Inter Press Service - June 25, 2007
George K Njogopa

This is the deadline for the achievement of the eight Millennium Development Goals (MDGs) of the United Nations (UN). The reduction of the mortality rate of children under the age of five by two-thirds is the fourth of the eight goals.

In Tanzania, observers and medical experts are sceptical about Tanzania's ability to reach the target as 2015 is around the corner. "Frankly speaking, we are far behind and I have my suspicions about whether the government is really keen to keep the deadline," Isaac Maro, a doctor at Muhimbili National Hospital in Dar Es Salaam, told IPS.

"Politicians are always feeding us enticing ideas but there is no way we can achieve goal four," said Maro.

Nationally, under-five mortality in Tanzania rose from an average of 137 per 1,000 live births in the period from 1992 to 1996 to 147 per 1,000 live births in the period 1995 to 1999, according to the World Health Organisation.

Tanzania's official National Bureau of Statistics put the average under-five mortality rate at 112 per 1,000 live births for the period 2000 to 2005. The average infant mortality rate was 68 per 1,000 live births over the same period, it says.

But the United Nations Children's Fund (UNICEF) puts it at 165 deaths per 1,000 live births in both 2000 and 2003.

"From my point of view we are facing three major challenges in implementing the MDGs, especially goal four. The issues of population, poverty and the lack of appropriate knowledge about child care still need special attention because they are causing the delay," Maro pointed out.

Regarding the issue of population, Maro argued that while the government claims that it has put in place a health policy most Tanzanians are not being reached by the health service. The population is bigger than the government's ability to provide the service, he said.

"It does not make sense to say we are giving free medicine and then you are not covering even 30 percent of the population with healthcare," Maro argued.

Tanzania is also facing the problem of inadequate numbers of qualified medical and healthcare practitioners. In a region famous for its agriculture production, Rukwa, there are only seven medical doctors covering 25 percent of the demand. This has forced Rukwa to close down 12 health centres and dispensaries.

Now people have to walk long distances to secure medical services, including child delivery, Rukwa's regional commissioner Daniel ole Njoolay told IPS. In Rukwa, infant mortality stood at 108 for every 1,000 live births in 2005 and 106 for every 1,000 live births in 2006.

The death rate for children under five in Rukwa was 175 per 1,000 live births in 2005 and 143 per 1,000 live births in 2006, according to Ole Njoolay. He described the rates as "unacceptable high".

Maro stressed that higher levels of education are generally associated with lower mortality rates because education exposes parents to information about better nutrition, the use of contraceptives to space births and knowledge about childhood illness and treatment.

However, little has been done to promote health knowledge among the public and that is why most people in rural areas are not seeking medical advice or attending the few clinics that there are, he said.

Moreover, "poverty is now a common phenomenon in Africa and it is getting even worse. It has reached the point that our people cannot afford to buy tablets. How do you think they will manage to pay for ultrasound diagnosis?" Maro asked.

The National Bureau of Statistics also noted that a child's chances of dying before reaching five are determined by place of residence, province, educational level of the mother and household wealth. The infant mortality rate is generally lower in urban than in rural areas and lower in the north of the country than in the south.

The prevalence of HIV/AIDS affects child mortality directly due to mother to child transmission and indirectly because maternal illness and death has negative consequences for child health.

Determining HIV transmission to children is complicated by maternal antibodies which may be detected in a child for up to 18 months, even if the child has not become infected, said Conrad Mnumi, a consultant physician at the Marie Stopes hospital in Dar Es Salaam.

He is encouraged by the fact that there has been a substantial increase in the level of basic knowledge about mother to child transmission of HIV over the last five years in Tanzania.

Shani Zubery, the chairperson of a government-owned centre with 40 mentally disabled children in Dar Es Salaam, is unaware of the MDGs. But she can report that there has been a significant improvement in social service at clinics and health centres. In her field the rate of child mortality has gone down, especially in urban areas.

"We still face some challenges in rural areas because of local beliefs and associated practices and a lack of proper implementation of health services," said Zubery.

She is worried that corruption in the country is undermining Tanzanians' ability to access health services.

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+ HEALTH-ZIMBABWE: Fighting the Spead of Polio - Again (http://www.ipsnews.net/news.asp?idnews=38299)

+ BOTSWANA: Even More Children Are Dying (http://www.aegis.org/news/ips/2007/ip070611.html)

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