The Norway-Tanzania partnership initiative: a model for reducing child mortality and improving maternal health.

• Author: Lomoy, Jon

On 29 November 2007, Norway and the United Republic of Tanzania signed a bilateral agreement to support Tanzania's efforts to reduce child mortality and maternal mortality. The modality for support is to channel funds through a common financing basket for the health sector, together with a number of bilateral and multilateral partners, with no earmarking of the Norwegian funds. This marks the end of a one-year planning process, whereby we have attempted to bridge one of the major divides in the current development practices--namely, between global initiatives mobilizing additional finances for specific themes (in this case, the reduction of child and maternal mortality) and country-led processes of harmonizing and streamlining donor financing--by incorporating assistance into the development budgets, preferably in the form of general, alternatively sectorial, budget support.

The Norwegian Government, with the strong personal leadership of Prime Minister Jens Stoltenberg, has made reaching the targets set for the Millennium Development Goals--specifically to reduce child mortality (MDG 4) and improve maternal health (MDG 5)--a priority for development cooperation. This is expressed through political initiatives, such as the establishment of a network of global leaders, and through earmarking of funds for that purpose in the development cooperation budget, to be used both globally and bilaterally in selected countries. The size of the country, the seriousness of the challenge in terms of the ratios of maternal and child mortality, and the potential for a partnership based on a strong political leadership were all relevant criteria for the selection of Tanzania as a pilot country.

Like many other developing countries, Tanzania has high rates of maternal and child mortality. The figures, from the Demographic and Health Survey of 2004, show a mortality rate of children under five years old at 105 per 1,000 for the country as a whole, with 108 per 1,000 in rural areas and 91 in urban areas. But maternal mortality is much more complicated to assess than child mortality. Multiple sources of information and careful calculation are required, for all estimates are retrospective. It was therefore no surprise that the rates of maternal mortality vary. The 2004 survey calculates the maternal mortality ratio between 1995 and 2004 at 578 maternal deaths per 100,000 live births, which was considered the official ratio. However, the World Health Organization...