12th Tanzania Joint Annual Health Sector Review 2011 by pptfiles


									           Technical Review Meeting
11 th   October 2011 - BOT, Dar es Salaam

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q   6 regions were chosen.

q   2 districts in each region were selected (t.f. total of 12 districts),
    where health facilities and health management teams were
    visited and interviewed, using a structured questionnaire.
      q Singida: Singida Vijinji/Dist. Council Iramba
      q Shinyanga: Kahama; Meatu
      q Tabora: Urambo; Nzega
      q Kagera: Biharamulo; Karagwe
      q Manyara: Mbulu; Semangiro
      q Lindi: Nachingwea; Liwale

q   Participants came from government (MoHSW, PMO-RALG, POPSM,
    MoFEA) and stakeholders in the sector which included DPs, CSOs,
    FBOs, and APHFTA.

q   The objective as per the TORs shared during the preparation of
    the JAHSR preparations and endorsed by the stake holders. This
    aimed at a snapshot on the health service quality and equity and
    also the health system components status.

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q   To assess the status and trend of the six health
    systems building blocks/ components (Service
    delivery, Human Resources for Health, Financing,
    Information, Medicines & Commodities, and
    Governance) in terms of performance and equity
    where applicable.

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HSS Building   Strengths                                  Challenges
[1]            qAll essential services qNot all services that are mandated are
Service        provided at Regional & provided at Health centres & dispensary , but
Delivery       district hospitals      FBOs fared better

                                       qAvailability of amenities - electricity &
                                       water affected service delivery; but in some
                                       areas local innovations were addressing the
                                       issues, again FBOs were ahead of the curve

                                       qHeavy workload or rather few HRH
                                       affected service delivery

                                       qLack of clinical waste disposal facilities
                                       particularly incinerator at lower facility levels
                                       presented a health risk
Equity         qServices accessible    qPhysical access to disabled citizens
               to all segments of      particularly in all old facility structures. (New
               society regardless of   facilities design OK)
               ability to pay

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HSS Building    Strengths                                        Challenges
[2]             qInnovative ways to attract and     qCritical shortage of HRH at all
Human           retain workers which are working    levels
Resources for   in some areas
Health (HRH)                                        qHRH supply problems when it
                qrecruiting from Training           comes to specialists (e.g. surgeons)
                Institutions by management
                visiting and talking to graduates   qBudget Ceiling

                qincentives including housing       qProlonged salary delays for newly
                facilities.                         recruited HRH.

                qHead hunting of HRH                qCumbersome Recruitment process
                colleagues                          and many actors in the process and
                                                    not well coordinated

Equity          qGender: HRH dominated by           qDistribution btn “urban” and
                women                               “rural” difficult to judge

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HSS Building Strengths                                      Challenges
[3]          qPresence of alternative      qLower facilities Health Centres &
Financing    sources of funding CHF,       dispensaries have difficulties
             NHIF and User fees, which     accessing CHF funds, have no own
             to a large extent have help   accounts
             improve service delivery
                                           qCHF members dissatisfaction in the
                                           case where they are required to
                                           purchase medicines at private drug
                                           store due to O/S at facility (potentially
                                           discourage future enrolments)

                                           qLate disbursements of approved funds
                                           (Basket & OC), less than full approved funds
                                           are disbursed (mainly O.C)

                                           qRHMT receive no direct funding from
                                           basket, have to depend on councils.

Equity       qFunds allocated              qDespite formula specific areas may
             according to formula          still be disadvantaged due to
             taking to account             geographical vastness and small
                                                                9/10/2013                 6
HSS Building Strengths                                 Challenges
[4]           qHealth Management           qLack of electronic system, means
Information   Information System (HMIS) in takes longer to process and use the
              are in place albeit manual   information captured.
                                           qShortage of MTUHA books
              qRegions and Districts
              and to some extent           qParallel information systems exist,
              facilities use available     increasing amount of record/ time
              data for planning            spent capturing and retrieving
                                           information, integration required
              qComputerized HRH
              system installed in some
              regions e.g. Singida

Equity                                   qPoor quality of information
                                         captured at facilities may potential
                                         affect decision making when
                                         allocating resources hence lead to
                                                             9/10/2013            7
HSS Building   Strengths                                  Challenges
[5]         qAvailability of medicines       qLess than 100% order
Medicines & was generally satisfactory       fulfillment by MSD and lack of
Commodities in spite of reported 50%-        Lab/ x-ray consumables
            60% order fulfillment rate
            by the central medical store     qQuestionable quality of
                                             commodities, e.g.
               qFacilities/ DMOs mainly      Thermometers, Mattresses and
               used CHF/ NHIF/ user fees     stethoscopes from MSD
               to purchase o/s medicines
               from private suppliers        qLong system of disposing expired
               qFacilities (health centres
               and dispensaries) use the
               Integrated logistics system
               to order and receive meds
               & commodities

Equity                                       qShortage of medicines affect
                                             service delivery, more often the
                                             poor do not have alternative
                                             sources.         9/10/2013          8
HSS Building Strengths                                      Challenges
[6]          qCouncil Health Service         qCHSBs/ HFGC need capacity building to
Governance   Boards (CHSB) and Health        better understand and perform their roles.
             Facilities Governing
             Committees (HFGC) are in        qWeak linkages between ZHRC/
             place.                          RHMT/CHMT/ facility management teams.

             qRHMT have limited              qNeed to strength lines of
             knowledge/ experience of        communication btn Central government
             PlanRep yet expect to support   and FBO particular in terms of
             and supervise council to        government HRH seconded to FBO.
             implement the same.

             qCollaboration between LGAs
             and DDHs is improved, service
             agreements in place.

Equity                                       qLack of clear understanding by
                                             management & citizens on how
                                             citizens priorities filter into facility
                                             plans.              9/10/2013                9
q   Inefficient manual HMIS and the shortage of MTUHA books for
    reporting as per guidelines

q   Critical shortage of skilled HRH in the facilities

q   Unsatisfactory order fulfillment by the central medical store where they
    reported receiving 50-60% of what is ordered.

q   Some of DCs have ambulances in all HCs While others do not have

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qThere  is problem of availability of Incinerators in many facilities in
the districts

qThe  budgets to run the health services in the district councils are
insufficient, funds often delayed and not fully disbursed

qThere   are problems with utilities water supplies and electricity

qThere is a need to put in place maintenance system for the solar
energy system installed for sustainability and cost containment

qProtracted  system of disposing expired drugs and this is deleterious
to the environment and the health workers

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q   The Regional Administrative secretaries (RAS) need to continue
    supporting the Councils' efforts in implementing various activities
    to improve the service availability and quality in the Councils and
    also to negotiate for adequate budgets to address the Workload
    including the development plans.

q   Address the weakness in the Regional Hospital Management Team

q   Address the critical shortage of staff needed to fill in the posts

q   See how the hospital budget can be increased by looking into the
    main sources of financing and maximizing the available funds

q   The expired drugs need to be disposed off safely and quickly. See
    how this issue can be resolved by discussions and negotiations in
    the different levels of the government.

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