Tanzania National Community Based Health Program

Proposed model for Program Design

Helen SemuAD HPS

Ministry of Health and Social Welfare

Essential pre-conditions (GoT driven, partner support)

1.       By Nov 2015, MOHSW completes the generic Program Design and launch the program2.       By November 2015, MoF commits to prioritize salary for at least 2000 CHW per year from 2016/73.       By December 2015, POPSM commits to prioritize positions for at least 2000 CHW per year from 2016/7.4.       By December 2015, PMO-RALG commits to prioritize training of at least 2500 CHW per year from 2016/17 .5.       By December 2015 LGAs in RMNCH-BRN Regions commit to prioritize absorption of at least 80% of the required CHW per year and establish district-led CBHP.6.       By April 2016, partners and GoT achieve a CHW-cost sharing agreement.7. By Dec 2015 Strategize and deploy partners to work with LGAs BRN-RMNCH regions to achieve the strategic goals 

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The components of Program Design• Identified and approved by the community, village GoT• Recruitment by LGA (WDC)• Training by National curriculum, HTI/setellites• Employed by LGA, NGOs, Private sector • Service delivery

– Standardized remuneration for existing CHWs to deliver a minimum package of RMNCAH mostly health promotion, disease prevention and referral (economic analysis proposed)

– Salaried – comprehensive and integrated package (health promotion, preventive and referral, basic curative, rehabilitative, disease surveillance, reporting vital statistics)

• Deployment and management by the LGA– Nearby facility staff– Village government

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CBHP Policy Guidelines“Essential health services cannot be provided by people working on a voluntary basis if they are to be sustainable and accountable. While volunteers can make a valuable contribution on a short-term or part-time basis, trained health workers should receive adequate wages and/or other appropriate and commensurate incentives”.

– Task shifting: rational redistribution of tasks among health workforce teams [Global recommendations and guidelines, recommendation 14]. Geneva: World Health Organization; 2008. task shifting guideline, MOHSW, 2015

In March 2014, MOHSW approved CBHP Policy Guidelines which calls for a Community Health Worker cadre that:

• Is chosen by their community and reports to their community;• Is formally trained according to government standards, paid and employed by the government

and enrolled in a scheme of service• Provides an integrated and comprehensive package of interventions to include RMNCAH services • Connects people across the household to facility continuum and engages health promotion,

preventive, basic curative, rehabilitative services and surveillance.

National CBHP Strategic Plan 2015-2020

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From 2015 to 2020…• Operationalize the CBHP country wide:

• Start scale up in “BRN – RMNCH regions (5)– Finalize tools to guide the program implementation - ongoing– Assess the capacity of HTI/Setellites – partly done– Equip to enable training – plans underway– Start training

• Build sustainable systems for national. replication and scale up

Five strategic objectives:1. Strengthen management and coordination mechanism of CBHP

at all levels.2. Formalize CHW cadre3. Strengthen institutional capacity to mobilize and manage

resources for CBHP4. Strengthen advocacy, communication and social mobilization5. Strengthen support systems for effective planning and

implementation of CBHP services at all levels.

Strategic goal 1: By June 2020, in at least 75% of LGAs, increased capacity to manage and coordinate the CBHP

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Outcome1.1:Strengthened the capacity of existing structures by 75% from the baseline by 2020

Outcome 1.2: By 2020, 100% of partners planned activities for CBHP are integrated into national and councils plans

Outcome 1.3: Mult sectoral collaboration for implementing CBHP established in 75% of LGAs by 2020

Partners: USAID, MUHAS, JSI, JhPiego, BMAF, BMGF, CHAI, IRISH AID, UNICEF, WB, DANIDA, WHO

Status of progress: 40% mostly national level

Next steps: solicit partners collaboration, financial and technical support - MoU

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Strategic Goal 2: By June 2020, at least 1/3 of required CHWs trained with the national curriculum be employed and deployed by the GoT

Outcome 2.1: By Dec 2015, roles and responsibilities of CHWs be adopted in the SoS for MA Outcome 2.2: The National curriculum for training CHWs in use in 80% of the HTI/satellites by June 2020,

Outcome 2.3: 1/3 of trained CHW’s are deployed by public and NGO’s implementing CBHPOutcome 2.4: By 2020, t least 80% of existing CHWs volunteers have capacity to delivery a minimum package of RMNCAH

Outcome 2.5: 80% of deployed CHWs are retained in service by 2020

Partners: WHO, DDCF, THET, Columbia, Comic Relief, IHI, *, BMGF, CHAI, UNICEF, USAID, JhPiego, Solidamed, SDC

Status of progress: 55% accomplished mostly national level

Next steps: Solicit collaboration, technical and financial support for program design, implementation in BRN regions, knowledge management and roll out

Strategic goal 3: By 2020, 80% of LGAs sustain CBHP

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Outcome 3.1: By 2020 80% of LGAs have increased the capacity to mobilize resources for CBHP

Outcome 3.2: By 2020, 80% of LGAs have increased capacity to manage CBHP

Potential partners: 1mCHWs Campaign, BMGF, CHAI, USAID, JSI, Comic Relief, THET, WHO, UNICEF, JhPiego, UNFPA, Status of progress: 10%Next steps: Develop strategies, toolkits for advocacy and capacity building on resource management at national and LGA level.

Outcome 3.3: By 2020, 75% of existing structures increase accountability on resource management

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Strategic goal 4: By 2020, 80% of LGAs will have the capacity to advocate, communicate and

social mobilization for CBHP.

Outcome 4.1 : By 2020, 80% of legislations and by-laws for improved community health will be enforced

Outcome 4.2: by 2020, 75% of community structures are accountable for CBHP services (social mob)

Outcome 4.3: By 2020, 90% of care takers of children aged 5 years and below improved early health care seeking behavour (ASBCC)

Partners: UNICEF, WHO have provided support which somehow touches the CBHP componentsStatus of progress: 20% a lot of  in country programs/ projects to learn from and use for CBHPNext steps: to determine partners to support the interventions.

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Strategic goal 5: 80% of support systems for planning and implementation of CBHP at all levels strengthend

Outcome 5.1: By 2020, community-based health component of HMIS established and functional

Outcome 5.2: Build capacity for effective and applied M&E and Operations Research of CBHP

Outcome 5.3: by 2020, 80% of CHWs work plan are successful implemented (supportive supervision)

Outcome 5.4: At least 80% of CHWs experience an uninterrupted supplies each year

Partners: Columbia/IHI, MUHAS/JHU, BMG/CHAI, USAID/JSI Status of progress: 15% - BRN, is strengthening logistics scheme and supervision systems, etc.M&E, research: Lessons learned from pilot work conducted by partners.Next steps: program design which will involve knowledge management, operational research and M&E plan for CBHP.

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