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  1. T A N Z A N I A(Mainland & Zanzibar) EARLY CHILDHOOD DEVELOPMENT & HIV CHALLENGES & STRATEGIES

  2. Positive Factors • High coverage of immunization (DPT/HB3-89%) • Wide coverage of Vitamin A supp. (over 90%) • High use of iodised salt (83%) • Good provision of antenatal care services. • Recent Estab. of the Directorate of Children’s Dev. in MCDG&C (2003) & Public Expenditure Review. • Active ECD network of NGO & Govt. partners. • Govt’s call for multi-sectoral partnership for community-based ECD support.

  3. SURVIVAL & HEALTH • More infants & young children struggling to survive than 10 yrs ago(IMR 99/1000; U5MR 147/1000;) • Mortality signif. higher in rural areas(113% vs. 89%) • Most deaths (75%) due to preventable conditions(HIV/AIDS, malaria, pneumonia, diarrhoea, malnutrition) 8 out of 10 die at home. Majority no contact w/ health facility • High MMR(530/100,000) related to Women’s high poverty levels, low social status, low educ. levels, early pregnancies, high work burden & declining access to health services.

  4. SURVIVAL & HEALTHRELATED TO HIV/AIDS • Reported AIDs cases for children under 5 - 4% (1987-2001) • 80% of infants infected by HIV at birth do not survive 2nd birthday. • Girls 15-19 yrs 6 times more likely to be infected than boys. • Approx. 2 million orphans & children affected by HIV/AIDs.

  5. FOOD & NUTRITION • High prevalence of Low birthweight & malnutrition – limited no. of feeding posts. • Heavy workload & poor nutrition of women. • Poor access to clean, potable water esp. in rural areas. • Seasonal hunger in rural areas. • Insufficient integration of micro-nutrient interventions within overall nutrition efforts. • Insufficient focus on child nutrition in Primary School children.

  6. STIMULATION, EARLY LEARNING & TRANSITION TO SCHOOL Insufficient opportunities for stimulation, play, early learning, pre-school participation due to: • Limited culturally & developmentally appropriate, family & community-based, integrated Care & Ed. opportunities that support diverse caregivers(teens, siblings, elders, relatives)in their multiple roles as carers & providers. • Limited maternal awareness re importance of early stimulation. • Inadequate childcare arrangements & insufficient male involvement. • ECD Progs. limited to urban areas, low quality, & fee paying which excludes the most vulnerable.

  7. PROTECTION & PARTICIPATION • Low levels of birth registration (esp. Rural) • High levels of child neglect, abuse & labour. • Insufficient concrete support for OVCs during EC.“An Orphan is only an orphan when they reach Standard 1”. • Insufficient concrete progs. for affected children & their caregivers (ie. pschosocial support, food, shelter, clothing, health needs, ARVs, school fees). • Need for greater representation of Women in village governments.

  8. POLICIES & LEGISLATION • Insufficient integration of ECD issues in social sector policies & guidelines (eg. Health, food & nutrition, water & sanitation, labour, gender/women’s development, community development, adult education, culture) • Need for alignment of 1981 Day Care Act & 1995 MOEC Pre-primary policy for 5-6 yr olds in order to provide clear framework for action at community & national levels.

  9. COORDINATION • Insufficient coordination of social service agency in supporting families. • Lack of national mechanism/structure for coordination. • Local Govt. Reform structures not maximized for coordination of ECD interventions at ward & district levels.

  10. CAPACITY BUILDING • Limited & uncoordinated human resource development initiatives. • ECD Training Limited, Expensive & Insufficient Govt. involvement. • Inadequate supervision of staff. • VHWs not institutionalized. • Insufficient linkage between Extension Workers & VHWs

  11. PUB ED./ ADVOC / SOC. MOB. • EC not included in human resource dev. agenda • Inadeq. focus of HIV AIDs efforts on YOUNG CHILD issues • ECD/HIV responses largely isolated projects with limited coverage. • No coordinated communication strategy and national IEC programme for ECD. • Insufficient sensitization of community leaders/members re HIV & cultural practices, status of women, stigma of HIV infected infants, children & caregivers, child abuse etc. • Insufficient participation of young children & women in issues affecting them.

  12. FINANCING & RES. MOBILIZATION • ECD not yet mainstreamed or prioritized in TZ’s PRSP. • Funding requirements for scaling-up successful interventions have not been determined. • Insufficient developm’t partners & int’l NGO support for ECD initiatives. • Funds for CSO’s re ECD/HIV programmes difficult to access via District Councils. • Insufficient income generating activities to strengthen community ECD responses.

  13. RESEARCH, MONITORING, EVALUAT. & DOCUMENTAT’N • Insufficient relevant, disagregated data on child status and existing support structures to guide programming. • Insufficient documentation & information exchange re. childrearing practices & “successful” ECD / HIV programmes. • Lack of research agenda for ECD.

  14. ECD STRATEGIES - GENERAL • Facility based IMCI in 80/131 districts. Community IMCI in 7 districts.Commitment of govt. to budget and scale up Community IMCI as part of national strategy. • Integration of immunization strategies with other health interventions • Linking Promotion of Participatory Hygiene & Sanitation Transformation & ORS promotion. • Quarterly Growth monitoring linked to breast feeding and complementary feeding promotion in 57 RCH clinics. Limited No. of feeding posts for severely malnourished. • National provision of Vitamin A supplements (over 90% coverage) & new strategy for linking deworming efforts.

  15. ECD STRATEGIES - GENERAL • Malaria communication strategy being developed as ‘pathfinder’ for integrated ECD. • Introduction of ITN Voucher scheme in 2 districts. • Inclusion of initial 3 ECD indicators in Community Based Information system. • 1,264 Day Care Centres (2-6 yrs) but mostly in urban areas. • Baseline survey/ needs assessment & Pilot project on EC stimulation in 1 district and development of parent education module.

  16. ECD / HIV STRATEGIES • PMTCT programme in 132 sites providing Voluntary Testing & Counselling services. • Baseline research and emerging strategies to establish community-based PMTCT in 9 districts. • PMTCT recently incorp. in National HIV strategy. • Documentation of best practices in refugee camps of Western Tanzania (PMTCT & Prevent. Of LBW) • National Plan of Action for OVCs. • Counselling support for Most Vulnerable Children & Families in 15 districts.