Agenda Health NKRA Focus Area HRH Distribution Health Facilities Health Commodities RMNCH Funding Situation Anticipated Challenges Moving Forward AOB 1
The focus areas of BRN Healthcare NKRA and the initiatives aims to achieve 4 broad outcomes for quick transformation HRH 6 initiatives 80% of primary health facilities to be rated 3 Stars and above 100% balanced distribution of skilled health workers at primary level 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 2
Agenda Health NKRA Focus Area HRH Distribution Health Facilities Health Commodities RMNCH Funding Situation Anticipated Challenges Moving Forward AOB 3
100% balanced distribution of skilled health workers at primary level Prioritize application of employment permits to regions with critical shortage of skilled HRH 1Analysis of Postings done in FY 2014/15 Total no Original Postings 8345 Posted after remedial plan % 9,735 100% Reported 8,312 85% Not reported at all 1,423 15% Reported and available 7,730 78% Reported and left 582 7% 2HRH Analysis for 2015/16 and 2016/17 q Analysis on funded Post received from POSPM for FY 2015/16 To conduct assessment and plan for redistribution of staff Noted challenge in the suggested posts, communicated to POPSM and are currently working on it q Approved funded posts FY 2016/17 o To determine the needs from LGA s ( per facility ) and share with POPSM before 1 st December 2015 o Communication made with PMORALG, tool sent to all regions & LGA s to collect data on gaps per facility 3 PPP ² Identified unmanned facilities through Star Rating ² Pre feasibility Study to be conducted in collaboration with PharmAcess on PPP model to be used under HRH Initiative ² Results will be out by December 2015 4
Density of Clinician and Nurses per 10,000 Population After remedial plan 20 18 16 14 12 10 8 6 4 2 0 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 9.3 7.74 2015 Nurses 2015 Clinicians 2014 Nurses 2014 Clinicians On average, 4 regions improved Katavi, Kagera, Mtwara & Mwanza 3 regions became worse from above to below 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 average for clinicians and nurses density 12 14 After 5
Situation in the first 9 Regions Density of HRH before and after remedial plan in 9 Regions 9.00 8.00 7.00 6.00 5.00 Baseline Nat. Aver 2014-7.74 6.4 Density of HRH BF 4.00 3.00 4.4 Density of HRHAF 2.00 1.00 0.00 Katavi Simiyu Tabora Geita Kigoma Rukwa Shinyanga Kagera Singida 6
Human Resource for Health Distribution 4 Redistribution of health workers Developed 40 National WSIN Develop National Standard to be used during assessments 1 st Training for Dodoma and Ruvuma Region 8 th November 2015 5 Ring Fencing of Subsistence allowances Met MOF directives given Letter sent to PMORALG to request them for follow up of permit for Fy 2015/16 PMORALG to develop a budget and submit official request for Ring fencing of subsistence allowances to MOF 6 Enforcing retention & incentive policy at LGA Met POPSM to discuss implementation of Pay and Incentive policy (2010) Requested officially the Implementation Guideline for the 29 LGA s To be used as basis to advice the LGA s on the implementation Reinforce Orientations and induction for newly hired staff 7 Letter was sent to PMORALG to remind LGA s to plan and budget for orientation and induction of new staff 7
Agenda Health NKRA Focus Area HRH Distribution Health Facilities Health Commodities RMNCH Funding Situation Anticipated Challenges Moving Forward AOB 8
Health Facilities 1 2 Star Rating Assessment Star Rating Completed in Mwanza, Shinyanga and Geita Regions Plan in place to develop reporting template for the districts Start assessment's for Mara, Kagera and Kigoma Regions as from 8 th November 2013, DSM in Dec 2015 To complete BRN Region in Feb 2016 Social accountability at the facility and community level Work plan for 2015/16 completed Completion of guideline, Piloting and TOT training Rolling out to 77 LGA s will be done 3 Opening of Accounts in lower Health Facilities Until May 2015 only 3652 (64%) out of 5699 had opened bank Accounts During Star Rating assessment 96% have opened bank accounts PMORALG to conduct visits as from next week 4 National Health Facilities User Satisfaction Level Scoring System Developing a concept Note and plan is to have stakeholders meeting in December Plan to have it place by March 2015 9
All Star Rating Assessment Findings 2 Star Rating 0 Star 1 Star 2 Star 3 Star Mwan za Simiyu Shinyanga Total % 151 70 40 261 36.8% 161 71 147 379 53.5% 37 12 17 66 9.3% 1 0 2 3 0.4% 4 Star 0 0 0 0 0.0% 5 Star 0 0 0 0 0.0% Total Facilities 350 153 206 709 Target 280 122 165 709 0-2 99.4% of alll facilities 10
Agenda Health NKRA Focus Area HRH Distribution Health Facilities Health Commodities RMNCH Funding Situation Anticipated Challenges Moving Forward AOB 11
1 Health Commodities 2 Improving governance, accountability, and sense of ownership of Health Commodities supply chain Toolkit for best prac0ces of health commodi0es implemented in Serenge0, Busega, Chato, Kwimba, Kigoma and Muleba districts. Concept note for resources mobiliza0on under development Revised dona0on guideline approved & to be disseminated Strengthen management of MSD working capital work Prime vendor on MSD zonal basis is on going well Government strategic review of MSD is in progress under independent reviewer DeloiFe to see how best MSD can be strengthened The dialogue for signing of MOU among MOHSW(ver0cal program actors), MSD and MOF is on progress 3 To complement MSD in the procurement & distribubon of medicines by engaging private sector ² Tender evaluation and Board Adjudication is completed. The offering will be announced any time from now ² MSD is in a procurement process to engage a consultant for conducting feasibility study on local manufacturing Plant under PPP. ² MOF have sources funding for the study 12
4 Introduction of ICT mobile applications platform at lower level facilities for improved communication and data management in supply chain Health Commodities 5 Use of SMS to report stock outs and quality of health services by service users and civil society Assessment of health facilities readiness to implement e-lmis done in 6 districts (Serengeti, Busega, Chato, Kwimba, Kigoma and Muleba districts). ICT unit is working on analysis. ICT Planning is on going 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. Pending availability of funds, editing, pilot testing of the documents and translation into Kiswahili will be done prior to implementation 6 13
Agenda Health NKRA Focus Area HRH Distribution Health Facilities Health Commodities RMNCH Funding Situation Anticipated Challenges Moving Forward AOB 14
1 RMNCH Expanding (CEmONC services at strategically selected health centers and hospitals to serve as satellite sites Strategically selected dispensaries and health centers to provide full fledge BEmONC Assessment for BEmOC, CEmOC was undertaken Identification of gasp per facility Quality Improvement plans done Plans is to upgraded and constructed in one year and CHW will be undertaken in 5 regions between April-June 2015 Identification of needs per districts ongoing 3 Develop integrated 360 Degree mass media campaign that can be multi sponsored through PPP Conduct Rapid Assessment of Mass Media needs at the 5 regions 2 Mobilise Community Health Workers (CHW) to improve RMNCH services Assessment of CHW conducted Review of training materials (3 Wks Training) will be conducted on 9 th to 21 st Nov ember 2015 Work plan and Budget in place Training to follow up in December 2015 Appreciate the response to GOT request on commitment Request Support in Training CHW 4 Regional Satellite Blood bank facilities supporting CEmOC Reviewed Work plan To operationalize Kigoma na Mara Regional BB. To construct Simiyu 15
Initial Findings (2/3) 2 EmONC assessment completed in 5 RMNCH regions. Final results: 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 16
IniBal Findings (3/3) 3 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. Full Results : 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 17
Agenda Health NKRA Focus Area HRH Distribution Health Facilities Health Commodities RMNCH Funding Situation Anticipated Challenges Moving Forward AOB 18
Funding Situation Funding source Budget Estimated Funds Disbursed % Expenditure % DANIDA 1,196,745,000 613,530,318 51% 613,530,318 100% World Bank 1,194,364,440 1,194,364,440 100% - 0% Basket Funds 6,919,123,000 632,575,000 (funds from fy 2014/15) 9% 632,575,000 100% UNICEF 432,567,900 432,567,900 100% 432,567,900 100% Irish Aid 356,293,000 356,293,000 100% 356,293,000 100% Government- Others Charges 1,578,673,048 35,028,925 2% 35,028,925 100% 11,677,766,388 3,264,359,583 28% 2,069,995,143 63% 19
CCHP Preparation Coordinator District Health Services and System Strengthening, Participated in the development of CCHP Plan guideline Activities for Fy 2016/17 included in the guide 20
Agenda Health NKRA Focus Area HRH Distribution Health Facilities Health Commodities RMNCH Funding Situation Anticipated Challenges Moving Forward AOB 21
Anticipated challenges in implementation & mitigation measures Anticipated challenges Suggested mitigation measures Shortage of funds to implement all the initiatives Delayed disbursement to the Ministry, implementing agencies and to the LGAs Buy-in from all stakeholders for smooth implementation Have an interim MDU members, Very very helpful - However, they have also to attend other issues Election year Competing priorities 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 Continuous communication and syndication with all levels of stakeholders to galvanize support for BRN, Advocacy at national level Continuous communication with PDB to fill the posts In some cases have to wait work on issues that do not require implementation 22
Agenda Health NKRA Focus Area HRH Distribution Health Facilities Health Commodities RMNCH Funding Situation Anticipated Challenges Moving Forward AOB 23
Moving forward 1 2 3 Complete baselining exercise and finalize the KPI and targets for BRN for the 3-year timeframe Onboarding PMORALG staff MDU & health department 10 12 December Finalization of KPI s & Start Tracking the results 4 Source for additional funding required to fund the gap for unfunded & underfunded initiatives 5 Frequent communication between MDU-PMORALG, PDB and Project Implementers on implementation details, updates and issues. What we would like from you A Full support and commitment from in realizing the implementation & to inform and escalate to MDU & PDB on any issues, roadblocks and risks 24
Healthcare NKRA contact details MDU Dr. Adeline Saguti-Nyamhiwura Ministerial Delivery Unit asaguti@gmail.com 0753545166 Dr. Rosina S M Lipyoga Ministerial Delivery Unit rosinasmlipyoga9@yahoo.com 0754294554 Interim MDU Dr. Joseph Hakororo MDU Liaison drhokororo@gmail.com 0767314190 Mr. William Reuben MDU Liaison reu66@hotmail.com 0784254572 Mr. Andrew Makoi MDU Liaison makoiak@hotmail.com 0754260883 PDB Team Dr. Linda Ezekiel Director, Social Sector lezekiel@pdb.go.tz 0754290499 Abdul Muiz Abdul Aziz Healthcare NKRA muiza@pdb.go.tz 0687966998 Azlin Niza Ismail Social Sector azlinn@pdb.go.tz 0785447843 Nasrul Yusuf Healthcare NKRA nasruly@pdb.go.tz 0785447381 25
BEMOC & CEMOC Assessments Results 26 26
InsBtuBonal Delivery 120 107 100 81.9 85.9 80 71.6 60 50.6 62.7 60.9 58.8 46.4 51 % Delivery in HF 40 28.4 27.6 22.6 25.2 % Delivery in fully funcbonal EMONC HF 20 11.6 10.7 14 0 27 27
Causes of Maternal Deaths in Study Zones Other indirect causes 4% Abor0on 19% Malaria 8% Hemorrhage 29% Anemia 12% Sepsis 7% Obstructed labour 13% Hypertensive disorders 8% 28 28
In which HF level were maternal deaths occurring (Figures in %)? Tabora 28 35 37 Simiyu 7.6 92.4 Shinyanga 6.1 21.2 72.7 Mwanza 8.7 22.4 68.8 Dispensary Mara 6.7 18.0 75.3 Health Centre Hospital Kigoma 21.4 39.3 39.3 Kagera 13.5 37.8 48.6 Geita 0 46.0 54.0 0 10 20 30 40 50 60 70 80 90 100 29 29
Asante Sana 30