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
100% balanced
80% of primary
distribution of skilled health workers at primary level
health facilities to be rated 3 Stars and above
4 initiatives
Health facilities
BRN Healthcare
20% reduction in maternal mortality ratio and neonatal mortality rate in 5 regions
6 initiatives
RMNCH 6 initiatives
Health commodities
6 initiatives
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%
582
7%
Reported and left
2 HRH 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 1st 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
9.3
10 8
7.74
6 2015 Nurses
4
2015 Clinicians
2 Kilimanjaro
Njombe
Iringa
Pwani
Mbeya
Dar Es Salaam
Arusha
Morogoro
Lindi
Manyara
Tanga
Ruvuma
Mwanza
Dodoma
Mara
Mtwara
Kagera
Singida
Shinyanga
Rukwa
Kigoma
Geita
Tabora
Katavi
2014 Nurses Simiyu
0
On average, 4 regions improved Katavi, Kagera, Mtwara & Mwanza • 3 regions became worse from above to below 7.74 – Manyara, Lindi & Mbeya
2014 Clinicians
Before
After
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
12
14
Regions above 2014’s national average for clinicians and nurses density
5
Situation in the first 9 Regions Density of HRH before and after remedial plan in 9 Regions 9.00 8.00
Baseline Nat. Aver 2014- 7.74
7.00
6.4
6.00
Density of HRH BF
5.00
Density of HRHAF
4.00
4.4
3.00 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 • 1st Training for Dodoma and Ruvuma Region – 8th November 2015
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
• • •
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 7
Reinforce Orientations and induction for newly hired staff
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 • • •
•
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 8th November 2013, DSM in Dec 2015 To complete BRN Region in Feb 2016
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
2 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
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
Mwan za
Simiyu
Shinyanga
Total
%
151
70
40
261
36.8%
161
71
147
379
53.5%
37
12
17
66
9.3%
3 Star
1
0
2
3
0.4%
4 Star
0
0
0
0
0.0%
5 Star
0
0
0
0
0.0%
350
153
206
709
280
122
165
709
Star Rating 0 Star 1 Star 2 Star
Total Facilities Target
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
Health Commodities 1
2
Improving governance, accountability, and sense of ownership of Health Commodities supply chain
Strengthen management of MSD working capital work • Prime vendor on MSD zonal basis is on
• 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
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
Health Commodities 4
5
Introduction of ICT mobile applications platform at lower level facilities for improved communication and data management in supply chain
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
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. Pending availability of funds, editing, pilot testing of the documents and translation into Kiswahili will be done prior to implementation 13
Agenda
Health NKRA Focus Area HRH Distribution Health Facilities Health Commodities RMNCH Funding Situation Anticipated Challenges Moving Forward AOB 14
RMNCH 1
2
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
Mobilise Community Health Workers (CHW) to improve RMNCH services • Assessment of CHW conducted • Review of training materials (3 Wks Training) will be conducted on 9th to 21st 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 Geita 2 Kigoma 4 Mara 3 Mwanza 7 Simiyu 1 Total 17
Target 12 23 22 34 14 105
Gap 10 19 19 27 13 88
Baseline 13 9 25 13 4 64
Target 56 100 113 123 61 453
Gap 43 91 88 110 57 389
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 :
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
23,184
12,804
10,475
Region
Total
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
9%
632,575,000
100%
632,575,000 (funds from fy 2014/15)
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%
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%
GovernmentOthers Charges
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 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
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 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
Complete baselining exercise and finalize the KPI and targets for BRN for the 3-year timeframe
2
Onboarding PMORALG staff – MDU & health department – 10 – 12 December
3
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
Interim MDU
PDB Team
Dr. Adeline Saguti-Nyamhiwura Ministerial Delivery Unit
[email protected] 0753545166
Dr. Rosina S M Lipyoga Ministerial Delivery Unit
[email protected] 0754294554
Dr. Joseph Hakororo MDU Liaison
[email protected] 0767314190
Mr. Andrew Makoi MDU Liaison
[email protected] 0754260883
Mr. William Reuben MDU Liaison
[email protected] 0784254572 Dr. Linda Ezekiel Director, Social Sector
[email protected] 0754290499
Azlin Niza Ismail Social Sector
[email protected] 0785447843
Abdul Muiz Abdul Aziz Healthcare NKRA
[email protected] 0687966998
Nasrul Yusuf Healthcare NKRA
[email protected] 0785447381 25
BEMOC & CEMOC Assessments Results
26
26
InsBtuBonal Delivery 107
120
85.9
81.9
71.6
51 25.2
46.4
% Delivery in HF % Delivery in fully funcBonal EMONC HF
14
22.6
27.6 10.7
11.6
20
28.4
40
58.8
50.6
60
62.7
80
60.9
100
0
27
27
Causes of Maternal Deaths in Study Zones
Other indirect causes 4% Abor0on 19% Anemia 12%
Malaria 8%
Hemorrhage 29%
Sepsis 7%
Obstructed labour 13%
Hypertensive disorders 8% 28
28
In which HF level were maternal deaths occurring (Figures in %)? 28
Tabora
37 35 92.4
Simiyu
7.6 72.7
6.1
Shinyanga
21.2 22.4
8.7
Mwanza
Health Centre
18.0
Mara
75.3
6.7
Kigoma
48.6
13.5
Geita
37.8 46.0
0 0
10
20
Hospital
39.3 39.3
21.4
Kagera
Dispensary
68.8
30
40
50
54.0
60
70
80
90
29
100 29
Asante Sana
30