Last week, Tanzania hosted the 5th Gavi Alliance Partners’ Forum that brought together global health and government leaders, academics, activists and scientists to explore ways to accelerate results, innovation, sustainability and equity in the field of immunization. United Nations Population Fund (UNFPA)’s Executive Director and Under-Secretary-General of the United Nations, Dr. Babatunde Osotimehin attended the meeting. Our staff writer, Stella Barozi was among the few journalists accorded the opportunity to have a chat with him. Excerpts…
Q. Could you tell us why you are here?
A. We are here to be part of the Gavi Alliance meeting. We in the global health arena believe that greater collaboration should occur between the various entities there and UNFPA sees this as an opportunity to pursue our relationships with other partners. But also to present our own position, that is the issue of reproductive health, reproductive rights and the empowerment of women and young people to be able to exercise reproductive rights. In the context of Tanzania just being able to understand that a lot has happened, we have done a lot with Tanzania, progress has been made but there are still some grounds to cover. When we talk reproductive health services we are talking family planning. We know that Family Planning can be better in Tanzania. Access can be better and we are working with government to improve it. We are also ensuring that we work with government in the long term to improve girls’ education and make sure they are in school because when you do that you also reduce the issue of unwanted pregnancies. And within the larger context to also work with our partners to ensure that young people have access to decent jobs and that they are able to determine themselves.
Q. We understand you had a meeting with President Kikwete. Can you brief us on the meeting?
A. We talked about these activities. I have a great deal of regard and respect for him and his commitment and passion for the people of Tanzania, particularly young people. He is very committed to the education of young people, particularly young girls. He is also committed to ensuring that Tanzania produces enough food to feed itself and is committed to the health of Tanzanians and ensuring that there is a great deal of cross-sectoral collaboration. We know that when people eat well and get good water supply, their health improves.
He is one leader which we have a lot of faith in and with whom we believe we are going to make a difference in Tanzania.
Q. Despite its efforts, the government is facing challenges in meeting its development goals. What can you say on this?
A. That’s why we are here. We are here as the United Nations to assist the government of Tanzania to be able to attain its development goals. And I want to say without equivocation that some of the development goals within the MDGs which Tanzania may not have met are not peculiar to Tanzania. Let me give the example of development goal five which is about maternal mortality. That is something which is common to many countries in this continent, indeed in South Asia. So we are realistic. We understand the challenges. We understand that Tanzania may not have all the resources it needs to deploy but we are very optimistic about the president’s attitude and his engagement. We have visited many countries before where we don’t get the same kind of commitment that we see. So with MDG 5 with maternal mortality which is a little high for Tanzania, we are working with government. That is why I talked about family planning. We know that if women have access to family planning, universal access to family planning will actually reduce maternal mortality by one third. Because we know that women run the risk of dying giving birth and they run the risk when we quantify these unplanned pregnancies. We know that various complications that occur during this period of time are preventable. We continue to work with government in terms of doing our best. What the United Nations brings and UNFPA in the specific terms is not a lot of money. What we bring is competencies, expertise, the ability to help the government think through problems, strategise and spend resources in a more optimal way than they will have done before. We are very happy that the government of Tanzania is very open. They listen and work with the UN. We are happy to be here and we are glad that progress has been made. As I said, like in many developing countries, there are still many rivers to cross…but the truth of the matter is we are going to get there if we continue this way.
Q. Inadequate health services, especially in rural areas contribute to maternal mortality in Tanzania. Any future intervention plans?
A. Maternal mortality is a matter of great concern to all of us particularly in Africa. Indeed in January of next year, working with Africa Union Commission and under their leadership, we are going to revisit the issue of maternal mortality. We want to see how we as UNFPA can help to accelerate the reduction of maternal mortality because it’s a major issue. If we have family planning we actually will reduce maternal mortality. We also need to ensure human resources for health are available where they are required. We have learnt and seen that it’s not about training doctors for ten years or nurses for five years. We can actually get community health workers who have some skills that will provide services in communities. This will reduce maternal mortality considerably and we have examples of that. Ethiopia is doing it, Rwanda did it. I think that is the way to go and that is the kind of thing that we are looking at.
Q. Contraceptives acceptance among married women is low in Tanzania partly due to the belief that they are not safe. What do you tell women?
A. What we tell women is that family planning is safe and is life saving. I think it is important for women to know that in the present context of the technologies that we have, we have different forms of family planning commodities. So you should go and be counseled and get information about the different forms of methods that are available. We are working with government to ensure that that is in place so they can have access to different methods, and choose which one they would like to have. And then also to be able to have follow-up so if there are problems they can also be properly assessed. The way to approach it is to make sure you get information from a family planning clinic that will give you the details of different choices and you will be the one to choose. And if there are problems we stand ready to make sure that we can correct those problems.
Q. When should we expect the money pledged at the London Family Planning Summit to start coming in?
A. I take the opportunity to thank President Kikwete for attending that summit because he sent a different message. He showed the commitment of the government of Tanzania to its people to provide good quality care especially family planning. About the monies pledged, the issues are already happening. We are not just starting family planning in Tanzania, we have always been here. What is going to happen is that we will go through, scale up and make sure the donors who have money to give will also give. What is more significant and I think it is important is to give credit to the government of Tanzania for committing itself to greater resources to family planning, and that they did at the London Summit.
Q. How is UNFPA going to work with Gavi Alliance in fighting cervical cancer?
A. We do appreciate what needs to happen because we now have a vaccine, HPV vaccine, which is effective in prevention of cancer of the cervix, especially if it is administered to young girls before they get into regular sexual activities. UNFPA is going to work with Gavi to optimize that and make sure young women can have access to the vaccine and prevent cancer deaths. We know that it’s a huge task because in the world there are 600 million adolescent girls who might require it. Every year there are 275,000 deaths from cancer of the cervix and we can avoid that. We are going to link this in my view, to the comprehensive sexuality education programme which I believe every young person should have. A young man and a young girl should know about their bodies. They should be able to tell what is going on with them. I have seen too many young girls get pregnant because they don’t know about their bodies. Too many of them make mistakes because they just don’t understand that they can avoid it. So if we give them that comprehensive sexuality education which will include issues of cervical cancer prevention, they can actually take that immunization and prevent it.
Q. What is the importance of involving men in family planning?
A. We do recognize men as partners and we recognize the fact that for family planning programmes to work effectively, you have to have men on the table, otherwise it won’t go anywhere. I will give you an example of what we have done recently in Niger Republic in West Africa, where we established what we called husbands’ schools. These brought together clerics, men who work in government, husbands in the community and community leaders. We went over the process by showing men what family planning does to women’s lives and how it saves women’s lives. It was a very good engagement. We ended up with the acceptance rate for family planning in that particular community going from 5 to 20 percent over a period of about three to four years. We also know that we need men to allow their wives to take family planning. We need fathers to allow their young daughters who might not be married to access family planning because this is something we have to address. If you have a young woman who you expect to go to university, finish university education and she is in her early twenties, sometimes older and you pretend she is not having sexual intercourse, you are wasting your time. It is possible that she could abstain but you have to assume that she is having. And if she is having you want her to be able to prevent pregnancies. Many of my African brothers don’t want to talk about it because they think we are spreading immorality. But the truth of the matter is that whether we talk about it or not it is happening. So it is best for us to confront it and to try and provide access based on choice. Let them have access so they can make choices themselves. Twenty-three per cent of adolescents in Tanzania get pregnant and you even have a law in this country that prevents girls who get pregnant from going back to school. Now why should we continue to deny women and girls the opportunity to reach that full potential when the young man who has caused the havoc goes on and on and then reaches his own full potential? He can stay in university, he can become a professor there and nothing happens to him, whereas these young ladies who in many circumstances are brighter than the boys, their prospects die there because of that small mistake they made. I don’t think it’s fair.