Progress Report. Report. August 2008 April August 2008 April April 2009

Transcription

1 RRHM08-14 Report August 2008 April 2009 Tanzania-Japan Technical Cooperation in Capacity Development for Regional Referral Health Management Report August 2008 April 2009 April 2009

2 Chapter 1: Summary COutline of TC-RRHM Period Target Area Base of Operation Objectives and Indicators From March 2008 to March 2011 (3 years) 21 regions Health Sector Reform Secretariat, Policy and Planning Department, Ministry of Health and Social Welfare, Dar es Salaam Overall Goal 1. Number of RHMTs that can be Regional Referral Health introduced as a good practice is increased. Management (RRHM) is improved 2. Quality of CCHP is improved. to provide sustainable health services. Purpose Regional Health Management Teams (RHMTs) are strengthened in order to provide quality regional referral health services. 1. Capacity assessment results of RHMTs are improved between , to respond to demand of both the Central and Districts. 2. Task assessment results of RHMTs are improved between Implementing Agencies Ministry of Health and Social Welfare Policy and Planning Department, Health Sector Reform Secretariat Human Resources Development Department, Continuing Education Section Chief Medical Officer s Office, Health Services Inspectorate Unit / Department of Health Policy, Health Information and Research Section Preventive Services Department Curative Services Department Zonal Health Resources Centres Prime Minister s Office Regional Administration and Local Government Regional Administration Department Sector Coordination Department Local Government Department Regional Secretariats Regional Secretariats Regional Health Management Teams (RHMTs) Local Government Authorities Council Health Management Teams (CHMTs) Council Health Service Boards Beneficiaries Direct: RHMT staff and personnel in 21 regions Indirect: CHMT staff and personnel / Health facilities staff and personnel / People who use health care services in Tanzania

3 TC-RRHM Diagram

4 Work Plan as of August Strengthening Organizational Capacity of RHMTs 2-1. Improving Dissemination Mechanism of Policy and Guidelines 2-2. Strengthening Regional Management Supportive Supervision (from RHMT to CHMTs) 3. Strengthening Regional Management Supportive Supervision (from Central to RHMTs) 4. Strengthening Coordination and Supportive Mechanism between Central and Regional Levels Year 1 Year 2 Year 3 Year Materials review Planning Modules Planning Modules&TOT WS1-a WS1-b Following up Revision WS3 Following up Revision Planning Modules&TOT WS2 Following up Region initiated training Revision Situation analysis Review Review Review Review Planning System formulation Activities continued and Reviewed System final revision Review Review Review Situation analysis Support to guideline formulation Following up Final revision & dissemination Situation analysis Planning Review Baseline data collection CMSS CMSS CMSS Guideline and tools formulation Review and revision Final revision & dissemination SWAP TSCM SWAP TSCM SWAP TSCM SWAP TSCM SWAP TSCM SWAP TSCM SWAP TSCM Planning JAHSR SWAP JAHSR SWAP JAHSR Action Plan Project Office ICR(D) PD PR1 PR2 PR3 PR4 PR5 FD JCC1 JCC2 JCC3 JCC4 M&E Planning Monitoring 1 Monitoring 2 Monitoring 3 Evaluation TSCM:Technical Sub-committee Meeting

5 Chapter 2: & Way Forward TC-RRHM Overall Revision of Project Design Matrix (PDM) The PDM version 3 was reviewed and revised to version 4 based on the Project current situation in the RHMT Monitoring Workshop held on October The operational indicators were set to measure achievement in TC-RRHM during its implementation. Visit of the Management Supportive Mission from JICA Headquarters The Management Supportive Mission (Leader, Dr. Sugishita, JICA Senior Advisor) visited the MOHSW, Dar es Salaam from 31 October to 30 November 2008 to oversee the operation of the TC-RRHM. The mission, after the visit to Kigoma and Morogoro Regions and discussions with senior management, provided suggestions to the TC-RRHM and MOHSW. The Regional Health Systems Strengthening (RHSS) Meeting The 1 st RHSS Meeting was conducted in Dar es Salaam on February The eight Best Contributors of the Leadership & Management Training were invited to the Meeting as a representative of respective zones. In the meeting, constructive ideas on improving the RS/RHMT trainings, mechanisms of policy dissemination and supportive supervision, and networking among regions were raised and discussed. Presentation in the MOHSW RMO/DMO Meeting in Mbeya The MOHSW officer in charge of TC-RRHM and Japanese experts participated in the RMO/DMO Meeting held in Mbeya on 2-7 March 2009, and presented progress and strategy of TC-RRHM. Mid-term Review of the TC-RRHM The Mid-term Review Mission will visit Tanzania during 20 May -13 June The visit to regions, discussions with senior management and the Review Meeting are planned for the Mission. The results of the 2 nd Central Management Supportive Supervision (CMSS: April 2009) will be fully utilized for the review. The 2 nd Joint Coordination Committee (JCC) Meeting of TC-RRHM The 2 nd JCC Meeting of the TC-RRHM is scheduled for early June The results of the Mid-term Review will be shared and the next year budget will be discussed among the stakeholders.

6 Way forward Securing of the central budget for RHMT strengthening in MTEF The TC-RRHM requested the MOHSW to secure the 2009/10 central budget for RHMT strengthening in MTEF. Priority should be placed on the implementation of bi-annual CMSS, zonal meetings for peer review and management trainings. The TC-RRHM shall closely follow up the procedure of budgeting for 2009/10. Securing of the regional budget for RHMTs RHMT Kagera recently reported that they have received the budget for RHMT. Budget disbursement to other regions should be followed by the MOHSW. The budget for RHMT for 2009/2010 should be also secured consistently. Output 1: Management Capacity Strengthening 1 st RS/RHMT Training on Leadership and Management The 3-day training on Leadership and Management was conducted in 8 zones from 12 November to 12 December inviting all (eight) RHMT members and 2 RS staff from each of the 21 regions. Topics included leadership, team building, costumer care, change management and strategic planning. Management Capacity Assessment of RHMTs RHMT members assessed their team s Management Capacity as a part of the Training. The assessment result of each team was visualized in a hexagon spider web (Buibui) diagram. This capacity assessment tool will be utilized during every CMSS. The results will be shared among RHMTs, Regional Secretariats, MOHSW and PMORALG. 2 nd RS/RHMT Training on Strategic Thinking and Planning (Phase I) Strategic Thinking must be first internalized as a base for strengthening the ability to develop an actual Strategic Plan. Nine Regions were provided 5-day training on Strategic Thinking and Planning during 16 March -3 April Those trained were Lindi, Kilimanjaro, Rukwa, Tanga, Dar es Salaam, Shinyanga, Coast, Kagera and Singida RS/RHMTs.

7 The 2 nd RS/RHMT Training on Strategic Thinking and Planning (Phase II) The above training will be conducted to remaining 12 Regions during 25 May 12 June The venues are Mwanza, Dar es Salaam and Morogoro. Planning of the training topics for 2009/2010 The training topics for 2009/10 will be discussed in the 2 nd RHSS Meeting and be finalized at the Joint Coordinating Committee meeting scheduled for early June Training topics may include coaching and effective communication, policy dissemination and supportive supervision. Way forward System building for self-learning and peer-learning Trainings need to be linked with self-learning within the team or peer-learning among regions for a concrete and conclusive capacity development and increased work performance of RHMTs. Opinions from RHMT members will be obtained during the RHSS meetings and utilized. Follow-up of RHMTs Strategic Plan preparation RHMTs trained on Strategic Thinking and Planning in March-April are scheduled to prepare their Strategic Plans by the end of May. The TC-RRHM will facilitate the networking for peer learning among RHMTs so that they can help each other to enhance the quality of their Strategic Plans. Output 2: Policy Dissemination & Regional Management Supportive Supervision 2.1 Strengthening of Policy Dissemination Mechanism Reconfirmation of RHMTs Demands for Policy Dissemination Great demands for the effective Policy Dissemination were expressed by RHMTs during the 1 st CMSS conducted in November Trial on Policy Dissemination Support Activity The Advocacy Unit of MOHSW in collaboration with TC-RRHM tested a dissemination of Health Sector Strategic Plan III (HSSP3) during the RS/RHMT Leadership and Management Training in Arusha in December The methods used were power-point presentation and group exercise with a case extracted from HSSP3.

8 Introduction of HSSP3 to RHMTs and Regional Planning Officers As part of the Strategic Thinking and Planning Training in March-April, RHMTs and Regional Planning Officers studied the structure and contents of HSSP3. They also read HSSP3 critically and discussed how they would use HSSP3 to fulfill their responsibilities. Time required for the session was about 4 hours excluding self-learning prior to the session. Refining Policy Dissemination methods and tools Using experiences of the trials in December 2008 and in March-April 2009, the Policy Dissemination Team will brush up Policy Dissemination methods and tools to make them more user-friendly. Preparation of the inventory of major policies and guidelines The inventory will be included into the Policy Dissemination Tools. It is expected to help RHMTs understand the hierarchy of various policies and guidelines. Way forward Dissemination tool kits shall be developed and applied in trainings and other occasions. Tool kits and methods could be aids to effective Policy Dissemination. However if not used, they would be a mere addition to the long list of materials produced by the ministries. Promoting the use of those tools and methods should not be overlooked. 2.2 Regional Management Supportive Supervision (RMSS) Strengthening of knowledge for effective supervision The basic concept of change management and strategic customer care was introduced to RHMT members through the Leadership and Management Training, which should be applied to management supervision from RHMTs to CHMTs. Exchange of views on supportive supervision with stakeholders The representatives of TC-RRHM attended a stakeholder meeting organized by GTZ where the RRHM s views on supportive supervision was briefly presented. In addition, discussion was made on the finalization of the National Supportive Supervision Guidelines for Quality Health Services. Pre-test of the checklists in the National Supportive Supervision Guidelines The checklists in the National Supportive Supervision Guidelines were voluntarily

9 pre-tested by RHMT Arusha. This can be seen as one of the positive effect of TC-RRHM implementation. Analysis of the results of the pre-test on the checklists The TC-RRHM is planning to organize the practical working team who are going to work on the checklists to make it useful for users (mainly CHMTs and RHMTs). Way forward Finalization of the National Supportive Supervision Guidelines The TC-RRHM will continue support for the Health Services Inspection Unit (HSIU) to coordinate stakeholders and finalize the Guidelines. Output 3: Central Management Supportive Supervision (CMSS) 3.1 Development of CMSS Guidelines and Tools Implementation of RHMT Monitoring Workshop The 3-day RHMT Monitoring Workshop was successfully conducted at CEEMI Complex, Dar es Salaam on October The main objectives of the Workshop were 1) to review the Project Design Matrix (PDM) of TC-RRHM with the stakeholders, 2) to set operational indicators when appropriate and 3) to develop tools for the CMSS. The CMSS is a supportive supervision which is given from the MOHSW to RHMTs. A total of 31 participants actively participated in the Workshop including two Assistant Directors from PMORALG and 4 RHMT members from 4 respective regions. Development of the draft tools for CMSS The draft tools for CMSS to RHMTs were developed during the RHMT Monitoring Workshop and subsequent technical meetings with the CMSS supervisors. The tools include the followings. 1) Interview Guide to CHMTs 2) Task Assessment Format 3) Capacity Assessment Diagram to RHMTs (Buibui Diagram) Refining of the draft CMSS tools and development of draft CMSS Guidelines The draft CMSS tools are being refined based on the review of 1 st CMSS. The draft

10 CMSS Guidelines will be developed and instructed to the CMSS supervisors during the Orientation session scheduled for 14 th April These tools and Guidelines will be further sophisticated after reviewing the application to the 2 nd CMSS scheduled for 19 April-1 May Way forward Sharing of the draft CMSS Guidelines and Tools The developed draft CMSS Guidelines and tools will be shared among the stakeholders. Authorization and standardization by the MOHSW and PMORALG will be discussed toward the sustainable utilization of them in the country nationwide. 3.2 Implementation of the CMSS Selection of target regions for the 1 st CMSS The eight target regions for the 1 st CMSS were selected from 8 zones respectively with the consultation of officials of MOHSW in October These are namely Dodoma, Morogoro, Arusha, Mwanza, Iringa, Mtwara, Mbeya and Kigoma Regions. Implementation of the 1 st CMSS (Baseline Survey), October-November 2008 The CMSS Supervisor Core Team (approximately 12 members) was formulated consisting of MOHSW officials and lecturers from Mhimbili University etc. Two supervisors made a sub-team. Eight sub-teams with different combination of supervisors visited eight regions respectively and conducted the 1 st CMSS. The three-day visit included a courtesy call to RAS Office and interviews with CHMTs on their expectation of RHMTs. In relation to RHMTs, the newly defined functions and tasks of RHMTs were introduced. The degree of achievement of their tasks was assessed and actions to be taken by various stakeholders were discussed. Feedback of the results of the 1 st CMSS to the RHMTs and stakeholders The CMSS Final Report was distributed or sent to the RHMTs visited, CMSS Supervisors, other MOHSW officials and PMORALG as a feedback. Coaching Training for the CMSS Supervisors (11-12 March 2009) The main objective of CMSS is that RHMTs and central ministries share management problems on site and discuss together what each stakeholder can do to solve those problems and improve the situation. To achieve this objective and increase cost-effectiveness of their visit, the CMSS Supervisors need advanced coaching and listening skills. The first Coaching Training was conducted for the CMSS Supervisors in Kigamboni. The Supervisors learned the importance of

11 interpersonal communication through practical exercises and games. They are expected to apply the acquired skills to the 2 nd CMSS implementation. Implementation of the 2 nd CMSS (19 April-1 May 2009) The 2 nd CMSS will cover the 8 RHMTs, which were visited by the 1 st CMSS, 6 months ago. A series of activities are planned before and after the 2 nd CMSS visits to the regions including improvement of CMSS tools, orientation to the CMSS Supervisors and results sharing. As an experiment, the 2 nd CMSS will invite one RHMT member from a non-host RHMT in the same zone to observe how the CMSS will be conducted. On return, those RHMT members are expected to share experiences with neighboring RHMTs and CHMTs, and prepare for the next CMSS scheduled for October 2009, in which those RHMTs are going to be visited. Way forward Appointment of a person in charge of RHMT issues in the PMORALG Collaboration with PMORALG is crucial to expand the CMSS toward 21 regions and to ensure the effectiveness of RHMT strengthening. Appointment of a person in charge of RHMT issues in the PMORALG has been requested by the MOHSW. Output 4: Networking 4.1 Strengthening of the Link between MOHSW and PMORALG Collaboration with PMORALG The assistant directors from Department of Regional Administration and Department of Sector Coordination, PMORALG participated in the RHMT Monitoring Workshop conducted in October 2008 and actively discussed with participants from MOHSW and RHMTs. A staff from PMORALG participated in the 1 st CMSS conducted in Dodoma Region. Information on the management trainings was also delivered to the relevant department in PMORALG. Organization of RRHM Sub-Committee of TC-SWAP The second RRHM Sub-Committee of TC-SWAP was merged into the TC-SWAP

12 Meeting. Facilitation of the budget disbursement for RHMTs for 2008/2009, more relevant budget plan and smooth disbursement for 2009/2010 will be discussed as well as the progress of TC-RRHM. Way forward Budgeting for RRHM Sub-Committee of TC-SWAP The RRHM Sub-Committee of TC-SWAP had not been budgeted in MTEF for 2008/09. The TC-RRHM has, therefore, proposed the MOHSW to include the budget for this bi-annual meeting into MTEF for 2009/10. The cost estimate was also submitted to the MOHSW. 4.2 Strengthening of Networking among RHMTs RHMT networking through trainings The RS/RHMT Leadership and Management Training was conducted in eight zones in November-December 2008, where the participants discussed how to strengthen network in each zone. The inventory of participants was distributed to the participants to keep them connected. Selection of The Best Contributors The Best Contributor, who contributed most by providing constructive and innovative ideas in the training, was selected at the end of the training in each site. Involving the Best Contributors in planning and networking activities The elected eight Best Contributors to the Leadership and Management Training were invited to the 1 st RHSS held in February After the meeting, the Best Contributors reported back to other RHMTs in their respective zones the results of the meeting. The TC-RRHM/HSRS Newsletter The 1 st TC-RRHM/HSRS Newsletter was issued in February 2009 as a special edition of HAM, that is, advocacy magazine of the MOHSW. The contents included the introductory comments from the CMO, TC-RRHM structure and activity, latest information regarding regional health management etc. The first volume was distributed at a series of important meetings, including the annual MOHSW RMO/DMO meeting held in Mbeya in March nd RHSS Meeting The 2 nd RHSS Meeting is scheduled for 2-3 June 2009.

13 Way forward Budgeting network activities at regional level RHMT Coast is budgeting network activities for 2009/10. TC-RRHM will monitor what actions have been taken by other RHMTs to materialize the networking with other RHMTs, particularly with those in the same zone. From networking to peer support In the long run, peer support among RHMTs will become an effective and sustainable means of their capacity development. Promoting networking among RHMTs through trainings, RHSS meetings, feedback and CMSS is the first step for TC-RRHM team to explore how peer support system can be built among RHMTs. Increasing the cost-effectiveness of TC-RRHM/HSRS Newsletter The TC-RRHM/HSRS Newsletter Be Connected is an extremely important information and communication tool for TC-RRHM. Its contents, utilization, timing of publication and means of distribution will be carefully planned in order to increase the value of TC-RRHM. The next issue will be expected in October 2009.