brn healthcare lab · mhealth overview of brn healthcare system healthy tanzanians reproductive...

BRN Healthcare Lab

Summary of Lab Output

4th December 2014

1

June 2016

Healthcare NKRA in the next 3 years

80% of primary health

facilities to be rated 3 Stars

and above

100% balanced distribution

of skilled health workers at

primary level

100% stock availability of

essential medicines

20% reduction in maternal

mortality ratio and neonatal

mortality rate in 5 regions

2,623 dispensaries+ will have at least

one skilled HRH

22.5 million Total OPD Visits (of

which 7 million are under-5 years old)

to benefit in improved Health services

2,418 health facilities are now

ranked 3 stars or above

June 2018

(*) health facilities at selected underserved regions, out of 3,023

health facilities

(+) Dispensaries in 13 underserved regions

June 2018

1.5 million mothers are now reminded

periodically on their Pre-natal and post

natal care visits through mHealth SMS

follow up system

Blood collection doubled to 90,000

units from previously 35,000 units

June 2015

6,760 health facilities to be

rated from Star 1 – 5

December 2017

6,760 Health facilities now with 100% Stock

availability of all essential medicines

1,813 health facilities* are now

ranked 3 stars or above

5,408 health facilities now has their

own bank account

June 2017

90 Health facilities now manned

by skilled private HRH through

PPP arrangements

December 2015

150 dispensaries now have

at least one skilled HRH

70% of graduated students are now

bonded and serves in health facilities

2

Without a healthy population, Tanzania risks NOT achieving

TDV2025’s aspirations…

USD 272.6 mn1

losses to GDP

420,000 total

mortality

A portion of USD 431 mn2 spent

on treatment could be used for

development purposes…

Sources:

WSP, WHO,IHME, GBD 2010, MoHSW Midterm review, MoF, team analysis

Note :

(1) Based on WSP’s studies on average annual lost due to premature deaths, productivity

losses due whilst sick or assessing healthcare and loss in national income due to burden of

chronic diseases. The 5 key diseases encompassed Diarrehea, LRI, infectious diseases,

NTD, Malaria, Diabetes, Cardio & circulatory diseases, etc.

(2) MoF’s 2013/14 Budget allocation based on annual average exchange rate at TSH 1618

per dollar

3

2014 onwards

Without Healthy population,

Tanzania will NOT achieve its

aspiration

1999

Tanzanian Government launched

Tanzanian Development Vision 2025

and healthcare has been one of the

primary focuses

2000 - 2013

Various Healthcare-centric

programmes were developed

over the years aiming to

achieve TDV 2025’s goal

2013

Current results 50% of

HSSP III’s plans are NOT

on-track

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egestas.

Many programmes and plans are in place but have not yield favorable results,

it’s a long journey to achieve Tanzania’s Aspiration

HSSP

Mkukuta

MTR 2013

2000 – 2013

The Healthcare sector

is not doing well

among the peers...

2014 onwards

Long way to catch up to

catalyse the effort in achieving

the aspired productive & healthy

Tanzanian population by 2025

Doc ID

Governance, Community and Civil Societies, Organizations & Private Sectors

5 Aspiration 1

TBD

6

Gov Structure

Aspiration 2

TBD

HSSP III R

ep

rod

uc

tive

& C

hil

d

He

alt

h

Ma

lari

a, H

IV/A

IDS

, T

B &

Oth

er

infe

cti

ou

s d

ise

as

es

No

nc

om

mu

nic

ab

le

Dis

ea

se

s &

In

juri

es

He

alt

h F

ina

nc

ing

He

alt

h S

ys

tem

Po

lic

ies

He

alt

h S

erv

ice

De

live

ry –

i.e

. C

om

mo

dit

ies

He

alt

h W

ork

forc

e

Healthcare NKRA focuses on 2 sub-sector of Health system under HSSP III

& A Special Focus on MNCH…

Health System Mortality & Morbidity

Special

Focus

SOURCE : BRN Healthcare Lab (2014)

5

6 initiatives

6 initiatives

6 initiatives

4 initiatives

The components of BRN Healthcare

BRN Healthcare

HRH

RMNCH

Health facilities

Health commodities

6

Overview of BRN Healthcare System

Healthy Tanzanians

Reproductive & Child

Health Infectious Diseases

Non-communicable

Diseases & Injuries Others

Human Resources for Health Health Commodities Health Facilities

Prioritise utilisation of

employment permits

Provide skilled HRH

through PPP/Private

sector engagement

Redistribution of

health workers

within regions

Improving health

commodities supply chain

Strengthen management of

MSD working capital

complement MSD in procurement &

distribution of medicines by engaging

private sector

Star-Rating

System

Fiscal decentralisation to

health facility level

Optimising

the pool of

new recruits

Synchronize

recruitment

process at

central level

Empowering

LGAs in HR

management

Social

accounta-

bility

Performance

targets &

contracts

ICT mobile

application

platform

SMS

reporting

system

Scale up 5S-

Kaizen TQM

initiatives

Special focus: RMNCH

CEmONC

BEmONC

Community Health Workers

mHealth (SMS) and Maternal CHW

application through PPP

Regional Satellite Blood bank

facilities supporting CEmONC

Develop integrated 360° mass media

campaign that can be multi

sponsored through PPP

7

Human Resource for Health 1

Prioritize allocation of employment

permits to regions with critical

shortage of skilled HRH

Provide skilled HRH through

PPP/Private sector engagement

Redistribution of health care

workers within the regions

Optimising the pool of new recruits:

Reinforce bonding policy

Introduce Compulsory

attachments for Clinicians and

Nurses

100% of the 9 Critical Regions to

reach the National Average for Density

of Clinicians and Nurses per 10,000

population


70% reduction in the number of

Dispensaries without Skilled HRH

16 Regions to implement HRH

redistribution between their own

districts & attain 100% reduction in no.

facilities without Skilled HRH

70% of government sponsored

students will be bonded to serve at

public facilities

6 compulsory attachment status for 6

cadres confirmed & 100% students

undergoing compulsory services

100% balanced distribution of skilled

health workers at primary level

8

Health Facilities 2

Assess, rate and develop specific

facility improvement plans for 1-

and 2-Star primary level health

facilities

Implement fiscal decentralization by

devolution from council level to

health facility level

Increase social accountability at

the facility and community level

to address local health

priorities/concerns

Introduce the use of performance

targets and contracts at the primary

facilities to address and enforce

staff accountability in delivery of

quality health services

80% of health facilities at identified

regions are elevated to level 3 &

above by 2017/18


80% of health facilities achieve

financial autonomy by June 2017

80% of LGAs have functioning social

accountability mechanisms by June

2017

80% of health facilities have attained

75% customer satisfaction and

above by June 2018

80% of primary health facilities to be

rated 3 Stars and above

9

Health Commodities 3

Governance:

Improving governance, accountability,

and sense of ownership of Health

Commodities supply chain to eliminate

frequent occurrence of stock-out

Finance & Business Model:

Strengthen management of MSD working

capital for sustainable availability of

medicines and medical supplies

Procurement & Distribution:

To complement MSD in the

procurement & distribution of

medicines by engaging private sector

Inventory Management:

Scale up 5S-KAIZEN-Total quality

Management(TQM) initiatives from

district level to lower health facilities

level

100% Health Facilities audited and

supervised by CHMT, 0% proportion of

facilities found with commodities pilferages


Establish baseline for current ratio, acid test

ratio & % Margin recovery

15 number of call off orders to prime

vendors & 15 signed contracts by 2015,

90% of medicines supplied against call off

orders by 2015

85% of dispensaries and health centres

adhering to good storage standards, 80%

of lower level health facilities submitting

accurate consumption reports to MSD

ICT

Introduce use of SMS to report on stock

outs and quality of health services by

service users and civil society

50% of stock-out complaints solved by

2015/16, 100% of stock-out complaints

solved by 2016/17



10

RMNCH 4

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 (7 signal functions).

Mobilise Community Health workers to

improve RMNCH services

Regional Satellite Blood bank facilities

supporting CEmONC

Reduction of maternal mortality ratio from

453 to 291 (per 100,000 live births) and

neonatal mortality rate from 20 to 10 (per

1000 live births), by 2017/2018


100% quality (measured be agreed

Standards Base Management Tool) of

services in facilities selected for provision of

a continuum of care package which

includes FP, ANC, BEmONC, PNC

Utilize community based initiatives to

improve RMNCH awareness to 100% and

uptake by 50% at community level by

2017/18

Establish centres and mobilize blood

donors and distribute safe blood to those

in need especially pregnant women and

new-born as close as to where they receive

CEmONC services by 100%.

Enhanced awareness and outreach

through mHealth (SMS) and Maternal

CHW App through PPP

Increase childbirth by skilled birth

attendant to 80%



11

Key:

• Regions with HRH distribution, HF,

commodities & RMNCH initiatives

• Regions with HRH distribution, HF &

commodities initiatives

• Regions with HF & commodities

initiatives

*assessment is done across all mainland

regions

Dar Es Salaam

Mara

Kilimanjaro

Manyara

Tanga

Lindi

Mtwara Ruvuma

Iringa

Morogoro

Pwani

Dodoma Singida

Rukwa

Mbeya

Kigoma

Tabora

Shinyanga

Kagera

Mwanza

Geita Simiyu Arusha

Katavi

Njombe

Harmonising the implementation plans at the most under-served regions

Source(s): BRN Healthcare Lab 2014

Doc ID

12

Healthcare NKRA require TZS 185 Billion spread across 3 years

Budget requirement to implement BRN Healthcare 2014/15 – 2017/18

Budget allocation by years, TZS (Billion)


TOTAL

185.1

2017/18

50.5

34.3

16.2

2016/17

49.1

35.8

13.3

2015/16

75.3

43.0

32.2

2014/15

(Additional)

0.8

0.5

0.3

2014/15

(realocate)

9.5

9.3 0.1

RE

DE

123

62

Development Expenditure

Recurrent Expenditure

Doc ID

13

Where ~80% of Total budget requests of TZS 185 Bn are primarily

anchored on PMO-RALG…

TOTAL

185

123

62

2017/18

50

34 16

2016/17

49

36 13

2015/16

75

43

32

2014/15

(Add)

1

0 0

2014/15

(realocate)

9

9 0

9%

6%

6%

Private Sector

MSD

MOHSW

PMO-RALG

80%

Budget requirement to implement BRN healthcare’s

4 work streams 2014/15 – 2017/18

Breakdown of Budget allocation by Implementation

Agencies

Budget allocation by years,

TZS (Billion)

% Budget allocation

Bulk of the budget request aims to upgrade existing health facilities to

BEmONC, CEmONC standards

100% = TZS 185 Billion

RMNCH HRH

Distribution

TOTAL

185

Health

Facilities

(Performance)

107

Health

commodities

31 32 14

Budget allocation by programmes,

TZS (Billion)

RE DE

Doc ID

President

Transformation & Delivery Council

NKRA Steering Committee Chair: Hon. Dr. Seif Suleiman Rashid (Minister of Health and Social Welfare) Secretariat:

Ministerial

Delivery

Unit

(MDU)

Members:

• Dr. Donnan Mbando (PS MoHSW)

• TBD (CMO, MoHSW)

• Dr. Servacius Likwelile (PS MoF)

• Mr. Omari Issa (PDB CEO)

• HMDU

• Mr. Jumanne A. Sagini (PS PMO-RALG)

• Dr. Deo Mtasiwa (DPS PMO-RALG)

• Mr. Mwaifani (MD MSD)

President’s Delivery

Bureau (PDB)

Interministerial Technical

Committee Meeting

To be determined by MoHSW

• RCHS, MoHSW

• PMO-RALG

RMNCH

• PSU, MoHSW

• MSD

• PMO-RALG

Health

Commodities

• DAHRM, MoHSW

• PMO-RALG

Health

Facilities

• DAHRM, MoHSW

• POPSM

• PMO-RALG

Human Resources

for Health

Implementers Project Owner – MOHSW

HEALTHCARE NKRA Governance Structure

Doc ID

Asante

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