Poverty and Human Development Report 2009 - UNDP in Tanzania

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POVERTY AND HUMAN DEVELOPMENT REPORT 2009 Since 2005, there has been a three-fold increase in the number of sites offering VCT, a four-fold increase in the number of clinics offering anti-retroviral treatment (ART), and a five-fold increase in sites with services to prevent mother-to-child transmission (PMTCT) (NACP, 2008). However, the number of people enrolled on care and treatment each year has increased much less quickly – around 50,000 new patients were enrolled in 2006 and 2007, before picking up to 53,354 in the first nine months of 2008 (projected annual enrolment of approximately 70,000). Strictly speaking, the MKUKUTA indicator is defined as the number of people currently on antiretroviral (ARV) therapy. Presently, this cannot be measured in Tanzania. 42 Therefore, the exact number of individuals who enrolled on ARV therapy – and are alive and continuing treatment – is not known. Figure 30 presents a model predicting the number of patients currently on ARV, based on actual enrolment and assumptions about patient retention, validated by the NACP’s 2005 cohort study. 43 The results predict that the number of patients currently on ART as at September 2008 is approximately 120,000. This falls a long way short of the target set in the national HIV/AIDS Care and Treatment Plan 2003/08 – where the number of patients currently on ART was expected to have reached 423,000 by the end of 2008. However, targets were set when HIV prevalence was estimated to be far higher than present levels, and when it was assumed that all patients enrolled would continue on treatment. Figure 30: Annual and Cumulative Enrolment and Projected Numbers Currently on ART, 2004 – 2008 Number of Patients 250,000 200,000 150,000 100,000 50,000 - 2004 2005 2006 2007 2008 Years Cumulative Enrolment on ART Annual Enrolment on ART Currently on ART (modelled) Source: Cumulative enrolment data from NACP. Annual enrolment data calculated from cumulative figures. Current enrolment modelled based on historic enrolment and assumptions on patient retention. Targets from National HIV/AIDS Care & Treatment Plan (MoHSW, 2003). 42 This is because the care and treatment information system does not hold patient level data beyond the clinic level. 43 The study shows that 63% and 54% of patients remain alive and on treatment 12 months and 24 months respectively after commencing treatment. This patient retention rate is a little lower than the weighted average of AIDS treatment programs in sub-Saharan Africa: weighted average retention at 6, 12, 24 months was 79%, 75% and 62% respectively (Rosen, Fox & Gill, 2007). 68
Projections based on the model indicate that patients currently on ART would not reach 400,000 even after a decade of enrolling new patients at the rate of 60,000 per year. It is therefore clear that the original targets were overly ambitious. Revision of these targets based on more realistic estimates of HIV prevalence, disease progression and patient retention is an urgent priority – without which the future budgetary needs of the Care and Treatment Programme cannot be known with confidence. In the meantime, it is imperative that all people clinically eligible for anti-retroviral therapy are enrolled on treatment. This figure is estimated at around 100,000 people per year, 44 compared with the 50,000 – 60,000 new patients enrolled in each of the past three years. Of equal importance, measures to improve treatment adherence and patient retention are needed to improve post- ARV survival and to reduce the development of drug resistance. Mother-to-Child Transmission Coverage under the programme to prevent mother-to-child transmission (PMTCT) of HIV has increased since 2005, but remains fairly low, despite a rapid increase in the number of programme sites. The percentage of HIV-positive pregnant women who receive nevirapine prophylaxis or start on ARV, is estimated to have risen from about 10% in 2005 to around 40% in 2008. There has been a major improvement in the proportion of pregnant women tested for HIV – largely due to the expansion of PMTCT-capable antenatal care clinics. However, this has been off-set by a decline in the proportion of HIV-positive women who actually receive prophylaxis (Figure 31). Figure 31: PMTCT Programme Performance, 2005 – 2008 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2005 2006 2007 Jan - Sept 2008 Source: Calculated from data provided by PMTCT programme, NACP CLUSTER II- GOAL 2 % of all births tested % +ve cases treated PMTCT coverage as % need 44 Based on the estimated number of people living with HIV in Tanzania (1 million), stable incidence, and approximately one-tenth becoming clinically eligible for treatment every year. 69
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UNITED REPUBLIC OF TANZANIA POVERTY
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COnTEnTS List of Tables ...........
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MKUKUTA Cluster II: CONteNts Improv
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CONteNts Data.for.Monitoring.......
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CONteNts HOUSEHOLD OCCUPATION AND P
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Table 25: Table 26: Percent of Adul
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Figure 21: Figure 22: Percentage of
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LisT Of AbbREViATiONs AIDS Acquired
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PRSP Poverty Reduction Strategy Pap
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ExECUTIvE SUMMARy The Poverty and H
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in poverty. Nonetheless, the challe
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evise allocations based on identifi
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Monitoring Implications A comprehen
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eXeCUtiVe sUMMarY Good governance a
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Chapter Progress towards the goals
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GDP Growth by Sector the principal
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Figure 2: Sectoral Contribution to
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Chapter I CLUSter 1 Box 2: The Impa
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Household Income (Consumption) Pove
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Income Poverty and GDP Growth the 2
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although global oil and food prices
Page 47 and 48: Figure 6: FDI Inflows 2000-2008 (US
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Page 51 and 52: Infrastructure Roads the condition
Page 53 and 54: quantity but also in quality. for i
Page 55 and 56: Chapter I CLUSter 1 GOaL 4 & 5 prop
Page 57 and 58: Customers Connected to Sources of E
Page 59 and 60: Cluster I Conclusions and Policy Im
Page 61 and 62: MKUKUTA INDICATORS - SUMMARY OF DAT
Page 63 and 64: Indicator Baseline Trend Target MKU
Page 69 and 70: MKUKUTA Cluster II: Improvement of
Page 71 and 72: Regional variations in enrolment ha
Page 73 and 74: CLUSTER II- GOAL 1 and/or not compl
Page 75 and 76: Pupil/Teacher Ratio Overall, the pu
Page 77 and 78: provision of housing, funding for w
Page 79 and 80: CLUSTER II- GOAL 1 Table 11: Primar
Page 81 and 82: Table 12: Benefit Incidence Analysi
Page 83 and 84: Figure 15: Infant and Under-Five Mo
Page 85 and 86: Figure 17: Prevalence of Malaria in
Page 87 and 88: Figure 19: Percentage of Children U
Page 89 and 90: Table 13: Indicators of Malnutritio
Page 91 and 92: CLUSTER II- GOAL 2 Ghana (Edmond et
Page 93 and 94: Figure 24: Percentage of Births Tak
Page 95 and 96: Figure 26: HIV Prevalence by Age Gr
Page 97: Figure 28: Projected Number of Adul
Page 101 and 102: Access to Healthcare Services On th
Page 103 and 104: Health Services Development Strateg
Page 105 and 106: Figure 34: Access to Clean and Safe
Page 110 and 111: POVERTY AND HUMAN DEVELOPMENT REPOR
Page 128 and 129: MKUKUTA INDICATORS - SUMMARY OF DAT
Page 130 and 131: Target Indicator Baseline Trend MKU
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POVERTY AND HUMAN DEVELOPMENT REPOR
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Indicator Baseline Trend Target MKU
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Chapter 2 An AnAlysis of household
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Composition of Consumption Consumpt
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the poverty line basket was valued
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Figure 50: Daily Caloric Intake per
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Figure 52: Poverty Incidence Curves
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Food share typically, a drop in the
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Liters per Adult Equivalent Kilogra
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Kilograms per Adult Equivalent 6 5
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Consumer Durables data from the hBs
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Additional data from the tanzania h
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Table 41: Percent of All Households
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Table 44: Percent of Males and Fema
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Table 46: Distribution of Household
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Conclusion Chapter 2 income poverty
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pOVertY aND hUMaN DeVeLOpMeNt repOr
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Chapter 2 Hoogeveen, J. & Ruhinduka
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Poverty and Human Development Report 2009 - UNDP in Tanzania

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