Briefing paper Population Dynamics and Poverty Reduction



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Briefing paper

Population Dynamics and Poverty Reduction




Tanzania’s Population Profile

Population growth and momentum

A key development challenge for Tanzania is its high population growth rate.

Tanzania’s population almost tripled during the 35 years between 1967 and 2002. The 2002 population and housing census placed the total population of Tanzania at 34,443,603 almost equally divided between males (49 per cent) and females (51 per cent). During the inter-censal period 1988 to 2002 the population increased 49 per cent (23.1 million to 34.4 million, respectively). The current official projections show that the population as of mid-2009 is about 41.9 million (NBS, 2009).

At a rate of 2.9 per cent1 the national average population growth rate ranks as one of the fastest in the world and translates to a net total of about 1.3 million people being added to the population annually. At this rate Tanzania’s population is projected to reach 65.3 million in 2025 and 88.3 million by 2050 (NBS, 2009).



The growth rates show regional variations from below 2.0 per cent in Kilimanjaro region and Lindi (1.4 per cent) to more than 4.8 per cent in Kigoma and 4.3 per cent in Dar es Salaam.



Age structure

Tanzania’s population is largely youthful with children under 15 years making up 44 per cent of the total population. When young people aged 30 years and below are put together, they make up close to 73 per cent of the total population (NBS, 2002 census).

The elderly, though currently a small segment of the population, is increasingly becoming a conspicuous cohort not only in terms of their caring capacity for HIV and AIDS orphans but also their health and social service needs. The size of the elderly population is increasing due to marginal increases in life expectancy.

In 2002 the number of old persons (above 65 years) was around 1.35 million. Elderly women are more vulnerable especially if they are widows. Many are informally employed and literacy rates are low.



Dependency burden

As a measure for economic dependency, the age dependency burden is used to define the working-age adults (ages 15 to 64) relative to children under age 15 and the elderly 65 years and older. When there is a high dependency burden then there are more people to support with the same income and assets. Tanzania has a high dependency ratio of 0.85 (Kenya at 0.84 and Uganda at 1.12).

The high burden of youth and old age dependency affects household income and spending and sets limits on household savings. It is estimated that the dependency ratio will continue to rise unless a major policy change is made to address the demographic transition.

Fertility

Tanzania’s rapid population growth rate is, for the most part, driven by high fertility rates, short birth intervals, early unset of sexual activity and related high adolescent fertility/teenage pregnancies.

In Tanzania, the average woman will give birth to 5.7 children in her life time. While there has been a slight decline in fertility since 1991 (6.3 children) the current rate has virtually stayed the same since 1996, meaning there has been persistently no decline in fertility in over a decade. Globally, Tanzania ranks among the countries with the highest fertility rates.

Regional variations exist and tend to mirror variations in growth rate with the highest rates in Kigoma (7.4), Bukoba (7.3) and Shinyanga regions (7.3) and the lowest in Kilimanjaro (3.9) and Dar es Salaam (2.5).



Poor women and women with no education have twice as many children as wealthier, more educated women. Contraceptive use is also lowest among the poorest and unmet need for family planning services among women in the poorest household is higher than unmet need among the wealthier households.

Teenage pregnancy is a common phenomenon. Many Tanzanian girls marry early or are sexually active before marriage. This exposes them to unplanned pregnancies and unsafe abortions, HIV and AIDS and risks associated with early pregnancy and child birth. Nationwide, two third of girls will be married before their 20th birthday. Twelve per cent of young girls and 7 per cent of young men will have had sex by age 15 years. The median age at first intercourse for girls is 17 years. Twenty six per cent of women age 15-19 are pregnant or have already given birth.

Early sexual activity is more common among less educated and rural young girls. Girls who marry young typically have children early and have more children than their peers who stay in school.

Early marriage, high adolescent fertility and early onset of sexual activity contribute to the current and persistently high levels of fertility in Tanzania. Teenage pregnancy also limits women’s opportunity for better education, jobs, income and ability to participate meaningfully in social and economic development.

With over 1.3 million people being added to the population annually together with the large number of young potential child bearers, there is an inbuilt population momentum and this will accelerate population growth for at least the next five decades even if fertility was to be reduced to replacement levels of 2 children per woman (current levels are 5.7).

Reducing the current fertility rate would require prioritizing voluntary family planning and increasing contraceptive prevalence rates to over 65 - 75 per cent. Presently, only about a quarter (26 per cent) of married women use some form of contraception of which only 20 per cent use a modern method. Contraceptive use is linked to education levels and marital status. Fifty per cent of married women with secondary school education use a contraceptive method compared to 13 per cent of married women with no education. Sexually active unmarried women are more likely than married women to us modern contraception and among unmarried women, 41 per cent use some form of contraception2.



Fig. 6

Of importance are the reproductive health choices that women in Tanzania would want to make around the number, spacing and timing of their children. More than one in five (22 per cent) married women in Tanzania will like to delay their next birth (15 per cent) or stop having children altogether (7 per cent), however are not using contraception for reasons such as affordability and lack of access and of information. This level of unmet need for contraception is high and is even higher among the poorest and among women with no education. The level of unmet need among non married and adolescents is not fully known, though modern contraceptive use among adolescent girls is only 12 per cent.

In summary, the drivers of high fertility in Tanzania include early marriage, early onset of child bearing and subsequent school dropout, low use of modern contraceptives and high unmet need for family planning. Furthermore, Tanzania remains a pronatalistic society with strong patriarchal systems and the influence of religion and culture cannot be overlooked. Large families, polygamy, children as assets, son preference remain some of the aspects that remain strongly engrained in many communities and mindsets.

Mortality

Life Expectancy

Life expectancy at birth is a function of infant and under-five mortality and is one of three indicators used to determine the human development index (HDI)3. In Tanzania between 1978 and 2002 there was a gain of 7 years in life expectancy at birth (44 years and 51 years, respectively). More recent estimates put the average for both sexes at 45.24 years, 44.56 for males and 45.94 for females (2005 data).

Although the AIDS epidemic has taken a severe toll on families and communities this has changed in the last few years and has not had a major effect on the overall population size or age structure (unlike it has in Botswana or Lesotho).

Infant and Child mortality

The Tanzania report on poverty and development (2007) notes that in health, sharp reductions in infant and under-five mortality have been recorded, with rates approaching the MKUKUTA target and on trajectory to meet the targets set by the Millennium Development Goals (MDGs – MGD4). However, enormous disparities in mortality rates persist between regions.

Infant mortality has declined from 170 per 1,000 live births in 1967 to 115 in 1988, 99 in 199, 68 in 2004/5 and further to 58 in 2007/2008.

Under-five mortality has also declined from 231 per 1,000 live births in 1978 to 192 in 1988, 147 in 1999, 112 in 2004/05 and 91 per 1,000 live births in 2007/08 (URT, THMIS).

In Tanzania more than 55 per cent of all births are in an avoidable high-risk category. The risk of infant mortality in Tanzania is more than twice as high when spacing of births is shorter than 2 years. In addition, adequate nutrition and access of pregnant women to antenatal and postnatal care will be crucial to reduction in maternal and child mortality in the country.

Maternal mortality

Maternal health is the notable exception to positive health trends in Tanzania. With official figures of 578 per 100,000 live births there is no indication of any improvement in maternal mortality. Moreover, neonatal mortality, which is closely linked to poor maternal outcomes, remains stubbornly high and now accounts for nearly half of all infant deaths.

To meet the MDG goal on maternal health (MDG5), Tanzania will need to reduce its mortality by three quarters from 578 to 145 per 100,000 live births and ensure universal access to reproductive health by 2015.

The irony is that maternal deaths are to a large extent preventable and can be addressed through relatively simple interventions including family planning to address unmet need and to space pregnancies, increasing the proportion of births attended by skilled personnel and ensuring the widespread availability of emergency obstetric care to treat complications arising during pregnancy and delivery.



HIV and AIDS

Another dimension to health is the negative effect of HIV and AIDS on the economy and society. About 2.2 million people were living with HIV and AIDS in Tanzania by 2004, largely among those aged 20-49 years. It is estimated that about 200,000 Tanzanians are infected with HIV each year. Urban areas have higher HIV prevalence rates than rural areas (9 per cent and 5 per cent respectively). Women are more disproportionately affected than men and older adults aged 30 years are more likely to be infected than younger age groups.

AIDS affects the human capital of the economy by distorting the skill composition of the labour force, with implications for productivity. The loss of productivity that results and the indirect costs such as loss of earnings, productivity losses arising from absenteeism, labour turnover, substitution of less qualified and experienced staff, additional training are significant. Another effect is the increasing number of orphans, now estimated to be about 800,000 in Tanzania.

Urbanization and Migration

The current population is distributed between the urban areas (26 per cent) and the rural areas (74 per cent). The population density is estimated at 45 people per square mile. However, the population is highly concentrated along Lake Victoria in the North, in the Southern highlands and around main business and trading centres like Dar es Salaam, Mwanza, Mbeya, Dodoma, Tanga and Arusha.

The population growth rates in urban areas are more than double that in the rural areas because of rural–urban migration – a key population dynamic variable. This poses important challenges to urban authorities. The average national urban growth rate was 4.3 per cent from 1988 to 2002. Dar es Salaam for example is growing at a rate of 4.3 per cent per annum and is now characterised as a “crisis area” in relation to its size and the resources it requires to sustain even the minimum standard of social service delivery.

The ICPD at 15 National Report (POPC, 2009) noted that rapid urbanization is a challenge because it has led to the emergence of informal traders, most of who migrate from the rural areas. The perceived or actual lack of opportunities in rural areas is the main push factor for young Tanzanians to the urban centres.

The results of the Tanzanian Household Budget Surveys (1991, 200, 2007) show that indeed there is rural poverty. Basic needs poverty (and food poverty) is relatively higher in rural areas (37 per cent are below the basic needs poverty line), followed by other urban areas (12.9 per cent) and Dar es Salaam (6.7 per cent). Therefore, people tend to move away from rural poverty, and this accelerates urban population growth and harbour large numbers of young job seekers, most of who end up with menial jobs, if any job at all.

One consequence of the high rate of urban population growth is the rise of unplanned settlements (squatters/slums) characterized by pressure on available basic services including housing and secures tenure, electricity, safe and reliable water supply, sanitation, access roads, drainage and waste collection management. Dar es Salaam alone hosts 56 unplanned settlements accommodating approximately 70 per cent of its population. This situation is likely to have an adverse influence on rates of HIV and AIDS, gender based violence, crime rates and degradation of the environment including waste and water pollution.

Apart from rural-urban migration, in recent years, Tanzania has also experienced rural-rural migration with a clear southward movement. This has brought new challenges in land use and water conflicts between agriculturalist and pastoralists; destruction of water catchments, game and forest reserves such as the Ireful wetlands in Usangu plains in Mbeya region and other places (ICPD at 15 National Report, POPC, 2009). These problems pose serious challenges for efforts to reduce poverty in the fast changing environment in which conflict among different land users is a most likely outcome.

Security in the sub-region has caused in-migration in the form of refugees. There are around X camps with a population of about y registered refugees within the camps. Refugees in Tanzania bring new population dimensions. Refugees being naturalized bring the challenges of settlements, social integration with local communities and planning for already over-stretched government services.

International migration is little studied and documented. One strand in argument sees “brain drain” from emigration of skills and labour generally for greener pastures in the “Diaspora”; another sees some opportunities in remittances and transfers (direct investments) if they can be harnessed. In the absence of data, Tanzania does not know the size of its emigrants, their characteristics and potential contribution to development; nor does it know similar perspectives of its immigrants, information about which is reported in censuses, albeit without further incisive analysis.

It is through systematic integration of population issues (distribution, migration, urbanization) into national and regional development policies and plans that the impact of population dynamics on the economy and society can be minimized. Conspicuously lacking in Tanzania is an explicit urbanization and mobility policy and implementation of the Human Settlements Development Policy of 2000.



Implications and Challenges

The present population profile and its dynamics have far reaching implications for development and poverty alleviation.

Studies have shown that two major factors will determine Tanzania’s future economic growth prospects: growth in the working-age share of the population and institutional quality meaning factors such as good governance, government stability, lack of corruption and a stable business environment that encourages domestic and foreign investors.

Tanzania’s young people can be the driving force behind economic prosperity in future decades, but only if policies and programmes are in place to enhance their opportunities. Positive national outcomes and a window of opportunity to save, also known as the demographic dividend (or bonus) can result from having a large and better educated workforce with fewer dependent children to support – children who will in turn be more educated and employable.

East Asia (Thailand, Indonesia) provides the best evidence of the potential impact of the population dividend. In the 1950s, the average East Asian woman had six children, but by the mid 1990s she had only two. A strong educational system and sound economic management made it possible to absorb the large generation of young adults (due to the population momentum) into the workforce. During this time growth in GDP per capita averaged more than 6 per cent per year. Researchers have estimated that the demographic dividend accounted for one-fourth to two-fifth of this growth.

If Tanzania continues on its current population trajectory, its economic gains as well as gains at the household level for poverty reduction will be undermined. In such situations, there is high pressure on the provision of social services and infrastructure, indirectly also impacting on development of other sectors such as education, health, water and sanitation, agriculture and environmental stability.

The 2008/09 State of the Economy discussed during the fiscal year’s Budget Session put the overall GDP real growth rate (at 2001 prices) in 2002-2008 at between 6.7 per cent and 7.8 per cent. While an impressive range by its own standards, still not by the standards expected if Tanzania is to meet its MDGs (which require consistent, minimum ranges of 8-10 per cent per annum) and particularly in light of the global financial downturn. Unfortunately, these economic indices are depressed by rapid population growth rate at the 2.9 per cent per annum rate.

Already this high population growth has partly arrested the would-be gains of economic growth and poverty reduction. The 2007 Household Budget Survey shows that the proportion of people living in poverty has decreased by 2.4 percentage points, from 35.7 per cent of the population in 2001 to 33.3 per cent in 2007. The reduction in the proportion of poor would translate into a reduced number of poor people only if the reduction in the poverty ratio was large enough to compensate for the increase in the population. The reduction in the poverty ratio indicated by the 2007 HBS data has, however, not been able to compensate for the growth rate of the population of about 2.9 per cent per year. As a result, the reduction in the proportion of poor translates to an increase of about 1.3 million people living in poverty between 2001 and 2007 from 11.7 million in 2001 to about 13 million in 2007.

Certainly, the high rate of population growth, resulting largely from persistently high level of fertility, poses a great challenge to the country’s target of meeting the demands for social services and facilities, particularly in such areas as health, education, employment, housing, environmental security and general well being. Spurred by high fertility, Government notes in the National Population Policy (2006) that between 650,000 and 750,000 persons are being added to the labour force annually, yet about 2.3 million remained jobless. A reduction in population growth rates will reduce the rate of supply of new entrants into the labour force and thereby compliment other strategies aimed at promoting employment.

In its budget prioritisation, Tanzania has placed emphasis on four key sectors – education, infrastructure, health and agriculture. It will be challenging for the government to achieve its aims in these areas if it does not take into account the impact that population dynamics will have on these sectors.



Education

For example, evidence shows that high fertility undermines the education of children in a variety of ways (larger families have less to invest in education of each child; early pregnancy leads to school dropouts, etc). In Tanzania, national educational indicators reveal largely positive trends particularly at the primary and secondary levels, although quality of education and gender gap especially at the higher levels, remain a major concern. Additionally, ongoing challenges exist in achieving geographic equity in educational outcomes and in meeting the needs of vulnerable children (URT, Poverty and Human Development Report, 2007). If all the children in the country – including the most vulnerable, excluded and marginalized – are to realize their right to a quality, rights-based education, then the underlying population factor in educational planning should be seen in the size, gender equity, growth rate and distribution of the school age population.

It is an up-hill task to increase the enrolment ratios because actual enrolments and supply of infrastructure and teachers must progress more rapidly than the increase in population itself. In addition, women in Tanzania are at an educational disadvantage compared to men.

What population sensitive interventions could do is to reduce the supply of potential pupils till a time when the resources (e.g. teachers, infrastructure and learning materials, etc) can be effectively balanced with the needs. If one million fewer children are born during the next MKUKUTA period through an effective family planning programme, this would enable the system to spread its resources on education and other services more effectively.



Health

The available body of evidence among countries shows that high rate of population growth calls for increase in health cost because the high fertility rate that promotes rapid expansion of the population requires increasing investments in obstetric and paediatric needs, as well as increasing outlays in general preventive and curative medical services and facilities to reduce the high rates of morbidity and mortality which characterize a rapidly increasing population (Population Council, 1994).

Empirical evidence has also shown that the early onset of fertility (teenage pregnancies and motherhood) and the close spacing of births (less than 2 years) present health risks and prematurely intensify pressures on families and governments to provide livelihoods for new generations of children.

Child survival is also related to child spacing, fertility and health of mothers. Under conditions of high overall death rate, as in the poor countries of the world, infants suffer most and this tends to influence parents’ reproductive responses, choice of family size and birth spacing.



Agriculture

In Tanzania women contribute more than half of the agricultural labor force and grow more than 70 per cent of stable crops. Investing in women’s health including maternal health will not only save the lives of many mothers and prevent disabilities, but also can ensure significant economic returns in terms of women’s own productive labour, as well as their care-giving roles within the household that may free time for the productive labour of others.

Agriculture remains the backbone of the Tanzanian economy; 70-80 per cent of all employed adults in Tanzania are engaged in agriculture and forestry activities (ICPD at 15 National Report, POPC, 2009). With low productivity in agriculture the challenge of poverty reduction remains daunting, which is why the corner stone of Pillar 1 of Kilimo Kwanza is the transformation of peasant and small-scale farmers to commercial farmers and improved agricultural productivity.

The role of population dynamics in agricultural development in Tanzania has been neglected. Yet, analysis of rural population distribution has shown that high and increasing population density in large areas of the country has generated negative impact on agricultural production and environmental integrity.



Environment

Rapid population growth puts pressure on the environment resulting in the increase in energy use and scarce resource. It is estimated that in the Usambara Mountains almost 70 per cent of the rain forests have been destroyed since 1954; and in areas like Tabora and Songea, tree felling for tobacco cultivation and curing is rampant; while slash-and-burn cultivators sets in motion a series of events leading to destruction of forests. These trends are reported to have several adverse consequences that include accelerated soil erosion, fuel wood scarcity, high rates of evaporation, and climatic change.

The sustainable supply of fuel wood in Tanzania is estimated to be 19 million cubic meters per year, but the total consumption is estimated at 43 million cubic meters per annum. Rapid population growth has been viewed as the main cause of deforestation in Tanzania4. Population growth reduction strategies will go a long way in slowing down the rate of environmental degradation and facilitate environmental conservation and improved agricultural productivity in general.

Policy framework

The Government recognized the relationship between population dynamics and development and therefore set as the primary objective of its National Population Policy to enhance its efforts in coordinating all population programmes and achieve integration of population variables into development plans at national, sectoral and district levels, and thereby harmonize population and economic growth.

Tanzania is signatory to the ICPD Programme of Action and other key international and regional development agendas that acknowledge the centrality of population dynamics in achievement of development goals.

Although Tanzania’s National Population Policy has been in place since 1992, with a more recent version of 2006, it has not been comprehensively implemented within the framework of MKUKUTA. Unfortunately, population issues, lumped with other cross-cutting issues and said to be mainstreamed in sectoral strategies and programmes has, in reality, been neglected in national development efforts. The neglect of population dynamics in poverty reduction interventions has translated to its casual treatment or omission in development planning, prioritization and budgeting.



Institutional framework

Frequent changes in custodians of population issues and of poverty reduction initiatives has posed challenges, as the two interrelated concerns constrain their implementation within their changing institutions (President’s Office Planning Commission and Ministry of Finance and Economic Affairs). This has adversely affected commitment in addressing them as an integral whole.

The current institutional structure mandated to oversee and coordinate population issues is the Social Services and Demographic Cluster of the President’s Office Planning Commission (POPC). In the absence of a formal, well staffed and high placed Population Planning Unit that has significant clout with other sector ministries and departments, the National Population Policy will remain the good policy that it is and nothing more. Furthermore, till the structures proposed in the National Population Policy – specifically the Tanzanian Council on Population and Development (TCPD); the National Population Technical Committee (NPTC) and Population Desks in all relevant Ministries at regional and district levels are established or reactivated, the structure will remain week.

There exist best practices in the region that can be emulated (Uganda’s Population Secretariat and Population Units and Kenya’s National National Agency for Coordination of Population and Development) should the government be committed to ensure a strong institutional home for population coordination.

Furthermore, since population dynamics was not considered under MKUKUTA I it failed to be reflected within the MKUKUTA Cluster or formal dialogue structures. Implementation of the National Population Policy (2006) and its corresponding Implementation Strategy (2007) has therefore not benefited from the sectoral or performance reviews that are typical of thematic and sectoral areas such as health, agriculture or education. Along the same lines, there has not been the level of coordination and dialogue among government, development partners, private sector, academia and civil society that one sees in other sectors or themes.

The recent efforts to review MKUKUTA I has lead to the establishment of an informal dialogue structure among interested stakeholders including key development partners like Netherlands, World Bank, USAID, GTZ and the UN system; the placing of population related discussions within MKUKUTA Cluster II; and a renewed effort by POPC to take leadership in coordinating population efforts.



Population and development capacities

Tanzania seems to have trained a number of demographic and population specialists and the University of Dar es Salaam’s Demographic Training Unit (DTU) currently offers a Masters programme in Demography. Unlike other fields that have strong professional association/bodies and that frequently network and meet, the true potential of Tanzania’s population expertise is not being realised. It is evident that only few Tanzanian demographers are being produced and the field does not seem to attract the same level of interest as it did in the past. Furthermore, the present pre-service demographic curriculum needs to be reconfigured in light of emerging population issues (e.g. gender, population and climate change) and development approaches.

Population related research is not well planned or coordinated and funding is not forth coming for efforts to transform the DTU into a Centre or Department of Population Studies. Until it can be a full-fledged department it has little opportunities to get a budget from University administration to recruit and retain its own staffing to deliver quality demographers/population specialists in-country.

The present capacity building approaches on integration of population variables into development planning is predominantly ad-hoc and in-service and is far from what is needed to produce and maintain population development capacities and capabilities.



Population-based data and research

Weak capacity spills over to population and development data management. Data generation is weak, and where it exists only first-level analyses are undertaken, implying unsatisfactory link between data producers and data consumers/users, not to mention lack of further analysis likely to generate more insightful results for planning, prioritization, budgeting and monitoring.

A particular area of concern is the lack of research, studies and policy on migration/human mobility and development. Only immigration data are available from population censuses and immigration statistics data compiled by the Ministry of Home Affairs. Unfortunately, there are no data on emigrant which leaves Tanzania at the mercy of its neighbours and other countries to provide such data that are often inaccurate.

Financial Investment

The actual investment in population related issues is challenging to determine particularly because the National Population Policy and its Implementation Strategy have not been costed. Every year, with much difficulty, the Netherlands Interdisciplinary Demographic Institute – NIDI in collaboration with UNFPA tracks resource flows for population and development activities. At the ICPD in 1994, the international community specified USD 17 billion in 2000, and 18.5 billion in 2005 is needed to finance programmes in the area of population dynamics, reproductive health, including family planning, maternal health and the prevention of sexually transmitted diseases, as well as programmes that address the collection, analysis and dissemination of population data world-wide. Two thirds of the required amount was to be mobilized by developing countries themselves and one third, USD 6.1 billion in 2005, was to come from the international community. There is a concern that the resources mobilized are not sufficient to meet current needs which have grown dramatically since the targets were agreed upon in 1994.

For Tanzania, in 2007 the total reported income by source for population activities was USD 70.8 million of which 44 per cent came from international sources and 56 per cent from domestic/national sources (NIDI 2007). Resource flows for population and development activities in 2008 amounted to about 44 million of which 34 per cent was international and 66 per cent domestic (NIDI 2009), confirming the decreasing trend in funding for population activities at a time when demands are increasing.

Way Forward – Policy Options

Political Commitment

Considering the importance and centrality that population dynamics plays in national efforts to reduce poverty and based on the aforementioned challenges it becomes difficult to conclude that national commitment to population issues are at the level they ought to be. The government’s recent interest in population issues and specifically the MKUKUTA PEED secretariat that is coordinating the MKUKUTA review, are particularly promising signs. Considering neighbouring countries in the region have good experiences (Rwanda, Uganda, Ethiopia), south-south collaboration should be encouraged.

Many aspects of population dynamics can be sensitive areas for governments and policy makers (family planning, early marriage, adolescent sexuality, unsafe abortion, etc) to address and particularly during election times, however, being bold and courageous at this stage in Tanzania’ demographic transition is what is needed to ensure the quality of life that all Tanzanians deserve.

Slowing Population Growth

With the growing and inbuilt population momentum, in the years ahead, the demands on social and economic services will increase remarkably, and in turn, this will mean that the amount of resources and infrastructure required to meet Vision 2025 and MKUKUTA goals will increase. Any development effort in support of a new generation MKUKUTA must therefore not overlook the importance and benefits of slowing the population growth.



Expanding Family Planning Services

Family planning is one of the most cost effective ways of slowing population growth and improving infant and maternal mortality. Evidence shows that family planning can reduce maternal deaths by 20 per cent, and for every dollar invested in family planning the government can save up to USD 31 in health care, water, education and housing5.

Tanzania should accelerate current efforts to re-launch its Green Star National Family Planning campaign so that access to family planning services is universal especially in the most disadvantaged areas and where fertility levels and unmet needs are high. Innovative ways include community based distribution programmes, social marketing and franchising, public private partnerships and linking family planning with HIV prevention efforts including clear strategies on dual protection.

It will also require that contraceptive supplies are kept constant and stock-outs do not occur especially as demand increases. This will require a strengthened Contraceptive Logistic Management System and increased allocation of funds under the contraceptive budget line of the MOHSW’s MTEF.



Strengthening Health Systems

Increasing life expectancy, reduction in maternal, newborn and infant mortality and preventing new HIV infections requires an effective health system that reaches down to and engages meaningfully the community including young people. Tanzania should continue to invest in implementing it Health Sector Strategic Plan III and health sector reforms with a focus on strengthening Primary Health Care. Challenges in the health system particularly in the areas of human resources for health, health management information systems and health care financing need to be urgently addressed. National budget allocation would have to increase from its current 10 per cent towards the Abuja target of 15 per cent and health budget allocations for reproductive and child health including adolescent sexual and reproductive health must also increase from its current 7 per cent level.



HIV Prevention key to the National Response

While there has been significant focus and investment in the treatment and care of people living with HIV and AIDS, less attention has been placed on prevention. Government should be supported to finalise and implement the National HIV prevention strategy and its corresponding two-year action plan (2009/10-2011). Preventing new infections among young people is key to ensuring an AIDS free generation.



Improve Education

Should Tanzania wish to reap the benefits of the demographic dividend (the youthful population bulge) it would need to ensure improvements in educational enrollment and retention, especially for girls and quality standards at all levels especially at the secondary and tertiary level. It would need to ensure that secondary and university education is relevant for the skills needed in the workforce and that there are stable and economic conditions conducive to growth and job creation. For older Tanzanians, adult education programmes especially for rural women can help correct past inequalities.

Linked to teenage pregnancy, given the impact of early child bearing and sexual activity, the need to pass legislation that would hasten the process of amending the 1971 Marriage Act and bar marriage before age 18 is critical, as is addressing teenage pregnancy in schools. Efforts must be strengthened to integrate population and family life education (POP-FLE) including sexuality and life skills education in the schools system with complementary outreach programmes for out-of-school youth.

Empowering women, ensuring gender equality

Population growth, economic development and women’s socio-economic status are intimitly linked and largely interdependent. Women’s access to health services, resources and assets may however greatly influence population variables. It is imperative that economic strategies, structures, policies and laws recognize women as vital in development. Improving women’s access to and control over resources can be a key lever for lifting families and communities out of poverty. Gender disaggregated data is critical to recognizing and counting women’s economic contributions and therefore accounting for their unpaid labour. Improvement in infrastructure would ease women’s burden and increase their use of social services including releasing girls to attend school.



Creating Jobs

Job creation including equal access to employment for male and female youth should be a priority. Tanzania’s current labour force comprises of largely less educated and unskilled workforce mainly working in the informal sector of the economy with low wages. Bring the job market into the 21st century should be the aim including ensuring equal access to employment for both men and women and recognition of the contribution that women make to the informal economy.



Implementing the National Population Policy and an Effective Institutional Architecture

Tanzania’s National Population Policy Implementation Strategy (2007) provides an effective framework for the needed multi-sectoral, multi-dimensional and integrated approach to population and development. The strategy would benefit from a comprehensive review and more specific target setting and costing in order to ensure a more effective and coordinated implementation. The corresponding effective institutional structures for coordination, monitoring and implementation would need to be available at all level – national, regional and district. A forward looking analysis of the capacities needed to effectively lead and coordinate the implementation strategy would be particularly helpful in developing a proper capacity building approach and particularly if the Social Services and Demographic Cluster, President’s Office Planning Commission is to remain the overall custodian of the National Population Policy.

Reactivation of the Parliamentary Committee on Population and Development and the Tanzanian Council on Population and Development will begin to create accountability for the Policy’s implementation. Population issues should be included as a substantive thematic area in the new MKUKUTA structure and subsequent dialogue structure allowing government, development partners, private sector, civil society and academia to engage in its performance and public expenditure review on an annual basis.

Integrating Population Variables into Planning

Appropriate data through research and surveys needs to be generated for policy formulation, planning, budgeting and implementation. The Population and Housing Census and periodic demographic and health surveys remain the main source of population data for planning and monitoring in Tanzania and as such, must continue to be supported. Efforts need to be continued to finalise and start implementing Tanzania’s Statistical Master Plan under the auspices of the National Bureau of Statistics. Funding and capacity building for the 2012 Population and Housing census needs to be secured.

Besides data generation and particularly at the district levels, capacity needs to be built to analyse and utilize data for proper planning and decision-making. Mobilising commitment of decision makers at the regional and district levels to allocate resources for the integration of population variables into development planning will be important. Such investment would allow the training of policy planner on population integration. A more strategic, sustainable and longer term approach needs to be put in place to address demographic and population expertise in the country including efforts to attract and develop young demographers and statisticians.

Prioritizing Urbanization and Migration

Migration including urbanization is an important aspect of population dynamics that requires special expertise and attention. Inadequately studied migration (both internal and international) and urbanization should become priority areas for research, with a view to institute and implement appropriate policies and plans.



Conclusion

It is clear that without addressing the issues of rapid population growth, high fertility, maternal and infant mortality and morbidity, HIV prevention and migration, and placing population issues central to national development planning, Tanzania has little chance of achieving its Vision 2025 and improving the quality of life of its people. Prepared by UNFPA Tanzania as input into the MKUKUTA Review Process, October 2009)



1 At an annual growth of 1.0% a population will double itself in 70 years; at 2.0%, the doubling time reduces to 35 years. Tanzania at about 2.9 per cent per annum will double its population in less than 25 years.

2 Women’s Health in Tanzania – key findings from the 2004-2005 TDHS and 2003-04 THIS.

3 HDI takes into account three key indicators, education, life expectancy and GDP. Tanzania’s HDI ranking is 151 of 182.

4 Ndalahwa F. Madulu, 2004.

5 Lancet maternal Survival and Women Deliver series 2006/2007; Meeting the needs, 2006 UNFPA and PATH.



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