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CMI REPORT DECENTRALISATION AND GENDER R 2008: 9
1. Introduction
By Liss Schanke, Siri Lange, and Lesley Saunderson
This report is a presentation of the PMO-RALG initiative “Gender and Decentralisation. Looking at
Coordination and Cooperation in LGAs on maternal health”, which the Norwegian Embassy has
supported since May 2006. The project ended mid-2008, coinciding with the close of LGRP. By
then twelve districts had been involved in the project.
Chapter two of the report describes the background for the project, former Norwegian-Tanzanian
initiatives in the field, project approach, objectives, and limitations. The section also gives some
general background to decentralisation by devolution in Tanzania and briefly describes the various
project activities. Chapter four presents the findings from visits to the five case study councils: Ileje
DC, Misungwi DC, Moshi DC, Serengeti DC, and Pangani DC. The chapter draws on a report that
was circulated among stakeholders in Tanzania in 2007 (unpublished). Finally, chapter five
summarises the observations and challenges for coordination and cooperation on gender issues in
district councils.
1.1 Project description
Project approach
The project has used maternal health as an example and entry point to look at coordination and
cooperation within LGA. Using maternal health as an entry-point was a method to make the
discussion concrete and practical - in order to avoid a general discussion on gender mainstreaming,
cooperation and coordination. The strategic issues were to be in focus rather than health-issues per
sé. The assumption has been that more cooperation and coordination in the field of maternal health
will motivate different actors to work together and create an environment for organising around
other women’s issues as well.
Maternal health is an important issue for all women, families, and employers. Like many other
African countries, Tanzania has great challenges in this regard:
- Every hour of a day, one woman dies of pregnancy related complications.
- The maternal mortality rate (MMR) of Tanzania has not gone down over the last decade. It
was estimated at 578/100 000 in 2005, up from 529/100 000 in 1996.
- Less than half of all Tanzanian women receive skilled attendance during childbirth.
- 10 000 qualified health staff is required to fill current gaps.
(NBS, 2005)
Measuring the MMR in Tanzania is very complicated, since around half of all births take place
outside of health facilties, and the women who do give birth at heath facilities tend to leave shortly
after the delivery – when the risk for complications is still there. The district level MMR figures
used in this report were provided by district authorities, and are in the majority of cases based on
registered deaths at health facilties. Some districts have a system for registering deaths outside of
health facilities at village level (through village health workers), and this gives more reliable data.
In most cases, the MMR statistics are based on recorded data, and not on surveys. The latter result
in far more accurate information.
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