Presentations from the 17 th Joint Annual Health Sector Review Technical Review Meeting

Presentations from the 17 th Joint Annual Health Sector Review Technical Review Meeting Karimjee Hall 3. & 4. November 2016 Volume II

THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN Overall strategic objective To reach all households with essential, quality health and social welfare services, meeting, as much as possible, the expectations of the population, adhering to objective quality standards, and applying evidence-informed interventions through efficient channels of service delivery. MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN Five specific objectives Five specific objectives Objective 1 Objective 2 The health and social services sector will achieve objectively measurable quality improvement of primary health care services, delivering a package of essential services in communities and health facilities. The health and social welfare sector will improve equitable access to services in the country by focusing on geographic areas with higher disease burdens and by focusing on vulnerable groups in the population with higher risks. Objective 4 Objective 5 The health and social welfare sector will achieve a higher rate of return on investment by applying modern management methods and engaging in innovative partnerships. To address the social determinants of health, the health and social welfare sector will collaborate with other sectors, and advocate for the inclusion of health promoting and health protecting measures in other sectors policies and strategies. Objective 3 The health and social welfare sector will achieve active community partnership through intensified interactions with the population for improvement of health and social wellbeing Strategic Directions 22 Strategic Directions guiding Operationalization in place MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN HSSP IV and SWAp HSSP IV and SWAp SWAp - an instruments for organizing sector dialogue Involving all sector partners Around strategic issues & policy directions Aiming to Create Medium term Collaborative Programme of Work (Strategic Plan) around Sectoral policies,strategies and Directions. Beginning with Technical Analysis Ultimately leading to Projections of Resource availability and expenditure plans. Concerned with Establishment of Efficient and Effective management systems by GOT and DPs resulting to Common Management Arrangement. MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN 1

Policy Level Technical Level Implementation Level 08/11/2016 Joint Annual Health Sector Review Timeline for the JAHSR Dialogue structures Input to the review Analysis and discussion Implementation Minister MOHCDGEC; Minister PO RALG; Ministry of Finance-PS, Presidence Office Public Service Management-PS; MOCDGEC-PSH, CMO, Directors; PORALG-Deputy PSH, Director HS; DPG- Health Troika; WHO, Private Sector; FBO, CSO, NGOs MOHCDGEC-PSH, CMO, TWG Chairs, PORALG-DPSH, DDHS; MOF; DPG- Health Troika; WHO; Private Sector; FBO; CSO; NGOs Health Sector Working Group Health Sector Technical Committee Annual National Policy Dialogue Linkages with Development Cooperation Framework High Level Dialogue & Cluster Working Group II Quality of Life and Social Well Being; other health related for a TNCM, GBS etc Health Basket Finance Committee Joint Field Visits DMO/RMOs conference Technical Review Policy Meeting Implementation and preparation for next years JAHSR MOHCDGEC-Assistant directors, Heads/Coordinators, Programme Officers; PO RALG DHS Assistant Directors, Officers; MOF; DP- Programme Officers; Private Sector; FBO; CSO; NGOs; others as appropriate TWG1, TWG2, TWG3,.11TWGs DPG-Health/AIDS/Social Protection, PPHF-Executive Board, Policy Forum etc October October November November December RHMT Core members; RHMT Co-opted members; RR HMT & co-opted members -Regional Technical Committee -Regional Hospital Advisory Committee Joint District Review -More input from district/facility/comm unity level CHMT core members; CHMT co-opted -Council Health Services Board Social Services Committee, members; HF in-charge; community -Council Technical Committee Village/ward Development representatives -Health Facility Governing Committee Committee MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN Participatory technical working groups Progress 11 Participatory TWGs-One New 27 Health SWAp members represented TOR in place for 11/11 Strategic Directions addressed in 11/11 Carried Over Interventions accommodated 10/11 Plans of Action and Milestones 8/11 MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN HSSP IV annual progress monitoring Asante sana! MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN 2

11/8/2016 Presentation Layout THE UNITED REPUBLIC OF TANZANIA Joint Annual Health Sector Technical Review Meeting 2016 Annual Health Sector Performance Profile 3 rd - 4 th November, 2016 Karimjee Hall Status of Health Strategic Plan (HSSP III) and Millennium Development Goals (MDGs) indicators as of year 2015 Recommendations towards Health Sector Strategic Plan (HSSP IV) and Sustainable Development Goals (SDGs) M&E Policy and Planning Sources of Data used: HSSP III Indicators Triangulation Routine HMIS/DHIS2 database Data from periodic studies (DHS, SPA, SARA etc) Program data Management data: Annual Budget Speech National Census Population Projection: Health Sector Strategic Plan III (HSSP III) had three types of indicators Health Status Service Delivery Health Systems Population Indicator Achieved Child Mortality Progress Indicator Life expectancy (years) (F/M) Total fertility rate of women 15-49 years Baseline 2009 52/51 (51.5) Target 2015 Results 2015 62/59 63.8/59.8 (61.8) 5.7 Trend 5.2 Status - Indication of positive change of wellbeing of the population Indicator Neonatal mortality rate (per 1,000 live births) Infant mortality rate (per 1,000 livebirths) Under-five mortality rate (per 1,000 live birth) Baselin e 2009 Target 2015 Results 2015 32 19 25 58 50 43 94 79 67 Status Put more efforts on Neonatal health and sustain the achieved indicators 1

HIV Prevalence (%) 11/8/2016 160 140 120 100 80 60 40 20 0 Childhood Survival 2000-2015 99 68 Childhood Mortalities(per 1,000 live births) 51 43 53 47 InfantMortality Child Mortality Underfive Mortality 32 25 1999 2004/05 2010 2015/16 Generally significant changes in the indicators 147 112 81 67 Indicator Nutrition status Proportion of under-fives severely underweight (weight for age) Proportion of under-fives severely stunted (height for age) Proportion of children under 5 receiving vitamin A twice per year Baseli ne 2009 Target 2015 3.7% 2% 3% 38% 20% 34% 95% 80% 73% Progress Results Achive 2015 ment Progress has been done but targets were not achieved: Maternal Mortality Ratio (MMR) Indicator Baseline 2009 Target 2015 Maternal Mortality Ratio (per 100,000 live births) MMR 578 265 Results 2015 Achieveme nts 432 Census 2012 (401 WHO 2015) Reduction of the MMR is insufficient Not Achieved 700 600 500 400 300 200 100 0 Maternal Mortality Trend 2000-2015 529 578 454 432 1996 TDHS 2005 TDHS 2010 TDHS 2012 CENSUS 401 265 2015 WHO 2015 HSSP III Target Maternal mortality declining but at al very low pace as compared to set target Indicator HIV AIDS Baseline 2009 Target 2015 Achieved Results 2015 HIV Prevalence Among pregnant women aged 15-24 6.7% 5% 3.9% HIV Prevalence Among 15-24 year 6.1% 5% old population male and female 2% Percentage of HIV positive women receiving ARVs to 34% 80% 90% prevent MTCT Number of persons with advanced 135,696 440,000 HIV infection receiving ARV Year 2010 839,574 combination treatment Achieved according to the set target Achieve ment % National Trends in HIV prevalence General population. 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 7.0 5.8 5.3 2003/04 2007/08 2011/12 Survey Year HIV prevalence show significant decrease in the general population 2

11/8/2016 Baseline Indicator 2009 Proportion of children under one vaccinated against measles Proportion of children under one vaccinated 3 times against DPT Hb3 Proportion of women receiving at least 2nd doses of TT vaccination Vaccination Target 2015 Results 2015 92% 85% 92% 91% 85% 93% 85% 85% 88% Achived Achievem ent Tanzania is among the Best performing country in Africa on Child Vaccinations % Trend age 12 23 Months Received all Vaccines Service delivery Progress 35 30 25 20 15 10 29.5 OPD diagnosis for Under Five Old year 20.7 2015 8.1 7.7 7.6 OPD diagnosis five years and above Old year 2015 5 3.8 2.9 2.6 1.6 1.6 0 Indicator Baseline 2009 Target 2015 Results Achiveme 2015 nt Out patient attendance per capita 0.68 0.80 0.66 Top Ten Causes of Death <5 years old Year 2015 Top Ten Causes of Death for 5 Years and Above Year 2015 Malaria is still the leading cause in OPD and Cause of death in IPD. NCD and Head injury are coming up Indicator RMNCH Proportion of pregnant women start ANC before 16 weeks of gestation age Proportion of pregnant women attending ANC al least 4 times during pregnancy Proportion of births attended by trained personnel in health facility Baseline 2009 Target 2015 14% Trend Achiv Results emen 2015 t 13.6% (12wks) 64% 80% 51% 51% 80% 64% Contraceptive prevalence rate 20% 30% 32% Percentage of 1) health centres and 2) dispensaries that can provide EmOC as defined in EHP Dip BEmOC - 0 H/C CEmOC - 0 Hosp CEmOC 64 Not acheaved 40% 40% 100% 13% 12% 59% 120 100 80 60 40 20 0 Trend of delivery care Years 2000 to 2015 93 96 98 ANC by a skilled provider 60 47 50 46 Birth occurred in a health facility TDHS 2004/05 TDHS 2010 TDHS 2015/16 46 64 Birth attended by a skilled provider 3

11/8/2016 60 50 40 30 20 10 0 Family Planning Contraceptive Services 24 22 22 Unmet need 20 27 32 Modern contraceptive use 46 46 53 Demand satisfied with modern methods TDHS 2004/05 TDHS 2010 TDHS 2015/16 Malaria Baseline Impact Indicator 1 2009 Proportion of mothers who received two doses of preventive intermittent treatment for malaria during last pregnancy (IPT2+) Proportion of vulnerable groups (pregnant women 15-49 yrs of age, children under 5) sleeping under an ITN the previous night Target 2015 IPT2 30% 80% 35.2% <5yrs -26% PW - 26% Proportion of laboratory confirmed malaria cases among all <5 = 51 OPD visits (disaggregated under 5 >5 = 59 and over 5) Prevalence of Malaria parasitaemia (under 5 years) 60% <5 = 80 >5 = 80 Progress Results 2015 Achive ment <5yrs = 54.5% PW = 54% <5 = 70 >5 = 73 18% 5% 14.8% Annual Malaria diagnosis in OPD of all health facilities by region 2015 Tuberculosis and Leprosy Achieved 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% malaria clinical_opd public malaria mrdt +ve_opd public malaria bs +ve_opd public Iringa, Manyara and Singida still had higher usage of Malaria Clinical diagnosis. DSM and Kagera used more Malaria BS while the rest had a big proportion use of MRDT Indicator TB Notification rate per 100,000 population Percent of Treatment success/completion Proportion of Leprosy cases diagnosed and successfully completed treatment Baseline Target Results 2015Achive 2009 2015 ment 163/100,0139/100, 125/100000 (New guidelines) 00 000 84.7% 90% 90% PB = 97% MB=91.7 % This area is well done? 97% 95% Infectious and Non-communicable diseases Not achieve d Cholera Incidence by Region year 2015 Indicator Incidence of cholera Proportion of treated cases of cholera who died Proportion of adult with high blood pressure Baseline 2009 3,284 (2005) Target 2015 Reduced by25% Results 2015 11,667 3% <1% 1.6% 37% Reduced by 25% 30.7% Achivem ent Total National Cholera cases 11,667. Cause of death due to Cholera 174 4

11/8/2016 Health Financing Not achieved Humann Ressources Not achieved Indicator Propotional of Government budget allocated to health sector Total GoT and donor (budget and off-budget) allocation to health per capita Proportion of population enrolled in CHF Baselin e 2009 Target 2015 Results 2015 12% 15% 10.1% Tsh. 13,193 Tsh. 52,800 Tsh. (MKUKUTA) 38,093 9% 30% 18% Achiv ement Indicator Skilled Health Staff per 10,000 population Medical Officers and Assistant Medical Officers per 10,000 population (by region) Nurse-Midwives per 10,000 population (by region) Pharmacists and pharmacy technicians per 10,000 population (by region) Health Officers per 10,000 population (by region) Laboratory staff per 10,000 population (by region) Number of training institutions with full NACTE accreditation Baseline 2009 Target 2015 6.7 23 WHO 9.3 0.7? 0.81 2.6? 6.30 0.15? 0.2 0.23? 0.49 0.27? 0.79 1 116 81 Results Achive 2015 ment Availability of Medicines Progress Public Health Facilities with Entire Package of tracer Medicines (10/10) through out the year 2015 by region Baseli Indicator ne 2009 Percentage of public health facilities with any stock outs of 5 tracer medicines and 1 vaccine and medical devices and supplies (representing laboratory, theatre, ward and clinic) Target 2015 20% 80% 45% Resul Achivem ts ent 2015 Indicator Overall Performance Baseline 2009 Target 2015 Achieved 16 37% Progress 12 28% Not achieved 15 35% Overall Performance 43 100% Rank 65% Top regions Kigoma 18 Upper middle Lower middle Lower Kagera 17 Mwanza 16 Simiyu 21b Geita 16b Shinynga 21 Katavi 19b Rukwa 19 Tabora 20 Mbeya 10 Mara 9 Singida 12 Njombe 2b Arusha 14 Dodom 11 Iringa 2 Manyara 13 Morgoro 7 Ruvuma 4 Kilimanja ro 1 Regional Ranking on Health System Strengthening 2012 Tanga 6 Pwani 5 Lindi 3 Mtwara 15 DSM 8 Western part of the country indicated to be left behind as compared to Eastern part 5

11/8/2016 Understaffing regions (BRN - HRH 2014) Kagera Mara Mwanza Arusha Simiyu Geita Kilimanjar Shinynga o Kigoma Manyara Tanga Tabora Singida Dodom Katavi Pwani Rukwa Iringa Morgoro Mbeya DSM Health Basket Fund (HBF) Performance Indicators Measured at Regional Reporting Year 2015 90 80 77 78 75 69 70 70 71 71 72 73 70 70 66 67 65 63 63 60 59 60 61 61 62 59 60 61 61 61 61 59 60 57 55 56 56 57 57 54 55 55 54 54 54 54 52 49 49 50 47 48 50 44 45 43 41 40 30 20 10 0 Njombe Lindi Selected regions for BRN- HRH Ruvuma Mtwara Western part is critical under staffed as compared to other parties of the country Target Y1; 2015/16 Achievement Regions of the western part are poorly performing than the rest 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Mainland Tanzania Star Rating in Twenty Regions 2015 /16 All Facility Types, N=5326 0-Star 1-Star 2-Star 3-Star+ On Average Average 0 Star was 36%, 1 Star was 52%, 2 Star was 11% and 3+ Star was 1%. 1.0% 11.0% 52.0% 36.0% Future Plan Conduct Analytical Evaluation of the HSSP III and MDGs Focus on Monitoring and Evaluation of the HSSP IV and SDGs Strengthen use of DHIS web portal (score cards) to support councils to improve performances Introduce Data Quality Assessment (DQA) tools to regions and councils Regions from the Western part are poorly performing Thanks 6

Reproductive & Child Health Malaria, HIV/AIDS, TB & Other infectious diseases Noncommunicable Diseases & Injuries Health System Policies Health Financing Health Workforce Health Service Delivery i.e. Facilities & Commodities Outline of Presentation Steps and BRN Methodology Healthcare National Key Result Areas (NKRA) Goals Priorities and Specific Initiatives: HRH Distribution, Health Facilities, Health Commodities and RMNCH National Key Result Area (NKRA),Ministry of Health, Community Development, Gender, Elderly and Children Initial Findings Anticipated Implementation Challenges and Expectations BRN Delivery System setup within the Government of Tanzania 2016 1 The Big Results Now (BRN) Methodology 1. Prioritise Initiatives that are catalytic, high impact, easily replicable Healthcare NKRA focuses on 2 sub-sector of Health system under HSSP III & a special focus on RMNCH Mortality & Morbidity HSSP III Health System 2. Rigorous Implementation and Monitoring Rigorous monitoring Weekly reports, monthly reports Proactive problem solving PSM, SC and IMTC Special Focus 20% of Effort 3. Accountability Minister Scorecard Annual Report 80% of results NKRAs - High impact areas. - Continuous prioritization. - Combination of high impact initiatives and easy quick wins. - Identify catalytic programmes that have high spillover effects. - Easily replicable and scalable. 2 Gov Structure SOURCE : BRN Healthcare Lab (2014) Governance, Community and Civil Societies, Organizations & Private Sectors 3 The focus areas of BRN Healthcare NKRA and the initiatives aims to achieve 4 broad outcomes for quick transformation Human Resource for 6 initiatives Health (HRH) 100% balanced 80% of primary distribution of skilled health facilities to health workers at primary be rated 3 Stars and level above HEALTH COMMODITIES 4 initiatives Health facilities BRN Healthcare Health commodities 6 initiatives 20% reduction in maternal mortality ratio and neonatal mortality rate in 5 regions 6 initiatives RMNCH 100% stock availability of essential medicines 4 5

6 Health Commodities : Initiatives focused on interventions on 5 key bottlenecks which affect proper governance of the health commodities supply chain External Factors Supply Chain Key Actors Financing Management of donated medicines Significant growth in the last 7 years, overloading the supply chain capacity Procurement MOH MSD DPs NGOs Governance Distribution Private sector Pilferages Loss of commodities due to pilferage & theft PO-RALG Inventory Management LGAs Health Facilities Health Commodities : 100% stock availability of essential medicines Improving governance, accountability 1 and sense of ownership of Health Commodities supply chain Rollout of Commodity Management Toolkit was completed in 10 districts. ( Serengeti, Busega, Chato, Kwimba, Kigoma and Muleba districts) Pilferage tool is developed ready for dissemination Donation guideline approved & to be disseminated 3 Strengthen management of MSD working capital Government strategic review of MSD is in progress to see how best MSD can be strengthened The dialogue for MOU among MOHSW (vertical program actors), MSD and MOF is on progress To complement MSD in the procurement & distribution of medicines by engaging private sector 2 Internal Factors Funding Inadequate funding & continued erosion of funds due to nonpayment Planning & coordination Poor planning & coordination between the key actors to fund & monitor Tracking of commodities Lack of proper mechanism & tools to track end-to-end supply chain Rollout of Commodity Management Toolkit was completed in 10 districts. Tender evaluation and Board for Private Distributors of health commodities was completed by July. MSD is in process to conducing feasibility study on local manufacturing Plant under PPP 7 Health Commodities : 100% stock availability of essential medicines 4 Introduction of ICT mobile applications platform at lower level facilities Assessment of health facilities readiness to implement e-lmis done in 6 districts (Serengeti, Busega, Chato, Kwimba, Kigoma and Muleba districts). Roll-out of elmis at district hospitals completed in 17 regions. ICT unit is working on analysis and further rollout. 5 Use of SMS to report stock outs and quality of health services by service users and civil society ICT development is on going. Development of SMS platform pending funding from Global Fund HUMAN RESOURCE FOR HEALTH 6 Scale up 5S-KAIZEN-Total quality Management (TQM) initiatives to improve inventory management from district level to lower health facilities level 5S -KAIZEN-TQM for health commodities manual and facilitators guide developed. Taught all district councils in Mwanza, Geita, Kigoma and Mara Training Manual and facilitator's guide Completed and printed in English and Swahili 8 9 9 HRH Distribution : By prioritizing underserved regions, the initiatives aims to achieve 100% equitable distribution of skilled health workers at primary level 13 Regions 15 Regions 14 Regions 0 Regions Lake Victoria 2014 Kagera Mara 2018 BELOW National Average for Density of Skilled HRH per 10,000 population BELOW National Average for Density of Clinicians per 10,000 population BELOW National Average for Density of Nurses per 10,000 population ACHIEVE WHO Skilled attendance at birth 22.8 per 10,000 population Kigoma Geita Katavi Rukwa Mwanza Shinyanga Tabora Mbeya Simiyu Singida Njombe Arusha Dodoma Iringa Ruvuma Manyara Kilimanjaro Morogoro Tanga Lindi Pwani Mtwara Dar Es Salaam Regions critically below 2014 s national average of clinicians and nurses density Regions at borderline of 2014 s national average for clinicians and nurses density Regions above 2014 s national average for clinicians and nurses density ALLRegions At / Above 2014 National Average for Density of Skilled HRH per 10,000 population 9 regions 4 regions 12 regions 10 HRH Distribution : The initiatives aims to achieve 100% equitable distribution of skilled health workers at primary level by improving HRM for the Health Sector in Tanzania Supply Distribution Forecasting and Planning Retention 1 Initiative 4 Enabler 2 Initiative Prioritise allocation of Optimising the pool employment permits Providing Skilled HRH of new recruits to areas of critical personnel via Public skilled HRH shortage (Bonding and Private Partnership Compulsory (PPP) 3 Attachments) Initiative 5 6 Redistribution of Enabler Enabler skilled HRH within the Empowering the Synchronising the regions LGAs in the recruitment process at recruitment and the Central level retention of HRH TARGET (Direct Postings, Awareness of Job Opportunities and Employment) (Incentive Policy, Orientation & Induction, Coaching & Mentoring, Subsistence Allowances) All Regions at/above 7.74 for Density of Skilled HRH per 10,000 population by 2017/18 11

12 Katavi Simiyu Tabora Geita Kigoma Rukwa Shinyanga Kagera Singida Mara Mtwara Mwanza Dodoma Tanga Ruvuma Manyara Lindi Morogoro Arusha Mbeya Dar Es Salaam Pwani Iringa Njombe Kilimanjaro HRH Distribution : 100% balanced distribution of skilled health workers at primary level Prioritize application of employment permits to regions with critical shortage of skilled HRH 1 Analysis of Postings done in FY 2014/15 2 HRH Analysis for 2015/16 and 2016/17 Total No % Posted staff 9,735 100% Conducting analysis on funded Post received from POPSM for FY 2015/16 is done Determine the HRH needs for FY 2016/17 Reported, out of which : 8,312 85% 3 Provide HRH through PPP Reported and available 7,730 93% Reported and left 582 7% Not reported at all 1,423 15% Conducting Pre feasibility Study in collaboration with PharmAcess on PPP model to be used under HRH Initiative. The work was expected to start in 2016 Revision of Service Level Agreement 13 Achieving the health-related MDGs. It takes a workforce! Only 5 of the 49 countries categorized as low-income economies by the World Bank meet the minimum threshold of 23 doctors, nurses and midwives per 10 000 population that was established by WHO as necessary to deliver essential maternal and child health services. These 49 countries have been prioritized by the UN Global Strategy for Women's and Children's Health. Countries that fall below this threshold struggle to provide skilled care at birth to significant numbers of pregnant women, as well as emergency and specialized services for newborn and young children. This has direct consequences on the numbers of deaths of women and children. 14 20.00 18.00 16.00 14.00 12.00 10.00 8.00 6.00 4.00 2.00 - Density of Clinician and Nurses per 10,000 Population After 2014/15 Posting 9.3 2015 Nurses 2015 Clinicians 2014 Nurses 2014 Clinicians National Average Density of Skilled HRH per 10,000 population increased from 7.74 to 9.3 per 10K population On average, 4 regions improved from below National average to above national average (Katavi, Kagera, Mtwara & Mwanza) 3 regions became worse from above to below baseline National average of 7.74 (Manyara, Lindi & Mbeya) Before Regions critically below 2014 s National average of clinicians and nurses density 9 10 Regions at borderline of 2014 s National average for clinicians and nurses density 4 1 Regions above 2014 s national National for clinicians and nurses density 12 14 7.74 After 15 Estimate Density of Clinician and Nurses per 10,000 Population after FY2015/16 Posting National Average Density of Skilled HRH per 10,000 population increased from 9.03 to 10.19 per 10K population 5 regions improved from below to above national average (Rukwa, Lindi, Mara, Dodoma, Singida) 7 regions remain below baseline National average of 7.74 (Simiyu, Kigoma, Tabora, Manyara, Shinyanga Mbeya, Geita) Before Regions critically below 2014 s National average of clinicians and nurses density 10 6 Regions at borderline of 2014 s National average for clinicians and nurses density 1 1 Regions above 2014 s national National for clinicians and nurses density 14 18 After HRH Distribution : 100% balanced distribution of skilled health workers at primary level 4 Trained 40 National TOT for WISN Develop National Workload Standard to be used Ruvuma, Mwanza, Mara, Iringa, Dodoma and Tanga,. Data have been collected and applied into WISN tool and reports are in place for guiding HRH distribution. 6 Redistribution of health workers Enforcing retention & incentive policy at LGA Requested POPSM Implementation Guideline on Pay and Incentive policy (2010) for the 29 LGA s Team was supposed to work of the guide from POSPM and develop a guide for LGA s 5 Ring Fencing subsistence Allowance - Discussions were held with Mr Charles A. Mwamaja from Government Budget Management Division - MOF on Ring Fencing DPP to develop a proposal for ring fencing of Subsistence allowance of newly recruited HCW for FY 2016/17 7 Ring Fencing of Subsistence Allowances Reinforce Orientations and induction for newly hired staff PMORALG issued a reminder note to LGA s to plan and budget for orientation and induction of new staff A total of 4400 National Orientation Package documents are printed to be distributed to all LGA s 16 17

18 HRH Distribution : 100% balanced distribution of skilled health workers at primary level 8 The review of modules was conducted in collaboration with BMAF ( As per BRN Document), members from LGA;s under the leadership of Director of human Resources development (DHRD) MOHCDGEC Conducting TOT Training and coaching and mentoring visits Conducting TOT Training and coaching and mentoring visits REPRODUCTIVE, MATERNAL AND CHILD HEALTH 19 RMNCH : 20% reduction in maternal mortality ratio and neonatal mortality in 5 BRN regions 1 Community Health Workers (CHW) Mapping of CHW for 5 RMNCH regions completed Review of CHW Training materials and guide completed Training to start in April 2016 2 360 Mass Media Campaign Mass Media Campaign has been done in 5 RMNCH regions, however, reports from the regions to MoHCDGEC are not sent as per BRN need What has been done RMNCH 1 EmONC assessment completed in 5 RMNCH regions Region Number of CEmOC Facilities Number of BEmOC Facilities Baseline Target Gap Baseline Target Gap Geita 2 12 10 13 56 43 Kigoma 4 23 19 9 100 91 Mara 3 22 19 25 113 88 Mwanza 7 34 27 13 123 110 Simiyu 1 14 13 4 61 57 Total 17 105 88 64 453 389 3 CEmONC & BEmONC Initiatives Baseline for CEmONC and BEmONC done Detailed implementation developed for Regional level Regional Satellite Blood bank facilities supporting CEmONC Construction and equipment delivery for the Blood Transfusion Services at regional level is completed at Mara and Kigoma. The centres are operating. Blood Collection Operation in Geita (519), Kigoma (6080), Mwanza (138), Simiyu (553), and Mara (5585) is ongoing, cumulatively 12,875 Units have been collected in Mara and Kigoma regions by June. 2 Community Health Workers (CHWs) Mapping was completed in Simiyu and Kigoma regions in July 2015, while the mapping for the other 3 regions of Mwanza, Mara and Geita was completed in Aug. Region Target for CHW Baseline of CHWs # of New CHW to be trained Geita 5,386 1,598 3,788 Kigoma 4,358 1,424 2,934 Mara 3,973 2,074 1,899 Mwanza 5,543 4,318 1,225 Simiyu 3,924 3,390 534 Total 23,184 12,804 10,475 20 21 RMNCH : Interventions are strategized to address three key delays, i.e seeking care, reaching care and receiving care Key interventions in addressing the 3 delays Initiative Engaging community through Community Health Worker, supported by mhealth/sms tools, aims to address Delay 1 and Delay 2 Initiative - (BEmONC & CEmONC) aims to address the Delay 3 at Health Facilities Delay 1: Recognition and decision to seek care Delay 2: Transport to care Delay 3: Receiving quality care Delay 2: Transport to care Delay 3: Receiving quality care PERFORMANCE MANAGEMENT OF HEALTH FACILITIES Transport Transport Pregnant Mother at home to care BEmONC Facility to care CEmONC Facility Enablers Strengthens the engagements both ways through Safe blood transfusion & mass media campaign through PPP Source: www.maternityworldwide.org, team analysis, CCBRT 22 23

24 Health Facilities : Performance Improvement of Primary Health Facilities is tackled by both specific and general intervention plans Health Facilities : 80% of primary health facilities to be rated 3 Stars and above Specific Intervention Plan Graded quality improvement General Intervention Plan Improve the financial management and allow facilities to manage their own funds Star Rating Assessment Financial Increased Incentives transparency and quality for clients Set expectation on the Improve health facilities services, manage complaints accountability to the and tie performance to communities targets and contracts 80% of primary health facilities to be rated 3 STARS and above by 2018 1 Star Rating Assessment Completed assessments in 12 BRN Regions by March 2016. That s a total of 25 regions have been assessed 6276 Primary Health Facilities from 24 regions except Arusha and Kilimanjaro have been assessed where 2263(36.06%) got no star, 3241(51.64%) got 1 star, 690(10.99%) got 2 stars, 77(1.23%) got 3 stars, 5(0.08%) got 4 stars and 0(0%) got 5 stars. 3 National Health Facilities User Satisfaction Level Scoring System The mechanism is in the process of being developed The system has been piloted in Mwanza Region in Nyamagana, Ilemela, Magu and Misungwi counsils The system and the tool is almost 80% developed 2 Opening of Accounts in lower Health Facilities A total of 2149 (34.24%) out of 6276 facilities have managed to open their bank accounts as per Government requirement. However, more that 90% of health facilities have commercial bank accounts More efforts are done to increase this number through PO RALG 4 Increase social accountability at the facility and community level Community Score Card have been rolled out in Pwani, Shinyanga, Mwanza, Geita and Simiyu regions. A total of 724 out of 1817 rural health facilities have been reached 25 Regions assessed so far Kagera Mwanza Mara Geita Shinyanga Simiyu Arusha Kilimanjaro Kigoma Manyara Tabora Tanga Singida Dodoma Katavi Dar Es Salaam Morogoro Iringa Pwani Rukwa Mbeya Njombe Lindi Ruvuma Mtwara 27 Plan to improve the health facilities Star Rating team had developed a specific indicators to be used for the tracking of the improvement at the Health Facilities by the facilities, councils and the region. The indicators and the tool has been communicated to all the facilities that has been assessed through Star Rating, and will be tracked by PO-RALG through the CHMT. Star rating is a performance indicator in the basket fund Through support from World Bank, regions not benefiting from Result Based Financing (RBF) initiatives, all facilities with zero staff in Dodoma, Singida, Kigoma and two districts of Tanga (Kilindi and Korogwe) regions have received Tsh. 10 Mill to improve their status by supporting implementation of QIP s Shinyanga and Mwanza regions have started implementing RBF to improve the QIPs 28 29

30 Star rating re assessment in Shinyanga region PRE POST REGION NUM OF HF 0-Star 1-Star 2-Star 3-Star+ 0-Star 40 3 22 12 3 1-Star 12 0 1 11 0 2-Star 0 0 0 0 0 3-Star+ 0 0 0 0 0 GOVERNANCE, HARMONISATION AND CHALLENGES TOTAL 52 3 23 23 3 31 Healthcare NKRA Governance Structure to support BRN Human Resources for Health DAHRM, MoHSW DHRD, MoHSW POPSM PO-RALG Implementers Health Commodities PSS, MoHSW DPP, MoHSW MSD PO-RALG Minister of HCDGEC M&E of Division of Policy and Planning Ministerial Delivery Unit (MDU) Project Owner MOHSW Health Facilities DHQA, MoHSW DCS, MoHSW DPP, MoHSW DAHRM, MoHSW PO-RALG PS RMNCH RCHS, MoHSW HEPS, MoHSW PO-RALG 32 The BRN initiatives intended to harmonise the implementation plans focusing at the most under-served regions KAGERA Lake Victoria Source(s): BRN Healthcare Lab 2014 MARA 55% MWANZA 50% 52% SIMIYU ARUSHA GEITA 47% KILIMANJARO 47% 57% SHINYANGA 66% 47% KIGOMA MANYARA 52% 53% TANGA TABORA SINGIDA 53% 60% DODOMA 58% KATAVI 59% DAR ES 57% SALAAM MOROGORO PWANI 71% IRINGA RUKWA 60% MBEYA 66% 67% 57% 59% Legend % Health MDG coverage index, 2010-2012 NJOMBE 66% RUVUMA 64% LINDI 66% MTWARA 63% Key: Regions with HRH distribution, Health Facilities, Commodities & RMNCH initiatives Regions with HRH distribution, Health Facilities & Commodities initiatives Regions with Health Facilities & Commodities initiatives * Baseline assessment to be done across all mainland regions 33 Anticipated challenges in implementation & mitigation measures Anticipated challenges Shortage of funds to implement all the initiatives Delayed disbursement to the Ministry, implementing agencies and to the LGAs Suggested mitigation measures Integrate budget into MTEF through government funding; identified funding gaps to be negotiated from the partners for respective LGAs To streamline the disbursement of funds at central level to LGA Thank You Buy-in from all stakeholders for smooth implementation Continuous communication and syndication with all levels of stakeholders to galvanize support for BRN 34 34 35

11/8/2016 Ministry of Health, Community Development, Gender, Elderly and Children & President s Office Regional Administration & Local Government CCHP- PlanRep4 harmonization with Epicor and DHIS Presented at the JOING ANNUAL HEALTH SECTOR REVIEW TRM 03-04 November, 2016 PO-RALG - HEALTH Presentations layout Introduction Process of developing CCHP Evolution of PlanRep Stage 1 HMIS Data for developing CCHP Evolution of PlanRep Stage 2 Evolution of PlanRep Stage 3 Evolution of PlanRep Stage 4 PlanRep-Epicor Integration Way forward Introduction Process of developing CCHP.. CCHP is a tool for delivering of quality healthcare services at the District/Council level The plan has to address the community needs and wants using data. The plan utilizes the scarce resources available efficiently to address cost effective interventions hence better quality of services to the population served reaching the household. HMIS Data for developing CCHP Use of HMIS/DHIS for Planning Linkage with the DHP Inadequate use of data at health facilities for planning and decision making. Health facility plan & CCHP is not addressing the recurring healthcare service delivery issues on the ground due to inadequacies in data management. Inadequate knowledge for data interpretation, analysis and use. Process The CCHP is prepared using the interpreted and analyzed data from HMIS/DHIS reports filled in the 14 tables in the PlanRep3 database system presenting the situational analysis of the district council ( District Health Profile report). Formulate the problem using the available data that you have analyzed at their level (CHMT/Hospital/ lower facility. Identify what causes the identified problems then set interventions linked to the problems Challenges Planning CCHPs& progress reports.. Data quality and reliability is still a problem in many councils - do not correspond with HMIS data - link DHIS2, HRIS, Lawson for POPSM and Epicor with the PlanRep- manual copy/transfer Complicated planning environment, particularly around resources NGOs, differ timing with GoT, cannot be reflected in Epicor not certain Reallocation was done to the Epicor- Financial Expenditure tool 1

11/8/2016 Recommendations JAHSR 2013/2014-2014/2015 Planning of CCHP Evolution of PlanRep Stage 1 MOHCDGEC, in collaboration with PORALG, to compile the suggestions for systems improvement from the LGAs and incorporate proposed suggestions to update PlanRep3 Micro (Health Sector), PlanRep3 Health Meso and PlanRep3 Health Macro and upcoming PlanRep4 web base. PlanRep4 to be web-based, and linkage with EPICOR and DHIS2 to be ensured (mutual export and import of data) Initiative to Develop PlanRep PORALG under LGRP took initiatives improve the situation by contracting UCC to develop PlanRep system. Desktop (not centralised) MS Access based system was developed at this stage Sharing of data between various levels of budgets has been through import-export featured built into the system where it was possible to enter data at cost centre levels and combined into department budget through import feature Benefits of PlanRep Stage 1 Various Plan and budget printouts to carter for different users and needs like budget summary, itemised budget printout, etc. Reduction of errors which were being introduced by the users when entering data by freely typing it in excel sheets Easy consolidation of departmental plans and budgets into one council file without introducing any further errors as this started to be done by the system itself Why PlanRep Stage 1 Having a tool which would roughly guide users/planners to have optimum allocation of scarce resources in their plans and thus having the Burden of disease graph and its related budget printouts were built into the system. The Ministry also required to have the physical implementation status or achievement obtained as a result of plans execution together with related budget/financial consumption as a result of budget execution. Benefits of PlanRep Stage2... WHY HARMIZATION OF THE SYSTEMS- DATA The BoD tool started to roughly guide the allocation of resources and it could be easily noticed in the plan whether or not funds were allocated into areas which have impact on the service to be delivered All the in-kind values and the funds which were sent straight to the council by some of the development partners without being recognised now feature in the council health plans. 2

11/8/2016 Benefits of PlanRep Stage 2... It became possible to have budget printouts by funders, priority areas and interventions. Challenges of PlanRep Stage 2... Together with such benefits there were challenges after this stage Technical, financial and combined Technical and Financial reports are now obtained from PlanRep. The main one being correctness/accuracy of the financial report obtained from PlanRep because in most cases the financial reports obtained from PlanRep differs from the one obtained from the counter financial system, Epicor. Challenges of evolution of PlanRep Stage 2... This is because Epicor is an accounting system for execution of budgets which are prepared using PlanRep but after entering the expenditure in Epicor, user manually re-enter the expenditure figures into PlanRep and hence introduction of the errors sometime un-intentionally and sometimes deliberately to just have reports balanced Challenges of evolution of PlanRep Stage 2... The process of having the financial reports into PlanRep could easily be done through the integration with Epicor and despite different initiatives taken to get the two systems communicate but nothing has materialised for more than five years now. The integration between Epicor and PlanRep could also see PlanRep provide budget figures and any other budget adjustments (supplementary budgets and budget reallocation) to Epicor without human intervention and hence improve accuracy and cohesion of data in Epicor and PlanRep through Chart of Accounts which is the basis of integration Problem: of PlanRep Stage 3 Benefits of evolution of PlanRep Stage 3 There was a need for having a way of measuring the planning and reporting performance of the councils before approval hence the introduction of assessment features for CCHP, Quarterly (technical and financial) and Quarterly (technical and financial) assessment. There was also a need for having sector plans to be consolidated at the region and national levels Council performance on CCHP, Quarterly (technical and financial) and Quarterly (technical and financial) reporting can now be obtained from PlanRep Introduction of Health PlanRep Meso, Health PlanRep Macro for health sector at regional and national levels. Introduction of Printout for compliance of the national policy of having distribution of health funds for medicines, medical supplies, equipment and laboratory reagents 3

11/8/2016 Challenges of PlanRep Stage 3... Current situation of PlanRep Stage 4 Inaccuracy of the financial part of the reports and sometimes even the budgets continues to be an area that needs special focus a solution to this is the integration of PlanRep and Epicor which has so far failed to materialise. Double entry of data which exists in other systems like DHIS, Epicor, Lawson/HRHIS, etc No control of ceilings as users enter ceilings for themselves There s a process underway of developing a centralised web based PlanRep which has been originated by the Ministry of Health in order to overcome the challenges faced by using the desktop version of the system Challenges of PlanRep Stage 4... Inconsistence of data available at the council, and national level and in Epicor as an accounting system, this is due to different instances of data at those different places Mismatch of the financial reports between PlanRep and Epicor Challenges of PlanRep Stage 4... Double entry of some of data which exists in other system and hence introduction of errors or mismatches Systems whose data is required by PlanRep for planning purposes (portraying the situation at the councils to the moment of planning) are HRHIS/Lawson, DHIS, elmis and HFR Systems whose data is required by PlanRep for reporting purposes are Epicor (finances) and DHIS (statistics) Percent of PHC facilities with 3 stars rating or higher Evolution of PlanRep Stage 4... Development Process of PlanRep Stage 4. Development Process: There were several unsuccessful calls (by the UCC to PORALG) for a need of having a centralised web based PlanRep which on the health sector side could solve most if not all of their planning, budgeting, control and monitoring challenges MoH adviced PORALG too without success, by advising to join forces so as to have the web based PlanRep developed MoH itself took initiative to start this huge and challenging exercise of developing the web based PlanRep Finally, MoH ( Basic Health Services) contracted UCC to do this assignment more than a year ago, according to the scope of the assignment the system mainly focused on health sector requirements but during the design of the system UCC took care of the possibility of having the other sectors accommodated in the future. 4

11/8/2016 Status of the Development of PlanRep Stage 4. Challenges of PlanRep Stage 4... System Development The development of the system itself is complete and it is about to be rolled out to the councils and giving initial training to the councils Systems Integration Integration with HFR and CTC3 databases is done Integration of PlanRep with DHIS is already underway Integration with Epicor is still not a success PlanRep-Epicor Integration - This area has not been implemented as a lot of efforts and initiatives have been taken for more than five years now without success and it is the same with the newly designed web based PlanRep - Meetings on the integration exercise started and exercise started gather pace whereby UCC as developers of the new PlanRep presented the integration data requirements and refinements were done following advice from SoftTech as vendors of Epicor Way forward of PlanRep Stage 4... Way forward of PlanRep Stage 4... The government under PORALG with the support of PS3 partners facilitates the exercise of incorporating requirements for the rest of the sectors into the newly developed web based PlanRep, this will see all other sectors coming on board and effectively use the system. The government using their authoritative organs need to intervene and make sure the integration of PlanRep and Epicor is achieved Funds should be set aside for adequate training to the users on the system usage Orientation workshops on PlanRep web-based to the LGAs is planned to take place this quarter. We need to go beyond the district where we have to have funds and service delivery to the health facilities. Systems for both financial and services will be captured and provide good results, QIPs, HBF scorecards, BRN scorecards be realised. Acknowledgement UCC for their patients and hard working to see this a success, unfortunately it has not been an easy way. SDC for the support to develop the Health PlanRep WHO support on training of RHMT on PlanRep and development PlanRep3 Health Meso World Bank through the Basic Health services programs Ahsanteni Kwa Kunisikiliza ICT section in MOHCDGEC with the District Health Services section ( MOHCDGEC and PO-RALG). 5

TECHNICAL REVIEW MEETING 03 rd NOVEMBER, 2016 NHA-tracks all health spending that flows in the country NHA tracks health fund From the source to the end user PER tracks all funds that passes through Exchequer system Tracks funds which are managed by the key implementers (MOH, PO RALG Tracks complementary fund Concept Overview Methodology General findings Use itemized report from MOH, LGA, Regions, and other ministries Collect data from, Donor NGO s, Employer, and Health Insurance Used NHA production tool for analysis Spending by specific diseases Recommendation 1

Total Health Expenditure (THE) has increased from TZS 3,417,002millions (USD2,199 Millions) in 2011/12 to 3,553,892millions (USD1,937 millions) 2014/15 Domestic Health Expenditure (GHE) out of Total Government Expenditure has increased from 5% 2011/12 to 7% in 2014/15 The role of central government in managing the funding has increased from 20.2% to 30.6% NGO s role has decreased from 28.4%-16.6% HH role is still significant at 25% LGA/regions role has remained at around 18% Out of pocket payments has marginally decrease though still high > need to establish effective pre payment schemes in context of overall HFS Role of LGAs in managing the fund has remained almost constant Spending in other disease conditions is increasing Donor financing is decreasing Also, role of NGOs in managing sector resources is still significant All stakeholders should work establish mechanism for improved monitoring of the operations and impact And harmonization of all funding to avoid duplication in one area(ngo s Coordination desk 2

Selected sub-analyses Complementary financing PER theme 2014/15 Recommendation 3

Availability and operation of Facility bank account How complementary fund are spent Accessibility of Complementary Funding 4

Sample was done by consider performance in complementary funding 34 district were analyzed 930 facilities were analyzed 94% had facility bank account 92% had operational bank account 60% are government account There is no uniformity in accessing complementary funding In almost all sampled district user fee and CHF are kept at the facility bank account NHIF reimbursement passes through district to health facilities bank account In average accessibility of matching funding ranges from 3 months to 6 months Most of the district are not aware on the difference between Government and Commercial bank account CHF administered by Donor funded project has increased enrollment and motivates health workers (Kilimanjaro, Mbeya, Mtwara and Dodoma) Some district have made self initiatives to increase enrollment (Singida DC, Mwanga, and Arusha DC) CHF services are offered up to district hospital in most of the districts. There is no common guideline for all complementary funds All partners are requested to disburse their budget commitment NHIF claims system needs to be modified before the implementation of strategy (Roll out e claims system) There should be one guideline for all Complementary funding 5

11/8/2016 MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN Outline Budget Preparation Process Budget Allocation - 2016/2017 VOTE: 52 BUDGET UPDATE AND IMPLEMENTATION OVERVIEW 2016/2017 Comparison on budgetary allocation - 2015/2016 & 2016/2017 Areas allocated with Development Funds - 2016/2017 Budget disbursement rates - 2015/2016 & 2016/2017 Directorate of Policy and Planning 1 Implementation Status Expectations 2 2016/2017-Budget preparation Process The Budget was prepared in accordance to the National Budget Guideline from MoF & P and informed by other relevant documents Budget scrutinization process Budget approval by the Parliament Budget Implementation 3 Budget Allocation - 2016/2017 Budget Category Allocated budget OC PE DEV Local 57.9bil 219.6bil 518.5bil TOTAL 796.1bil Key messages The Government has deliberately made the following changes The percentage of recurrent expenditure to the total budget has been reduced from 84% (2015/2016) to 46% in 2016/2017 The percentage of development expenditure to the total budget has increased from 16% (2015/2016) to 54% in 2016/2017 The funds allocated for Medical commodities has increased 8 times from 31bil (2015/2016) to 251.5bil (2016/2017), equivalent to 706% Comparison-Budgetary Allocation for 2015/2016 & 2016/2017 Budget Category 2015/2016 2016/2017 Recurrent: % of change Others Charges 103.7bil 57.9bil -44.1 Personnel Emoluments 236.3bil 219.6bil -7.1 Sub Total-Recurrent 40.09bil 277.6bil -18.4 Development: Local 66.02bil 320.1bil 384.9 Basket Fund 12.5bil 6.9bil -44.9 Other Foreign 362.05bil 191.45bil -47.1 Sub Total Foreign 374.6bil 198.37-47.0 Subtotal - Development 440.6bil 518.5bil 17.7 Grand Total 780.7bil 796.1bil 2.0 5 Some Areas Allocated with Development Funds-2016/2017 (Local &Foreign Funds) Item Procurement and distribution of medicine, Medical equipment, vaccines, & reagents Strengthening of Referral Hospital Counter Part Funding for joint project- Global fund support to TB, HIV/AIDS, Malaria and HSS interventions Implementation of interventions supported by Basket Fund Special hospitals, Zonal hospitals, National Hospital (MNH, MOI, Mirembe, Kibong oto, ORCI, MRH, BMC, KCMC, Mtwara) Budget (Tshs) 251.5billion 13.5 billion 10.6 billion 106.2 billion 6.9 billion 25.6 billion 1

11/8/2016 Disbursement Rates - 2015/2016 & 2016/2017 Budget Category October 2015 2015/16 2016/2017 % of total budget October 2016 % of total budget RECURRENT OC 38.8bil 24 13.2bil 23 DEVELOPMENT PE 89.6bil 26 53. 4bil 24 Sub-Total Recurrent 128.4bil 25 66. 6bil 24 Local 5.2bil 8 43. 8bil 14 Foreign -Basket Fund 1.85bil 14 2. 3bil 34 Foreign - Others 7. 6bil 2 5.8bil 3 Sub Total Foreign 9.45bil 2 8. 2bil 4 Sub-Total Development 7.6bil 2 31. 9bil 6 Grand Total 141.65bil 18 96. 2bil 12 Implementation Status Operational costs for the Ministry and Institutions under it (Including Health Training Institutions are met as planned Staff Salaries are paid accordingly Processes for procurement of Medicines, vaccines, medical equipment and reagents is going on Interventions with support from GF Program continue to be implemented HBF interventions are at the take off stage Expectation Both local (Government ) and Foreign funds will be disbursed as per approved Ministry s budget within the 2016/2017 Financial year timeframe All activities/projects will be implemented to completion as planned within the 2016/2017 Financial year timeframe THANK YOU For Your Attention 9 10 2

THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN Areas of Policy Commitments 1 PREVENTION and COMMUNTY HEALTH 2 EQUITY 3 HEALTH FINANCING AND PUBLIC FINANCIAL MANGEMENT 4 GOVERNANCE AND LEADERSHIP 5 HUMAN RESOURCES FOR HEALTH 6 COMMODITIES 7 MONITORING & EVALUATION and DATA MANAGEMENT 8 SERVICE DELIVERY MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN Status and way forward Prevention and Community Health Policy commitments were agreed in february 2016 8 months of implementation Some commitments should be carried forward to this years policy commitments MOHCDGEC together with PO-RALG and other core stakeholders, agree on the outstanding priority issues related to institutionalisation of the new Community Health Worker cadre by end of the first quarter 2016, through a dedicated high level Round Table meeting -Roundtable May 2016 -Outstanding Issues are Selection process, Curriculum, training time, deployment -TWG 2 to follow up -To be carried forward to next years policy commitments MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN Equity HF and PFM A comprehensive geographic mapping of external resources will be undertaken by the end of 2016 -Overview of partners at all levels is available - TWG1 to follow up -Assignment is huge - technical assistance might be needed -Next step is to develop ToR which will be presented and discussed in TWG1 Together with partners, make an evidence-based case for an increase in domestic financing of the Health Sector budget in the FY2016/17 budget cycle. Together with PORALG, establish simple planning, budgeting and financial reporting mechanisms for health facilities by end 2016 -Health Sector budget for the year 2016/2017(1,988bl) has increased as compare to 2015/16(1,821 bl). -Gap of Tshs.2,145 bl compare to the target set for implementing 2016/17 HSSP IV priorities(t.sh 4,113bl). -Health facility planning and reporting guideline revised, draft has been circulated for use by facilities for 2016/17 planning. MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN 1

HF and PFM Governance and Leadership Lead the establishment of a cross-ministerial Public Financial Management Technical Working Group with a view to improving the efficient use of available financial resources by end June 2016. -Cross Ministerial PFM Technical Working Group (4) has been established, among 11 TWG supporting operationalization of HSSP IV -Draft TOR available and shared. -Developing 2016/17 POA ongoing Together with PORALG and partners, endorse the SWAp Code of Conduct and finalise review of the Common Management Arrangements to include clear accountability framework for MOHCDGEC and PORALG, and to promote multi-sector collaboration by end of March 2016. -SWAp Code of Conduct reviewed and endorsed by health TC-SWAp in April 2016-26/27 Stakeholders have registered their Commitment by Signatures -HSSP IV Common Management Arrangements with 11 TWGs approved in May 2016 MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN Governance and Leadership Human Resources for Health Reach agreement with MOF on piloting of direct facility funding - both for Health Basket Fund as per 2015/16 Side Agreement, and for Results Based Financing (RBF) by end of March 2016 -Side Agreement 2015/2016 Basket Fund endorsed the move towards facility financing and -work has started with RBF region -Concept for Zonal approach ongoing MoHCDGEC together with PO-PSM and PORALG, take action by end March 2016 to implement amendments to policies and processes required to achieve HRH BRN targets -BRN HRH recruitment amendment proposal has been developed -Interministerial meeting recommended need oriented HRH requests (LGAs) and permits. MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN Human Resources for Health Commodities Finalise the national Continued Professional Development guidelines by end June 2016, for approval by the statutory regulatory bodies. -Orientation of Professional bodies on the CPD framework by the International Training and Educational Centre for Health (ITECH) and MOHCDGEC conducted. -NCPD-Guideline development planned for FY 2016/17 Together with PORALG, ensure that both existing and new resources for logistics/commodities are channelled towards agreed priority BRN initiatives within the 2016/17 plans and budgets at all levels -Analysis of 182 CCHPs of 2016/17 shows that councils channelled a reasonable budget to BRN identified priority areas including 27% for medicine, medical equipment and supplies -However on average HRH received 56%,MNCH 7.3%,Commodities 11.8% -Follow-up on implementation is planned quarterly. MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN 2

M&E and Data Management Service Delivery Finalise the Health M&E Strengthening Plan by end March 2016 Together with PORALG, disseminate findings of national assessments and relevant data to LGAs and other users in a timely manner, and in relevant, user-friendly formats to inform service planning and decision-making -M&E Strengthening plan finalised March 2016 -Relevant data on available National program resources to LGAs planning organised Sep 2015. Available fora - DMOs and RMOs meetings are used as information sharing for LGAs and regions. MOHCDGEC and PO-RALG will ensure that as findings of the Star-Rating Assessment of all primary health facilities become available, they are translated into facility-specific quality improvement interventions captured within the facility plan and CCHPs, for follow-up through supportive supervision, by June 2016 -Findings of Primary Facility Star rating are immediately discussed on site with Facility Management Teams and draft Facility-quality improvement plans developed MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN Service Delivery MOHCDGEC will revise the supervision guidelines to separate inspection and supervision functions, and to effect a move away from the current checklist approach towards a harmonised joint (MOHCDGEC & PO LARG) mentoring and coaching model, by end December 2016 -A draft of the revised supervision guidelines is in place -To be finalised in December 2016 Asante sana! MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN 3

APHFTA For Quality Healthcare SUMMARY OF 2015/2016 REPORT Promoting and Sustaining Quality Healthcare in Tanzania Through the Private Sector 2015/2016 Report Joint Annual Health Sector Review 2016 Technical Review Meeting Samwel Ogillo CEO, APHFTA APHFTA SDP IV & Institutional Reorganization Expansion of Quality improvement programs to 25 Regions Expansion of AMiF services to 5 Regions with loans to 308 healthcare facilities worth TZS 2.2 Billion Expansion of NCD School program to 200 schools and to more than 150 healthcare facilities Supporting PPPs and SLAs APHFTA & PSI Maternal and Child Healthcare Services Malaria Innovative Approaches with PPP component Establishment of APDRI Dar es Salaam 1 2 APHFTA s Strategic Development Plan IV 2016-2020 APHFTA is currently implementing its Fourth Strategic development plan - In line with HSSP IV and SDGs Vision: - A strong private health sector delivering sustainable high quality health care services Mission: - To promote quality health care services through the private health sector in Tanzania and beyond 3 PRIVATE HEALTH SECTOR FOR QUALITY HEALTH CARE APHFTA MEMBERSHIP 10% Up Currently >800 Registered Member Facilities Eligible Members: *Clinics * Pharmacies *Dispensaries * Laboratories *Health Centers * Imaging Centers *Diagnostic Centers *Maternity & Nursing Homes *Hospitals * Physiotherapy Centers *ADDOs and others 4 APHFTA s Strategic Development Plan 2016-2020 Strategic Objectives: 1. To improve human resources for health in the private health sector 2. To support the delivery of public health goods and services 3. To sustain improve and sustain quality of health care in the private health facilities 4. To strengthen and sustain private health sector s influence in the district Regional and National level 5. To imbed use of ICT in the private health sector 6. To reorganize and sustain APHFTA 5 APHFTA s Strategic Development Plan 2016-2020 Objective 1- To improve human resources for health in the private health sector Africa Healthcare Professional Development and Research Institute (APDRI) now Registered Strengthen Association of Private Health Colleges in Tanzania (APHECOT) Assessment and monitoring of the private health sector human capital for health Motivation and Retention of HRH in the private health sector 6 1

APHFTA s Strategic Development Plan 2016-2020 Objective 2 - To support the delivery of public health goods and services Continue to collaborate with National Disease Control Programs at local and central government levels NCDS, Malaria, HIV/AIDS and TB RCH Services (MNCH, FP, HBB) APHFTA s Strategic Development Plan 2016-2020 Objective 3 To improve and sustain quality of health care in the private health facilities Enhance Quality of health care services in the private health facilities Improve supportive supervision Create awareness on health services stakeholders rights (Patient and provider) New health programs with focus on SDGs 7 8 APHFTA s Strategic Development Plan 2016-2020 Objective 4 - To strengthen and sustain private health sector s influence in the district Regional and National level Public Private Partnerships strengthened at all levels Formalize PPPs in the delivery of Public Health Goods (SLAs) Identify and promote health PPPs opportunities APHFTA s Strategic Development Plan 2016-2020 Objective 5 -To imbed use of ICT in the private health sector Promote use of ICT in the private health sector to improve quality of heath care services Improve access to ICT hardware and software (through affordable financing) Build capacity of APHFTA ICT unit 9 10 APHFTA s Strategic Development Plan 2016-2020 Objective 6 To Reorganize and Sustain APHFTA Establish APHFTA Foundation What APHFTA requires to achieve the IV SDP 1. Strong leadership and Governance in Place 1. Supportive government Policies In Place Establish APHFTA Investment wing - AFYA Micro Finance -Africa Healthcare Professional Development and Research Institute (APDRI) Strengthen APHFTA NGO - Membership Growth - Strengthen Leadership - Strengthen Secretariat Functions 11 1. Skilled and adequate Human Capital In place 1. Financing: - Social Health investors - Result Based financing - Low interest long term loans - Equity financing - Grants 12 2

Public Private Health Forum Public Private Health Forum A strong Entry point to meaningful and effective PPPs To be a resource center for health PPPs Needs Support Partners already contributing from own funds, and DANIDA providing technical support Housed by the TPHA Needs support 13 PPHF- brings together health care actors from the public and private sectors for policy dialogue and collaboration. Sensitize government officials and private sector stakeholders to the benefits of and mechanisms for implementing PPPs Familiarize stakeholders with the relevant policies and regulatory frameworks for PPPs Empower local stakeholders to innovate on traditional PPP models Elect an executive committee and define next steps for carrying forward PPHF activities 14 Service Level Agreements - Are important step towards meaningful PPPs that are results based - Can start with no financial transactions - Accountability and efficiency in the delivery of public health goods - APHFTA and PSIs are using a model that is aiming at responding to the hereto existing audit queries from the relevant offices Signing Service Level Agreements 15 16 Emerging lessons from the PPHF efforts Benefits for the Health System More men, women, and children will have increased access to quality health services Allow Government to use limited resources more cost-effectively Create competitive forces in the health market, to improve quality and efficiency Position the Government as the Steward of the health system of Tanzania, esp. under health financing mechanisms such as RBF and SNHI Opportunities There is political commitment from key stakeholders within government and civil society Key groups such as the MOHCDGEC and APHFTA are spearheading change and collaboration Challenges There is still misinformation and pockets of resistance to working with the private sector Key institutions in the public and private sectors are understaffed and under-resourced Afya Micro Finance- Innovative Financing Reaching the rural poor Ensuring Every one is served and benefits Sustainable way to Promotes public health goods and ensure they are always available Can be adopted to multiple healthcare programs Ensures funding, medicines and commodities are always available at affordable prices Ensures ADDOs sustainability 18 3

KARIBU! The Private Health Sector Healthcare For Quality 19 20 4

11/8/2016 INTRODUCTION Christian Social Services Commission JAHSTRM MEETING Engagement and Contributions of Faith Based Organizations Peter Maduki Executive Director Christian Social Services Commission Dare es Salaam, November 2016 CSSC Overview Established in 1992 jointly by the Christian Council of Tanzania (CCT) and the Tanzania Episcopal Conference (TEC). Mandated to chart out a common action, within the policies and the laws of URT, aimed at expansion, improvement and development of the provision of the health and education services Vision: An enlightened and well educated community that is enjoying quality life and is free from diseases of poverty. Mission: CSSC strives to support delivery of social services by church institutions in Tanzania through collaboration and partnership, advocacy, lobbying, capacity building and selected interventions, with the compassion and love of Christ. www.cssc.or.tz www.cssc.or.tz 2 INTRODUCTION Cont.. CSSC Overview Main Objectives Contribute to the physical, mental, social and spiritual development of the Tanzania people through facilitation the provision of quality social services to all the people regardless of color, race, creed To foster promotion, improvement and expansion of Education, Health and other social services all over Tanzania. KEY FUNCTIONS OF CSSC Participate effectively in the formulation/review of national and church Policies and legal frameworks and strategies for improving accessibility and quality of the Education and Health services. Provide essential technical support to Church institutions providing health and education services Develop and implement programme interventions or joint actions Administer, manage and monitor the use of finances borrowed, granted, generated or allocated through the commission to support facilities. Enhance planning, financing, coordination, expansion and quality social services in Health and Education sectors. Provide technical services in Education and Health sectors. www.cssc.or.tz 3 4 CSSC ZONES AND OFFICES PERFORMANCE UPDATES Lake Zone Western Zone Northern Zone Southern Zone Eastern Zone Lake Zone: Shinyanga Mwanza, Simiyu, Geita, Mara,Kagera Northern Zone: Arusha,K njaro,manyara Eastern Zone:Dodoma, Morogoro, Tanga, Dar, Z bar isles &Coast Southern Zone: Mtwara,Mbeya, Lindi, Rukwa, Iringa, Njombe, Ruvuma & Katavi Western Zone: Kigoma,Tabora, Singida CONTRIBUTIONS TO THE HEALTH SECTOR AND ACHIEVEMENTS MADE www.cssc.or.tz 5 www.cssc.or.tz 6 1

11/8/2016 Area of Focus Health Financing Shared information with FBO facilities on the expected introduction of Single National Health Insurance legislation. Continued to encourage Church facilities to join NHIF. Through advocacy and consultations, about 50% of FBOs hospitals have been accredited and are accessing NHIF services, so far have managed to improve quality of health services and improved health insurance membership enrolment. CSSC continued to advocate for FBO facilities to provide quality financial data and records. Area of Focus Governance and Leadership CSSC continued to provide support and encourage FBO health facilities to renew and strengthen their Facility Governing Committees (FGC) and also monitor the operations of the FGCs; train the members to adhere to the FGC guidelines, understand their roles and responsibilities. Trained 60 FBO Hospitals on how to develop CHOPS and continued to support building their capacity for effective participation in Comprehensive Council Health Planning (CCHP) and Council Health Service Boards (CHSB). Participated in review and provided recommendations for finalization of the NHIF price schedule for accredited NHIF health facilities. www.cssc.or.tz 7 www.cssc.or.tz 8 Area of Focus Human Resources for Health (HRH) Conducted mapping of the institutions/facilities providing CPD, results were shared with MOHCDGEC and other stakeholders then established a web-based portal/link namely CPD Tanzania Portal (http://cssc.or.tz/cpd/) Through the Global Fund R9 (HSS) grant support, CSSC has been engaged on supporting expansion of FBOs health training institutions to increase capacity of enrollment of more students (St. Bakhita and Mvumi Training Institutes). Contributed to increase number of HRH (clinicians, nurses, lab and pharmaceutical technicians) and quality of training through 62 FBOs health training institutions. Area of Focus Commodities Have established a medical supply company - Mission for Essential Medical Supplies Company (MEMS) to complement existing supply chains aiming at improving supply and distributions of medicines to member church health facilities as well as other health facilities in the country. Facilitated scaling up of e-logistic Management Information System (e-lmis) to 53 facilities both Public and private in 14 district councils (Mwanza, Geita & Rorya District); Introduced Stock status SMS platform; Gap filling of OI drugs and Lab reagents also Supported the use of inventory management tools which helped to reduce HIV/AIDS commodity stock out by 60% www.cssc.or.tz 9 www.cssc.or.tz 10 Contributions to Healthcare Service Delivery Strategic Partner Currently CSSC work with a network of over 900 church health facilities including 102 hospitals, 104 Health Centers and 694 Dispensaries. In addition, a network of 68 middle cadre Health Training Institutions. CSSC has developed her 3 rd Strategic Plan (2016 2020) which is in line with the MOHCDGEC Health Sector Strategic Plan IV (2015-2020). The developed SP promotes adherence to National Health Policy, laws and guidelines; also it is focusing on strengthening partnership in health service delivery; strengthen capacity FBO facilities governance and leadership CSSC as an umbrella FBO, continued to be one of the key and strategic partner in coordinating and facilitating delivery of quality healthcare services in the country. Public Private Partnership Continued to be actively engaged on enhancing adherence to national policy and legal framework for effective engagement of FBOs hospitals in health service delivery. Continued to advocate and promote PPP in health by ensuring that both the Councils, FBOs as well as other stakeholders abide to PPP policy, laws and guidelines. By June 2016 have managed to conduct 20 District/Council PPP orientation meetings which have contributed to improved stakeholders knowledge on PPP and its legal frameworks and advocated for establishment of functional PPP Forums in respective district. Member of the National PPP Forum as well as SWAP TWG and play a key role in policy and advocacy, advocate for concerted actions between FBOs and stakeholders to improve health service delivery. Enhance PPPs in the provision of health services through advocating for FBO facilities to sign Service Agreement. To date there are 87 FBO hospitals which have signed services agreement with the Government. Advocated and actively contributed to the review of the terms of the Service Agreement template (2007). 11 www.cssc.or.tz 12 2

11/8/2016 Response to HIV and AIDS, Tuberculosis and Malaria Continued to be a potential partner in HIV and AIDS, TB and Malaria response in the country. Managed to provide support and improve access to quality, integrated and comprehensive HIV care and treatment and TB services to more than 40 districts/councils which have been supported through the ART and Tunajali II and Global Fund programs respectively. Successful spearheaded the HVL Pilot Project and coordinated initiation of routine HIV Viral Load testing in Lake zone as well as scale up countrywide through the support of BMC PCR Lab in collaboration with MOHCDGEC and CDC. CSSC designed and facilitated scale up an of an electronic sample and results tracking software which has reduce the Turn Around time of results from 3 months to 2 weeks. Supported 57 blood collection hubs countrywide to use the sample tracking tools. Response to HIV and AIDS, Tuberculosis and Malaria In collaboration with MOHCDGEC (NACP), participated and actively contributed to the development of the National HIV Viral Load (HVL) testing guidelines and reporting tools Provided technical and financial support to more than 342 CTC sites, 1,314 PMTCT sites in 8 regions. Procured and distributed Laboratory Machines to support HIV/AIDS service delivery in 14 District Councils (mwanza, Geita & Rorya) (1 Facs Calibre, 2 CD4 counts, 1 Gene xpert, Biochemistry haematology, lead microscopy machines Over 51,000 clients received VMMC services through static points and outreach services (Nyamagana & Sengerema) in collaboration with BMC. www.cssc.or.tz 13 www.cssc.or.tz 14 Quality Improvement Initiatives Continued to provide technical support to FBO health facilities to improve quality of health service delivered using the SafeCare model. A total of 107 FBO health facilities were assessed and supported to develop improvement plans. Based on the Safecare intervention, some FBO facilites performed very well for the Star Rating assessment done by the Government such that, in Lake zone facilities like Mugana, and Nyakahanga attained 4 Stars and Bukumbi Hospital was the only facility in Mwanza region (for both public and private) which scored 3 Stars. NB: HRH is one of the critical element which influence rating of health facilities. Recommendations & Areas of Improvements Establish and strengthen PPP health fora at Regional and Council levels. Introduce short professional courses which will result to the delivery of quality health care services To promote and enhance the right and correct use of modern medical/healthcare technology, need to speed up shift from paper based to electronic systems of records. Join hands to promote the delivery of quality health care services in Tanzania www.cssc.or.tz 15 www.cssc.or.tz 16 The End ASANTE SANA KWA USHIRIKIANO 3

17 th Joint Annual Health Sector Technical Review Meeting Day 1 Recap Karimjee Hall, Dar es Salaam November 3-4, 2016 DP, CSO and Private Sector commended the GOT for strong leadership, accountability and strong focus on human development MOHCDGEC on its role as the steward of the health sector and leading the development of HSSP IV, SWAP Code of conduct PORALG on facilitating implementation Commended the partnership DPs, CSOs and Private Sector Suggestions and recommendations Need to update the National Health Policy and formalizing the national health financing strategy Clarity on the scope of work for the PFM-TWG Direct health financing to health facilities Need to introduce an integrated paperless HIS Clarify criteria for accrediting regional referral and specialized hospitals DPs, CSOs and Private Sector Suggestions and recommendations Importance of stakeholders collaboration in achieving health sector goals Meaningful change requires time Basic Health facility standards are high, require stepwise improvements Concerned that only 10% of external financing is spent in country no plans for skills transfer on TAs No project evaluation after projects are completed LGAs hesitate to sign Service level agreements with Private health facilities although does not require funding Opening Speech by PS SWAp and JAHSTRM have laid a solid foundation for the gains made in the health sector The TRM discussions will pave a way for health sector improved performance, get away from business as usual and come up with the game changer to move forward Equitable access to services particularly on geographical areas with higher disease burden and quality improvement of primary health services were among issues that were urged for discussion HSSP IV Framework and Implementation Status Overview of the Overall objective, five strategic objectives of HSSP IV and its interconnectedness with SWAp was shared Implementation Status 11 Participatory TWGs with TOR and strategic direction in place 27 Health SWAp members represented Carried Over Interventions accommodated 10/11 Plans of Action and Milestones 8/11 1

Annual Health Sector Performance Profile Focused on the indicators of HSSP III and MDG as of 2015 The status of health status, service delivery and health systems was shared Achievements made in: population indicators, IMR, U5MR, HIV, TB & Leprosy. Not achieved: MMR, 3/5 RMNCH indicators, 2/4 Malaria indicators, Proportion of budget allocation to Health Sector, Proportion of population enrolled in CHF, 1/8 HRH indicators Overall performance of the indicators was 65% Annual Big Results Now KPI s HRH Reported and available 93% Manyara, Lindi & Mbeya fell bellow national HRH density Commodities Pilfrage tool developed ready for dissemination Rollout of Commodity Management Toolkit was completed in 10 districts. Health Facility Performance SRA completed in 24 regions (except Arusha and Kilimanjaro) 2263(36.06%) got no star, 3241(51.64%) got 1 star, 690(10.99%) got 2 stars, 77(1.23%) got 3 stars, 5(0.08%) got 4 stars and none got 5 stars. RMNCH Gap CEmOC 88 and BEmOC 389 health facilities Harmonization of CCHP, EPICOR and Planrep Benefits Allows resource allocation based on the BoD Allows budget printouts by funders, priority areas and interventions. Ability to provide both Technical, financial and combined Technical and Financial reports Challenges - Failure to integrate PlanRep and Epicor: inaccuracy of financial part No control on data entry in ceilings in Plan rep as users enter ceilings for themselves Mismatch of the financial reports between PlanRep and Epicor National Health Accounts Policy issues raised Marginal decrease in out of pocket payments (they are still high) > need to establish effective pre-payment schemes in context of overall HFS Role of LGAs in managing the fund has remained almost constant Spending in other disease conditions is increasing Donor financing is decreasing Role of NGOs in managing sector resources is still significant. Need to: establish mechanism for improved monitoring of the operations and impact And harmonization of all funding to avoid duplication in one area(ngo s Coordination desk) Public Expenditure Review Key Findings Health Spending lags behind budget in absolute and real terms. Same for per capita budget allocation and per capita health spending Share of Health spending as % total government spending has not increased Domestic funding has shown an increasing trend in spending, though decreasing trend in budget NHIF repayments generally higher in FBO and private, though in 2015/16 Public second to Private (largest share in referral hospitals) CHF/TIKA coverage still low (18%), only one region over 50% (Singida 67%) PER Theme for 2014/15 Complementary Financing There is no uniformity in accessing complementary funding In almost all sampled district user fee and CHF are kept at the facility bank account CHF administered by Donor funded project has increased enrollment and motivates health workers (Kilimanjaro, Mbeya, Mtwara and Dodoma) Some district have made self initiatives to increase enrollment (Singida DC, Mwanga, and Arusha DC) 2

PER Recommendations All partners are requested to disburse their budget commitment NHIF claims system needs to be modified before the implementation of strategy (Roll out e claims system) There should be one guideline for all Complementary funding Areas of Policy Commitments 1 PREVENTION and COMMUNTY HEALTH 2 EQUITY 3 HEALTH FINANCING AND PUBLIC FINANCIAL MANGEMENT 4 GOVERNANCE AND LEADERSHIP 5 HUMAN RESOURCES FOR HEALTH 6 COMMODITIES 7 MONITORING & EVALUATIONand DATA MANAGEMENT 8 SERVICE DELIVERY Status and way forward Policy commitments were agreed in february 2016 8 months of implementation Some commitments should be carried forward to this years policy commitments Private Sector Presentations APHFTA Updated vision and mission Changes in structure and organization Strategic plan in line with HSSP IV FBO CSSC as umbrella organization of FBO in social services Discussion was deferred MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN Responses for carried over questions How is carry over funds from HBF reflected in 2016/17 budget? How can the Govt. track income and expenditures in health facilities? In which ways can the Basic Health Facility standard incorporate community efforts? 3

Purpose JAHSR Field Visit Findings and Recommendations To and assess progress towards improvement in the quality of monitoring and evaluation for evidencebased decision-making Technical Review Meeting Karimjee Hall 04 November, 2016 Specific Objectives 1. To gain a better understanding of health services data collection, recording and utilization for planning 2. To evaluate routine data quality by conducting data verification of selected 4 HMIS indicators 3. To assess the issues, challenges and opportunities in monitoring and evaluation 4. To share lessons learnt and recommendations on key issues Regions Areas Visited Districts Mtwara (95.8%) Nanyumbu (99.9%) Masasi TC (86.5%) Dodoma (91.4%) Bahi (97.9%) Dodoma MC (84.8%) Geita (84.9%) Mbogwe (91.5%) Chato (79.5%) Source: DHIS, 2015 Purposive selection based on reporting completeness 4 health facilities in each District selected by level and ownership Data Collection Conducted on 12 17 September 2016 Tools: Checklists and interview guide Indicators : 1. Number of women who delivered in the health facility 2. Number of pregnant women who tested HIV +ve (first test) 3. Number of clients who chose injection for their 1st FP method 4. Number of mrdt +ve People met: RAS, DED, RHMT, CHMT, HMT, HFGT Meeting Masasi CHMT 1

Main Findings Good data completeness and timeliness High community involvement in governance and accountability of health facilities Data Verification S/N. Indicator Score (%) 1 Number of pregnant women who tested HIV +ve (first test) 75 Committed LGAs to their role in HMIS in spite of limited resources 2 Number of women who delivered in the health facility 65 Local initiatives in data quality audit and financial allocation to HMIS tools Limited data interpretation and use for planning, monitoring disease trends 3 Number of mrdt +ve 35 4 Number of clients who chose injection for their 1st FP method 30 Average Verification Score by Health Facility Number of clients who chose injection for their 1st FP method 900 800 700 600 500 400 300 200 100 0 MTUHA Register Tally Sheet Facility Summary Form DHIS Result Number of clients who chose injection for their 1st FP method by June 2016 915 Main Challenges Multiple and fragmented data collection tools 910 Limited skills in data management and utilization 905 Inadequate feedback on data issues 900 895 Shortage of some HMIS tools 890 Lack of information dissemination guidelines 885 DHIS 2 Result Facility Summary Form Tally Sheet MTUHA Register Limited internet connectivity for data transfer 2

Registers Recommendations M&E Integrate and harmonise the current HMIS Revisit data validation rules and controls to capture anomalies Assess the feasibility of an electronic HMIS at health facility level Roll-out national DQA system Enhance human resource capacity in data management Operationalize free fiber-optic network and the available internet access (Halotel) Recommendations Other Perform readiness assessment to pay for CHF and review the current user fees, to improve health service delivery Clarify role and responsibility for health services of PO- RALG compared to MoH at all levels Update of service agreement for ensuring smooth PPP at Council level Remove restrictions/ceilings in the HBF at Council level Thank you 3

THEME: Enhancing Quality of Health Services Experiences and knowledge from the field 17 TH Joint Annual Health Sector Technical Review Meeting 3-4 TH NOVEMBER 2016. Experiences and knowledge from the field Overview and resolutions from the RMO and DMO Conference 2016 PRESENTERS: DR. LEONARD SUBI-RMO MWANZA & RMOS-CHAIR DR. NTULI KAPOLOGWE -RMO SHINYANGA& DEPUTY RMOs-CHAIR 8-Nov-16 JAHSR - DSM 03-04/ 11/2016) 1 PRESENTATION LAYOUT OVERVIEW OF THE RMO CONFERENCE EXPERIENCES FROM THE FIELD RESOLUTIONS & RECOMMENDATIONS FROM RMOS CONFERENCE 8-Nov-16 2 JAHSR - DSM 03-04/ 11/2016) OVERVIEW OF RMO CONFERENCE KEY AREAS 17-20 TH OCTOBER 2016 OFFICIATED BY THE VP HE. SAMIA S. HASSAN ATTENDED BY HON. MINISTRES & DEP. MIN PS,DPS, DP RMOS, DMOS, RNO, MOI, DIRECTORS AND MANAGERS OF INSTITUTIONS, AND MINISTRY OFFICIALS THEME: Quality health systems and service delivery: A key drive towards an industrialized middle income Tanzania RESOLUTIONS. The meeting focused Health System thinking 8-Nov-16 JAHSR - DSM 03-04/ 11/2016) 3 8-Nov-16 JAHSR - DSM 03-04/ 11/2016) 4 OVERVIEW OF RMO CONFERENCE RMOS AND DMOS CONVEYED SPEECH AND PRESENTATION THAT FOCUSED ON 6 AREAS. MEDICINE, HOSPITAL SUPPLIES, EQUIPMENTS ESSENTAIL & TRACER MED,ADDRESS SHORTAGE, IMPROVE ALLOCATION AND PAYMENTS OF DEBTS USE OF PRIME VENDORS TO REGIONS HF DEBT 28BIL HRH SHORTAGE OF 49% (334 HF LEAD BY MA AND > 1300 BY NURSES) HEALTH INFRASTRUCTURE/AND QUALITY OF HEALTH SERVICES 1,353 UNCOMPLETED HF AT LGAS, MMAM/HSDG TO IMPROVE HF INFRSTRUCTURE (WATER &POWER) 8-Nov-16 STAR RATING 36 % O STAR, JAHSR - DSM 03-04/ 11/2016) OVERVIEW OF RMO CONFERENCE HEALTH CARE FINANCING NHIF/CHF-25 % ( CHF-18% & NHIF-7%), USER FEE COLLECTIONS IMPROVEMENT AND APPLICATIONS OF ELECTRONIC SYSTEM (49-60 % PTS OPD/IPD EXEMPTED) WAYS TO ATTAIN UNIVERSAL HEALTH INSURANCE PREVENTION AND CONTROL OF INFECTIOUS DISEASES SANITATION, TIOLETS AND PREVENTION OF OUTBREAKS LIKE CHOLERA WATER SUPPLY (PUBLIC FACILITIES AND COMMUNITY LEVEL) REGIONAL REFERRAL HOSPITAL -MAJORITY WERE UPGRADED FROM HEALTH CENTRES, DISTRICT HOSPITAL -SHORTAGE OF ESSENTAIL DIAGNOSTIC EQUIPMENTS AT THIS LEVEL, NONE OF THE 27 RRH HAVE CT SCAN /MRI -SHORTAGE OF SPECIALIST MAJORITY IN DSM (70%) AND THE REST 30% (25 REGIONS) 8-Nov-16 JAHSR - DSM 03-04/ 11/2016) 6 1

PRESENTATIONS MADE Establishing Sustainable Emergency Care Services in Tanzania: Experience from Muhimbili National Hospital EMD PPP-TANGA EXPERIENCE NBTS-DSM EXPERIENCE HBF NEW ARRANGEMENTS MODALITIES IVD IMPROVEMENT OF HOSPITAL REVENUE COLLECTION DOM EXPERIENCE REVIEW OF 2007 HEALTH POLICY GUIDELINE DESIGN DRAWING FOR DISP &HC RRH MNH-HEALTH CARE DELIVERY SERVICE HIMS OUTREACH SERVICES SINGIDA EXPERIENCES SITUATION OF HEALTH SERVICES IN THE COUNTRY-CMO NATIONAL NCD STRATEGIC PLAN 2016-2020 OVERVIEW OF PHARMACEUTICAL MANUFACTURING IN TANZANIA Summary of the Independent Verification of Health Service Results Supported by the Health Basket Fund (HBF) and the Strengthening Primary Care for Result Programme (SPCRP) 8-Nov-16 JAHSR - DSM 03-04/ 11/2016) 7 JAHSR - DSM 03-04/ 11/2016) What can Regional Hospitals do? How? Area What can you do? Resources Professional Development Identify Champions: Train MNHT EMAT MUHAS Financial Sustainability Semi-autonomous units MNH EMAT MUHAS Infrastructure changes and maintenance HR Investments Communication Business model can support this Designate specific finance and procurement staff to the EM team (even part-time) Regularly report to and get feedback from EM team and hospital. MNH and EMAT assessment and recommendations Small changes make a huge difference in Emergency Care and patient outcomes. You also have many resources available through EMD and EMAT. (OUTREACH SERVICES -SINGIDA EXPERIENCE) TO RURAL DISTRICTS USING AVAILABLE SPECILISTS WITHIN THE REGION NUMBER OF PATIENTS ATTENDED THROUGH OUTREACH AT DIFFERENT SPECIALITS No. AREA PATIENTS ATTENDED Iramba Dc (Kiombo i Dc Hosp) Singida Dc (Mtinko CDH) 1 DENTAL 141 68 2 PAEDIATRICTS 104 55 3 GYN&OBS 164 97 4 GENARAL 160 140 SURGERY 5 INTERNAL MED 262 281 6 EYE CARE 341 238 7 (ENT) - 92 8 CERV CA SCREE - 93 9 GENERAL PRAC 185 - JUMLA KUU 1,357 10 1,064 JAHSR - DSM 03-04/ 11/2016) IMPROVEMENT OF ELDERLY SERVICES WITH PPP AT MWANZANGE ELDERLY HOME TANGA BLOOD TRANSFUSION SERVICES - EASTERN ZONE (NBTS-EZ) EXPERIENCE FROM DAR-ES-SALAAM REGION In adequate staff ( there is only 5 staff ) No water supply. No fumigation for a long time Inadequate mattress Inadequate cleaning of the environment Inadequate food and other supplies No transport. Unfriendly infrastructure Adequate safe and clean water supply. Environment is clean after procurement of 3 dust bins The home is provided with TV, 3 sofa set and new curtains in the rooms. The walls are painted Rooms have been fumigated Elders are provided with new mattresses, mosquito-nets, blankets and pillows Provision of adequate food (with proper diet) TICC pay for transport to HF for sick elder(s) Safe blood requirement per year 300,000 units For the year 2015, collected 67,980 For the FY 2016/17, NBTS projected to collect 230,000 units which translates to 77% of the total requirements. Decentralization of safe blood services to Regions & Districts Lessons learnt from Dar Es Salaam, total cost to collect, process and transfuse one unit of blood is TZS 75,000/= No cost recovery strategy JAHSR - DSM 03-04/ 11/2016) 8-Nov-16 JAHSR - DSM 03-04/ 11/2016) 12 2

BLOOD TRANSFUSION SERVICES - EASTERN ZONE (NBTS-EZ) EXPERIENCE FROM DAR-ES-SALAAM REGION Secrete of Success SUCCESS Satellite blood centers increased from 1 to 8 (3 RRHs, 3DHs,Mbweni Mission, MNH) Availability of safe blood and products from 20-30% to 60-70% Referrals to MNH due to blood services reduced by 60% More voluntary donors (individual, companies, religious groups etc) Allocation of three municipal staff to NBTS EZ Increased Regional capacity in recruitment, donation, storage and transportation of blood and its products. About TZS 20m allocated by each municipality to support NBTS FY 2016/2017 Collaboration between the Region, NBTS-EZ, MNH and partners JAHSR - DSM 03-04/ 11/2016) CHALLENGES High costs (lack of cost recovery guideline) Inadequate resources (transportation, reagents, supplies, staff) Lack of Automated Analyzer at NBTS-EZ (untimely processing and issuing of results) Knowledge gap at HFs on utilization of blood and its products Increased demand of safe blood in DSM (population, National Referral Hospitals, MTA, deliveries etc. HOW DID THEY MAKE IT? High level advocacy meeting under RC office Formulation of technical committee and fact finding Formulation of resource mobilization committee Development of community mobilization package and implementation plan Establishment of 8 satellite blood centers Training of 40 staff (MNH, RRHs, DHs, RHMT,CHMT) Purchase of basic equipments and supplies M&E, technical support (NBTS-EZ,RHMT,CHMT) High level Support JAHSR - DSM 03-04/ 11/2016) Launching 08/02/2016 NEW MODALITY OF HEALTH BASKET FUND DISBURSMENT REGION REFERRAL HOSPITAL New HBF arrangement Recently the partners have New HBF arrangement have signed a new MOU 2015-2020. HBF will continue as a funding modality for HSSP IV 2015 2020 (including BRN) HBF in this period include performance component to incentivise higher outputs at implementation levels. Origin: 24 RHs + 3 Municipal Hospitals (DSM) 27 RRHs Based on: GoT Gazette, No. 828 of 05 th November 2010 Ten (10) FBO-owned Hospitals in 10 different regions were Officially recognized as RHs at regional level Bed Capacity:.Range 176-450 beds Staffing level 681 with at least 21 specialists (Deficit > 40% in most facilities) NEED SPECIAL ATTENTION DIAGNOSTIC CAPACITY-CT/MRI INFRASTRUCTURE DEVELOPMENT SPECIALIST /SPECIALISED CARE JAHSR - DSM 03-04/ 11/2016) 15 8-Nov-16 JAHSR - DSM 03-04/ 11/2016) 16 PHC Health Facilities star status per region. PHC Health Facilities star status per region. Region 0 star 1 star 2 star 3 star 4 star Total Mwanza 151 161 37 1 0 350 Geita 70 69 12 0 0 151 Shinyanga 40 147 17 2 0 206 Kigoma 132 102 17 0 0 251 Mara 80 142 44 5 0 271 Simiyu 144 64 0 0 0 208 Dar Es Salaam 58 276 101 28 2 465 Singida 37 143 31 2 0 213 Pwani 153 137 10 1 0 301 Kagera 83 150 58 5 2 298 Katavi 16 55 8 1 0 80 Tabora 121 146 32 5 0 304 Region 0 star 1 star 2 star 3 star 4 star Total Songwe 82 74 6 1 0 163 Mbeya 90 157 47 3 0 297 Manyara 90 86 12 0 0 188 Ruvuma 139 109 30 3 0 281 Mtwara 103 112 6 0 0 0 Lindi 90 117 12 1 0 220 Tanga 91 219 51 9 0 370 Njombe 79 132 33 2 1 247 Iringa 66 146 26 3 0 241 Singida 37 143 31 2 0 213 Dodoma 140 203 30 2 0 375 Morogoro 107 202 56 3 0 368 8-Nov-16 17 JAHSR - DSM 03-04/ 11/2016) 8-Nov-16 18 JAHSR - DSM 03-04/ 11/2016) 3

Health Facilities star status per region. Region 0 star 1 star 2 star 3 star 4 star Total Rukwa 103 92 12 0 0 207 Arusha Kilimanjaro BRN assessment not yet done BRN assessment not yet done Total 2,263 (36.06%) 3,277(51.64%) 690(10.99%) 77(1.23%) 5(0.08%) 6,272 8-Nov-16 JAHSR - DSM 03-04/ 11/2016) 19 Where are we now? HRH, Health service provision & infrastructure Region No. of HFs Un completed HFs (through MMAM) Staff Houses deficit Available HRH (Excluding MNH and Zonal Hosp) Shortage of HRH Shortage of Specialist s at RRH Shinyanga 218 127 161 1,804 (60%) 1,952(40%) 21 14 Tanga 376 72 176 2,018 (62%) 1,024(38%) 24 19 Singida 221 69 737 1,804 (43%) 2,404(57%) 19 20 Songwe 167 77 400 1,070(37.7%) 1,767 (62.3%) 24 26 Manyara 196 43 239 1,934 (46%) 1,924 (54%) 10 32 Mara 286 54 373 2,169(58%) 1,548(42%) 23 23 Geita 155 14 318 1,997 (43%) 2,078 (57%) 19 9 Mbeya 300 20 280 1,970 (54%) 1,568 (46%) 18 15 Kagera 310 54 311 1,924 (53%) 1,763(47%) 22 16 Ambulanc e deficit Katavi 82 8 117 762 (36%) 1,344 (64%) 22 6 8-Nov-16 20 JAHSR - DSM 03-04/ 11/2016) Where are we now? HRH, Health service provision & infrastructure.. Region No. of HFs Un Staff completed Houses (MMAM) Available HRH Shortage of HRH Shortage of Specialists at RRH Kilimanjaro 405 10 208 1,683(48%) 1,805(52%) 18 25 Lindi 233 22 622 1,365 (41%) 2,047(59%) 18 13 Mtwara 227 21 398 711 (42%) 1,289(58%) 19 18 Ruvuma 287 57 280 2,623 (55%) 2,360 (45%) 19 17 Rukwa 225 233 50 1,162 (54.5%) 970 (45.5%) 20 12 Tabora 304 89 342 1,735 (45%) 2,667 (55%) 24 25 Dodoma 381 30 650 2,438(49%) 2,510(51%) 7 16 Arusha 346 24 456 3,096(46%) 3,260(54%) 16 24 Pwani 312 51 261 3,083 (54%) 2,692(47%) 18 24 Ambulance deficit Where are we now? HRH, Health service provision & infrastructure.. Region No. of HFs Un Staff complete Houses d (MMAM) Available HRH Shortage of HRH Shortage of Specialist s at RRH Iringa 243 63 189 1,462 (40.5%) 2,148 (59.5%) 19 21 Njombe 251 75 97 1,574 (45.1%) 2,048(54.9%) 19 34 Morogoro 389 40 306 3,142 (54%) 2,921(47%) 7 38 Mwanza 378 57 661 2,799 (45%) 3,399 (55%) 21 19 kigoma 278 22 396 1,881 (45%) 3,126 (55%) 18 13 Simiyu 217 12 27 1,558 (47%) 2,120 (53%) 12 10 Dar Es salaam 593 9 103 Total 7,380 1,353 8,158 (<40%) 4,639 (70%) 1,954 (30%) 79 34 52,403 (49%) 54,658(51%) 536 523 Ambulance deficit 8-Nov-16 JAHSR - DSM 03-04/ 11/2016) 21 8-Nov-16 JAHSR - DSM 03-04/ 11/2016) 22 Region Where are we now? Facilities which are manned by Unskilled Personnel Medical attendants No. Of Dispensaries Region No. Of Dispensaries Region Lindi 41 Kagera 11 Singida 0 Dodoma 37 Iringa 9 Katavi 0 Njombe 27 Rukwa 7 Geita 0 Shinyanga 26 Kilimanjaro 5 Dar Es Salaam 0 Mtwara 25 Mbeya 5 Songwe 22 Tabora 4 Kigoma 21 Manyara 2 Morogoro 21 Mwanza 1 Simiyu 20 Mara 1 Pwani 18 Tanga 16 Ruvuma 12 No. Of Dispensaries Total 334 8-Nov-16 23 Region Where are we now? Medicines, exemptions & Statutory benefits % of tracer medicine availability in the previous 6 months Shinyanga 71% 52% Mwanza 71% 48% Katavi 72% 59% Geita 52 % 56% Rukwa 76% 53% Kigoma 64% 53% Tabora 73% 52% Mbeya 74% 63% % of Patients/clients who received exemption benefits per annum (January December, 2015) 8-Nov-16 24 4

Table 4: Where are we now? Medicines, exemptions & Statutory benefits Where are we now? Medicines, e xemptions Region % of tracer medicine availability in the % of Patients/clients who received exemption previous 6 months benefits per annum (January December, 2015) Dar Es Salaam 67% 71% Ruvuma 67% 40% Kilimanjaro 46% 43% Lindi 67% 40% Mtwara 64% 46% Songwe 72% 48 Pwani 38% 36% Tanga 62% 41% Arusha 55% 67% Dodoma 72% 54% Kagera 8-Nov-16 34% RMOs & DMOs ANNUAL MEETING - 35% DODOMA (17-19/ 10/2016) 25 JAHSR - DSM 03-04/ 11/2016) Region % of tracer medicine availability in the % of Patients/clients who received 6 months previous exemption benefits per annum (January December, 2015) Iringa 86% 45% Njombe 76% 46% Morogoro 86% 50% Simiyu 65% 58% Mara 65% 35% Singida 82% 45% Manyara 78% 47% Total 66.7% 49.3% 8-Nov-16 JAHSR - DSM 03-04/ 11/2016) 26 Where are we now?... o Health Service Delivery Majority of RRHs have poor infrastructure, limited diagnostics and inadequate specialists (536). Majority evolved from MCH/Dispensaries Poor flow of funding to those under construction (Shinyanga, Simiyu,Moro,Lindi etc) CeMONC services offered by (9%) health centers, target 50% by 2015. BeMONC services at Dispensary (20%), target 70% CeMONCservices for Hospitals is 73%, target 100% Shortage of safe blood at all levels, shortage 77% Poor quality of services to elderly, pregnant mothers, children under five and other groups. Limited financial support to the social welfare facilities Where are we now?... o Leadership and Governance Low capacity of HAB and HFGC (roles & functions) Only 158/184 (86%) councils with functional CHSB o Health Information system o DATA QUALITY IS CRUCIAL AT ALL LEVELS FOR DECISION, PLANNING ET o CURRENTLY WE HAVE HIMS tools and software e.g. DHIS2,DHRHIS Logistic e.g. ELMIS and ILS Gateway DISP & HC-MANNUAL-TO COUNCIL (DHIS) COMPUTERS TO ALL FACILITIES, POWER SUPPLY 8-Nov-16 27 JAHSR - DSM 03-04/ 11/2016) 8-Nov-16 JAHSR - DSM 03-04/ 11/2016) 28 Where do we want to go?... o Information system All fragmented HIS should be integrated into a single national HIMS by 2018 o Health Service Delivery Special strategy to support 87% of HFs with 0 to 1 star to upgrade to at least 3 stars by 2018. All zonal Cancer centers should be made functional e.g. Bugando All RRH to be equipped with relevant diagnostics e.g. CT Scan, endoscopy to reduce congestion at MNH The MoHCDGEC to facilitate PPP in improving diagnostic facilities. There should be a constant Supply of Vaccine and its supplies Cost recovery in blood transfusion services e.g. NHIF coverage 8-Nov-16 29 JAHSR - DSM 03-04/ 11/2016) 8-Nov-16 JAHSR Meeting (03-04/11/2016) 30 5

Resolutions Resolutions. SN Issue Resolution Responsible Person 1. Unpaid statutory benefits 2. More than 80% of medicines, supplies and equipment consumed in TZ are procured abroad Subsistence allowance foe new employee should be ring fenced as in the education sector The Govt to allocate budget to pay for the HCW debts GoT should attract investors to construct pharmaceutical industries au utilize effectively available resources to reduce costs from imports (cotton wool, Sanitary pads, Gauze absorbent and bandages IV infusions etc). Time Frame MoFP By June, 2017 MoHCDGEC By June, 2017 MoHCDGEC By June, 2020 8-Nov-16 JAHSR Meeting (03-04/11/2016) 31 S N Issue Resolution Responsible Person 3. High costs incurred while attending causalities of road traffic accidents and delays in compensations 4. More than 91% HFs do not have 3 stars status hence low service utilizations 5. Inadequate (49%) number of skilled personnel in the Country leading to 334 of HFs being manned by MATT and > 1,300 HFs don't have clinicians Establishment of special fund for RTA victims. Contributions should come from road licenses and vehicle insurances RALGAs should make sure that 50% of their HFs attains 3 status All graduates should be employed RALGAs to conduct redistribution of HWs in their respective areas Permanent Secretary RMOs DMOs POPSM PO-RALG MoHCDGEC PO-RALG RAS DED Time Frame By June, 2016 By June, 2017 By June, 2017 By January, 2017 8-Nov-16 JAHSR Meeting (03-04/11/2016) 32 Resolutions. Resolutions. SN Issue Resolution Responsible Person 6. Inadequate medicines, supplies and equipment at the health care facilities with MSD order fulfil rate of about 47% To install electronic system for cash collection in all Regional Referral and Council Hospitals Establishment and recruitment of Prime Vendor systems in all Regions To establish drug revolving fund at Regional and Council level Every region referral Hospital should have MSD community outlet PO-RALG RALGs Time Frame By June, 2017 DG-MSD By June, 2017 RMOs DMOs By June, 2017 RMOs By June, 2017 Debt to MSD should be MoHCDGEC By June, 2017 serviced JAHSR Meeting (03-04/11/2016) 33 8-Nov-16 SN Issue Resolution Responsible Person 7. Low (18%) CHF enrollment in the Country 8. A total of 1,353 of buildings which were envisaged to be constructed PHCDP- MMAM by the year 2017, are yet to be completed. 9. Low morale and performance of MOI/c of RRHs To increase enrollment rate for CHF up to 50% PoRALG /LGAs to solicit fund to complete health facility buildings with immediate effect Moi/c posts should be made superlative so that to increase efficiency and performance DMOs/NHIF PO- RALG/LGAs PO-RALG POPSM Time Frame By June, 2017 By September, 2017 By June, 2017 10 Fragmentation of HMIS All fragmented HIS PO-RALG By June, leading to increased should be integrated into MoHCDGEC 2018 8-Nov-16 workload a JAHSR single Meeting national (03-04/11/2016) HIMS 34 Resolutions. Resolutions. SN Issue Resolution Responsible Person 11 Low capacity of RRH to offer specialized and referral services To equip 5 RRH with essential diagnostics CT-Scan, Endoscopy, ECG, Ophthalmological Dental equipment MRI, To engage Private sector through PPP (service agreement) in improving Diagnostic services To facilitate training of Anesthesiologist, Radiologist, Orthopedic surgeons MoHCDGEC MoHCDGEC MoHCDGEC (Sponsor) Time Frame By June, 2018 By June, 2018 Standardization of Salaries for all MoHCDGEC By June, Medical specialist in the country 2017 JAHSR Meeting (03-04/11/2016) 35 8-Nov-16 RS By June, 2018 SN Issue Resolution Responsible Person 12. Lack of emergence and Disaster services in the regions and Districts Councils 13. Rapid increase in number of people suffering NCDs Establishment of independent emergence and disaster centers in all cities and municipality in the country RALG to establish outreach and mobile services for NCD screening RALG to budget for activities which are geared towered promotion of healthy living Time Frame MoHCDGEC June, 2018 DMOs June, 2018 DMOs June, 2018 8-Nov-16 JAHSR Meeting (03-04/11/2016) 36 6

Resolutions. Resolutions. SN Issue Resolution Responsible Person 14. Inadequate provision of health services to people with special needs (older people, PWD) To facilitate geriatric training to interested HWs DHIS2 should constitute performance indicators for people with special needs LGAs should training their HCPs on how to attend people with special needs Identification and registration of people withspecial needs MoHCDGEC MoHCDGEC DMOs RALGs Time Frame By June, 2018 By June, 2018 By June, 2017 By June, 2017 SN Issue Resolution Responsible Person 15. About 80% of Health centers do not offer CEMONC services Every Council should make sure that it identifies strategic area for construction of Operating theatre as there are about 100 OT will be built To train the required HWs to be deployed at the HCs which offers CEMONC services To start one year certificate cert course for assistant anesthetists to be manned at CEMONC sites DMO DMO Time Frame December, 2016 December, 2016 MoHCDEGC June, 2017 8-Nov-16 JAHSR Meeting (03-04/11/2016) 37 8-Nov-16 JAHSR Meeting (03-04/11/2016) 38 Recommendations o A total of 1,353 of buildings which were envisaged to be constructed MMAM by the year 2017, are yet to be completed. o Recommendation o The GoT together with DPs should have an emergence plan to finish these facilities Recommendations.. o Presence of RRHAB o They should become executive boards with all the needed mandates 8-Nov-16 JAHSR Meeting (03-04/11/2016) 39 8-Nov-16 JAHSR Meeting (03-04/11/2016) 40 Recommendations.. o Shortage of HCWs Recommendations OOP o Recommendation o GoT should try to absorb all the available graduates who are currently estimated to be around 20,000 CHF, NHIF, Other Insurances SNHI 8-Nov-16 JAHSR Meeting (03-04/11/2016) 41 8-Nov-16 RMOs & DMOs ANNUAL MEETING - DODOMA (17-19/ 10/2016) 42 7

RESOLUTIONS SN Hoja Maazimio Muhusika Muda wa utekelezaji 1 Uhaba wa 1. Kusimamia ukusanyaji wa mapato OR-TAMISEMI Juni, 2017 dawa, vifaa tiba na Matumizi kwa kukamilisha Waganga Wakuu wa na vitendanishi usimikaji wa mfumo wa Mikoa na katika vituo vya kutolea huduma za afya kielektroniki kwenye Hospitali za Halmashauri Rufaa za Mikoa na Hospitali za Wilaya. nchini 1. Hospitali za Wilaya na Mikoa Waganga Wakuu wa Juni, 2017 zifungue akaunti za mfuko wa Wilaya na Mikoa kuzunguka wa dawa (Revolving Fund) 1. Kila Halmashauri ihakikishe inakuwa Mkurugenzi wa Juni, 2017 na dawa muhimu zikiwemo tracer MSD, medicines angalau kwa 80% wakati Wakurugenzi wote Watendaji wa Halmashauri 8-Nov-16 JAHSR Meeting (03-04/11/2016) 43 8-Nov-16 44 RESOLUTIONS. RESOLUTIONS. SN Hoja Maazimio Muhusika Muda wa utekelezaji 2 Tathmini ya utoaji wa Mikoa na Halmashauri zihakikishe Waganga Wakuu wa Juni, 2017 huduma inaonesha kuwa asilimia 50 ya vituo vya kutolea Mikoa na asilimia zaidi ya 91 bado huduma vinafikia nyota 3. Halmashauri hazijafikia angalau hadhi ya nyota tatu. 3 Kiwango kidogo cha 1. Kila Halmashauri ihakikishe Halmashauri Juni, 2017 wanachama (kaya) inafika asilimia 50 ya kaya zilizojiunga na Mifuko ya kujiunga na Mfuko wa Afya ya bima (25%) katika Jamii. Halmashauri zote nchini. 4 Kutokuwepo kwa utaratibu 1. Kila Halmashauri ianzishe Waganga Wakuu wa Juni, 2017 imara wa kuchunguza utaratibu wa kuchunguza Mikoa na wananchi kabla magonjwa yasiyoambukiza Halmashauri hawajaugua magonjwa (NCDs) kwa wananchi katika yasiyoambukiza (NCD) maeneo yao mfano Shinikizo la damu, kisukari, saratani na lishe bora 8-Nov-16 45 SN Hoja Maazimio Muhusika Muda wa utekelezaji 5 Kuwepo kwa changamoto 1. Halmashauri zifanye RAS/DED (RMOs na Juni. 2017 nyingi za upatikanaji wa huduma za Afya na Ustawi utambuzi wa wazee, DMOs) walemavu na makundi wa Jamii kwa wazee, maalumu na walemavu na watu wenye kuwapatia mahitaji maalumu hapa vitambulisho vya nchini. kuwawezesha kupata huduma za afya bila vikwazo. 6 Vituo vingi vya afya nchini 1. Halmashauri zianze DMOs Desemba, 2016 haviwezi kufanya upasuaji kuainisha maeneo ya na huduma nyingine za kimkakati ambapo dharura kama CEmONC. vyumba vya upasuaji 100 vinaweza kujengwa ili kuleta matokeo bora. 8-Nov-16 46 RECOMMENDATIONS SN Hoja Mapendekezo Muhusika Muda wa Utekelezaji 1. Watumishi wa Sekta ya 1. Fedha za kujikimu kwa ajili ya WAMJW/ Septemba, 2017 Afya na Ustawi wa watumishi wapya zitumwe Fedha na Jamii kutolipwa stahili pamoja na watumishi Mipango zao kwa wakati wanapopangiwa vituo vyao vya kutokana na fedha kazi kidogo inayotengwa 2. Fedha ya Likizo kwa watumishi kwa ajili ya stahili zao. wa afya na ustawi wa jamii zipangiwe bajeti maalum (ring fenced) 2. Zaidi ya 80% ya dawa na vifaa tiba vinavyotumika hapa nchini vinanunuliwa nje ya nchi hivyo kuigharimu serikali fedha nyingi za kigeni. Serikali iratibu suala la ujenzi wa viwanda vya kutengeneza dawa na vifaa tiba ili zitengenezwe nchini kupitia wadau na wawekezaji mbalimbali. WAMJW Wizara Fedha Mipango na Septemba, 2017 ya na 8-Nov-16 47 RECOMMENDATIONS.. SN Hoja Mapendekezo Muhusika Muda wa Utekelezaji 3. Hospitali zimekuwa 1. Uanzishwe mfuko wa kuhudumia majeruhi KM Wizara ya Septemba, zikiingia gharama kubwa wa ajali za barabarani. Gharama za Afya/ O-R 2017 kuwahudumia majeruhi matibabu zichangiwe kupitia leseni ya Utumishi wa barabarani na barabara na bima ya magari. magonjwa mengine ya dharura. 4 Uhaba wa dawa, vifaa tiba na vitendanishi katika vituo vya kutolea huduma za afya nchini. 1. Kusimamia ukusanyaji wa mapato na Matumizi kwa kukamilisha usimikaji wa mfumo wa kielektroniki kwenye Hospitali za Rufaa za Mikoa na Hospitali za Wilaya. OR-TAMISEMI Juni, 2017 Waganga Wakuu wa Mikoa na Halmashauri 1. OR TAMISEMI itoe maelekezo kwa barua OR-TAMISEMI Oktoba, 2016 kwa Makatibu Tawala wa Mikoa na Wakurugenzi wa Halmashauri ili Hospitali za Rufaa za Mikoa na Hospitali za Wilaya ziruhusiwe kufungua akaunti Maalumu za dawa. 1. Kuwe na bei elekezi ya dawa nchini ili MOHCDGEC Septemba, kuzuia dawa kuuzwa kwa bei ambazo si halisi 2017 48 8-Nov-16 8

RECOMMENDATIONS.. SN Hoja Mapendekezo Muhusika Muda wa Utekelezaji 5 Upungufu wa asilimia 49 1. OR TAMISEMI, Makatibu Tawala wa OR-TAMISEMI Desemba, 2016 wa watumishi wenye sifa Mikoa na Wakurugenzi wa RAS unaosababisha zahanati Halmashauri waangalie uwezekano DED 334 nchini zinasimamiwa wa kufanya mgawanyo sawia na wahudumu wa afya (Redistribution) wa watumishi (ambao si wataalamu). wenye sifa ili vituo hivi viweze kupata watumishi stahili wa kuvisimamia bila kuzalisha madeni. 6 Uwepo wa majengo 1. Serikali iwe na mkakati wa dharura OR-TAMISEMI/ Septemba, 2017 yasiyokamilika 1,353 wa makusudi kwa ajili ya kutoa WAMJWW nchini ambayo yapo katika fedha za ukamilishaji wa vituo hivi hatua mbalimbali kupitia MMAM. yaliyojengwa kwa nguvu za wananchi 7 Kiwango kidogo cha 1. Serikali ihakikishe kuwa sheria ya WAMJWW Juni, 2017 wanachama (kaya) bima ya Afya kwa wote OR-TAMISEMI zilizojiunga na Mifuko ya inakamilishwa na inaanza kutumika bima (25%) katika 49 8-Nov-16 Halmashauri zote nchini RECOMMENDATIONS.. SN Hoja Mapendekezo Muhusi ka 8 Mfumo wa Uongozi na Utawala wa Hospitali za Rufaa za Mikoa na Kanda na haukidhi haja 9 Uwepo wa mifumo mingi ya ya Taarifa ya TEHAMA ambayo haiwasiliani katika utoaji wa huduma za afya nchini. 10 Hospitali za Rufaa za Mikoa hazina uwezo wa kutoa huduma za tiba za kibingwa inavyokusudiwa kama 1. Bodi za Ushauri za Hospitali za Mikoa zifanywe kuwa Bodi kamili zenye mamlaka ya kutoa maamuzi na kusimamia utekelezaji 2. Waganga wafawidhi wa Hospitali za Rufaa Kanda, Mikoa na Halmashauri watambuliwe kwa vyeo vya madaraka na walipwe mishahara na stahiki husika za madaraka kulingana na kazi ngumu wanazofanya. 1. Utafutwe mfumo mmoja sahihi unaofaa kutumika nchi nzima. 1. Serikali itoe vifaa vya uchunguzi kwa angalau hospitali tano za Mikoa ya kimkakati kwa kuanzia 2. Kuhamasisha Mpango wa usimikaji vifaa vya uchunguzi katika vituo kupitia ushirikishaji wa sekta Binafsi/ ubia (PPP) uimarishwe katika ngazi zote 3. Wizara iandae mpango na bajeti ya mafunzo kwa wataalamu wa usingizi, mionzi na Wataalamu wengine muhimu kwa ajili ya utoaji wa huduma Muda wa Utekelezaji WAMJW Juni, 2017 na OR TAMISE MI WAMJW OR- TAMISE MI WAMJW OR TAMISE MI Juni, 2017 Septemba, 2018 8-Nov-16 50 SN Hoja Mapendekezo Muhusika Muda wa Utekelezaji 11 Kutokuwepo kwa WAMJW Juni, 2017 Mfumo wa na huduma za dharura kwa wagonjwa na maafa (Emergency Ambulance Service) 12 Kuwepo kwa changamoto nyingi za upatikanaji wa huduma za Afya na Ustawi wa Jamii kwa wazee, walemavu na watu wenye mahitaji maalumu nchini. hapa 1. Zianzishwe huduma za dharura kama kitengo kinachojitegemea kwenye majiji yote ili kuhudumia dharura mbalimbali ikiwa ni pamoja na ajali 1. Wizara ya Afya, Maendeleo ya Jamii, Jinsia, Wazee na Watoto iandae vigezo vya ufanisi (Performance Indicators) kwa wazee, walemavu na makundu maalumu na kuingizwa kwenye mfumo wa taarifa za utoaji huduma. 1. Serikali iandae utaratibu wa kuwapatia watoa huduma za afya na ustawi wa jamii stadi za kuwasiliana na kuwahudumia wagonjwa wenye mahitaji maalumu ifikapo Desemba 2016 Wizara ya Afya, Juni, 2017 Maendeleo ya Jamii, Jinsia, Wazee na Watoto Wizara ya Afya, Juni, 2017 Maendeleo ya Jamii, Jinsia, Wazee na Watoto Ofisi ya Waziri Mkuu. 8-Nov-16 51 8-Nov-16 52 9

PRESIDENT OFFICE REGIONAL ADMINISTRATION AND LOCAL GOVERNMENT PORALG-HEALTH DEPARTMENT ROLES AND RESPONSIBILITIES IN IMPLEMENTING HEALTH, SOCIAL WELFARE & NUTRITION POLICIES Presented at the AJHSR 04 November, 2016 1 OUTLINE OF THE PRESENTATION Introduction PO-RALG Mandate and Vision Establishment of Health, Social Welfare and Nutrition Division (HSND) at PO-RALG HSND functions Achievements Challenges The Way forward 2 PO-RALG Mandate INTRODUCTION The president of the United Republic of Tanzania created the President Office, Regional Administration and Local Government (PO-RALG) through Government Notice No., of PORALG is mandated to oversee, support and guide operations of Regional Administration and Management of Local Government Systems, both upper and lower, under/their local authorities that are empowered to provide quality services to their respective communities. The Regional Authorities and Local Government Authorities are created under the Regional Administration Act No. 19 of 1997 and the Local Government Act No. 7 of 1982. INTRODUCTION In addition, the PO-RALG is mandated for formulation, monitoring and evaluation of Decentralization by Devolution (D by D) process. Example: Decentralizing part of Councils roles and responsibilities to Health Facilities (primary facilities), so that, facilities can manage the funds and develop their own plans. Formulation of by laws guidingchf PO-RALG also has mandate in the development and implementation of Rural and Urban Policies PO-RALG VISION PO-RALG aspires to be a leading institution in empowering Tanzanians to improve their quality of life and eradicate poverty through a capable Regional Administration with autonomous and accountable Local Government Authorities. ESTABLISHEMENT OF HSN DIVISION AT PORALG In order to achieve the Vision & Mission of the Ministry, the GOT established the Division of Health, Social Welfare and Nutrition Services last year in July 2015 at PO-RALG. Under which HSND being among the several Divisions within PORALG which has full fledged four Section headed by Assistant Directors to oversee the health, social welfare & nutrition interventions are well coordinated and implemented at decentralized levels. 1

Link with Other Divisions To meet its objective, the Health, Social Welfare & Nutrition Services Division, links with other Divisions and Units under PO-RALG. Linkage between the Division with: a) Information Technology Division (Custodian of Epicor & other ICT systems) b) Internal Audit Unit (Audit LGAs, RS) c) Finance & Accounts (Fund Disbursement in LGAs, RS d) Inspectorate & Finance Tracking Division Link between MoHSW and HSND The MoHCDGEC is mandated for formulation of health and social welfare policies and monitoring and evaluating their implementation as well as ensuring that all Tanzanians access quality health and social welfare services. Exist a firm link between the two Example: Working together during implementation of HSSP, BRN, The National Road Map Strategic Plan to accelerate Reduction of Maternal, Newborn and Child Deaths, National Nutrition Strategy, RBF. Link btw the Division and RA, LGAs Overall objective of the Division: The Health Sector in the region is headed by RAS, assisted by Assistant Administrative Secretary -Health, who is technically a Regional Medical Officer. As per new Staffing levels for MoHSW Guideline (2014-2019), health services are coordinated by RHMT under guidance of the RS at Regional level and CHMT under the guidance of Council Management Team (CMT at the Council level) To provide support, guidance and follow up the distribution and equity of health services. Monitor the provision of Health, Social Welfare and Nutrition Services and Guide Sectoral Development within the RA and service provision in Local Government. HSND FUNCTIONS This division has the following functions: To provide supportive supervision to enhance good governance and conduct monitoring and evaluation of health, social welfare and Nutrition services provision in Regions and LGAs; To interpret national policies and guidelines related to health, social welfare sector and nutrition development and financing strategies; To coordinate health, social welfare sector and nutrition projects and programmes; Functions cont. To coordinate and undertake follow up to Regions and LGAs for policies and regulations compliance; To coordinate and update country data on health social welfare and nutrition services for RSs and LGAs; To coordinate and advise RSs and LGAs to enhance community participation and ownership in managing health, social and nutrition services; To coordinate, monitor environmental cleanliness and hygiene; 2

HSND FUNCTIONS.. To coordinate capacity building and provide administrative support to RS/ RHMTs and LGAs; and ensure they perform their functions. To undertake studies to identify factors influencing social evils and crime among street children and violence against women and children; To receive and consolidate projects and programme reports based on living MoUs; CURRENT ACHIEVEMENTS The core members of RHMT and CHMT have been approved to form Governance/ management Committee to oversee resource mobilization and utilization and system management. Technical committee is formed by core members plus co opted members CURRENT ACHIEVEMENTS CHALLENGES Establishment of Nutrition Steering Committees at Regional and Council level Currently there are 19 (73%) Nutrition Officers (Professionals) at RSs and 104 (56%) at Councils. There is a realised collaboration between partners in nutrition at Regions and Local Government Authorities. There has been an improvement of partners integrating their plans into Regions and Councils plans which has resulted in good performance of HSN interventions. As the PORALG through HSND responsible for managing and providing national information on the performance of LGAs. no accurate figures on the number of partners who are working with LGAs in providing health services No forum of bringing various stakeholders who provide health services in the community to discuss various issues relating to the delivery of health care in the Local Authorities No reference point/ information centre to enable stakeholders to know the appropriate area to redirect their efforts CHALLENGES WAY FORWARD Technical committees not fully established in all Regions and LGAs Funding of HSN activities in the Regions and LGAs is inadequate There is shortage of Human resources for Health, Social Welfare and Nutrition professionals in some Regions and Councils. Currently there are 49% for HRH, 27% RSs and 44% Councils with no nutrition professionals, Social Welfare Officers Establishment of the Health Sector Resource Center Coordination and dissemination of already available innovations, methods, systems at LGAs Collect baseline information of available innovations in all LGAs Mapping activities and results Conduct M&E of activities/innovations implemented by different stakeholders Harmonize interventions implemented by different stakeholders 3

WAY FORWARD Cont Thank you for attention Create a pleasant environment for learning Collect, and analyze the reports of various stakeholders working in LGAs Provide a range of health information services relevant to users Organize periodic forums with stakeholders working with LGAs To discuss performance of LGAs in delivering of Health, social welfare & Nutrition services Share experiences To discuss upcoming health, social welfare & Nutrition issues 20 4