THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH

THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN Highlights and Recommendations from the 2016 Technical Review Meeting Prof. Muhammad Bakari Kambi Chief Medical Officer Ministry of Health, Community Development, Gender, Elderly and Children 7 th December 2016 MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN

Presentation Outline • The Strategic Framework of the Health sector • Health Sector Strategic Plan IV (HSSP IV) and Sector Wide Approach (SWAp) • Timeline and contents of the Joint Annual Health Sector Review (JAHSR) • Highlights from the Technical Review Meeting (TRM) • Overview of proposed Policy Commitments for 2017/2018 MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN

Tanzania Vision 2025 -Achieving Middle-Income Status -Improved Quality of Livelihood MMAM (review process has started) Tanzania Health Policy Big Results NOW (BRN) Sustainable Development Goals Universal Health Coverage (under revision) Health Sector Strategic Plan IV MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN Ruling Party (CCM) Election Manifesto Components of the Strategic Framework

Objectives of HSSP IV Overall objective To reach all households with essential, quality health and social welfare services, meeting, as much as possible, the expectations of the population, adhering to objective quality standards, and applying evidence-informed interventions through efficient channels of service delivery. Objective 1 The health and social services sector will achieve objectively measurable quality improvement of primary health care services, delivering a package of essential services in communities and health facilities. Objective 2 The health and social welfare sector will improve equitable access to services in the country by focusing on geographic areas with higher disease burdens and by focusing on vulnerable groups in the population with higher risks. MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN

Objectives of HSSP IV Objective 3 The health and social welfare sector will achieve active community partnership through intensified interactions with the population for improvement of health and social wellbeing Objective 4 The health and social welfare sector will achieve a higher rate of return on investment by applying modern management methods and engaging in innovative partnerships. Objective 5 To address the social determinants of health, the health and social welfare sector will collaborate with other sectors, and advocate for the inclusion of health promoting and health protecting measures in other sectors’ policies and strategies. MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN

HSSP IV and Sector-wide Approach (SWAp) • HSSP IV provides guidance to the transformation of the health sector and an opportunity for long term planning • SWAp offers continuous sector dialogue and commitment to work in the same direction • The Joint Annual Health Sector Review Meeting is a forum that assesses sector performance and recommend adjustments when needed MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN

Monitoring of performance MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN

Timeline for the JAHSR Input to the review Joint Field Visits October DMO/RMOs conference October Analysis and discussion Technical Review November Policy Meeting December Implementation and preparation for next years JAHSR December Policy priorities for 2017/2018

Contents of the Technical Review Meeting • Presentations – Annual Health Sector Performance Profile – Health Care Financing Update – Joint Field Visit – RMO’s and DMO’s Conference Update – Presentations from PORALG – Presentations from Partners • Discussions • Group Work – generated Policy Priorities MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN

Highlights: Health Sector Performance in 2015 Indicator Target 2015 19 Results 2015 Neonatal mortality rate (per 1, 000 live births) Baseline 2009 32 Infant mortality rate (per 1, 000 livebirths) 58 50 43 Under-five mortality rate (per 1, 000 live birth) 94 79 67 More work needed on: -Maternal mortality Ratio still at 401 per 100, 000 live births -% of dispensaries providing BEmo. NC 13%(2015) vs. target of 40%, Health Center CEm. ONC 12% (2015) vs. target 40%, Hospitals CEmo. NC 59% (2015) vs. 64% (2009) -Proportion of budget allocation to Health Sector 10. 1% in 2015 vs. 12% (2009) - Prevalence of Malaria Parasitaemia Malaria 14. 8% (2015) vs. Target of 5% 25 Achievements in: -Life expectancy increased from 51. 5 yrs (2009) to 61. 8 (2015) -HIV - Number of persons with advanced HIV infection receiving ARV combination Rx increased to 839, 574 (2015) from 135, 696 MMR trends MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN

Highlights: Health Care Financing Update MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN

Highlights: Health Care Financing Update § The health spending in absolute terms and per capita has only increased slightly from 2014/15 to 2015/16 § Proportion of development expenditure out of total budget Increased from 16% (2015/16) to 54% (2016/17) § Budget for medical commodities increased 8 times from 31 bil (2015/16) to 251. 5 bil (2016/17 A funding gap - If the HSSP IV are to be fully implemented MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN

Highlights: Health Care Financing Update • Increased development funds from domestic financing e. g. remarkable increase of funds for medicines, equipments and consumables • High levels of out of pocket payments despite marginal decrease. Therefore, need to establish effective pre-payment schemes in context of overall Health Financing Strategy • Spending in other diseases other than Malaria, HIV/AIDS and TB is increasing • Donor financing is decreasing • Role of NGOs in managing sector resources is still significant Need to: – establish mechanism for improved monitoring of the operations and impact evaluation – harmonize funding to avoid duplication

Highlights: Joint Field Visit • Focus this year: Monitoring and Evaluation • Broad agreement from the discussion: – the area is crucial for decision making, planning and assessing performance of health services – the system is in place and people are keen to improve – there is a need to focus on computerization, quality and use of data MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN

Highlights: RMO’s and DMO’s Conference Recommendations from the field: § Support Health Facilities with 0 to 1 star to upgrade their status § All Regional Referral Hospitals to be equipped with relevant diagnostics and relevant medical specialists § Facilitate training of Medical Specialists § Streamline Health Information System § Increase CHF and ensure social protection of victims from traffic accidents MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN

Highlights: RMO’s and DMO’s Conference Recommendations from the field: § The Mo. HCDGEC to facilitate PPP in improving diagnostic facilities. § Ensure constant supply of medicine, vaccines and supplies § Establish emergency care at hospital level § Make a plan for disaster preparedness MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN

Highlights: Areas of discussion The following areas came up during discussions: – Inequitable geographical distribution of resources (in relation to disease burden), – Weak Health Systems – Maternal Mortality, yet to improve significantly – Human Resources is insufficient in some areas – Significant number of Health Facilities with low star rating – M & E needs more focus in terms of data collection and reporting – Insufficient availability of Essential Medicines – Better planning and availability of funds at lower level MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN

Road map to Policy Commitments - participatory process Discussions in the Technical Review Meeting Group Work in the Technical Review Meeting MOHCDGEC making a draft 0 Technical discussions on draft 0 Final Draft tabled at the Policy Meeting Policy Commitments for 2017/18 MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN

Policy Recommendations for 2017/18 Area Focus of policy commitments Quality Improvement § Monitoring and evaluation strengthened § Referral system strengthened § Emergency hospital care improved Innovative partnerships § Private sector engagement though PPP enhanced Social determinants § Inter-Ministerial cooperation on health security and emergencies § Strengthen education at community level on nutrition, water and sanitation Big Result Now § Continued focus on achieving targets for RMNCAH, HRH, Facility Performance, Commodities MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN

Continued focus on Policy Recommendations 2016/17 Area Focus of policy commitments Prevention and Community Health § Deployment of CHWs Equity § Comprehensive geographical mapping of resources Health Financing and § Harmonise different CHF/NHIF approaches Public Financial Management Governance and leadership § Direct facility financing institutionalized Commodities § Clear model for Complementary procurement MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN

Asanteni sana! MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN