Abstract
BackgroundAssessments of subnational progress and performance coverage within countries should be an integral part of health sector reviews, using recent data from multiple sources on health system strength and coverage.MethodAs part of the midterm review of the national health sector strategic plan of Tanzania mainland, summary measures of health system strength and coverage of interventions were developed for all 21 regions, focusing on the priority indicators of the national plan. Household surveys, health facility data and administrative databases were used to compute the regional scores.FindingsRegional Millennium Development Goal (MDG) intervention coverage, based on 19 indicators, ranged from 47% in Shinyanga in the northwest to 71% in Dar es Salaam region. Regions in the eastern half of the country have higher coverage than in the western half of mainland. The MDG coverage score is strongly positively correlated with health systems strength (r = 0.84). Controlling for socioeconomic status in a multivariate analysis has no impact on the association between the MDG coverage score and health system strength. During 1991–2010 intervention coverage improved considerably in all regions, but the absolute gap between the regions did not change during the past two decades, with a gap of 22% between the top and bottom three regions.InterpretationThe assessment of regional progress and performance in 21 regions of mainland Tanzania showed considerable inequalities in coverage and health system strength and allowed the identification of high and low-performing regions. Using summary measures derived from administrative, health facility and survey data, a subnational picture of progress and performance can be obtained for use in regular health sector reviews.
Highlights
Regular reviews of health systems progress and performance are critical for the improvement and implementation of health policies and programmes
Assessments of subnational progress and performance coverage within countries should be an integral part of health sector reviews, using recent data from multiple sources on health system strength and coverage
Assessments of inequalities in health services and intervention coverage within countries should be an integral part of health sector reviews in, for instance, the context of universal health coverage strategies [2]
Summary
Regular reviews of health systems progress and performance are critical for the improvement and implementation of health policies and programmes. Such reviews should be part and parcel of the implementation of the national health sector strategic plan and focus on the analysis of progress towards national targets for the core indicators of the national plan [1]. Assessments of inequalities in health services and intervention coverage within countries should be an integral part of health sector reviews in, for instance, the context of universal health coverage strategies [2]. Assessments of subnational progress and performance coverage within countries should be an integral part of health sector reviews, using recent data from multiple sources on health system strength and coverage
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