 0.03 0.04 0.02 0.02 0.02 0.01 0.20 0.04 0.05 0.02 0.02 0.02 0.02 0.24 0.05 0.06 0.02 0.02 0.02 0.02 0.27 0.06 0.07 0.02

National 0.03 0.08 0.01 0.13 0.02 0.03 0.07 0.03 0.08 0.01 0.16 0.02 0.03 0.06 0.04 0.09 0.01 0.18 0.03 0.04 0.06 0.04 0.10 0.02 0.21 0.04 0.04 0.06 0.04 0.10 0.02 0.24 0.05 0.05 0.06 0.04 0.11 0.02 0.26 0.06 0.05 0.06

Method mix 9.7% 21.8% 1.7% 36.5% 4.2% 8.0% 18.2% 8.6% 20.6% 2.3% 38.7% 6.0% 8.1% 15.8% 7.7% 19.7% 2.8% 40.4% 7.3% 8.1% 13.9% 7.1% 18.9% 3.3% 41.8% 8.4% 8.2% 12.4% 6.5% 18.3% 3.6% 43.0% 9.3% 8.2% 11.1% 6.0% 17.8% 3.9% 43.9% 10.1% 8.2% 10.1%

Fster: Female Sterilization

Inject: Injectables

Cond: Condoms

Trad: Traditional methods

United Republic of Tanzania | National Family Planning Costed Implentantation Program

Tanzania’s FP program must be revitalized to achieve an annual growth rate in CPR of 5 percentage

points or to even return to a growth rate of 1.5 percentage points. The NFPCIP has ﬁve SAAs to

revitalize and reposition FP to obtain an overall increase in CPR consistent with the One Plan target

of 60%. Each SAA has a set of strategic actions that are broken down into the various activities

or steps needed for implementation, and the activities are further speciﬁed with required inputs

that form the basis for estimating the cost. The strategic actions and activities address the issues

and challenges discussed previously to ensure that FP considerations and resources are integrated

with other ongoing health sector strategic programs, such as the HSSPIII, PHSDP, and HRHSP.

As noted elsewhere, the activities and their costs included here are aimed speciﬁcally at what is

needed to address, elevate, and include FP as a coequal program along with other health sector

program initiatives. These costs therefore do not duplicate investments in other strategic health

programs. Cost estimates for implementing activities at the District level have not been included

in the NFPCIP. These have been included in a complementary document to guide District planners

to budget essential interventions that will contribute to the NFPCIP targets and thus should be

included in the CCHPs. Furthermore, the government contributions to the NFPCIP, including

salaries for human resources and infrastructure (equipment, furniture, supplies, electricity, and

water supplies), can range from 40 to 60 percent of the total budgetary estimates. These estimates

have not been included in the NFPCIP.

The following tables describe the activities for each SAA, and the timeframe and process for

implementation are indicated. A detailed breakdown of factors is shown as the basis for estimating

the costs for each activity. Finally, the success indicator for monitoring Plan implementation is

shown for each SAA. More detail for each SAA is provided in Appendix E.

Given the need to fulﬁl increasing demand for FP services in the country, two areas have been identiﬁed

as the key priorities for implementation and funding of the NFPCIP: ensuring contraceptive security

and enhancing service delivery and capacity building, in particular, strengthening integrated service

delivery of FP in all aspects of the health sector, including HIV/AIDS, immunization services, PNC,

and PAC. As such, contraceptive commodities represent 91 percent of the total NFPCIP budget.

In the beginning stages, focus will be on meeting demand; in subsequent years, efforts will be

enhanced to generate and sustain demand for FP to meet the One Plan target.

This SAA refers to expanded availability and choices of safe, effective, acceptable and affordable

contraceptive methods. It addresses contraceptive logistics and security, ensuring that supplies

of all contraceptive commodities are adequate to meet the needs and preferences of family planning

clients.

Based on the method-mix targets to be achieved in each region by 2015 to meet the One Plan target

(see Table 7), the number of users to be reached is an estimated 5.23 million WRA at an annual cost

ranging from Tshs 16 billion in FY 2010–2011 to 25 billion in FY 2015–2016.

United Republic of Tanzania | National Family Planning Costed Implentantation Program

STRATEGIC ACTIVITIES TIMEFRAME

SUCCESS

INDICATOR

COST

(FY 2010–2016)

Strategic Action 1. Ensure adequate supply of contraceptive methods at all levels

1(a) Ensure sufﬁcient donor and MoFEA funds

to cover all public-sector contraceptive

commodity needs

Years 1–6 Funding requests match

resource needs

119,997,745,046

1(b) Establish a forum of regular monthly

meetings with MSD, RCHS, PSU, World

Bank, and Supplies Unit to discuss status of

ongoing procurement, identify bottlenecks,

and stock situation countrywide and by zone

Year 1 # meetings held; evidence

that issues identiﬁed are

dealt with before next

meeting

54,952,500

1(c) Streamline forecasting, procurement,

distribution, use monitoring, and reporting

Year 1 Increased budget

allocation for

contraceptives; reduced

stock-outs

81,940,500

1(d) Develop an automated system to capture

facility-level logistics data and make

available to district, regional, and central

decision makers (may involve use of

cellphone technology)

Year 1: develop

Years 2–6:

implement

Increased availability of

accurate data

1,005,226,000

1(e) Conduct supportive supervisions to MSD

HQ, Zonal MSD, and health facilities for

contraceptive commodities (4 supervisions

per quarter); supervisory team to include 2

RCHS, 1 Zonal RCHCO, 1 RCHCO, and

DRCHCO

Years 1–2:

3–6: distribute

Reduce % unmet needs;

increase CPR

189,360,000

Contraceptive Security Total (in Tshs): 121,329,224,046

DRCHCo = district reproductive and child health coordinator; MSD = Medical Stores Department; PSU = Program

Support Unit; RCHCo = district reproductive and child health coordinator; RCHS = Reproductive and Child Health

Section.

This SAA refers to capacity building of providers to deliver and support the safe, effective

use of FP methods and services. It addresses the capacity of the people who deliver FP services.

Capacity-building considerations include the numbers, categories, attitudes, skills, supervision, and

remuneration of service personnel at all levels and in all sectors.

STRATEGIC ACTIVITIES TIMEFRAME SUCCESS INDICATOR

COST

(FY 2010–2016)

Strategic Action 1. Increase availability and improve distribution of FP service providers

1(a) Develop, implement computerized

inventory of staff by facility to identify

gaps and ensure equitable distribution

Years 1–6 On-line facility speciﬁc

staff inventory available

and updated annually

Strategic Action 2. Implement task shifting to all levels of the health system

2(a) Identify opportunities for task shifting

by cadre of health services provider for

expanded and integrated FP provision

Year 1 Report on potential for

task shifting and necessary

changes

22,250,500

2(b) Consultations with professional

associations and registrars (MAT, TAMA,

AGOTA, PAT, pharmacists, lab associates)

on how best to implement evidence-based

task shifting for FP provision

Year 2 Report on potential for

task shifting and necessary

changes

14,310,000

United Republic of Tanzania | National Family Planning Costed Implentantation Program

STRATEGIC ACTIVITIES TIMEFRAME SUCCESS INDICATOR

COST

(FY 2010–2016)

2(c) Consult with relevant authorities on

recommendations for policy amendments

Year 3 Recommendations

developed for task shifting

14,310,000

2(d) Produce and disseminate policy

amendments nationwide

Year 3 Policy amendments made 4,225,000

Strategic Action 3. Improve provider capacity to deliver FP services

3(a) Update national FP training strategy Year 1 Updated strategy in place 24,288,750

3(b) Identify and update an inventory of

national FP trainers

Years 1, 5 Inventory of FP trainers

available

200,000

3(c) Print additional copies of the updated FP

procedures manual (3,000) and training

curricula (500–Module I; 300–Module II;

100–Module III)

Year 2 # materials produced by

type

7,950,000

3(d) Disseminate updated FP procedures

manual and training curricula

Years 1–2 # trainers oriented with

the new manual and

curricula

102,060,750

3(e) Update preservice curricula with up-to-

date and comprehensive FP content

Years 1–2 Updated pre-service

curricula available

32,456,500

3(f) Train 80 tutors per year in pre-service

training institutions on FP curricula

Years 2–4 # tutors trained in new

curricula

113,048,000

3(g) Review job aids on client-provider

interaction. Print 5,000 job aids for

client-provider interaction.

Year 1 Final job aid produced 54,876,000

3(h) Disseminate/orient providers on client-

provider interaction.

Year 1 # copies of toolkit produced 173,702,500

3(i) Increase the pool of zonal FP trainers Years 2–4 # trainers produced 316,434,000

3(j) Conduct CTU in-service training using

updated curricula and job aids

Years 1–6 # trainings conducted 3,624,672,000

3(k) Conduct training on short- and long-

acting methods

Years 1–2 # trainings conducted 483,115,0003

3(l) Conduct training on permanent methods Years 1–2 # trainings conducted 393,140,0003

Strategic Action 4. Retain retiring and rehire retired health workers

4(a) Identify retiring and retired health

workers, especially those with FP

experience, and rehire

Years 1–6 # of retiring and retired

health workers retained

4(b) Identify training needs and develop

training plan for rehired workers

Years 1–6 Training needs

documented, training plan

developed

4(c) Implement training as needed for retired

health workers and allocate as needed

Years 1–6 Trainings held, # trainees

reached, increased # of SP

providing FP services

Strategic Action 5. Include non-coercive FP indicators in pay-for-performance initiative

5(a) Develop noncoercive FP indicator in pay-

for-performance initiative

Year 1 Report on-job satisfaction

survey

5(b) Ensure inclusion of FP indicator in the

beneﬁts package

Years 2–6 Beneﬁt package system

established/reviewed

5,617,000

Strategic Action 6. Build capacity for FP advocacy at regional and district levels

2a) Develop training curriculum for building

FP advocacy capacities at regional and

district levels

Year 2 Advocacy capacity building

strategy in place

212,204,283

United Republic of Tanzania | National Family Planning Costed Implentantation Program

STRATEGIC ACTIVITIES TIMEFRAME SUCCESS INDICATOR

COST

(FY 2010–2016)

2b) Orient representatives from regional and

district councils on FP advocacy

Years 2–4 Advocacy activities led

by district council RH

workers and local FP

stakeholders

84,818,000

Capacity Building Total (in Tshs): 5,683,678,283

Addressed in HRHSP 2008–2013, strategic objective 4: To improve Workforce Management and Utilization.

Addressed in PHSDP 2007–2017 under the objective Human Resources for Health.

Activity included in the central budget for the rst two years to allow districts to incorporate CCHPs in future years.

Resources for this activity in the future will be mobilized through CCHPs.

AGOTA = Association of Gynaecologists and Obstetricians of Tanzania; CCHPs = Council Comprehensive Health

Plans; CTU = contraceptive technology update; MAT = Medical Association of Tanzania; PAT = Paediatric Association

of Tanzania; TAMA = Tanzania Midwives Association.

This SAA refers to strengthened service delivery systems and increased options for delivery of

quality, affordable, and sustainable FP.

Service delivery systems are the organizational components that affect access to family planning

services. They include facility- or clinic-based services, CBS, and other modalities and channels

within and outside of the health sector. Service delivery systems include physical infrastructure,

equipment, and supplies, as well as special considerations and opportunities, such as integration of

services, to meet the needs of vulnerable populations such as youth, men, women receiving PNC or

PAC, or HIV-infected women.

STRATEGIC ACTIVITIES TIMEFRAME

SUCCESS

INDICATOR

COST

(FY 2010–2016)

Strategic Action 1. Strengthen systems, facilities, infrastructure to support FP services at

appropriate levels

1(a) Ensure availability of equipment,

infrastructure, and supplies for FP

provision (coordination meetings of

RCHS with PHSDP, RHMT, CHMT, and

implementation partners to improve FP

services)

Years 1–6 # of facilities

improved

1(b) Training on use and maintenance of

equipment and physical structure and

systems

Year 1 Training completed 0

1(c) Incorporate plans for health facility

improvement in annual operating plans

Years 1–6 Funds allocated for

facility improvement

Strategic Action 2. Foster cost-effective integration and referral of FP with HIV, ANC, PNC,

and PAC services for men, women, and youth

2(a) Develop, implement operational tools for

cost-effective integration and referral of FP

with HIV, ANC, PNC, PAC services for men,

women, youth

Year 1 Supporting documents

aligned and ready for

use

96,770,000

2(b) Orient RHMTs and CHMTs on operational

tools in zonal dissemination meetings

Years 2, 5 Meetings held,

materials distributed

55,770,000

2(c) Produce 20,000 copies of logo for branding of

SDPs providing services

Years 1, 3 # logos produced 20,000,000

United Republic of Tanzania | National Family Planning Costed Implentantation Program

STRATEGIC ACTIVITIES TIMEFRAME

SUCCESS

INDICATOR

COST

(FY 2010–2016)

2(d) Brand all public and private SDPs providing

FP services with Green Star Logo

Years 1, 3 # branded SDPs 5,000,000

Strategic Action 3. Strengthen and increase availability of integrated CBS

3(a) Print additional copies of existing CBD

guidelines, training curricula, and job aids

Year 1 # copies produced 17,500,000

3(b) Update guidelines, training curriculum, job

aids, etc. for CBD

Years 3–4 Updated support

materials for CBDs

150,540,000

3(d) Conduct TOTs on guidelines, training

curriculum, job aids, etc for CBD

Years 2, 4 # trained CBD

trainers in each zone

325,215,000

3(e) Training of CBD supervisors Years 2–3 # trained CBD

supervisors per district

328,324,000

3(f) Explore opportunities to increase access

to quality provision of injectables in the

community

Year 3 # completed studies

with ﬁndings

implemented

270,000,000

3(g) Supportive supervision from the central level

(integrated)

Years 1–6 # supervision visits 384,000,000

3(h) Expand methods available through

pharmacies, ADDOs, drug shops, social

marketing

Years 2–5 # of new access points

and sales volumes

32,200,000

3(i) Sensitize RMTs and CMTs on introducing or

revitalizing the CBD program

Years 2–3 # of sensitization

meetings held

110,190,000

3(j) Conduct training of 1,500 CBD workers per

year, including youth workers

Years 1–6 # of CBDs trained 0

Strategic Action 4. Increase awareness and acceptability of FP services by males

4(a) Conduct situational analysis of male

involvement and participation in FP/SRH

Years 1 Situational analysis

conducted

60,000,000

4(b) Develop print messages and radio spots to be

deployed in all regions

Years 1 # posters radio and

TV spots developed

23,567,500

Strategic Action 5. Increase availability of FP-related YFS

5(a) Update FP trainers on the key strategies on

adolescent YFS and peer education

Year 1 # FP trainers trained

on the provision of

YFS

143,190,000

5(b) Train providers in provision of YFS Year 2 # providers trained

and providing YFS

Strategic Action 6. Strengthen, expand FP through private sector (includes NGOs, FBOs,

social marketing, commercial sector, private clinics, etc.)

6(a) Assess capacity, qualiﬁcations of a sample

of private-sector facilities (FBO, NGO,

commercial) to provide FP services according

to national standards and guidelines.

Year 1 Assessment conducted 60,000,000

6(b) Build capacity and promote provision of

FP services by the private sector, including

increasing the number of facilities registered

for RCH services

Year 1 Inventory of private

sector SDP available;

coordination

mechanism in place

52,432,500

6(c) Orient CHMTs, zonal training institutions,

and APHFTA on the plan and their expected

roles to support its implementation

Years 2, 3 # People oriented on

role of private sector

in FP service provision

95,150,000

6(d) Promote enhanced private sector provision of

FP services

Years 2–5 # People oriented on

role of private sector

in FP service provision

48,607,500

United Republic of Tanzania | National Family Planning Costed Implentantation Program

STRATEGIC ACTIVITIES TIMEFRAME

SUCCESS

INDICATOR

COST

(FY 2010–2016)

6(f) Explore the feasibility for expanding social

marketing of FP products by CBD (formative

research study)

Year 1 Study completed; way

forward documented

60,000,000

Strategic Action 7. Develop, promote, implement approaches to ensure increased access to FP

for low-income and vulnerable groups

7(a) Conduct segmentation analysis to determine

health-seeking attitudes, behaviours, access to

FP by economic quintile

Year 1 Report on health-

seeking attitudes and

behaviours by wealth

quintile

2,400,000

7(b) Research access barriers and establish

means and approaches to enhance service

accessibility among the economically

disadvantaged

Year 2 Report on access

barriers and

recommendations to

overcome them

3,360,000

7(c) Develop advocacy strategy to help overcome

barriers faced by the economically

disadvantaged

Year 3 Changing proportions

in service access by

wealth quintile

1,200,000

Strategic Action 8. Update/revise and disseminate the FP Provision Policy Guidelines and

Standards

8(a) Revise FP Provision Policy Guidelines and

Standards, update supervisory checklist

against updated FP standards and guidelines

Year 1 Updated policy

guidelines and

standards, and

supervisory checklist

34,500,283

8(b) Print and distribute 8,000 copies of the policy

guidelines

Year 2 # policy guidelines

distributed

46,000,000

8(c) Orient DRCHCo, RCHCo, other stakeholders

on the updated FP Policy Guidelines and

supervisory checklists

Year 2 # of DRCHCos and

RCHCos oriented by

zone

48,805,000

Service Delivery Total (in Tshs): 2,213,991,783

To be conducted in liaison with the PHSDP 2007–2017.

Resources to be mobilized through CCHP.

ADDOs = accredited drug dispensing outlets; ANC = antenatal care; APHFTA = Association of Private Health Facilities

in Tanzania; CBD = community-based distribution; CCHP = Council Comprehensive Health Plan; CHMT = Council

Health Management Team; CMT = Country Management Team; DRCHCo = reproductive and child health coordinator;

PAC = postabortion care; PNC = postnatal care; RCH = reproductive and child health; RCHCo = reproductive and child

health coordinator; RHMT = Reproductive Health Management Team; RMT = Regional Management Team; SDP =

service delivery point; SRH = sexual and reproductive health; TOT = train the trainer; YFS = youth-friendly services.

Reinvigorated advocacy increases the visibility of and support for FP as a key investment for

improving the lives, health, and well-being of Tanzania’s people. This objective addresses the

underlying causes of loss of visibility and momentum in the Tanzania FP program as well as the

knowledge-use gap among FP clients.

Strategic actions proposed are aimed at sustaining support for FP from the highest policy levels and

at promoting public dialogue at all levels, national through community, about the important role of

FP in promoting health and gender equity and supporting development. It also involves addressing

policies that may impede achievement of the other objectives, such as restrictions on what level

of provider is authorized to provide certain contraceptive methods, or how funds for programs are

allocated and channelled.

United Republic of Tanzania | National Family Planning Costed Implentantation Program

Addressing the knowledge-use gap will involve addressing myths and misinformation about FP and

fear of side effects and health concerns that impede its adoption and use. Additionally, it addresses

demands for FP that must go beyond maintaining current levels of use and meeting unmet needs if

the One Plan target is to be met.

STRATEGIC ACTIVITIES TIMEFRAME

SUCCESS

INDICATOR

COST

(FY 2010–2016)

Strategic Action 1. Organize advocacy to prioritize FP with separate budget line for FP

1(a) Review mechanisms of FP budget-

development and resource-allocation

systems

Year 1 Report describing budget-

development & resource-

allocation systems

3,240,000

1(b) Advocacy meetings involving key

stakeholders, PMO-RALG, and MoFEA

ofﬁcials leading to establishment of a

separate FP budget line item at national,

regional, and district levels

Years 1, 2 Budget line established

at national, regional, and

district levels

10,523,330

Strategic Action 2. Ensure inclusion of FP in major national policy documents, implementation

plans that determine budget allocations, stressing signiﬁcance of FP to national development

2(a) Conduct a consultation meetings to

ensure inclusion of FP in major national

policy documents, strategies and plans

Years 1, 3 Report from consultation

meeting

6,482,000

Strategic Action 3. Conduct and sustain advocacy targeting development partners and donors

to raise level of FP support

3(a) Mapping of development partners

interested in supporting FP

Year 1 Report on local

development partners’

funding criteria, priorities

20,000,000

3(b) Develop, implement FP resource

allocation advocacy strategy targeting

development partners

Year 2 Resource allocation from

development partners for

FP increases

133,690,330

3(c) Organize two 1-day meetings per year

involving FP stakeholders on repositioning

Years 2–5: Meetings held and

minutes on ﬁle indicating

action items

29,986,500

Strategic Action 4. Reposition, reinstate Green Star logo as a National FP program

4(a) Conduct one national relaunch of

the Green Star logo by high-level

governmental ofﬁcial (include launch

materials, e.g., caps, T-shirts, stickers)

Years 1, 2 % of respondents

recognizing the logo as a

symbol of FP (survey)

161,750,000

Strategic Action 5. Conduct sustained national FP advocacy campaign to provide accurate

information, address rumours/misconceptions, promote male involvement, inﬂuence social

values, and reach vulnerable groups

5(a) Prepare, produce, broadcast radio spots

(52/yr), radio soap opera “Zinduka

program“ 52 episodes/yr) and TV

programs (52 episodes/spots/yr) on FP

Years 1–6 # radio and TV spots

produced and aired and

estimated listenership

468,000,000

5(b) Produce, distribute revised print materials

(posters, IEC, BCC materials) to all

clinics and training centres

Years 1–6 Qty of materials produced

& distributed by type

1,000,000,000

5(c) Conduct FP campaigns in all ongoing

health campaigns and national festivals

Years 1–6 # overall health campaigns

adapted to include FP

messages

201,300,000

5(d) Revive/orient FP media group to support

a multimedia dissemination campaign

Years 1–6 # articles published per

year

25,396,750

United Republic of Tanzania | National Family Planning Costed Implentantation Program

STRATEGIC ACTIVITIES TIMEFRAME

SUCCESS

INDICATOR

COST

(FY 2010–2016)

Strategic Action 6. Establish a network of community-level champions (community leaders,

religious leaders, politicians) to reassure the population of the acceptability and beneﬁts of FP

6(a) Orient DRCHCo and RCHCo about the

Champions initiative

Year 1 # oriented on Champions

Initiative

123,355,500

6(b) Train zonal trainers on champions

approach

Year 1 # Trainers trained to

support Champions

Initiative

323,980,000

6(c) Support, follow-up districts/regions on

the process to identify, select and recruit

champions (communication costs only)

Year 1 # Champions recruited 200,000

6(d) Orient recruited champions Years 1–3 # Champions trained 1,334,850,000

Strategic Action 7. Establish a network of national-level champions to reassure the population

of the acceptability and beneﬁts of FP

7(a) Identify, select, recruit champions

via consultations between RCHS and

National FP Working Group and other

stakeholders

Year 1 # of Champions in place

and active

100,000

Advocacy Total (in Tshs): 3,638,932,250

BCC = behaviour change communication; DRCHCo = reproductive and child health coordinator; IEC = information,

education and communication; MoFEA = Ministry of Finance and Economic Affairs; PMO-RALG = Prime Minister’s

Ofce–Regional Administration and Local Government; RCHCo = reproductive and child health coordinator; RCHS =

Reproductive and Child Health Section.

Strengthened health systems management and M&E of the national FP program. This objective

addresses the need to reinforce the management capacity at all levels—central, regional, and district

council levels. Effective management systems include ensuring that ﬁnancial resources are made

available in a timely manner to all implementing levels, coordinating with other governmental

ministries and implementing partners, regular tracking of activities and deliverables needed to

achieve plan objectives, integrating with and using the HMIS, and tracking M&E data to improve

program performance.

STRATEGIC ACTIVITIES TIMEFRAME

SUCCESS

INDICATOR

COST

(FY 2010–2016)

Strategic Action 1. Strengthen leadership and management capacity at RCHS at all levels

1(a) Organize and conduct a 1-day initial

alignment meeting for 60 key persons from

national, zonal, regional, and district levels

to generate necessary support for the LDP

Year 1 # MoHSW staff who

participate, written

commitment to support

LDP

15,234,750

1(b) Organize and deliver the LDP in three

5-day workshops for six teams of ﬁve from

central, zonal, and regional level RCH staff

Years 1, 2 # teams formed with

action plans

148,663,000

1(c) LDP-trained teams prepare for, present

results achieved by implementing

action plans in a 2-day meeting for key

stakeholders

Year 2 end # action plans

implemented yielding

measurable results

26,356,000

1(d) Conduct internal, external study tours to

FP providers to learn best practices

Years 1–6 Documented best

practices, updated

guidelines to support QI

62,304,000

United Republic of Tanzania | National Family Planning Costed Implentantation Program

STRATEGIC ACTIVITIES TIMEFRAME

SUCCESS

INDICATOR

COST

(FY 2010–2016)

1(e) Support RCHS staff to attend FP courses

and national/international meetings

Years 1–6 # of RCHS staff who

attended training

courses

154,573,800

1(f) Procure a vehicle for RCHS Year 1 Vehicle procured 270,000,000

Strategic Action 2. Develop, maintain, coordinate, implement an M&E system aligning inputs

to outputs at all levels, national through district

2(a) Conduct rapid assessment of FP services/

data, report to key regional and district staff

to guide design of new reporting framework

(research assessment, 2-day workshop to

share results)

Year 1 Identiﬁed gaps in

reporting mechanisms

and data collection

obstacles

30,168,000

2(b) Establish framework, guide, methods for

collecting and reporting RCH/FP data at

district and regional levels

Year 1 Documented framework

for collection and

reporting of data on

RCH/FP indicators

11,386,250

2(c) Provide training at regional and district

levels in strategic planning, using data

to set realistic goals, plan and monitor

program activities

Years 2–3 Key RCH/FP staff

trained in use of data for

planning, monitoring

performance, developing

Annual Action Plans

43,090,000

2(d) Develop, implement executive dashboard

to monitor FP program, NFPCIP

implementation

Years 2, 3 Using executive

dashboard for NFPCIP,

FP programs

86,724,250

Strategic Action 3. Strengthen forums on FP to facilitate exchange of information, leverage

resources, synchronize activities, and share lessons

3(a) Conduct monthly National FP Working

Group meetings

Years 1–6 # National FP working

group meetings held,

documented per year

15,120,000

3(b) Revive and maintain RCHS Web site Years 1–6 Up-to-date FP issues

Web site

168,000,000

3(c) RCHS participates in annual coordination

meetings with zonal level

Years 2–6 RCHS presence

at annual zonal

coordination meetings

54,495,000

Strategic Action 4. Establish existing funding levels and applications (public and private

sectors) as a basis for resource mobilization

4(a) Mapping of current FP system - who

(public, CSOs, NGOs, FBOs) is doing

what, where, when, etc., including

National FP Subaccounts; establish and

maintain database for FP ﬁnancing (current

and commitments)

Year 1 Report on current

structure of FP services,

source and use of funds

80,000,000

4(b) Disseminate results of National Family

Planning Subaccounts and identify gaps

and opportunities for increasing FP

ﬁnancing

Year 1 Reports disseminated 13,935,000

4(c) Disseminate information in ongoing

forums at national, regional, and district

levels to enable coordination of activities

and share lessons learned; engage policy

makers, donors

Years 2–6 Functioning cross-sector

forum for sharing hosted

by RCHS

25,825,000

Health Systems Management Total (in Tshs): 1,121,230,800

CSOs = civil society organizations; FBOs: faith-based organizations; LDP = Leadership Development Plan; NGOs =

nongovernmental organizations; QI = quality improvement; RCHS = Reproductive and Child Health Section.

United Republic of Tanzania | National Family Planning Costed Implentantation Program

The NFPCIP will be implemented under the leadership and management of existing governance

structures at all levels of the health system. However, the cooperation, input, and actions from a wide

range of partners and stakeholders at all levels are required for success in achieving goals effectively

and efﬁciently. The NFPCIP will be implemented in collaboration with relevant stakeholders,

which include related ministries and agencies, development partners, the civil society, community-

based organizations (CBOs), professional associations, FBOs, voluntary agencies, and the private

sector, among others. The National Family Planning Working Group is expected to continue to

play an important role during implementation of the NFPCIP over the next six years. The roles and

responsibilities of the many different stakeholders are summarized below.

At the central level, the MoHSW is responsible for overall coordination and oversight of all

aspects of the NFPCIP. This includes responsibility for developing or updating policies that affect

implementation, for resource mobilization, and for monitoring and evaluation. The NFPCIP will be

considered a ‘living document’: as the monitoring and evaluation of implemented activities provide

new information, as changes emerge as a result of the DHS 2009–2010, or as situations evolve, the

MoHSW will be responsible for adjusting the Program to incorporate needed changes. Coordination

also includes ensuring that the strategic actions and activities of the NFPCIP are integrated and

harmonized with and supported by other health-sector programs. Resource mobilization includes

the development of annual budgets in collaboration with the MoFEA and in the context of the

MTEF. It also involves collaboration with development partners, including those who participate in

the sector-wide approach.

Key agencies under the MoHSW also will play crucial roles in implementing the NFPCIP, including

MSD and the Tanzania Food and Drug Authority (TFDA). Close coordination and improvements

in procurement of contraceptive commodities through the MSD are essential to provide adequate

supplies of FP methods for all service delivery partners, in both the public and private sectors.

During the next six years, new, improved, or more cost-effective contraceptive technologies may

become available, and incorporating such new methods into the program will require review and

approval of the TFDA.

A large segment of the NFPCIP is aimed at improving the FP knowledge and skills of health

providers. This includes updating and strengthening the FP components of training through public-

and private-sector training institutions and the Zonal Training Centres.

Health services, including FP, are the responsibility of the MoHSW and of LGAs. Planning

and budgeting for health services delivery has been decentralized to the district level, including

prioritizing the inclusion of FP in CCHPs. As the LGAs assume greater responsibility for planning,

budgeting, and monitoring delivery of services in the communities in their districts, they will

similarly play critical roles in achieving the NFPCIP objectives.

United Republic of Tanzania | National Family Planning Costed Implentantation Program

The PMO-RALG directly supervises the LGAs and, with the MoHSW, reviews and assesses the CCHPs.

Reviews pay close attention to ensure the inclusion of FP resources and adequate justiﬁcation in the

CCHPs before they are approved for funding.

The PMO itself provides overall government coordination, including the coordination of the

government’s response to HIV/AIDS. The Tanzania Commission on AIDS (TACAIDS) operates

under the auspices of the PMO, and it will be instrumental in ensuring the integration of FP as a

key strategy for HIV/AIDS prevention.

The MoFEA collaborates closely with the MoHSW in budget planning, disbursement of funds, and

accounting for expenditures. Improved coordination and communication between the MoFEA and

MoHSW will ensure timely disbursement of funds needed for implementation of the NFPCIP.

The Ministry of Education is responsible for health cadres with university-level training. As

such, this Ministry will be a crucial partner in ensuring the inclusion of evidence-based FP curricula

in pre-service training for health personnel in collaboration with the MoHSW.

Included in this category are the bilateral and multilateral donors. Also included in this category

is a host of implementing partners that provide technical assistance and expertise in support of the

national FP program. Donor agencies will be called upon to increase their support and to augment

the resources that will be required for the NFPCIP.

Implementing Partner will continue to be called upon by and under the coordination of the

MoHSW for their wide variety of expertise. These reﬂect all ﬁve of the SAAs and will be drawn

from experiences in Tanzania and throughout the world to ensure that the implementation of the

NFPCIP reﬂects state-of-the-art information and interventions.

Although about 80 percent of FP services are provided through the public sector, a number of

NGOs and FBOs also play important roles in service delivery. As such, they are critical partners

in implementing the NFPCIP. The FBOs are important sources of broader health care, especially

in some rural areas of Tanzania, and many of them include FP as components of their services. The

MoHSW will continue to look to these partners in implementing the NFPCIP. This includes ensuring

coordination and training, procurement of contraceptive commodities, and ensuring adherence

to set service standards and guidelines. These organizations are also expected to contribute their

service data for M&E, to assist the MoHSW in maintaining a comprehensive picture of NFPCIP

implementation, as well as identifying needs and opportunities to expand services.

The level of resources that will be required for successful implementation of the SAAs to reposition

FP and achieve the One Plan target for FP will need to expand considerably and quickly. The

main sources of funding for the current program include the Tanzanian government; the Basket

funds managed through the MTEF, through which most multilateral and bilateral donors currently

contribute; and ‘out-of-basket’ funds from a few donors, most notably the United States Agency for

International Development (USAID). Other sources of support include funding from NGOs and

FBOs as well as costs recovered through fees for service by private-sector providers.

United Republic of Tanzania | National Family Planning Costed Implentantation Program

In implementing the NFPCIP, the MoHSW will provide guidance to ensure that annual budget

requests to the MTEF from the district levels include FP, so that Basket funds can be used to support

FP. Improving understanding of the budgeting process, as well as increasing the level of priority for

FP at the district level are both key recommended implementation actions of the NFPCIP that can

help to address this resource mobilization challenge. Recent recommendations from the Tanzania

Parliamentary Association for Population and Development call for a larger portion of Basket funds

to be spent on FP commodities, and for creating an independent FP budget line item in the budget

guidelines. Such actions are currently underway under the leadership of the MoHSW.

Expanding involvement of the private sector, including building on current social-marketing

programs, will also be promoted to increase resources for FP. NGOs and FBOs can also play a greater

role by mobilizing and allocating resources for implementing the NFPCIP.

Managing and implementing the NFPCIP effectively will require a carefully developed and

implemented framework and system for M&E. Although the M&E framework and indicators should

link with the national HMIS, the HMIS includes only a limited number of indicators for FP. Hence,

tools to collect monitoring data must be updated to include a comprehensive list of FP indicators.

Because of the many activities and inputs that must be tracked to ensure timely and effective

implementation of the NFPCIP, a management monitoring tool to track implementation of the

strategic activities and achieving the objectives of the NFPCIP will be developed.

The M&E framework can be used routinely at several levels, including the government, the FP

Working Group, development partners, and donors to track achievement of the implementation

actions and activities, to identify problem areas in implementation or shortfalls in resources.

Developing and applying an M&E framework has been facilitated by the inclusion in the NFPCIP

of success indicators for each implementation action and the activities and steps expected to be

carried out under each. Success indicators for the NFPCIP are expressed in terms of outputs and

outcomes to be achieved by each activity. Ultimately, successful implementation of the NFPCIP

must be measured in terms of its effect on contraceptive prevalence, but measuring the effect is

beyond the capacity of the proposed M&E system and is instead provided by the DHS, which will

occur next in 2009–2010 and 2014–2015.

Finally, the implementation actions and activities recommended in the NFPCIP are evidence-

based. Over the ﬁve years of implementing the NFPCIP, however, new issues and questions will

undoubtedly arise about the most cost-effective alternatives for implementation, or additional

evidence will be required as a basis for scale-up of program components. These issues and questions

can help to inform a research agenda to support continued innovation and ensure a sound, evidence-

based program to reach the NFPCIP targets.