Tanzanian German Programme to Support Health. Annual Report Better Services for Better Health. Tanzanian German Programme to Support Health

Transcription

1 Implemented by Tanzanian German Programme to Support Health Tanzanian German Programme to Support Health Annual Report 2014 Better Services for Better Health

2 Imprint Published by: Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH Tanzanian German Programme to Support Health (TGPSH (TC)) 76 Ali Hassan Mwinyi Road Dar es Salaam, Tanzania T /66/88 F E TGPSH@giz.de I Authors: Dr. med. Susanne Grimm Dr. med. Baltazar Ngoli Dr. med. Christian Pfleiderer Ms. Kristina Kloss Mr. Erick Msoffe Mr. Joseph Joel Matimbwi Edited by: Dr. med. Susanne Grimm Ms. Vida Mwasalla Photos: TGPSH (TC), CCBRT, Femina HIP, TANAM Design and layout by: andreas korn visual communication, Dar es Salaam Printed at: Dar Es Salaam, May 2015 As a federally owned enterprise, we support the German Government in achieving its objectives in the field of international cooperation for sustainable development.

3 Table of Contents List of Abbreviations 2 1. Introduction to TGPSH (TC) 3 2. Executive Summary 5 3. Soko la Afya 8 4. Achievements of TGPSH (TC) in Social Health Protection and Health Financing Quality Improvement of Health Services Decentralized Health Governance Cooperation with the Private Sector Strengthening Civil Society Organizations 26 List of Publications supported by TGPSH (TC) 28 1

4 List of Abbreviations AIDS APHFTA ATE BFC CAMHS CCBRT CHMT CHF CCHP CIM CSO CSSC DHS DMO DPG DSW EAC FBO GAVI GFATM GIZ HIV HMIS HRH HSSP KfW LGAs MNCH MDGs MoHSW MSD NHIF P4H PMO-RALG PPP PPHF SWAp SRHR TACAIDS TNCM ZHRC Acquired Immune Deficiency Syndrome Association of Private Health Facilities of Tanzania Association of Tanzanian Employers Basket Finance Committee Computer Assisted Hospital Management System Community Based Rehabilitation in Tanzania Council Health Management Team Community Health Fund Comprehensive Council Health Plan Center for International Migration Civil Society Organization Christian Social Services Commission Demographic and Health Survey District Medical Officer Development Partners Group Deutsche Stiftung Weltbevoelkerung East African Community Faith Based Organization Global Alliance for Vaccines and Immunization Global Fund for AIDS, Tuberculosis and Malaria Deutsche Gesellschaft für Internationale Zusammenarbeit GmbH Human Immunodeficiency Virus Health Management Information System Human Resources for Health Health Sector Strategic Plan German Development Bank Kreditanstalt für Wiederaufbau Local Government Authorities Maternal, Neonatal and Child Health Millennium Development Goals Ministry of Health and Social Welfare Medical Stores Department National Health Insurance Fund Providing for Health Initiative Prime Minister s Office Regional Administration and Local Government Public Private Partnership Public Private Health Forum Sector Wide Approach Sexual Reproductive Health and Rights Tanzanian Commission on AIDS Tanzanian National Coordinating Mechanism Zonal Health Resource Centre 2

5 1. Introduction to TGPSH (TC) The Tanzanian German Programme to Support Health executed by the Ministry of Health and Social Welfare and supported by German Development Cooperation (GIZ and KfW) on behalf of the Federal Ministry for Economic Cooperation and Development (BMZ) contributes since commencement in 2003 to the achievements of the Health Sector Strategic Plan of the Tanzanian Government. Whereas, KfW provides financial support to the Ministry of Health and Social Welfare to improve access to and quality of health services, GIZ provides Technical Cooperation through Tanzanian and international experts advising policy makers and implementers of health services alike. This report only takes into account the Technical Cooperation by GIZ which will be referred to as TGPSH (TC) or the programme throughout the document. The TGPSH (TC) has been launched in The current phase has a term of three years (from April 2013 to March 2016) with a German contribution of up to EUR 14,130,000. The Ministry of Health and Social Welfare, the Regional Medical Offices in Tanga, Mbeya, Mtwara and Lindi, selected Councils and partner hospitals provide significant time and expertise of technical and management personnel, logistical as well as limited financial resources needed for the implementation of programme activities. The objective of the TGPSH (TC) reads as: Important prerequisites are in place for equal and sustainable access for men, women and young people to health services of an acceptable quality. In order to achieve its objective, the programme supports the Government of Tanzania in five key areas of the health sector reform agenda: 1. Social Health Protection and Health Financing 2. Decentralized Health Governance 3. Quality Improvement of Health Services 4. Cooperation with the Private Sector 5. Strengthening Civil Society Organizations. 3

6 The target group of the TGPSH (TC) activities in Lindi, Mtwara, Tanga and Mbeya regions are its seven million inhabitants with a high proportion of poor people (around 40%) as well as children and young people (around 67% under 25). In addition, the achievements sought through policy advice to the Ministry of Health and Social Welfare are to benefit the entire population of Tanzania. TGPSH (TC) team 4

7 2. Executive Summary Indeed recent years have seen a significant progress in improving public health and strengthening the health care system in Tanzania. However, several factors continue to have a negative impact on public health and key targets will not be achieved by For example, only 9% of the targeted 50% of health centres are able to provide comprehensive emergency obstetric care. Even though services are subsidized by the Government, the unavailability of quality obstetric care in the vast majority of the country undermines Tanzanians trust in health care services and results in low utilization. With a target of 80%, only 61% of deliveries take place in health facilities and maternal and newborn mortality rates remain unacceptably high. Underlying reasons for the current status of health services are manifold and range from a considerable lack of resources to insufficient technical and management capacities as well as shortcomings including weak governance in the public health sector administration impeding the efficiency and effectiveness of the public health system. Against this background the Ministry of Health and Social Welfare (MoHSW) has prioritized its reform agenda in 2014 targeting key obstacles within the public health system compromising significant progress in health outcomes. The Sharpened One Plan (2014/15) and the Big Results Now intitiative (BRN) (2014/17) set clear targets for significantly reducing maternal and child mortality within a few years. Through these plans, key reforms are prioritized and scarce resources are dedicated to their implementation. Complementary, the MoHSW has developed key policies and strategic plans in the areas of quality improvement, human resource management, health financing and public-private partnerships 5

8 in Through this, the Government of Tanzania has put key pre-requisites in place to guide the short- and medium-term health sector development. All policies and strategic plans inform the Health Sector Strategic Plan IV (HSSP IV, ), which will be the overarching basis for the ministry and development partners for their joint engagement over the next five years. Mbeya TGPSH supported regions Tanga Lindi Mtwara TGPSH (TC) is embedded in the Tanzanian health Sector Wide Approach (SWAp) working through its formal structures under the guidance of the MoHSW and contributing to common objectives in close cooperation with other development partners. Firm integration of TGPSH (TC) into the SWAp has proved efficient and effective for informing national strategy development processes with evidence deriving from TGPSH (TC) s implementation in the four partner regions namely Tanga, Mbeya, Mtwara and Lindi. In 2014, the programme advised six technical working groups of the ministry on the development of strategic key documents in the fields of quality improvement, HR management, health financing and cooperation with the private sector. Many innovative approaches and lessons learned from TGPSH (TC) s field experiences were incorporated in these documents now benefitting the whole of Tanzania s public health system. In addition, TGPSH (TC) accomplished major achievements in 2014 in all five areas of support: Social Health Protection and Health Financing, Quality Improvement of Health Services, Decentralized Health Governance, Cooperation with the Private Sector and Strengthening Civil Society Organizations. Examples are increased enrolment in Community Health Funds, increased availability of staff in rural health facilities, favorable framework conditions for public-private partnership in health and significantly increased revenues of hospitals due to IT based hospital management to name a few. Details are available in chapter 4 of this report. The remarkable reduction of newborn mortality in the Lindi Regional Referral Hospital due to the leadership of the RMO and the programme s successful support has not only received adequate recognition by the MoHSW and Local Government but fortunately also been rewarded with additional funds from the German Federal Ministry for Economic Development and Cooperation (BMZ). The new project on Improving Maternal and Newborn Child Health in Lindi and Mtwara regions is meant to scale up the successful approach from Lindi Regional Referral Hospital to all districts in both regions from All approaches of TGPSH (TC) already proven to be successful in field implementation as well as the rich knowledge and experiences of the programme gained in 10 years of practice have been presented and showcased during the Soko la Afya, a national dissemination event jointly organized by the MoHSW and TGPSH (TC) in September The Soko la Afya, in English Market for Health, was launched by the Acting Honorable Minister of Health and Social Welfare and acknowledged by His Excellency, the German Ambassador. Details of the approaches presented and results achieved so far are outlined in chapter 3. We are indebted to the Ministry of Health and Social Welfare for its effective leadership including all our partners for their support, contributing to the achievements which have resulted to improved access of Tanzanians to better health services. 6

9 2014 Highlights at a Glance Official launch of the District Modular Course Soko la Afya official opening by Dr Donan Mmbando representing the MoHSW in the presence of HE German Ambassador Mr Kochanke Health workers discussing on newborn data using the triage tool. Official launch of the Public Private Health Forum, graced by the Hon Minister Health Dr Seif Rashid New pediatric ward at the Lindi Regional Referral Hospital, saving babies lives The TGPSH staff during a team building event Youth sharing health information through role plays The Regional Commissioner Mbeya Hon Mr Kandoro officiating the Computer Assisted Hospital Management System at the Mbeya Regional Referral Hospital Demonstration on saving babies lives during the Soko la Afya PR event Health workers successfully completed training on newborn care at the Lindi Regional Referral Hospital A talk show on youth and health during the Soko la Afya moderated by Femina HIP main speaker Mr Lekule from TACAIDS 7

10 3. Soko la Afya In September 2014, the Ministry of Health and Social Welfare in collaboration with the TGPSH (TC) organized an event referred to as Soko la Afya (Market for Health) aimed at sharing successful TGPSH (TC) approaches to improve health services in Tanzania. The event was launched by the acting Honorable Minister of Health and Social Welfare, the now Permanent Secretary, Dr. Donan Mmbando, a long standing partner of German Development Cooperation in health. His Excellency, the German Ambassador Mr. Kochanke acknowledged the contribution TGPSH (TC) has made so far to the health sector development in his welcome speech. Sharing successful approaches of recruitment and retention The event was attended by about 200 representatives of Development Partners including the World Bank, the European Union, bilateral donors, Senior Officials of the Ministry of Health and Social Welfare, the Prime Minister s Office, the BMZ and the German Embassy, Non-Governmental Organizations and representatives of the private sector. Throughout the event the following approaches were presented. Staffing Rural Tanzania Proactive Recruitment and Retention in Rural Areas Insufficient health workers moving and staying in rural areas continues to be a challenge. TGPSH (TC) addresses this by helping partners cooperate with local health training institutions in order to proactively recruit graduates into health services. Following recruitment the programme supports partners in helping new employees getting started. This includes need based trainings at hospital level, room and board as well as other benefits. This package of proactive recruitment and retention in rural areas has been provided to local health authorities in form of user-friendly guides, available at TGPSH (TC). 8

11 Key Results In total 5 councils are already practicing proactive recruitment and retention i.e. Nachingwea, Tandahimba, Masasi, Kilwa and Nanyumbu. 28 New staff have been recruited by Nachingwea Council, Nanyumbu, and one radiographer employed by Tandahimba through proactive recruitment. Local Health Planning How to Meet the Needs of Communities A lack of involvement of community representatives in health planning causes many issues to remain unsolved. This challenge is tackled by training regional and district health managers in exercising participatory planning for local communities. The participatory planning empowers communities to actively engage during the planning process and ensure resource allocation based on their needs. Key Results In the four TGPSH (TC) partner regions trained regional health managers started practicing participatory planning engaging civil society in the process. Briefing on health planning at community level Improving Hospital Efficiency IT based Hospital Management Efficiency of services and revenue collection are at the focus of the Computer Assisted Hospital Data Management System (CAHMS). Furthermore it provides quality data for planning and management. TGPSH (TC) supports the implementation of this system in 12 target hospitals. Key Results In total 55 CAHMS users and 25 hospital management team members have been trained in operating the system. There have been increases in revenue as high as 270% at Tanga RRH, 45% at Muheza DDH and 12% at Lushoto DDH. Mbeya RRH is the fourth hospital operating with CAHMS. Computerization of Lindi RRH is currently underway and expected to be operational by December

12 Showcasing benefits of computerization in a hospital Community Health Funds Reducing Impoverishment due to Illness The informal sector is made up of low income groups such as small business, farmers and street vendors. Without health insurance they are vulnerable to impoverishment through health related expenditures. Community Health Funds (CHF) are in place to cater for this population. It is a low cost health insurance scheme in rural Tanzania allowing subscribed members to receive examination and treatment for free. TGPSH (TC) support includes enrolment to the CHFs through sensitization campaigns, joint enrolment plans with rural cooperatives and public-private partnerships with various companies. Further support the CHFs management structures in financial and data management which leads to increased availability of funds from CHFs and a better supply of drugs from hospitals. Key Results More than 400,000 people have joined Community Health Funds in the last 4 years. Role play sensitizing the community to join the Community Health Funds 10

13 Improved Health Services through Public Private Partnerships For the majority of the rural population, access to private health facilities poses a challenge due to financial barriers. By developing and introducing formal agreements referred to as Service Agreements public and private facilities agree on an arrangement of complementing each other. This allows poor people to access government subsidized health services where public health facilities are not available. TGPSH (TC) support includes the establishment and facilitation of a dialogue platform. Here both public and private actors can express their interests and needs. Furthermore the programme offers capacity development for the private sector to be able to effectively engage in discussions with the government. This includes technical assistance in developing new partnerships. Key Results A Public Private Health Forum has been established and launched in April of 2014 with an advisory Board consisting of members from both the public and private sector. 28 Private hospitals within the programme supported regions have signed service agreements to provide free health services to pregnant women and children under the age of 5. Briefing on cooperation between public and private health sector Reducing Newborn Mortality Advanced Newborn Care With close to half of all child deaths occurring during the first 4 weeks, newborn care plays a vital role in reducing mortality rates. Hence TGPSH (TC) aims its efforts at contributing to the establishment of advanced newborn care within hospitals. Along with essential equipment and medicine the programme supports capacity development of health staff through on the job training. In addition TGPSH (TC) carries out supervision of staff in peripheral health facilities. 11

14 Key Results So far Lindi Regional Referral Hospital and Masasi District Hospital have established advanced newborn care. In total more than 275 health workers have been trained to provide quality newborn care and 73 health facilities have been supervised jointly by experts from Nyangao Designated District Hospital and Masasi District Hospital. This has led to a notable reduction of newborn mortality recorded at Lindi Regional Referral Hospital with rates decreasing from 32% to 10% on average. Demonstrating newborn care Workplace Programmes Promoting Health and Increasing Profits Illness at the workplace can be detrimental not only to the employee s health but also to their productivity and ultimately the profitability of the company. Thus, employers have a strong incentive to care for the health of their employees. Health checkups promoting wellness at workplace TGPSH (TC) builds employers capacities in identifying cost effective interventions suited to their labour force, acquiring the know-how for setting up effective workplace programmes and fulfilling their commitment to corporate social responsibility and safety at the workplace. Such interventions include awareness raising regarding disease prevention, leading a healthy life style and access to basic health services. The employers in turn, are rewarded with prevented losses in productivity. Key Results 2,863 (65%) public servants at the national level, 20,223 (63.2%) public servants at regional level and 19 councils in Tanga, Mtwara and Lindi were reached through information campaigns. 11,224 public servants were tested and counselled for HIV and workplace policies were developed for different companies, such as Olam Ltd. Tanzania. 12

15 Addressing Reproductive Health of Adolescents by Working with Civil Society Organizations Role play portraying barriers to access health services for youth Young people are often neglected regarding access to health information and services and are not well represented in discussions that address this situation. Since CSO represent and serve the communities, TGSPH (TC) works with them to reach the young population. TGPSH (TC) builds CSOs capacities in project management as well as health and youth related topics to enable them to provide services for the young population. Key Results 11 CSOs have been trained in project management and are receiving on-thejob support. CSOs have set up youth clubs to reach young people with health information and to encourage them to use health services when needed. The collaboration between CSOs and LGAs has been enhanced, thus CSOs are recognized as serious civil society partners. In addition, CSOs have been able to raise extra funds from various sources to implement their activities. Impressions from the Soko la Afya Feedback from the invited guests was very positive. The Ministry of Health and Social Welfare as well as the BMZ and German Embassy congratulated TGPSH (TC) on its successful achievements in recent years which have significantly shaped progress in the public health system. In closing: The GIZ Country Director, Dr Regine Qualmann, voiced her appreciation of everyone s active participation, which helped make the event a great success. Interview with the Ministry representative, Dr. Donan Mmbando during the Soko la Afya 13

16 4. Achievements of TGPSH (TC) in Social Health Protection and Health Financing Illness is a major cause and consequence of poverty. Without any health insurance, most people, particularly the poor and the vulnerable groups e.g. people living with disabilities, are unable to access quality health services. This forces them to pay out of their pocket, often requiring them to sell their property or remove children from school in order to cover the health expenses. For people working in the informal sector with small businesses e.g. farmers, street vendors, shop owners, the Community Health Funds (CHF) scheme is a viable option to protect themselves and their families from impoverishment due to illness. TGPSH (TC) supports CHF sensitization campaigns in 8 partner districts for enrolment with rural cooperatives and public private partnerships with companies such as Tanga Fresh or the farmers associations, etc. The programme also supports the CHF management structures in financial and data management processes which leads to timely availability of CHF funds used for example for better availability of medicines at the hospitals. This scheme reduces the out-of pocket payment of citizen, thus mitgating financial barriers especially for poor people accessing health care services. At the policy level TGPSH (TC) contributes to the development of an equitable and efficient Social Health Protection system as laid out in the Health Financing Strategy, paving the way towards Universal Health Coverage in Tanzania. 14

17 Results at National Level Progress on Health Care Financing In 2014, the ministry significantly progressed in developing the National Health Financing Strategy. TGPSH (TC) in close cooperation with Providing for Health (P4H) partners in Tanzania provided technical and financial expertise feeding into evidence based decision making processes and national stakeholder consultations. The technical support from P4H partners to the ministry s Technical Working Group Health Financing has been coordinated by the P4H Coordinator appointed by the GIZ supported sector programme Providing for Health and hosted by TGPSH (TC). P4H partners include KfW, Swiss Development Cooperation, USAID, WHO, the World Bank and the African Development Bank. Under the leadership of Mariam Ally, the Chair of the Technical Working Group, and through the support of development partners, the ministry submitted a final draft of the Health Financing Strategy by the end of 2014 to the interministerial Steering Committee, ready to be costed and finalized in TGPSH (TC) also actively supported the refinement of the national Results Based Financing (RBF) design, its roll-out plan, and RBF related capacity development activities through a short-term international consultant integrated in the Minsitry of Health and Social Welfare. The revised RBF design and roll out plan have been presented to stakeholders at the end of 2014 with roll-out envisaged to start in Timeline showing the process of developing the strategy Results at Regional and District Level Improved Access to Health Care Services through Community Health Funds TGPSH (TC) focused on strengthening governance and management capacities of Community Health Funds (CHF) managers in eight partner districts through the consulting partners EPOS and the Tanzania National Community Health Fund (TNCHF). Core areas to work on with the respective district authorities were defined e.g. staffing and budgeting for CHF administration, transparent funds flows in district accounts and improving access to CHF for the poor. In 2014, TGPSH (TC) provided eight districts with data management software, in order to improve membership databases and support successful CHF applications for matching grants from the National Health Insurance Fund. 15

18 The programme also supported the setup of medicine buffer stocks in two districts for essential medicines to mitigate the frequent drug stock outs which cause citizens dissatisfication with the health services resulting in refrainment from joining CHF. As a result, implementation of the CHFs in the eight partner districts has improved, leading to a rise in the CHF enrolment. To date, approximately 400,000 people in partner districts joined CHF over a period of 4 years. CHF window available at health facilities for patients who are members Challenges Late endorsement of the Health Financing Strategy and provision of funding for its implementation delays progress in Universal Health Coverage. Delayed payments of matching grants by the National Health Insurance Fund (NHIF) to CHFs result in lack of funds for health service provision at health facilities. Limited access of TGPSH (TC) to NHIF limits coordination between NHIF and CHFs. Frequent stock-outs of medicines and inadequate quality of health services result in low re-enrolment rates of CHF members. Outlook In 2015, TGPSH (TC) will focus on the following: Finalization and endorsement of the costed Health Financing Strategy, Improving coordination between the NHIF and TGPSH (TC), Improving CHF administration at CHFs and NHIF for timely payment of matching grants, Continuing capacity strengthening of District authorities for CHF management, Consolidating buffer stocks for medicines at selected health facilities. Staff organizing their buffer stock 16

19 4.2 Quality Improvement of Health Services Renovated pediatric ward in Lindi regional referral hospital Continously improving the quality of health services is key to improving the health status of all Tanzanians. Due to the challenge of increased volume and complexity of services on the one hand and insufficient resources and capacities on the other, most health facilities are unable to provide quality services, record low revenue collection and lack reliable data for decision making. This results in poor health outcomes such as high maternal and newborn deaths amongst others. To improve the quality of health services and the efficiency in service delivery, TGPSH (TC) supported the Ministry of Health and Social Welfare in advancing with its national Quality Improvement reform agenda and assisted four regional and eight district hospitals with human and institutional capacity development in the area of quality management. Results at National Level Facilitating Progress on the National Quality Improvement Reform Agenda Under the leadership of the MoHSW, TGPSH (TC) supported the establishment of the national TWG on Quality Improvement in July This TWG is aiming at establishing the national framework for sustainable quality improvement of health services in Tanzania based on the National Health and Social Welfare Quality Improvement Strategic Plan ( ). As one major accomplishment of the TWG in 2014, this National Quality Improvement Strategic Plan has been costed. TGPSH (TC) is a permanent member of the TWG and continuously provides technical expertise to various activities. TGPSH (TC) also worked closely with the MoHSW in organizing the 3rd National Quality Improvement Forum which took place in October The programme sponsored 11 participants from its partner regions to attend the Forum for learning and sharing their own lessons learned and experiences with quality improvement of health services. Besides, TGPSH (TC) sponsored a high ranking staff from the Directorate of Health Inspectorate and Quality Assurance to participate in a three days international conference on Quality Improvement held in June 2014 in Heidelberg, Germany. 17

20 On the job training how to save babies lives Results at Regional and District Level Integrated Quality Improvement at Regional and District Hospitals To improve quality assurance in hospitals, the programme supported an experts panel to select and reformulate Tanzania s national indicators for quality of sexual and reproductive health services. Based on the approved indicators, TGPSH (TC) developed questionnaires to assess the performance of hospitals as regards quality of sexual and reproductive health services. All twelve targeted hospitals in the four partner regions used the questionnaires to assess their own performance. Using the assessment results, the hospitals developed their first Quality Improvement action plan. Regional and District health authorities then selected Quality Improvement Coaches from the regular health personnel of the hospitals. TGPSH (TC) capacitated these Coaches to facilitate the implementation of the Quality Improvement action plans in the twelve hospitals. In addition, efforts to develop a system for recognition and awarding quality achievements by health personnel are ongoing. Hospital computerization for improved service delivery 18

21 Efficient Health Service Delivery through IT based Hospital Management Trained staff capable of using the computer system TGPSH (TC) supports the institutionalization of Computer Assisted Hospital Management Systems (CAHMS) in a number of partner hospitals to increase efficiency of health services. The support includes initial provision of IT infrastructure to selected hospital departments i.e. the registration, the outpatient department and the pharmacy, and capacitating mostly IT illiterate hospital staff in using CAHMS effectively. Hospitals benefitting so far from CAHMS are the Bombo Regional Referral Hospital in Tanga, the Designated District Hospital in Muheza and the District Hospital Lushoto, both in Tanga region, the Mbeya Regional Referral Hopsital and the Sokoine Regional Referral Hospital in Lindi. In total, 32 staff members including hospital managers received training and mentoring on using the CAHMS software Afyapro. To promote peer learning and improving the development of CAHMS, the annual Afyapro User Forum was held in Tanga. Due to CAHMS, hospitals have shown a significant increase in revenue collection as it allows for example to collect correct claims from patients and health insurers for services provided and prevents pilferage of medicines from the hospitals pharmacies. Improved Newborn Care in Lindi and Mtwara Regions TGPSH (TC) supported the RMO in Lindi in improving the quality of newborn care through the establishment of advanced newborn care at the Sokoine Regional Referral Hospital and the Masasi District Hospital, which reported considerably high newborn mortality rates in the past. The support included human and institutional capacity building, supervision and mentoring of staff in peripheral facilities to enable correct and timely referrals of newborns at risk, and provision of basic equipment for newborn care. Over 250 staff at 73 health facilities have been trained on newborn care. The improvement of neonatal services has not only reduced the mortality rate of babies requiring treatment and increased the utilization of services, but also prompted the regional government to request expansion of TGPSH (TC) s support to all the districts in the region. Subsequently, a new proposal was submitted to the German Government for improved maternal and newborn child care covering all districts of Lindi and Mtwara regions. The BMZ has kindly agreed Trained personnel attending a newborn 19

22 to provide additional funding and commissioned GIZ in implementing the new project Improving maternal and newborn child health jointly with the MoHSW and concerned regional and district health authorities beginning in Challenges Multiple Quality Improvement approaches are applied and do not allow for a standardized quality assessment of health services. Continued shortage of medicine, equipment and human resources restrict health service quality significantly. Insufficient investment in IT infrastructure and training of staff limits efficieny of hospital management and revenue collection of hospitals. Insufficient use of data for decision making in health facilities compromises effective health service delivery. Health education session for mothers Outlook In 2015, TGPSH (TC) will focus on the following: Supporting the MoHSW in implementing the National Health and Social Welfare Quality Improvement Strategic Plan , Consolidating the institutionalization of CAHMS in partner hospitals and extending the system to the Lindi region, Consolidating the integrated Quality Improvement Approach in the 12 partner hospitals, Under the leadership of the MoHSW, RMO Lindi and RMO Mtwara preparing the commencement of the new project Improving Maternal and Newborn Child Health, Supporting the MoHSW in implementing Big Results Now activities relating to improving quality of health services where applicable. 20

23 4.3 Decentralized Health Governance In many Tanzanian communities, annual health sector planning does not necessarily take into account solving existing community health challenges e.g. getting needed clinical officers, nurses, medical equipment and basic medication. Hence, continued unavailability of required health staff, equipment and medicines are the result. TGPSH (TC) supports strengthening regional and district health managers to plan according to communities priorities by imparting local communities with the knowledge and capacity to engage in local health planning. The programme also assists local health managers to be more proactive in recruiting and retaining health staff through the application of different incentives to attract, motivate and retain health workers in rural areas. Results at National Level Progressing on Human Resources for Health Good governance starting at the community level TGPSH (TC) supported the development and launching of the new Human Resources for Health and Social Welfare Strategic Plan This plan provides guidance to local health managers on how to address the critical lack of human resources in their areas of responsibilities. To facilitate proactive recruitment and retention, TGPSH (TC) developed a user guide for Local Governments and health care providers. (see list of publications) Laying the Foundation for State-of-the-art District Health Management in Tanzania Together with MoHSW and the Prime Minister s Office Regional Administration and Local Government, the programme has successfully launched a district health management course in order to train District health managers. This training will be offered nationwide from 2015 onwards at three Zonal Health Training Institutions (Mtwara, Iringa and Arusha). Comprehensive Council Health Plans for 2015/16 provide financial resources for the participation of a number of District Health Managers from various regions in Tanzania. 21

24 Health planning session at community level Results at Regional and District Level Increased Availability of Human Resources Five councils, namely Nachingwea, Tandahimba, Masasi, Kilwa and Nanyumbu, have been supported in actively practicing the proactive recruitment and retention of health staff. As a result, Nachingwea and Nanyumbu recruited 28 new staff and Tandahimba employed one critically needed radiographer. Improving Accountability in Hospitals TGPSH (TC) supported partner hospitals in enabling and addressing feedback from health service users as well as staff. This includes capacitating hospital staff to conduct awareness sessions on health ethics for staff and managers, and capacitating complaint officers to develop effective complaint management mechanisms for their hosptial. To date, TGPSH (TC) has trained six complaint officers from the Bombo Regional Referral Hospital, the Muheza and Lushoto District Hospitals in Tanga region. Complaint management Patients at the complaint office 22

25 mechanisms have been established which link complaints directly with the hospital s Quality Improvement Team which addresses concerns and deficiencies as part of their regular Quality Improvement activities. Challenges Lack of social accountability culture at local levels and inadequate capacity of communities to effectively engage in health sector planning limit meaningful involvement of civil society in the planning processes. Outlook In 2015, TGPSH (TC) will focus on the following: Further supporting civil society participation in annual health sector planning at community and council level, Extending support to partners for proactive recruitment and retention. 4.4 Cooperation with the Private Sector Health promotion at the workplace The increasing demand for health care services and the rising burden of diseases in Tanzania poses growing challenges to both the government and private sector in the country. As the government faces economic challenges to sufficiently address increasing health care needs, companies suffer loss of productivity due to absence of employees from work related to preventable illness. The Ministry of Health and Social Welfare acknowledges the need for better collaboration with the private sector in order to complement efforts towards the common goal of better health care for all including effective prevention of illness. TGPSH (TC) supports the ministry in developing a favorable policy, legal and institutional framework to guide Public Private Partnership (PPP) implementation in various forms. This support is complemented by the institutionalization of formalized dialogue structures for public and private stakeholders. In addition, TGPSH (TC) capacitates private companies e.g. Olam Ltd. Tanzania, to develop workplace policies on occupational safety and health and other health related matters, and to set up and carry out respective workplace programmes. 23

26 Results at National Level Shaping the Environment for Private Sector Investment in Health TGPSH (TC) contributed to the review of the Public Private Partnership Act, which has been endorsed by the government in December For the first time, the Act now provides a regulatory framework for public-private partnerships in the context of social service provision. This includes service agreements between private health care providers and public health authorities and will ease their implementation in future. TGPSH (TC) also provided technical expertise to the review of the PPP Strategic Plan ( ) aiming at synthesizing lessons learnt and informing future health sector policies and strategies, such as the upcoming Health Sector Strategic Plan IV. TGPSH (TC) supported the development of a PPP communication strategy to improve the understanding of stakeholders on their roles and responsibilities. Complementing the regulatory framework, TGPSH (TC) in collaboration with other stakeholders supported the formation of the Public Private Health Forum (PPHF) to facilitate the dialogue between public and private key stakeholders such as the Ministry of Health and Social Welfare, the Ministry of Finance, the Ministry of Education, professional associations, health care providers and private companies. In April 2014, the forum was officially launched with the Minister of Health and Social Welfare, Dr. Seiph Rashid, as the guest of honour mentioning the government s commitment to the public private dialogue. The PPHF s board is chaired by a government representative and co-chaired by a representative from the private sector. Members of the PPHF board during the launch Results at Regional and District Level Capacitating Local Government for Private Sector Engagement in Health TGPSH (TC) supports regional health authorities in proactively seeking private sector investment in health at regional level. The national PPP implementation guidelines along with information material have been disseminated to partners in Mtwara, Lindi, Tanga and Mbeya to facilitate awareness of existing PPP arrangements in health and encourage new partnerships. 24

27 In addition, the Public Private Health Forum has been introduced in 2 districts in Mbeya region namely Mbeya Rural and Mbozi District Council with support from the programme. Increasing Availability of Maternal and Child Health Services to the Poor TGPSH (TC) supports the ministry in establishing and implementing contractual service agreements with private health care providers. These service agreements enable especially poor pregnant women and children under 5 years to access health services at private facilities free of charge through government subsidies, where public services are not in reach. To date, there are 28 service agreements in place within the four TGPSH (TC) partner regions. In collaboration with the Christian Social Service Commission training has been provided to Faith based hospitals and local health authorities in Mbeya to improve the administration of the service agreements. This initial capacity development effort shall serve as a pilot initiative for further roll out in Improving Health of Employees through Preventive Workplace Programmes TGPSH (TC) supported the Association of Tanzania Employers (ATE) in its role as the focal point for HIV and health in the private sector. The programme assisted in developing an action plan for the operationalization of the Strategic Plan as regards the private sector s response to HIV/AIDS and health issues at the workplace. TGPSH (TC) co-funded the private sector HIV/AIDS coordinator since 2012 and supported the development and dissemination of manuals for workplace programme coordinators. A number of largescale private companies such as Unilever, Mufindi Tea and Coffee Ltd., Tanzania Breweries Limited, Tanga Cement and Ecobank implement preventive workplace programmes ultimately benefitting a significant number of employees. Challenges Insufficient knowledge of stakeholders limit scaling up of PPP in health. Lack of information and awareness on Corporate Social Responsibility compromises private sector engagement in proactive health promotion. Insufficient knowledge and capacities of local health authorities and private health care providers alike impede efficient and effective administration of service agreements. Outlook In 2015, TGPSH (TC) will focus on the following: Facilitating the exchange between private companies committed to CSR and public health authorities at both the regional and district level paving the way to future PPP arrangements, Strengthening further capacities of Government partners to advocate for stronger engagement and investment of private companies and health service providers in health. 25

28 4.5 Strengthening Civil Society Organizations CSO members during a capacity building session Engaging Civil Society Organizations (CSOs) is an important strategy to foster people-centered and transparent health services. However, lack of coordination structures at the national level hinder participation of CSOs in meaningful participation in decision-making. Likewise, weak management capacities of CSOs excludes many small organizations from funding opportunities, thus jeopardizing the sustainability of their work. TGPSH (TC) supports civil society organizations to claim and exercise their role in the governance of the grants provided by Global Fund to Fight AIDS, Tuberculosis and Malaria. This is achieved by capacitating CSOs to effectively collaborate and thus strengthen their position in decision-making processes of the Tanzanian National Coordination Mechanism for the Global Fund. Besides, in Mtwara region, TGPSH (TC) builds the management capacities of small CSOs promoting health and targeting young people. Results at National Level Improved Coordination for Effective Engagement of Civil Society Organizations The non-state actors of the Tanzanian National Coordination Mechanism (TNCM) launched an informal coordination group, led by the TNCM Vice Chair and managed by a secretariat supported by TGPSH (TC). Through this group, the non-state actors have established processes for better monitoring the Global Fund in Tanzania. Improved information exchange, representation in relevant committees and coordinated action have resulted in successfully voicing CSOs concerns during key decision making processes and ensuring the inclusion of their recommendations in relevant documents such as Tanzania s HIV/ Tuberculosis funding request to the Global Fund in

29 Sharing health information during a youth rally Results at Regional and District Level Enhanced Capacities for Better Services In Mtwara, TGPSH (TC) supported a multifaceted training program for community-based Civil Society Organizations. 11 CSOs, all having a strong background in raising health awareness for young people, were trained on strategic planning, financial management, resource mobilization and project cycle management. Through a small grants facility, they actively applied gained knowledge and furthered their management capacities. Through the partnership with the NGOs Deutsche Stiftung Weltbevölkerung and Femina Hip, TGPSH (TC) builds on the expertise and network of these two organizations that have a long track record in the area of adolescent sexual reproductive health and rights. Challenges Existing political commitments to key populations are only very slowly transforming into collaboration with CSOs Outlook In 2015, TGPSH (TC) will focus on the following: Consolidating empowerment of CSOs representing marginalized groups in Global Fund related decision-making Consolidating management capacities of CSOs in Mtwara Advocating at the Local Government in Mtwara region for direct participation of young people in health planning Exploring synergies with the Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) with regards to inclusion of people living with disabilities Engaging youth in health communication 27

30 List of Publications supported by TGPSH (TC) 1. Proactive Recruitment and Retention of Health Staff : Experiences from Lindi and Mtwara regions A guide for main actors, TGPSH (TC) GIZ, 2014 Edition. 2. Proactive Students Enrollment into Training Institutions: Experiences from Lindi and Mtwara A guide for main actors, TGPSH (TC) GIZ, 2014 Edition. 3. Sponsoring and Bonding of Students and Health Workers: Experiences from Lindi and Mtwara, A guide for main actors, TGPSH (TC) GIZ, 2014 Edition. 4. Issue 35 of Femina Hip s Fema Magazine Seeing Opportunities in New Markets, for economic empowerment and skills development of young people, featuring the Mtwara region is available in Kiswahili. 5. Mapping of malaria Non-State Actors to inform the planning of the Global Fund concept note on malaria in cooperation with TANAM. 6. Sexual Harassment and Gender-Based Violence in the Public Service Workplace in Tanzania Mainland, A Case Study in Mtwara Region and Dar es Salaam Region. 28

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