Tanzania’s south-eastern Lindi region, close to the border with Mozambique, has some of the worst odds of child survival in the country.
Lindi is the fifth-largest region in Tanzania and is about the same size as the Republic of Ireland.
There are limited economic opportunities in Lindi – the rural communities are predominantly agricultural and live off their land.
According to the regional authorities in Lindi, the average household income is less than TZS 20,000 (£8), which is three times lower than the national minimum wage.
Tanzania has made considerable progress nationally on reducing mortality among children under five and is projected to meet its national millennium development goal target of reducing child mortality by two-thirds by 2019.
But with limited access to even the most basic of health services, children from Lindi are four times more likely to die from common childhood illnesses, compared to those from the rest of Tanzania.
Not enough food
According to government figures, more than half of than children under five in Lindi are stunted, and this widespread chronic malnutrition has contributed to the excess morbidity and mortality in the region.
High rates of under-nutrition also means that common childhood illnesses are often more complicated than in a child who has the strength to fight off, and recover from, illness more easily.
Combined with the fact that common childhood illnesses are routinely untreated in communities, children often end up at health facilities with complications.
The cost of a complicated illness requiring hospitalisation overnight comes up to TZS 30,000 (£12), which is a huge cost to an average rural household in Lindi.
The government of Tanzania has a vision to build one dispensary in every village across the country, staffed by a trained health worker (clinical officer) and a support worker (rural medical attendant).
However, this is far from reality in Lindi, where one dispensary serves up to four villages and is staffed by rural medical attendants only.
The Tanzania constitution warrants free healthcare for all children under five, yet with limited human resources or drugs, more than half of children in Lindi do not receive basic treatments for common childhood illnesses like pneumonia, diarrhoea and malaria.
Attracting and retaining health workers has been an ongoing challenge in Lindi. According to health authorities, about half of clinical posts remain unfilled.
What we have been doing
Save the Children has been working in Lindi to improve child survival over the past decade.
Our innovative model of integrated healthcare, health education and hunger reduction has benefited scores of children and communities across the region.
Progress has been slow due to limited resources available to the health authorities, however a recent analysis by the Ifakara Health Institute reports positive trends on child survival in Lindi and projects significant reduction in under-five mortality.
What needs to be done
There is a pressing need to accelerate progress on child survival in Lindi. Local best practices need to be sustained and replicated across the region.
The health authorities must adequately resource their primary health facilities in order to improve access to essential health services. Locally qualified and deployed health workers can help address the perpetual challenges on getting enough health workers for the jobs available.
The government of Tanzania must address the policy constraints on access to child health services at the community level.
Community case management of childhood illnesses is a proven child-survival intervention that works well in remote rural communities such as Lindi. It can address access gaps in the medium term, while systematic issues to open dispensaries at the village level are resolved.
Tanzania has co-led the UN commission on Accountability for Women’s and Children’s Health. It is now time to ensure that its promises of resources for children’s health and survival are kept.