zanzibar human resource for health 5 year development plan final version1

REVOLUTIONARY GOVERNMENT OF ZANZIBAR

MINISTRY OF HEALTH AND SOCIAL WELFARE

HUMAN RESOURCE FOR HEALTH

5 -YEAR DEVELOPMENT PLAN2004/05 – 2008/09

WHO Emblem (Subject to WR’s Approval)

October, 2004

TABLE OF CONTENTS

CONTENTS PAGE

The Technical Working Group on HRH iForeword iiAcknowledgment iiiAbbreviations ivExecutive Summary 1

CHAPTER ONE: INTRODUCTION 3

1.0 Country Profile 31.1 Demography 31.2 Health Services Infrastructure 31.3 Health Status 31.4 Burden of Disease 31.5 HRH Statement in Health Policy 41.6 Plan Purpose 41.7 Human Resource Planning Concepts 5

1.7.1 Human Resource demands 51.7.2 Supply 51.7.3 Human Resource Stocktaking 51.7.4 Career development 6

CHAPTER TWO: HUMAN RESOURCES FOR HEALTH POLICY 7

2.0 General Aim of the Policy 72.1 Policy Goals 72.2 Policy Objectives 72.3 The HRH Policy Priority Areas 7

2.3.1 Organisation of the Human Resource Division 72.3.2 Planning 72.3.3 Training 82.3.4 Recruitment, Deployment and Management 82.3.5 Human Resource Quality maintenance 82.3.6 Human Resource Financing 82.3.7 Ethics, Discipline and Human Rights 82.3.8 Plan Implementation and Evaluation 8

CHAPTER THREE: HRH SITUATION ANALYSIS 9

3.0 Government Initiatives 93.1 Successes 103.2 Identified Problems 10

3.2.1 HRH Planning 103.2.2 Management 103.2.3 HRH Development 113.2.4 HRH Quality in relation to Performance 113.2.5 Gender issues in HRH 11

3.2.6 HRH Financing 12

3.3 HRH Challenges 12

CHAPTER FOUR: HRH PLAN AIM, OBJECTIVES AND STRATEGIES 14

4.0 Aim 144.1 Objectives 144.2 Priority Areas 14

4.2.1 HRH Medium Term Plan Advocacy and Promotion 154.2.2 HRH Development 154.2.3 Retention 154.2.4 Quality Care at all Levels 154.2.5 HRH Data Base 164.2.6 Capacity Building for the College of Health Sciences 16

4.2.7 Mnazi Mmoja as a Referral Hospital 174.2.8 Monitoring and Evaluation 18

CHAPTER FIVE: HRH PROJECTIONS 19

5.0 Essential Health Package (Service at each level) 195.0.1 1st line PHCU 195.0.2 2nd line PHCU 195.0.3 Primary Health Care Centre (PHCC) 195.0.4 District Hospitals 20

5.1 Staffing Level 205.2 Demand and Supply 265.3 Gap filling Strategies 275.4 Dealing with Surplus staff 285.5 Establishment of HRH Data Base for HRH Projections 28

CHAPTER SIX: HUMAN RESOURCE DEVELOPMENT 24

6.0 Quality of training 246.1 Selection of Students 246.2 College Accreditation 246.3 Career Development 256.4 Pay and Rewards 256.5 Training Plan 256.6 Continuing Education 26

CHAPTER SEVEN: HUMAN RESOURCE MANAGEMENT 27

7.0 Deployment and Redeployment 277.1 Proper Utilisation 277.2 Performance Appraisal 277.3 Focal Person 277.4 Motivation 27

CHAPTER EIGHT: HRH FINANCING 29

8.0 Budget for implementing the Medium Term Plan 298.1 Sources of Financing. 298.2 Sustainability. 29

CHAPTER NINE: MONITORING AND EVALUATION 35

9.0 Why Monitoring and Evaluation 309.1 Coordination of HRH Activity 309.2 Research 31

CHAPTER TEN: ASSUMPTIONS AND RISKS 32

10.0 Assumptions 3210.0.1 Existence of training facilities 3210.0.2 Availability of staff 3210.0.3 Recruitment, transfer and retrenchment procedures 3210.0.4 Support from senior management, development partners and politicians 3210.0.5 Strengthening of Department of Policy and Planning 32

10.1 Risks 3310.1.1 Constrained resource base of the government 3310.1.2 Political environment 3310.1.3 Competitive labour market 3310.1.4 Slow progress in the implementation of Public Sector Reforms 33

ANNEXES

ANNEX I: Activities, Output, Indicators, Time frame and Financial 35 Requirement for each Priority Area

ANNEX II(a): HRH Situation as at June, 2003: Core Medical Occupations at Primary Level (PHCUs and PHCCs) 81

ANNEX II(b): Core Medical Occupations at the Secondary Level (District Hospitals) 83

ANNEX II(c): Core Medical Occupations at the Tertiary Level (Mnazi Mmoja Hospital) 85

ANNEX II (d): Core Occupations at the Government Central Laboratory 88

ANNEX II (e): Core Occupations at the College of Health Sciences 90

ANNEX II (f):Core Occupations at the MOHSW 92

ANNEX III: Expected Number of Graduates from the College 94 of Health Sciences, 2004/05 – 2008/09

ANNEX IV (a): Summary of Deficit and Surplus 1st Line PHCU Unguja and Pemba 95

ANNEX IV (b): Summary of Deficit and Surplus 2ND Line PHCC Unguja and Pemba 96

ANNEX IV (c): Summary of Deficit and Surplus for PHCCs Level Unguja and Pemba 97

ANNEX IV (d): Summary of Deficit and Surplus for Secondary Level (District Hospital) 99

ANNEX V: Immediate and intermediate gap Filling Plan and the Criteria used to determine the immediate and intermediate gaps to be filled 103

ANNEX VI: Redeployment of Staff at Primary, Secondary and Tertiary level of Health Care 107

ANNEX VII: Non Citizen Workers 113

ANNEX VIII: HRH Career Development by Cadre: PHCU/PHCC and District Hospitals 114

ANNEX IX: Current Organogram for the MOHSW 116

ANNEX X: Proposed Organogram for the MOHSW 117

ANNEX XI: Proposed Organogram for the HRH Division 118

ANNEX XII: Justification for the New Proposed Organogram 119

ANNEX XIII: Consultant’s Assessment Report 123

THE TECHNICAL WORKING GROUP ON HUMAN RESOURCES FOR HEALTH

NAME DESIGNATION INSTITUTIONMs. Mwaka A. Said Director /Planning MOHSWMr. Fadhil Abass Planning Officer MOHSW

Mr. Khamis Hussein Training Coordinator MOHSW

Ms. Sharifa Awadh CE. Officer CEU MOHSW

Dr. Mkasha H. Mkasha H/Coordinator MOHSW Pemba

Ms. Jokha Khamis Academic Officer CHS

Mr. Waziri Juma Adm. Officer CHS

Mr. Abdalla Rashid CHS. Tutor CHS

Dr. Ali Salim Med Superintendent Mnazi Mmoja Hosp

Dr. Mohamed Dahoma ZACP I/C MOHSW

Ms. Fatma Juma Matron Mental Hospital

Ms. Asha M. Seha Adm Officer ZACP, MOH

Mr. Othman Mussa CNO MOHSW

Mr. Kai Bashir Administrator DPP Office

Mr. Suleiman M. Juma Adm Officer Z’bar State University

Mr. Issa A. Mussa Hd/HDP&L MOHSW

Mr. Ali Hassan Rajab Adm. Officer C.S. Commission

Ms. Khadija Khamis Planning Officer MOHSW

Ms. Salama Thabit M. PHNO “U” MOHSW

Mr Ali H. Suleiman Planning Officer MOHSW

Ms. Mwakalukwa HRH Officer MOH Dar es Salaam

Ms. B. Tillya HRH Officer MOH Dar-es-salaam

Mr. John B. Mwinuka Assistant Director PO-PP

Dr. Nangawe MPN WHO – Dar es Salaam

Max Mapunda HSD WHO – Dar es Salaam

Mr. Shaibu Khamis Hd. H. Resource Div. MOHSW

Mr Abdalla M. Ali Zonal Administrative Pemba

Mr. Shaib Khamis Head Personnel Unit MOH&SW

Ms. Tausi Yusuf Secretary WHO – Dar es Salaam

Ms. Maryam Ali Secretary MOHSW

Ms. Tatu S. Abeid Secretary MOHSW

Mr. Hamad Ali Driver MOHSW

Mr. Abdalla Sharia Driver MOHSW

FOREWORD

The Revolutionary Government of Zanzibar continues with the implementation of ZPRP, whose overall objective is to eradicate poverty and promote the well - being of her people.

All developing countries emphasize the poverty reduction policy and strategies in different sectors (through chosen productive employment and the provision of basic social services including quality health care delivery through knowledge, skills and right attitude of their human resource as a basis for increasing productivity and overall human development).

The status of health in any country is a useful indicator of human development and therefore the poverty levels. The implication of this fact is that health care services must be made accessible (on an equitable basis) to all Zanzibar. In addition, it must respond or be relevant to the needs of all persons in Zanzibar on other words the Health system must be seen to function optimally: for this to happen Human Resource for Health Development is a critical element.

The Human Resource for Health Development Plan emphasizes on improving quality of health care by providing the right number of health worker in the right place, at the right time, with the right skills and motivation in line with Zanzibar Health Sector Reform guidelines.

The aim of the plan is to build HRH management capacity at district and higher-level institutions/organizations and to strengthen the mechanism for productivity and proper utilization of available HRH plan through integration of HMIS database with the MOH&SW.

However, the success of implementation of the HRH Plan depends on the cooperation and or collaboration with all stakeholders including other government ministries and departments, partners/donors and more critically, the community, which is the ultimate consumer of the health services.

It is on this note that I invite wide participation and commitment to make this plan successful in contributing to strengthening Zanzibar’s health system. I encourage every one to take this document seriously as it has the full backing of the Ministry of Health and Social Welfare and the Revolutionary Government of Zanzibar in general.

It is a homegrown initiative based on our problems and needs with interventions that will have far reaching implications for the health of our people and the development of Zanzibar as a whole. Together we can make a difference.

Hon. Salum Juma OthmanMINISTRY OF HEALTH AND SOCIAL WELFAREZANZIBAR.

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ACKNOWLEDGEMENT

This HRH Medium Term Plan is a result of a collaborative activity between local experts of the Ministry of Health and Social Welfare and Consultants, Advisor and Officials from WHO, CEDHA, Ministry of Health Tanzania Mainland and the President’s Office, Planning and Privatisation Dar-es-Salaam.

On behalf of the Ministry of Health and Social Welfare, I would like to thank all people who played a vital role in preparing this HRH Plan.

Their contributions were extremely valuable in helping us develop the features and content of the document.

Last but not least, I would like to thank all Zanzibar Human Resource for Health team members who spared their time to ensure the completion of this document.

Cooperating partners’ ideas that enriched our policy documents, strategic plans and frameworks have greatly influenced the concepts and outlined strategies in this plan. It is our hope that partners’ contributions in terms of ideas to improve the document and commitment to move it forward shall be forthcoming to enable achievement of our common goals in health development.

Dr. Omar M. ShauriPRINCIPAL SECRETARY,MINISTRY OF HEALTH AND SOCIAL WELFARE, ZANZIBAR.

iii

ABBREVIATIONS

ADO - Assistant Dental Officer

AMO - Assistant Medical Officer

BSc - Bachelor of Science

CEU - Continuing Education Unit.

CHN - Community Health Nurses

CHS - College of Health Science

CO - Clinical Officer.

CSO - Civil Society Organization

CT - Computerised Tomography

DCO - Diploma in Clinical officer

DDS - Doctor of Dental Surgery

DDT - Diploma in Dental Therapist.

DEHS - Diploma in Environmental Health Sciences.

DGNM - Diploma in General Nursing and Midwifery

DGNP - Diploma in General Nursing and Psychiatry

DHMT - District Health Management Team

DMU - Drugs Management Unit

DNA - Diploma in Nursing Anesthetist

DPT - Diploma in Pharmaceutical Technician.

HMIS - Health Management Information System

HPMS - Health Personnel Management System

HRH - Human Resources for Health

HS - Hospital Secretary

MD - Doctor of Medicine

MMED - Master of medicine

MMH - Mnazi Mmoja Hospital

MO - Medical Officer

MOH&SW - Ministry of Health and Social Welfare

MSc - Master of Science

MTEF - Medium Term Expenditure Framework

NACTE - National Council for Technical Education

NCD - Non-Communicable Diseases

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OPD - Out Patient Department

PHC - Primary Health Care Centre

PHCU - Primary Health Care Unit

PhD - Doctor of Philosophy

PHNB - Public Health Nurse B

SASE - Selective Accelerated Salary Enhancement

SWOT - Strengths, Weaknesses, Opportunities and Threats

TB - Tuberculosis

ZHMT - Zonal Health Management Team

ZHSR - Zanzibar Health Sector Reform

ZPRP - Zanzibar Poverty Reduction plan.

v

EXECUTIVE SUMMARYEXECUTIVE SUMMARY

The Situation Analysis Study identified problems in a number of areas including HRH planning,The Situation Analysis Study identified problems in a number of areas including HRH planning, management, HRH development, HRH quality in relation to performance and HRH financing.management, HRH development, HRH quality in relation to performance and HRH financing. The HRH Policy was formulated to address the issues raised in the Situation Analysis Study andThe HRH Policy was formulated to address the issues raised in the Situation Analysis Study and the previous study conducted by the African Development Bank. the previous study conducted by the African Development Bank.

This five year HRH Plan has tried to translate some of the concerns addressed in the HRH PolicyThis five year HRH Plan has tried to translate some of the concerns addressed in the HRH Policy and the Situation Analysis Study into implementable activities in eight priority areas, namely:and the Situation Analysis Study into implementable activities in eight priority areas, namely: HRH Medium Term Plan, HRH Development, Retention, Quality Care at all levels, HRH DataHRH Medium Term Plan, HRH Development, Retention, Quality Care at all levels, HRH Data Base, Capacity Building for the College of Health Sciences (CHS), Mnazi Mmoja as a ReferralBase, Capacity Building for the College of Health Sciences (CHS), Mnazi Mmoja as a Referral Hospital and Monitoring and Evaluation. Hospital and Monitoring and Evaluation. The main aim of the plan is to develop the HRH by improving their skills and management capacity that will ensure provision of quality health services.

Interventions are proposed to:Interventions are proposed to:

Disseminate and promote the HRH Medium Term Plan to stakeholders,Disseminate and promote the HRH Medium Term Plan to stakeholders, Restructure the HRH Division within the Department,Restructure the HRH Division within the Department, Ensure effective and efficient running of the Personnel Unit,Ensure effective and efficient running of the Personnel Unit, Have adequate number of skilled personnel in the health sector,Have adequate number of skilled personnel in the health sector, Create a conducive working environment to MOHSW staff,Create a conducive working environment to MOHSW staff, Build management and organization capacity in line with HSR/ZPRP,Build management and organization capacity in line with HSR/ZPRP, Strengthen the HRH Information System (Data Bank),Strengthen the HRH Information System (Data Bank), Upgrade the knowledge and skills of CHS staff,Upgrade the knowledge and skills of CHS staff, Make the College of Health Sciences (CHS) recognized by NACTE and other learningMake the College of Health Sciences (CHS) recognized by NACTE and other learning

institutions,institutions, Ensure access to essential equipments and supplies to meet the demand of the CHS,Ensure access to essential equipments and supplies to meet the demand of the CHS, Increase the CHS income,Increase the CHS income, Increase the quality and standard of work performance at the CHS,Increase the quality and standard of work performance at the CHS, Introduce incentive packages in the CHS,Introduce incentive packages in the CHS, Establish an integrated Health Management Information System (HMIS) for CHS,Establish an integrated Health Management Information System (HMIS) for CHS, Develop and transform Mnazi Mmoja Hospital (MMH) into a functional semi-Develop and transform Mnazi Mmoja Hospital (MMH) into a functional semi-

autonomous Referral Hospital,autonomous Referral Hospital, Increase the quality and standard of work performance at MMH, Increase the quality and standard of work performance at MMH, Build the capacity of health care workers at MMH to deliver quality health care, andBuild the capacity of health care workers at MMH to deliver quality health care, and Monitor and evaluate the HRH Medium Term Plan implementation processMonitor and evaluate the HRH Medium Term Plan implementation process

The Five-year HRH Plan is estimated to cost US $ 6,438,220, and its breakdown per PriorityThe Five-year HRH Plan is estimated to cost US $ 6,438,220, and its breakdown per Priority Area is as follows:Area is as follows:

HRH Medium Term Plan HRH Medium Term Plan US $US $ 33,500 33,500 HRH DevelopmentHRH Development US $ US $ 4,653,720 4,653,720 RetentionRetention US $ 40,000US $ 40,000 Quality Care at all LevelsQuality Care at all Levels US $ 75,000US $ 75,000 HRH Data BaseHRH Data Base US $ 70,000US $ 70,000

HRH 5-Year Plan – Ministry of Health & Social Welfare Zanzibar 1

Capacity Building for the College of Health SciencesCapacity Building for the College of Health Sciences US $ 878,000US $ 878,000 Mnazi Mmoja as a Referral HospitalMnazi Mmoja as a Referral Hospital US $ 653,000US $ 653,000 Monitoring and EvaluationMonitoring and Evaluation US $ 35,000US $ 35,000

HRH Development has taken the lion’s share of the total estimate (72.3 per cent). This isHRH Development has taken the lion’s share of the total estimate (72.3 per cent). This is justifiable because this priority area deals with the development of staff of the primary andjustifiable because this priority area deals with the development of staff of the primary and secondary levels of health care, which constitute the majority of workforce in health caresecondary levels of health care, which constitute the majority of workforce in health care delivery.delivery.

The Medium Term Plan will require an annual average budget of US $ 1,287,644. The Medium Term Plan will require an annual average budget of US $ 1,287,644.

CHAPTER ONECHAPTER ONE


INTRODUCTION

1.0 Country Profile

Zanzibar comprise of two main Islands, Unguja and Pemba. Unguja Island covers an area of about 1464 square kilometers and Pemba Island covers an area of about 864 square kilometers. There are five administrative regions, three in Unguja and two in Pemba island which are subdivided into 10 districts and more than 230 Shehias, the lowest administrative level of the government structure.

After the 1964 revolution, Zanzibar joined with the then Tanganyika to form the United Republic of Tanzania. Zanzibar maintains its own government and is directly responsible for all non-union affairs, including health services.

1.1 Demography

According to the 2002 Population and Housing Census, Zanzibar has a total population of 984,625 people with an annual growth rate of 3.1%1. Unguja has a population of 622,459 and Pemba has 362,166. Viewed from a gender perspective, the female population is 502,006 while the male population is 482,610. Zanzibar is one among the highest densely populated areas in Africa with about 370 people per square kilometre. However, urban centres such as Zanzibar town, which is the capital of the country, have higher density rates.

1.2 Health Service Infrastructures

Health service in Zanzibar is organized through 118 Primary Health Care Unit (PHCU’s), 4 Primary Health Care Centre (PHCC), 3 district hospitals, Mental, Mwembeladu Maternity home, and Mnazi Mmoja Referral Hospital.

1.3 Health Status

The life expectancy at birth for Zanzibar was estimated to be 48 years by 2002. The infant mortality rate for Zanzibar is estimated at 83 per 1000 and for children below five years mortality is 114.3 per 10002. Maternal mortality rate is estimated at 377 per 100,0003 live births, and continues to be high despite the numerous health service delivery interventions.

1.4 Burden of disease

Zanzibar has documented marked increases of both communicable and non-communicable diseases. Cardiovascular diseases and Neoplasms account for a greater proportion of the NCD while Malaria (which accounts for more than 40% of both the admitted as well as OPD cases) is the leading cause of morbidity and mortality in Zanzibar.


Periodic cholera outbreaks with marked fatalities have also been documented. Like many of the Sub-Saharan African countries, Zanzibar has also experienced slight rise of the cumulative HIV/AIDS cases, with a general population seroprevalence of 0.6% among the sexually active adults (MOHSW 2002) with a significant presence of predisposing risk factors.

1.5 HRH statement in Health Policy:

The Zanzibar Health Policy, which was endorsed by the 19 th session of the 5th Zanzibar House of Representatives on the 17th day of April 2000, underscores the importance of human resources. One of its objectives is to ensure the availability of adequate number of skilled personnel at all levels of health care delivery. This is to be achieved through the following strategies: Developing a human resource plan that meets the health services delivery plans; Abiding by the advice on personnel policy and regulations as set by the Government

of Zanzibar; Developing a training policy and plan that includes basic, post-basic training,

continuing education and induction.

1.6 Plan Purpose:

Human resources in the health sector take long periods to train and after being trained they are characterized by high mobility. This makes it necessary to develop a human resource plan to contribute to effective stabilization of the labour force in the sector. The plan is more important now when the Ministry is seeking to improve the quantity and quality of health service delivery.

In the process of implementing the Health Sector Reform, priority will be given to human resources for health by ensuring that qualified and skilled personnel provide the services needed at all levels.

The HRH study conducted in May/June 2003 revealed the following:

There is improper balance, distribution and utilization of HRH at all levels of health care delivery both in the rural and urban areas.

There is no clearly stipulated essential health care package at all levels of care. There is no staffing level document (Staff Establishment) for all levels of health care

in Zanzibar.

To address the above concerns, there was justification to develop a HRH Medium Term Plan that will ensure the availability of the right number of human resources at the right place, with the right skills at the right time and at affordable cost.

1.71.7 Human Resource planning concepts:Human Resource planning concepts:


In developingIn developing a Human Resource Plan, there are various elements that need to bea Human Resource Plan, there are various elements that need to be addressed in order to develop an implementable Plan. These include:addressed in order to develop an implementable Plan. These include:

1.7.11.7.1 Human Resource Demand Human Resource Demand::This is a requirement for specified types of staff with particular skills to carry out theThis is a requirement for specified types of staff with particular skills to carry out the work of an organization based on its objectives. It is usually expressed as a number ofwork of an organization based on its objectives. It is usually expressed as a number of posts (staff) required at a particular time. Demand forecasting is an essential feature ofposts (staff) required at a particular time. Demand forecasting is an essential feature of managerial decision-making. The basic questions that need to be answered include:managerial decision-making. The basic questions that need to be answered include:-- Does the work need to be done?Does the work need to be done?-- Are the correct numbers of employees doing it?Are the correct numbers of employees doing it?

-- Have the employees the requisite skills?Have the employees the requisite skills?

There are different ways of estimating demand. Hall T. and Mejia A. (1978) outline fourThere are different ways of estimating demand. Hall T. and Mejia A. (1978) outline four ways of estimating demand within the health sector based on:ways of estimating demand within the health sector based on:-- Health needsHealth needs

-- Service targetsService targets

-- Health (or economic) demandHealth (or economic) demand

-- Human resource/ population ratioHuman resource/ population ratio

In any Human Resource Planning activity in the health sector, a mixture of these fourIn any Human Resource Planning activity in the health sector, a mixture of these four methods will be used. In preparing the HRH Medium Term Plan for Zanzibar, the first,methods will be used. In preparing the HRH Medium Term Plan for Zanzibar, the first, third and fourth methods were used to determine the staffing levels for the primary,third and fourth methods were used to determine the staffing levels for the primary, secondary and tertiary levels of health care.secondary and tertiary levels of health care.

1.7.21.7.2 Supply:Supply:Supply represents the availability of the organisation’s workforce, i.e. the numbers ofSupply represents the availability of the organisation’s workforce, i.e. the numbers of people categorized by occupation, grade, level, skill etc. that are available for work nowpeople categorized by occupation, grade, level, skill etc. that are available for work now and in the future. The basis for this is provided by human resource stock taking. and in the future. The basis for this is provided by human resource stock taking.

1.7.31.7.3 Human Resource Stock taking:Human Resource Stock taking:It involves carrying out of personnel inventory to determine the existing numbers andIt involves carrying out of personnel inventory to determine the existing numbers and deployment by level of care, cadre, grade and sex. It also involves estimating the attritiondeployment by level of care, cadre, grade and sex. It also involves estimating the attrition rates for the major cadres of staff and reviewing the levels of productivity, includingrates for the major cadres of staff and reviewing the levels of productivity, including coverage and anticipated expansion of health facilities.coverage and anticipated expansion of health facilities.

Supply forecasting is part of Human Resource Planning. Essentially, it is aboutSupply forecasting is part of Human Resource Planning. Essentially, it is about generating predictions of the future. It is a necessary guide to the decision makers. Itgenerating predictions of the future. It is a necessary guide to the decision makers. It enables them to influence future events by adjusting Human Resource strategies andenables them to influence future events by adjusting Human Resource strategies and policies to ensure a match between human resource demand and supply that shifts thepolicies to ensure a match between human resource demand and supply that shifts the organization forward to achieving optimum performance.organization forward to achieving optimum performance.Human Resource Supply forecasting requires an understanding of how staffs move intoHuman Resource Supply forecasting requires an understanding of how staffs move into and out of service. The basic variables involved are:and out of service. The basic variables involved are:-- RecruitmentRecruitment

1.1. Direct from trainingDirect from training


2.2. Transfers inTransfers in-- Wastage (losses) from the organization through:Wastage (losses) from the organization through:

1.1. EmigrationEmigration2.2. Transfers outTransfers out3.3. RetirementRetirement4.4. DeathDeath

Stocktaking for Zanzibar HRH was done in 2003 by conducting the Situation AnalysisStocktaking for Zanzibar HRH was done in 2003 by conducting the Situation Analysis Study and head count of all staff that were in post by occupation, level of education andStudy and head count of all staff that were in post by occupation, level of education and health facility. Supply forecasting was done by estimating the number of students whohealth facility. Supply forecasting was done by estimating the number of students who are taking medical and health programmes at various training institutions who will beare taking medical and health programmes at various training institutions who will be graduating in the coming five years. These will be recruited by the various healthgraduating in the coming five years. These will be recruited by the various health facilities. Other staff will be transferred in the health facilities from other organizations.facilities. Other staff will be transferred in the health facilities from other organizations. Forecasting for wastage was not done because currently, there are no ratios for the fourForecasting for wastage was not done because currently, there are no ratios for the four components for Zanzibar. A separate study is needed that will come out with such ratios. components for Zanzibar. A separate study is needed that will come out with such ratios.

1.7.41.7.4 Career Development:Career Development:This is an organized, planned effort consisting of structured activities or processes thatThis is an organized, planned effort consisting of structured activities or processes that align organizational and individual goals. There are two aspects involved in this process,align organizational and individual goals. There are two aspects involved in this process, namely, career planning and career management.namely, career planning and career management.

In career planning a deliberate effort is made to determine opportunities, choices,In career planning a deliberate effort is made to determine opportunities, choices, consequences and constraints; to identify career related goals and programme work,consequences and constraints; to identify career related goals and programme work, education and training to reach those goals. Career management is a process of preparing,education and training to reach those goals. Career management is a process of preparing, implementing and monitoring career plans undertaken by the individual alone or inimplementing and monitoring career plans undertaken by the individual alone or in conjunction with the organisation’s career system. These two aspects need to beconjunction with the organisation’s career system. These two aspects need to be integrated in an organisation’s development plan.integrated in an organisation’s development plan.

Career development is an important concept in Human Resource Planning in the senseCareer development is an important concept in Human Resource Planning in the sense that it addresses individual needs as well as organizational pressures. The individual hasthat it addresses individual needs as well as organizational pressures. The individual has motivational needs, wants pay and job security and also an opportunity to grow andmotivational needs, wants pay and job security and also an opportunity to grow and develop. In terms of organizational pressure, career development can be a means ofdevelop. In terms of organizational pressure, career development can be a means of solving certain human resource problems such as high labour turnover amongsolving certain human resource problems such as high labour turnover among professionals and low productivity among middle level workers. professionals and low productivity among middle level workers.

In the case of Zanzibar, a career development of the core medical cadres has beenIn the case of Zanzibar, a career development of the core medical cadres has been suggested (See Annex VI). It shows the scope of the career ladder from the time ofsuggested (See Annex VI). It shows the scope of the career ladder from the time of recruitment of a worker to the time of his/her retirement.recruitment of a worker to the time of his/her retirement.

CHAPTER TWOCHAPTER TWO


HUMAN RESOURCE FOR HEALTH POLICY

2.0 General Aim of the Policy

The Ministry has developed a HRH policy which aims at addressing the HRH challenges and issues such that a framework to achieve a balanced multi disciplinary health work force, well trained, motivated and equitably distributed according to the health needs and health facilities shall be developed, managed and sustained.

2.1 Policy Goals

To contribute to poverty reduction through ensuring universal and equitable access to primary health services,

To align health sector human resource development plans with the health needs, To establish transparent human resource management functions and procedures in

accordance with the existing and future civil service procedures and regulations, To establish reliable financial resources mobilization mechanisms to support

training programmes for individual, community, government and collaborating agencies.

2.2 Policy Objectives

Provide the human resource planning mechanism and guidelines, Institutionalise and practice the recruitment, deployment management procedures for

HRH, Institutionalise the HRH quality maintenance methods, Create alternative mechanisms for human resource financing, Re-activate Professional Councils to monitor standards, ethical and discipline issues. Manage HRH development including career development.

2.3 The HRH Policy Priority Areas

2.3.1 Organization of the Human Resource DivisionHuman resource for health Division (HRD) will be established and will be responsible for Human Resource for Health at MOHSW under the directorate of Planning and Administration. The division will coordinate and control Human Resources for Health policy compliance through monitoring its existing units, planning, development and management. The division shall be headed by a duly qualified officer, and shall be assisted by a competent team.

2.3.2 PlanningThe Division of Human Resource for Health at MOHSW will be responsible for coordinating and controlling Human Resources for Health planning and management practices in the country. The plan shall indicate skills mix based on demand and needs,


workload, turn over and costs. The plan shall be reviewed at the end of but not later than the 4th year in the current plan period.

2.3.3 TrainingTraining will ensure that human resource for Health is qualified and prepared to meet the disease pattern and health care needs of the country.

2.3.4 Recruitment, Deployment and Management All employees will be served with induction/orientation training upon their recruitment to understand better job content and context. In this regard, a health personnel management system (HPMS) shall be established and the function assigned to dully trained and qualified staff.The HRH management will ensure that the Personnel Information System (PIS) is used to assist in planning for retirees’ replacement particularly for professionals and management cadres. Other causes of attrition shall also be monitored through the PIS and replacement action decisions taken.

2.3.5 Human Resource Quality MaintenanceThe Human Resource division will coordinate the review of supervision guidelines for each level of health facility personnel based on their competencies and working environment. In liaison with the Civil Service Department, the HRD will develop a transparent performance appraisal scheme based on job objectives and develop a performance appraisal audit mechanism to monitor the processes and their outcome.

2.3.6 Human Resource FinancingThe human resource financing will attract a consortium of actors, including government, individual, donor community and other collaborating agencies.

2.3.7 Ethics, Discipline, and Human RightsThe Professional bodies will be entrusted to compliment Civil Service regulations in the monitoring of adherence to professional ethics, discipline, and human rights at work places in line with the provisions of respective governing councils/boards.

2.3.8 Plan Implementation and EvaluationThe Human Resource Division will on medium term basis convene the stakeholders to review the outcomes of plan implementation and relevance of the plan contents in line with HRH policy.


CHAPTER THREECHAPTER THREE

HRH SITUATION ANALYSIS

3.0 Government initiatives

The Revolutionary Government of Zanzibar in her endeavor to control diseases and manage effectively the protection of her people’s health and alleviate suffering, developed a policy that included provision of free, accessible and equitable health services to both urban and rural population.

Human Resource for Health has been an issue that has received significant attention in the health care delivery system in Zanzibar in almost all post independence health policy documents. The familiar Vision 2020 and the Zanzibar Poverty Reduction Plan (ZPRP) have both highlighted the need to improve HR for Zanzibar and the recently approved Health Sector Reform Strategy has specifically stressed the need for a sound HRH system for efficient and effective delivery of health services in Zanzibar.

3.1 Successes

There have been remarkable successes as briefly outlined below: The primary health care facilities are in place and they fall under two categories:

PHCUs and PHCCs: There are 118 PHCUs and 4 PHCCs, (2 in Unguja and 2 in Pemba) offering PHC services. The PHCCs act as referral centers for PHCUs. These together form the PHC infrastructure at the lowest level. This expanded PHC infrastructure called for expanded production of health cadres. The first line primary Health care Units provide out patient and community health services to the population ranging from 3,000 to 5,000 peoples. They have two beds for observation. The second line Primary health care units are the same as first line PHCUs, but in addition they provide laboratory and dental services. They have four beds for observation and two beds for delivery. The primary health care centres provide health services to the population of about 50,000 peoples. They provide in-patient and out patient services and they are referral facilities for the first and second line PHCUs. They have 30 beds.

The Ministry has managed to establish the College of Health Sciences (CHS) that generates paramedical staff for the PHC levels.

Opportunities exist for training undergraduate and post graduate Doctors, Pharmacists, Dentists and other health cadres in Tanzania mainland and overseas Universities. Training of Health workers to work at different levels of the health care system started in the late 1930’s.

The Continuing Education programme is well organized and managed, and integrates training of all cadres in the front line. The creation of Continuing Education Committees, Resource Centers near PHCUs and PHCCs is an example of this.

The Personnel Information System is in place with software, which will assist the human resource for health planning and management.


Schemes of service for health personnel have been reviewed and implemented in 2001.

3.2 Identified Problems

3.2.1 HRH Planning Zanzibar lacks a HRH plan drawing from a clear HRH policy. Specifically, the following shortfalls exist:

There is no elaborate HRH Plan, Staffing levels are not available (Staff Establishment)Frontline health facilities still face shortages of staff in the right skills mix due to misdistributionHRH Personnel Information System is not regularly up-dated and the reporting system is not in place.

3.2.2 ManagementThe Ministry’s organizational structure follows the traditional models of having so many hierarchical points of authority with overlapping roles, characterized by poor coordination. Government rules and procedures that are in place are not well implemented. Such rules and procedures include:

- Recruitment and selection of personnel,- Induction/on the-job-training,- Succession planning- Performance management and career development,- Codes of conduct,- Disciplinary and grievances procedures,- Structure and administration of remuneration and other benefits.

There is misallocation of the available HRH.- The majority of front-line workers targeted to work at PHCUs and PHCCs are

inappropriately placed at the Referral Hospital and PHCUs that are located in urban areas, thus negating their planned deployment.

- The human resources are deployed into specific vertical programs rather than placed in health facilities where they can provide the services cost effectively and in an integrated manner.

Performance appraisal guidelines are not in place and most heads of departments do not understand the appraisal system.Unqualified personnel fill some technical and managerial posts. This is particularly so at PHCC, ZHMT, DHMT, and District Hospitals and even in some vertical programs. The same situation applies at the central level.It is not clear as to who has the final responsibilities for the HRH management function.The socialization function is inadequately performed and seems to be unfamiliar to most of the supervisors and their subordinates.The political environment sometimes makes the allocation of HRH difficult.


The proposed HRH policy needs legal machinery that can compel and bind decision makers on the issue of restructuring the Ministry.

3.2.3 HRH DevelopmentThe study has revealed that the human resource development effort is facing the following constraints:

The undergraduate candidates training programme for Doctors and Pharmacists is constrained by lack of qualified candidates with proper combinations in science subjects.

Funds for sponsoring health personnel for undergraduate and postgraduate programs are not disbursed as required or regularly.

The formula for opportunity for post basic training for some cadres doesn't exist. The College of Health Sciences has a shortage of full time tutors in some courses and

even full time tutors are inadequately specialized. For example, Diploma holders teach diploma students of the same discipline.

There is delay in reviewing the curriculum for College disciplines to cope with the advancement of Technology taking place globally.

The College of Health Sciences has no basic academic rules in the form of College handbook (prospectus).

The College is lacking modern equipment such as Computer and Internet services; telefax machine, overhead and slide projectors, and a well-equipped resource centre.

Inadequate resources for the students at clinical areas lead to improper implementation of the curriculum in practical sessions.

The College is not yet registered by National Council for Technical Education (NACTE).

Physical infrastructure at the College of Health Sciences is inadequate.

3.2.4 HRH Quality in relation to PerformanceGeneral staff performance is sub-standard and is mainly attributed to shortage of materials and erratic supplies and services. In addition, there is no standard guideline for staffing levels at all work places. Staff training is on ad-hoc basis, hence leaving the majority of staff with minimal training opportunities or uncertain as to when they will receive additional training or retraining within the specialties they serve. Generally, the education level for staff in most of the departments is low. The majority of the paramedical staffs have attained the minimum basic qualification for that particular cadre i.e. certificate, with very few having been awarded a diploma or advanced diploma.

3.2.5 Gender issues Gender differences explain the current staff disposition in which males dominate most of the posts in health service provision. There is increased recognition among health care providers and researchers of the need to consider gender issues in health policy, planning, and practice. This helps to reduce both health inequalities and to increase the efficiency and effectiveness of health care services. The aspect of gender is important to health for a number of reasons. These include:

Vulnerability and illness.


Burden of Diseases Health status Quality of care. Access to promotion Prevention and curative measures

The other factors are: health information and research, and priority for funding health services.

The current situation in the MOH&SW is that the majority of females join the nursing profession while males join environmental health, medical and other professions. Although there are no specific gender disaggregated data by profession, the PIS recorded the total number of workforce in relation to gender as shown in the table below:

MALE FEMALE TOTALUNGUJA 1116 1369 2485PEMBA 594 407 1001TOTAL 1710 1776 3486 Source MOH&SW- PIS at MOH&SW August 2004.

In the Five year HRH Plan it is proposed to consider gender balance among the professions. There is a need to recruit more male nurses and more females in other specialties and clinical graduate courses. These will help to bring about fairness in health care provision in the system. There should be accurate data records in relation to gender perspective among the professions and services provision.

3.2.6 HRH Financing Gross under-funding of the health service as a whole affects HRH performance. Low remuneration for the HRH staff, which is below minimum living standards, has

negative effect on staff performance and retention.

3.3 HRH ChallengesThe problems outlined in the Human Resources for Health situation analysis that was conducted before preparing the HRH policy and this plan pose the following challenges:

The Zanzibar Health Sector Reform initiative requires decentralization of management functions to the districts level that will demand a properly balanced DHMT with the right professional skills and maturity in leadership and management. The challenge is to develop district health management capacity at an accelerated pace.

This also will be applicable to the College of Health Sciences and Mnazi Mmoja Hospital when they become semi autonomous.

The prevailing burden of Diseases (BoD) calls for a sustained availability of duly trained health workers at all levels of care with sufficient working tools, equipment, and drugs. Similarly, the emerging diseases and chronic conditions such as


HIV/AIDS call for extra compliment of skills and services to keep the health system running.

Attrition of qualified health personnel due to competitive market conditions poses the risk of depriving the people of the badly needed health service, thereby causing inequity, as the poor may not be guaranteed access.

Development of HRH to the required skills is needed to comply with the HSR Requirements. Quality of training and capacity of CHS within a resource constrain environment is a key challenge.

HRH Studies and Research need to be conducted to improve HRH performance. Establishment of comprehensive HRH Data Base is needed to facilitate accurate

management decisions. The urban attraction tendency for some of the PHC cadre and the difficulties

experienced in redeployment attempts affect effective functioning of Mnazi Mmoja hospital as a tertiary referral facility.


CHAPTER FOUR

HUMAN RESOURCE FOR HEALTH PLAN AIM, OBJECTIVES AND STRATEGIES

4.0 Aim

The main aim of the plan is to develop the HRH by improving their skills and management capacity that will ensure provision of quality health services.

4.1 Objectives

The specific objectives of the Plan are: To improve the quality of health care by providing the right number of health workers

in the right place, at the right time, with the right skills and motivation, To build HRH management capacity at district and higher level institutions/

organization for quality health care provision. To provide basic and post basic training program equipping HRH with knowledge,

skills and the right attitude for the implementation of the Health Sector Reform (HSR).

To strengthen the mechanism for equitable and proper utilization of the available HRH.

The plan objectives address the concerns raised in the Situation Analysis. They also translate some of the statements contained in the HRH policy into implementable activities without losing sight of the Health Sector Reform requirements.

4.2 Priority areas

The HRH Plan has singled out 8 areas among those addressed in the HRH Policy and Situation Analysis, and these shall be given special attention during the coming five years. These areas include: HRH Medium Term Plan advocacy and promotion, HRH Development Retention Quality care at all levels HRH Data Base Capacity Development for the College of Health Sciences Mnazi Mmoja as Referral Hospital Monitoring and Evaluation

In each priority area, a number of interventions and strategies have been proposed that will be applied to bring about the intended changes. According to the HSR, the College of Health Sciences and Mnazi Mmoja Referral Hospital are expected to become semi-autonomous. To reflect this, these two priority areas have been treated as separate entities.


A detailed description of the activities, outputs, indicators, time frame for carrying out the various activities and financial resources requirement, is contained in the matrix in Annex I.

4.2.1 HRH Medium Term Plan advocacy and promotion

Intervention: 4.2.1.1 To disseminate the HRH Medium Term Plan to stakeholders

Strategy: 4.2.1.1.1 Develop advocacy mechanisms for sensitization of the HRH Medium Term Plan

The total cost will be US $ 33,500.

4.2.2 HRH Development

Intervention: 4.2.2.1 To restructure HRH Division within the department (The proposed Organisational Structure of the Directorate of Planning and Administration is shown in Annex XI).

Strategy: 4.2.2.1.1 Review the organizational structure of the Ministry. (The current and the proposed Organisational Structures of the MOHSW are shown in Annex IX and X respectively).The justification for a re-organised Ministry is given in Annex 12.

Intervention: 4.2.2.2 To ensure effective and efficient running of the Personnel UnitStrategy: 4.2.2.2.1 Strengthen the Personnel Unit

Intervention: 4.2.2.3 To have adequate number of skilled personnel in the Health sector

Strategies: 4.2.2.3.1 Strengthen the Training Unit and its functions

4.2.2.3.2 Strengthen the Continuing Education Unit and its functions

4.2.2.3.3 Develop the training plan for HRH. The proposed Five Year Training Plan for PHCU, PHCC, District Hospitals, DHMT and ZHMT is shown in Annex 1.

4.2.2.3.4 Develop socialization system

The total cost will be US $ 4,653,720.


4.2.3 Retention

Intervention: 4.2.3.1 To create a conducive working environment to MOHSW staff

Strategy: 4.2.3.1.1 Develop a system for job satisfaction


4.2.4 Quality care at all levels

Intervention: 4.2.4.1 To build management and organization capacity in line with HSR/ZPRP

Strategies: 4.2.4.1.1 Ensure provision of minimum standard of health services at all levels

4.2.4.1.2 Develop and implement comprehensive participatory performance and evaluation system


4.2.5 HRH Data Base

Intervention: 4.2.5.1 To strengthen the HRH Information System (Data Bank)

Strategy: 4.2.5.1.1 Update and integrate PIS into HMIS to meet the planning, management and development needs of HRH


4.2.6 Capacity Building for the College of Health Sciences

The College of Health Sciences is the only institution in Zanzibar that provides training in the health sector and was officially opened in November 1989. It has a capacity of accommodating 200 students on campus and takes 80 more students who stay off campus. So far, 783 students have graduated from the college since its inception 14 years ago. As a result of the Situation Analysis Study of the college, the following interventions are being proposed to address the identified problems:

Intervention 4.2.6.1: To upgrade the knowledge and skills of the college staffStrategy: 4.2.6.1.1 Provide short and long courses for college

staff

Intervention 4.2.6.2: To make the college recognized by NACTE and otherlearning Institutions (Accreditation)

Strategies: 4.2.6.2.1 Comply with the conditions set by NACTE


4.2.6.2.2 Improve curriculum

Intervention 4.2.6.3: To ensure access to essential equipments and supplies to meet the demand of the college

Strategy: 4.2.6.3.1 Purchase the required supplies

Intervention 4.2.6.4: To increase the College incomeStrategy: 4.2.6.4.1 Introduce short courses on commercial basis

4.2.6.4.2 Introduce cost sharing

Intervention 4.2.6.5: To increase the quality and standard of work performance

Strategy: 4.2.6.5.1 Develop and implement Participatory Performance Approach and Performance appraisal system

4.2.6.5.2 Adapt current schemes of services

Intervention 4.2.6.6: To introduce incentive packagesStrategies: 4.2.6.6.1 Consolidate salary and allowances

4.2.6.6.2. Develop a system of job satisfaction

Intervention 4.2.6.7: To establish an integrated HMISStrategy: 4.2.6.7.1 Purchase the necessary equipment and train

staff


4.2.7 Mnazi Mmoja as a Referral Hospital

Mnazi Mmoja is the main referral hospital in Zanzibar, with 400-bed capacity and 18 functional departments. The hospital also serves as a training center for the College of Health Sciences. After conducting a head count staffing assessment and a complementary rapid departmental analysis, three main interventions are being proposed for Mnazi Mmoja Hospital:

Intervention 4.2.7.1 To develop and transform MMH into a functional semi-autonomous referral institution

Strategies: 4.2.7.1.1 Formulate policy to transform MMH into a semi-autonomous referral Hospital

4.2.7.1.2 Strengthen managerial and technical capacity of MMH

4.2.7.1.3 Establish effective HMIS

Intervention 4.2.7.2 To increase the quality and standards of the working


environment for better staff performance and service delivery

Strategies: 4.2.7.2.1 Formulate employee performance evaluation guideline and staff promotion schemes

4.2.7.2.2 Develop career path HR and career advancement plans

Intervention 4.2.7.3: To build capacity of health care workers to deliver quality health care

Strategies: 4.2.7.3.1 Develop a special training programme for staffs on different specialties

4.2.7.3.2 Design a special workplace education programme [continuing education]


4.2.8 Monitoring and Evaluation

The aim of Monitoring and Evaluation is to ensure that there is an effective translation of HRH Policy and institutionalization in all sub-sectors. M &E is also intended to assist in assessing the HRH Medium Term Plan contribution in improving the quality of delivered services. Based on this, the MOHSW will develop a standardized tool for monitoring and evaluation.

Intervention: 4.2.8.1To monitor and evaluate the HRH Medium Term Planimplementation process

Strategy: 4.2.8.1.1 Develop a standardized tool for monitoring and evaluation of the HRH Medium Term Plan implementation


The total cost for all the priority areas is US $ 6 ,438,220


CHAPTER FIVE

HUMAN RESOURCE FOR HEALTH PROJECTIONS

5.0 Essential Health Care Package: Services at Each Level

The following health care services are obtained at different levels of health care facilities:5.0.1 1st Line PHCU

Outpatient services, which include management of STI, IMCI and other common diseases and injuries.

Maternal and child health services, which include growth monitoring, immunization, antenatal, intra-natal and post-natal services

Family planning and youth friendly services Health education and counselling Environmental health services Outreach services/community based health care services (including home-based

and aging health care)The Technical Working Group has proposed that 7 workers of 6 skill mixes should man this level of facility.

5.0.2 2nd Line PHCU

Outpatient services, which include management of STI, IMCI and other common diseases and injuries,

Maternal and child health services, which include growth-monitoring, immunization, antenatal, intranatal and postnatal services.

Family planning and youth friendly services Laboratory services Dental services Health education and counselling Environmental health services Outreach services/community based health care services (including home

based and aging health care)The Technical Working Group has recommended that this level of facility should have 11 workers mixed in 9 skills.

5.0.3 Primary Health Care Centres (PHCC)

Outpatient services Inpatient services (30 beds) Laboratory services including blood transfusion services Antenatal, intranatal and postnatal services, Consultation of special conditions/illness e.g. surgical, medical, pediatric and

gynecological care


Dental services Community health services including community based home care Health education Family planning and counselling Rehabilitation services Mental health services Minor surgery

For this level of facility, it has been proposed to have 53 workers with a mix of 26 skills.

5.0.4 District Hospital (Secondary Level)

Bed capacity ranging from 80 – 120 Outpatient services (Receiving out-patient 80 – 200 daily) Reproductive services 20 – 40 clients daily Maternal and child health complicated services from the lower facility level Mental health services Rehabilitative Health Services including physiotherapy, occupational therapy

and orthopaedic services Special consultation clinics i.e. obstetric and gynaecology, surgical services,

pediatric and ophthalmology Health education and counseling Outreach/community health (including home based and aging health care) Operational Research Coaching students from health training institutions, during practical and field

work attachmentThe Technical Working Group has proposed that this level of facility should have 137 workers mixed in 35 skills.

5.1 Staffing Level

A staffing level guideline will be adjusted based on proposals in this plan and early government approval shall be sought. The staffing level for the different levels of service delivery will be reviewed regularly to reflect the prevailing circumstances. The staffing level guideline will clearly indicate the skill mix required at all levels of health care and the number of staff required.

The staffing level will consider criteria which are in line with the workload/ WHO standards and working environment. The staffing level guideline will indicate the qualification of the in charge or management team of the respective services level.

5.2 Demand and Supply


Annex 2 shows the staff position of core medical staff by cadre and by level of facility as at June 2003 based on the Situation Analysis and head count of all staff that were in post on that date and the staffing level proposals prepared by the Technical Working Group (Team A, B, C, and D) formed by the Ministry of Health and Social Welfare.

The situation analysis has revealed that the skills gap is very wide for the first and second levels of medical facilities. At the primary health care level, (see Annex II(a)) it is observed that there are 700 employees in the core medical posts against the required 1128 employees. It is also observed that 428 posts are vacant, which is equivalent to 38 per cent of the required posts. Although there are staff shortages in some occupations, there is an excess of 388 employees in occupations like MCHA (147), Health Assistant (75), Health Orderly (59), General Nurse (30), Nurse/ Midwife (18) and Public Health Nurse A (7) occupations. Shortages of staff are significant for the Public Health Nurse B (212), Public Health Assistant (119), Clinical Officer (101), Pharmaceutical Technician (117) and Community Health Nurse (77) occupations.

At the secondary health care level, (see Annex II(b)), 244 core medical posts have been filled against the 411 required posts. Some 167 posts are vacant (equivalent to 40 per cent of the required posts), but there is also an excess of 27 workers. Occupations which have significant shortages include the Medical Specialist (12), AMO (11), Medical Recorder (12), Pediatric Nurse (12), PHNA (9), Theatre Nurse (10), Physiotherapist (6) and Pharmaceutical Technician (6). Surplus workers are in the following occupations: Laboratory technician (11), Nursing Officer (11), Radiographer (4), and Ophthalmic Nurse (1). A more elaborate disposition of surplus staff and staff shortage from First line PHCUs to District Hospitals for Unguja and Pemba is shown in Annex IV(a) – IV(d).

At the tertiary health care level, Annex II(c) shows that there are 494 core medical workers against the required 566; 72 posts are vacant (equivalent to 13 per cent) and there is an excess of 158 workers. Significant shortages of staff are in the following occupations: Medical Officer (18), Medical Specialist (5), Assistant Medical Officer (5), Laboratory Technologist (9), Nursing Officer (32), Nurse A (7), Nurse/Midwife (13), Ophthalmic Nurse (8), Orthopaedic Nurse (12) and Pharmaceutical Technician (13). Excess staffs have been observed in the following occupations: Hospital Orderly (56), Laboratory Technician (16), Laboratory Assistant 16), Clinical Officer (14), Pharmaceutical auxiliary 21) etc.

The staffing position for the Government Central Laboratory, the College of Health Sciences and the Ministry of Health and Social Welfare is shown in Annex II(d) – (f). At the Government Central Laboratory, 30 posts, equivalent to 75 per cent of the required core medical posts are vacant. Similarly, 34 posts or 67 per cent of the required core academic posts at the College of Health Sciences are vacant while in the Ministry of Health and Social Welfare, 87 posts representing 87 per cent of the required posts are vacant.


In addition to the vacancies shown above, there are 39 posts that are held by non-citizens in both Unguja and Pemba on contract terms (See Annex VII). These posts constitute an additional HRH requirement because they will have to be filled by citizens when the contracts of the non-citizens expire. There will also be gaps that will be caused by wastage through transfers-out, retirements and deaths. Furthermore, there may be expansion programmes of the medical facilities during the plan period that will require additional medical staff.

In this plan, no estimate has been made for the additional staff requirement due to expansion and wastage because data was not available. As such, this plan is basically concerned with filling the gaps that were determined by the staffing level proposals prepared in 2003 and the gaps that will be come when the contracts of non citizens expire. Although the plan has confined itself to the public sector, the government will create conducive environment for the private sector to participate fully in the provision of health care and in the training of health personnel.

5.3 Gap filling Strategies

The projection of manpower supply to fill the identified gaps is based on the traditional estimation of annual output from the College of Health Sciences that caters for primary health care facilities. Annex 4 shows that from 2004/5 to 2008/9, annual output from the College will range between 73 and 81, making a total supply of 400 graduates by 2009. This output will not be enough to fill the skill gaps shown in Annex II(a) and II2(b).

In order to meet the great HRH demand, students from Zanzibar will be enrolled at Medical Schools in Tanzania mainland for undergraduate and post-graduate courses. Tanzania mainland has several health schools and Universities that offer medical courses, while Zanzibar has only one Health School (College of Health Sciences) that offers pre-service and in-service courses in the following disciplines:

Diploma in General Nursing with Midwifery/Psychiatry (DGNM/DGNP), Diploma in Environmental Health Sciences (DEHS), Diploma in Clinical Medicine (DCM), Diploma in Community Health Nursing (DCHN), Diploma in Medical Laboratory Technology (DMLT), and Certificate in Public Health Nursing “B” (CPHN “B”)

The College is in the initial stages of introducing other courses like Diploma for Pharmaceutical Technicians, Diploma for Dental Therapists and Diploma for Nurse Anesthetists. For scholarships, candidates directly apply through the Ministry of Education, Culture and Sports in Zanzibar and the Ministry of Science, Technology and Higher Education in Dar es Salaam for training and funding fellowships. Zanzibar graduates from institutions of higher learning in the medical field from Tanzania Mainland and abroad come to fill the skill gaps in the secondary and tertiary levels of health care. Since the training of medical personnel for the secondary and tertiary level takes a longer gestation period, it


may be necessary to recruit non-citizens to fill the current gaps while the local staffs are being trained. Annex V gives a detailed description of the immediate and intermediate gap filling plan and the criteria that has been used to determine the gaps to be filled.

5.4 Dealing with the Surplus Staff

The Situation Analysis Study has revealed that there is improper balance, distribution and utilization of HRH at all levels of health care delivery, both in the rural and urban areas. To address this problem, a coordinated mechanism to re-deploy excess personnel in the identified areas to the understaffed health delivery points has been suggested, basing on the manning level proposals that were prepared by Team A, B, C and D. The details of the redeployment proposals are shown in Annex VI.

5.5 Establishment of HRH Data Base for HRH Projections

The MOHSW has established a comprehensive HRH Unit to ensure proper utilization of up to-date information in planning and management. However, experience shows that there is need to strengthen the existing unit to ensure proper data collection, processing, analysis, interpretation and utilization. The HRH database will be regularly updated to determine demand and supply and turnover of HRH. Districts, Zones, Programs and departments/institutions shall provide quarterly and annual HRH reports to HRH information unit to update the HRH Data Base, and in that way facilitate planning.

There will also be a need to solicit user-friendly software for forecasting HRH demand, supply, attrition and productivity. Websites like www.workforce-logistics.com can be contacted to solicit such software.


http://www.workforce-logistics.com/

CHAPTER SIXCHAPTER SIX

HUMAN RESOURCES DEVELOPMENT

6.0 Quality of Training

The Ministry of Health and Social Welfare (MOHSW) and the National Council for Technical Education (NACTE) control quality at middle level technical training institutions. These organizations set conditions for establishing learning institutions in terms of quality and adequacy of physical infrastructure, teaching and learning materials, equipment quality and quality of teachers, students entry qualifications, standard of examinations and marking procedures, including curriculum for the programmes that are offered. The other areas that are considered include courses duration and grading of students awards.

The quality of training in the College of Health Sciences as indicated in the ZHSR has not yet fully been met due to teaching methods, transport problems, inadequate resources such as lack of equipment during practical sessions in hospitals or other teaching premises. What students learn and experience in those areas does not relate with what they are taught in the class.

The quality of examination is assured through the use of internal and external examiners whose assessment is considered in the evaluation of students. The whole process of marking and grading the candidates is done by examiners and then approved by the council through the academic board of CHS.

6.1 Student selection

Selection of students is conducted by evaluation of the applicant’s basic qualification against the entry requirements set by the College’s Academic Board. Students have to pass the oral matriculation interview to verify their academic capabilities. In order to undertake the programmes, the College Council approves applicants.

6.2 College accreditation

The College of Health Sciences is recognized by the MOHSW. The Ministry through College Councils and professional bodies approves all curricula and examinations done. The college is I the initial process of registration by NACTE. Some of the conditions to be fulfilled for accreditation include: -

To ensure that there are enough tutors and supporting staff with good qualifications.

To ensure there are adequate teaching materials and teaching aids. Availability of regular transport. Ownership of Physical infrastructures. Availability of Internet and other communication sources.


A training board for vetting and certification of all paramedical/allied health science courses shall be established. For future academic development and scholarship, the recognition of CHS by the Department of Higher Education shall be vital.

6.3 Career Development

This is an organized and planned effort to align individual and organization goals. The individual has motivational needs, wants good pay and job security. For the organization, career development is one of the means of solving certain HRH problems like high labour turn over.In this plan a career structure of the core medical cadres for PHCU, PHCC and district hospital has been suggested, (see Annex VIII). It shows the career ladder from the time of recruitment of a worker to the time of his/her retirement.

6.4 Pay and Rewards

The Ministry of Health and Social Welfare instituted an incentive package to its employees. It provides the consolidated health allowance, which is paid at the rate of 30% of the salary, and professional allowances ranging from Tshs 5,000/= – 9,000/= for Certificate and Diploma holders, 15,000 and 100,000 for Advanced Diploma and Degree holders respectively. However, the basic salaries remain low in comparison with Tanzania Mainland and neighboring countries.

The Ministry of Health and Social Welfare shall review the existing salary scales for all health professions so that workers are remunerated appropriately. Incentive packages such as: Professional allowance, House allowance, Leave allowances, Promotion, and Retirement benefits. Transport allowance Annual incrementshould also be reviewed with the intention of improving performance.

6.5 Training Plan

The Situation Analysis Study revealed that staff training in the health sector is on ad hoc basis and it leaves the majority of staff with minimal training opportunities. To address this problem, a Five Year Training Plan has been developed for PHCU, PHCC, District Hospitals, DHMTs, ZHMTs, Mnazi Mnazi Mmoja Referral and the College of Health Sciences. The Plan has two types of Programmes, one is for short courses and the other is for long courses (Annex I). However, before implementing the Plan there will be a need to conduct a thorough training needs assessment because the needs may have changed.


6.6 Continuing Education

The MoHSW established the Continuing Education Programme in 1991 “to improve educational opportunities for health workers in order to improve health care services they provide and contribute to personal and professional growth. . .”

The present CE activities do not reach the majority of health workers of whom over 60% are fluent in Kiswahili only, less that 50% have Form IV qualifications and 100% have not been oriented or received training for present job responsibilities. Establishing new approaches and programmes for self-learning, upgrading and performance evaluation are a major focus of the MoHSW’s reform process for the Continuing Education Unit and Human Resource Department to meet these challenges.

The main aim of the reformed CE programme is to enable the motivated health workers to access programmes and information that can improve health care service and performance and can create opportunities for upgrading professional roles or status.

Achieving this aim will be done in stages over a period of 3-5 years through developing MoHSW human resource and training priorities, strengthening CEU in distance education, establishing a learning materials production unit under the CEU and expanding resource center educational facilities.


CHAPTER SEVEN

HUMAN RESOURCE MANAGEMENT

7.0 Deployment and Redeployment

The management of HRH in Zanzibar shall ensure that effective and efficient human resource utilization targeting quality care provision is institutionalized. The situation analysis revealed that performance of the human resources management and development system is inadequate. The study also found a very heavy hierarchical system that antagonizes effective utilization. To rectify this, clearly defined job descriptions and a guideline on appraisal systems for delivery of quality service will be put in place.

7.1 Proper Utilization

Clear job descriptions and guidelines shall be developed for each cadre in order to achieve quality health care and to ensure availability of the right number of human resource with the right skills at the right place. Schemes of Services shall be prepared for cadres that do not have by adapting the schemes used by the health sector Tanzania Mainland to suit the prevailing situation in Zanzibar. The HRH Division shall be responsible for analyzing inter-institutional balance and equity of staff distribution. The Division shall also take measures to adjust imbalances and mal-distribution by implementing the deployment and redeployment proposals prepared by Teams A, B, C and D. (See Annex VI).

7.2 Performance Appraisal

The current performance appraisal system is not objective and task oriented. The Human Resource Division in liaison with all Directorates and the Civil Service Department shall put in place proper performance appraisal guidelines that are geared to productivity. The performance appraisal shall be transparent so that employees become motivated to measure their own achievement and satisfaction on the job.

7.3 Focal Person

In order to be successfully managed, there will be a responsible focal person (Health Secretary) at every level (Central, Zonal, Hospital, District) to monitor and implement HRH activities. The focal persons will be given special training in phases on how to manage HRH issues.

7.4 Motivation

At the moment, staff motivation is not based on productivity. Future plans for improving health staff motivation will include the following:


Consolidation of salary and allowances to raise employees’ basic salary. This will have a positive effect when calculating the terminal benefits.

Identification of training needs and designing a sound training program. This will ensure that the prioritized needs are met and are resulting from objective performance appraisal.

Putting in place a system of reward and promotion based on competence and performance rather than seniority and other non-job criteria. This will motivate people to work hard and diligently. It will also enhance employees’ morale and commitment as there will be a clear link or relationship between the reward or promotion and competence or performance.

Establishment of special and attractive responsibility allowance to be paid to all people who are given responsibility of manning key positions and difficult stations.

Tying promotion and training opportunities to the period of service in ‘difficult’ (remote) stations.

Creating an advantageous proportionate salary package that assures meeting basic needs the more peripheral (remote) one gets from the center.

Putting in place a participatory decision-making that creates a sense of belonging. Introducing a system of recognition of employees’ outstanding performance,

whether individual or group innovations or contribution to the success of any initiatives. This creates a sense of one’s discrete effort being valued.

Introducing career development by cadre whereby each worker knows his/her career ladder from the time he/she is recruited until retirement. The career development for various cadres is shown in Annex VIII.


CHAPTER EIGHT

HRH FINANCING

8.0 Budget for implementing the Medium Term Plan

The proposed budget for implementing the Medium Term Plan is as a follows: Activities for priority Area 1……………………………US $ 33,500 Activities for priority Area 2……………………………US $ 4,653,720 Activities for priority Area 3……………………………US $ 40,000 Activities for priority Area 4……………………………US $ 75,000 Activities for priority Area 5……………………………US $ 70,000 Activities for priority Area 6……………………………US $ 878,000 Activities for priority Area 7……………………………US $ 653,000 Activities for priority Area 8……………………………US $ 35,000

Total …………………………………………………US $ 6,438,220The detailed budget for all the priority areas is presented in Annex I.

8.1 Source of financing

The proposed budget for implementing the plan is beyond government allocation to the health sector. The government allocation to the health sector on an annual basis has been ranging from sh 2,957.9 million or 5.8% of total government expenditure (1999/2000) to sh 2,581.3 million or 8% (1997/98) while the HRH plan requires an average sum of sh 1.3 billion per annum. The current Health sector budget will therefore not be enough to meet the total financing requirement of this plan.

In order to enhance the government’s ownership and leadership of the plan, the government will allocate 10 percent of the HRH financing requirement annually. The remaining financing requirement will be met through private sources by individuals contributing to fees for their training and upgrading programmes in the local training institutions. The government will also welcome other actors, including the private sector, the donor community and other development partners to finance HRH.

8.2 Sustainability

Human resources development is a costly exercise. To ensure that financing of the Plan is sustainable, the following shall be done: Cost-sharing activities shall be expanded and strengthened to assist in the training; HRH Plan shall be implemented according to the budget; Staff Retention Scheme shall be implemented. This will involve taking a holistic view

of reducing staff turnover by introducing a variety of initiatives to improve internal career opportunities, supporting work-life balance and creating an attractive and interesting working environment.


CHAPTER NINE

MONITORING AND EVALUATION

9.0 Why Monitoring and Evaluation

Monitoring and evaluation constitute the hub for governing and ensuring efficient and effective implementation of a unified HRH Plan. It is the systematic observation and recording of specific targets, strategies, measures, lines of actions and immediate outputs. It is dynamic, and hence needs to be continuous. It is linked with implementation and the data and information generated is used continuously to make adjustments to the implementation processes.

The purpose of HRH - ME is to ensure that there is an effective HRH policy translation and institutionalisation in all sub-sectors within the Health sector. In addition, a sound ME will be responsive to HRH demand and supply, development and management. Monitoring and Evaluation of HRH is also intended to assist in assessing the HRH plan contribution to improving the quality of delivered services. Furthermore, the ME will provide vital information that will be used to track HRH accountability and its equitable distribution as determined by the manning level.

Based on the above, the MOHSW will develop standardised ME tools. An integrated form of ME for Activity Reporting System for HRH interventions [with indicators and data sources] will also be institutionalised. This plan contains output indicators and process indicators. A rolling HRH Annual Plan will be drawn from the HRH Medium Term Plan, and this will be fed into the Medium Term Expenditure Framework (MTEF). The plan will be evaluated annually. However, at national level, mid-plan and end of plan implementation evaluation will be conducted to assess outcome indicators.

9.1 Coordination of HRH activity

Given the fact that HRH activities are conducted at various levels and in different sections within the health sector, intra-departmental coordination for HRH activities will be vital. The internal coordination mechanism will have the following features:a. MOHSW Technical Committee meetings quarterly and annually. b. Consultative stakeholders meeting that involve various sectors both public and non-

public.c. A technical platform between various stakeholders for information sharing.

In order to ensure smooth institutional performance, there is need to appoint sectoral HRH focal persons who shall ensure that HRH issues receive appropriate attention. This will also facilitate institutional memory and provide secretarial services to HRH activities that will take place in each department. The focal person shall:

a. Promote networking, linkages and partnerships with other players in areas relating to HRH,


b. Engage in resource mobilization activities for HRH in the institution,c. Document HRH issues within the sector/sub-sector, andd. Monitor the function of PIS and HRH management, namely: allocation, performance

appraisal and HRH financing.

9.2 Research

Research is one of the tools that are used to provide additional information on HRH issues. Effective identification of HRH research priority areas and utilisation of research findings will strengthen the ME and will contribute to HRH development. Research on HRH will enable the system to identify gaps and deviation or misinterpretation of HRH policy, documenting best practices and innovative intervention, retention and motivation, to mention just a few. Furthermore, HRH research will assist in mapping up HRH factors that contribute to the quality of delivered services.

The department of planning in collaboration with various research institutions [local and international] shall ensure that researches that address functions and system performance are promoted and institutionalized.


CHAPTER TEN

ASSUMPTIONS AND RISKS

10.0 Assumptions

The success and failure of the implementation of the Human Resource for Health depends on the assumptions and risks on which the plan is based. The assumptions provide the strength on which the plan is built while the risks are the threats, which the plan tries to mitigate in order to minimize and overcome. This plan is expected to be successfully implemented because of the existing assumptions within the Human resource for Health area in Zanzibar.

10.0.1. Existence of Training facilities

Zanzibar has one College for Health Sciences, which trains six categories of health disciplines. Moreover, training institutions in Tanzania Mainland provide more opportunities for the training of all cadres that are required to fill the most important posts in the Health system.

10.0.2 Availability of staff

All health facilities are staffed with personnel, some who can be upgraded through training. The proposal for upgrading staff will therefore not face any problems to find appropriated staff.

10.0.3 Recruitment, transfer and retrenchment procedures

In a process of right sizing the workforce, the implementation of the plan will be using the existing procedures for recruitment and reattachment. The plan will only need to support the procedures in order to expedite and make them more effective. More over the existing process of transferring staff will be used to shift staff from areas with surplus to those with deficits.

10.0.4 Support from Senior Management, Development partners and politicians

Their expectation is that improvement in Human Resource for Health management will lead to improvements in health services performance as such they are determined to see that developments is taking place in the area of Human Resource for Health. Work that has been supported by ADB and WHO in this area is one of the evidences of development partners’ interest.

10.0.5 Strengthening of the Department of Policy and Planning

Creation of a Human Resource for health Division through strengthening the Department of Policy and Planning in MOHSW not only calls for shift action but requisite


competencies have to be in place within this organ. In particular, programme management competency shall be vital to ensure the plan components are fully operationalised.

10.1 Risks

Although there is optimism in the success of the plan, there are also some risks that need to be addressed as the plan is being implemented. These include:

10.1.1 Constrained resource base of the Government

Government allocation to the health sector is not adequate to finance the plan. The plan shall rely on the support of other financiers. The Advocacy and promotion element of the plan needs to play a vital role in this area.

10.1.2 Political environment

Involvement of development partners has very often depended on the political environment, which has varied frequently after the 1995 general elections. The support from the development partners will depend on the continuation and consolidation of the current political consensus.

10.1.3 Competitive Labour market

Differences in the remuneration and benefit package to health professionals in Zanzibar vis a vis their colleagues in Tanzania Mainland may retard the pace of professionalisation of Zanzibar health services. It is assumed that government shall put policy measures in place to establish an adequate motivation package to address attraction, equitable deployment and retention of health workers.

10.1.4 Slow progress in the implementation of Public Sector Reforms

Decentralisation may facilitate improvement in management of Human resource because the workforce will be managed at the district level. Since this process is going slowly, it is threatening the speed of implementation of the plan. The Ministry of Health will collaborate with the Public Service Department to accelerate the on-going public sector reforms.


BIBLIOGRAPHY

1. Zanzibar Health Sector Reforms – Strategic Plan 2002/3 -2006/7Ministry of Health and Social Welfare, 2002

2. Zanzibar Health Sector Reforms Priority areas Action Plan 2002-03Ministry of Health and Social Welfare, 2002

3. Zanzibar Health PolicyMinistry of Health and Social Welfare, 2002

4. ADB Health Development Requirement Study Phase III Report: Addendum I:Human Resources Supply Requirements ForecastZanzibar, 2002

5. Situation Analysis for Human Resource for Health ZanzibarMinistry of Health and Social Welfare, 2003

6. Human Resource for Health PolicyMinistry of Health and Social Welfare, 2003

7. Human Resources for Health Sector in Tanzania, A Five Year PlanMinistry of Health, Dar es Salaam, 1996

8. Staffing levels for Health Facilities/InstitutionsMinistry of Health/Civil Service Department, Dar es Salaam, 1999

9. 2002 Population and Housing Census: General ReportNational Bureau of Statistics, Dar es Salaam, 2003

10. Zanzibar Poverty Reduction Plan, 2002www.tzdoc.ortz/znz/health.doc


http://www.tzdoc.ortz/znz/health.doc

ANNEX I

ACTIVITIES, OUTPUT, INDICATORS, TIME FRAME AND FINANCIAL REQUIREMENT FOR EACH PRIORITY AREA

PRIORITY AREA 4.2.1: HRH Medium Term Plan Advocacy and Promotion

OBJECTIVE 4.2.1.1: To disseminate the HRH Medium Term Plan to stakeholders STRATEGY 4.2.1.1.1: Develop Advocacy mechanisms for sensitization of the HRH Medium Term Plan.

Activities Main Actor

Output Indicator Time Frame Financial ResourcesUSDY1 Y2 Y3 Y4 Y5

Translate and print 1000 copies of HRH Medium Term Plan @ 2500/=

Conduct 6 workshops/meetings for 120 stakeholders(Decision makers, technical staff, development partners and community) to advocate HRH Plan

DPF&A

Swahili version of the document in place

Increased awareness to decision makers.

Number of copies translated and printed

Number of meetings and workshops

X

X X

2,500

30,000

Total for 4.2.1 32,500


PRIORITY AREA 4.2.2: HRH DEVELOPMENT

OBJECTIVE 4.2.2.1: To restructure HRH Division within the department STRATEGY 4.2.2.1.1: Review organization structure of the Ministry


Output Indicator Time Frame FinancialResources –USDY1 Y2 Y3 Y4 Y5

Develop roles and responsibilities of HRH division.

Recruit Head of HRH Division

DPF&A Roles and responsibilities developed

Head of the HRH division recruited

Job descriptions of staff

Report of filled Vacancy

X

X

-

3,000

Sub Total 3,000OBJECTIVE 4.2.2.2: To ensure effective and efficient running of personnel unitSTRATEGY 4.2.2.2.1: Strengthen the Personnel Unit


Output Indicator Time Frame FinancialResources -USDY1 Y2 Y3 Y4 Y5

1. Recruit two qualified personnel officers.

2. Train one personnel officer at Master Degree level.

DPF&A Qualified personnel officers recruited.

Personnel officer trained

Number of personnel recruited

Number of staff trained

X

X

-

10,500


3. Procurement of equipment and supplies (2 filing cabinets, 3 computers with accessories) for the division

Equipment and supplies in place

Number of equipment and supplies procured.

X 16,000

Sub Total26,500

OBJECTIVE 4.2.2.3: To have adequate number of skilled personnel within health sector.STRATEGY 4.2.2.3.1: Strengthen the Training Unit and its functions.

Activities Main Actor Output Indicator Time Frame FinancialResources –USD

. Y1 Y2 Y3 Y4 Y5Conduct 14 day workshops to update training policy and guidelines

DPF&A Policy and guidelines updated

Numbers of Workshop conducted

X 8,000

Liaise with local and international

DPF&A Fellowships/scholarships

Number of fellowships/scholarship

X X -


institutions to secure fellowships/scholarships

secured s secured.

Train 2 Unit Staff at Master Degree level

DPF&A Staff trained Number of staff trained 1 1 16,000

Procure equipment and supplies (2 computers, 2 filing cabinet ) for the unit

DPF&A Equipment and supplies procured

Number and types of equipment and supplies purchased

X 15,000

Introduce Health information resource centers (data bank) at all levels

DPF&A Health information resource center introduced

Number of centers operating.

X 15,000

Conduct 2 weeks workshop to develop training modules and manuals for Unit Staff.

DPF&A Training manual and modules developed.

Numbers of Modules and Manuals documents produced

X 15,000

Conduct 5 days meeting to develop strategies to attract A Level students to join

DPF&A Marketing strategies developed

Numbers of strategies documents produced

X 3,000


health sectorSub Total 72,000

Strategy 4.2.2.3.2: Strengthen the Continuing Education Unit and its functions



1. Develop and ensure CE guidelines and regulations are in line with human resource policies and plans

2. Resource CE with

DPF&A Guidelines and regulations developed

Qualified

Guidelines and regulations documents

CE Unit strengthened

X

X X

10,000

10,000


qualified personnel in areas of CE management, distance education, net-based CE and learning materials development

3. Establish and maintain a central data base for compiling, analyzing CE information from districts and zones

personnel recruited

Central data base established

Central Data base operating

X X X 5,000

Sub Total 25,000

Strategy 4.2.2.3.2: Develop the Training Plan for HRH. The proposed Five Year Training Plan for PHCUs, PHCCs, District Hospitals, DHMTs and ZHMTs is shown below.

SHORT COURSE FOR PHCU AND PHCCActivities Main Actor Output Indicator Time Frame Financial

Resources -USDY1 Y2 Y3 Y4 Y5

Train 130 PHC In charge for 4 weeks on Management and Computer skills

ZMO Trained PHC Unit in-charges

Number of Staff trained

26 26 26 26 26 26,000

Train 270 PHC staff for 4 weeks on ZMO Trained PHC Number of 54 54 54 54 54 54,000


information management ( Data Collection processing and analysis, storage interpretation and utilization

Staff PHC Staff trained

Train 275 PHC staff for 2 week son community participation, to enable them to integrate with community involvement

ZMO Trained PHC Staff

Number of PHC Staff trained

55 55 55 55 55 50,000

Train 150 staff for 3 month on computer skill to manage the development of modern technology

DPS Trained PHC Staff

Number of PHC staff trained

30 30 30 30 30 30,000

Provide on job training ( Continuing Education) for 450 PHC Staff in charge on new technology, emerging new health problem and medical procedure

DPA Trained PHC staff

Number of PHC staff trained

90 90 90 90 90 10,000

Conduct 4 weeks training to 300 community leaders and 200 workers on Health Sector Reform and their role in the implementation of HSR

DPA Trained community leaders and workers

Number of community leaders and health workers trained

120 120 120 120 120 100,000

SUB TOTAL 270,000LONG COURSES FOR PHCU AND PHCC



Up grade ( through training ) 8 Clinical officer to AMO to serve in PHCC

DPA AMO trained Numbers of AMO trained 2 2 2 2 64,000

Upgrade 8 Dental DPA Dental Therapist

upgradedNumbers of ADO 2 2 2 1 1 64,000


Therapist to ADO

Train 5 Medical Doctors to Serve PHCC (5years )

DPA Medical Doctor trained

Numbers of Medical Doctor

2 2 160,000

Train 100 clinical officers to serve PHC Units ( 3 years training )

DPA Trained Clinical Officer

Numbers of Clinical Officers trained

20 20 20 20 20 600,000

Train 10 Health Secretaries at Certificate level ( 2 years )

DPA Health Secretaries trained

Numbers of Health Secretary trained

2 2 2 2 2 60,000



Train 15 Nursing officer in specialized nursing skills at advanced Diploma/ BSS Nursing ( 2 years )

DPA Specialized Nursing Officers Number of Specialized

Nursing Officers

3 3 3 3 3 90,000

Train 200 PHNB to serve PHC facilities ( 2

DPA PHNB trained Number of PHNB trained 40 40 40 40 40 40,000


years )

Train 80 community Health Nurses to work in PHC facilities ( 2 years )

DPA Community Health Nurses Trained

Number of Community Health Nurses Trained

16 16 16 16 16 40,000

Train 30 Pharmaceutical Technicians for PHC facilities ( 3 years )

DPA Trained PharmaceuticalTechnician

Number of PharmaceuticalTechnician Trained

6 6 6 6 6 90,000

Train 20 Nursing Officer on Advanced Diploma in PHC skills to cope with services , community and sectoral integration

DPA Trained Nurse Officer

Trained Nurse Officer 4 4 4 4 4 140,000

Train 10 dental Therapist at Diploma Level

DPA Trained Dental Therapist

Number of Dental Therapist Trained

2 2 2 2 2 30,000



Train 10 Medical Recorders on Diploma in Medical Records ( 2 years )

DPA Trained Medical Recorders

Number of Trained Medical Recorders

2 2 2 2 2 20,000

Train 4 Secretary on office Management skills and computer

DPA Trained Secretary Number of Trained Secretaries

1 1 1 1 8,000


(stage III ) 2 years

Train 4 Librarian at Certificate level to serve in PHC library

DPA Trained Librarian Number of Trained Librarian

1 1 1 1 8,000

Train 4 Social workers on social welfare and counseling at Certificate level

DPA Trained Social Workers

Number of Social Workers Trained

1 1 1 1 16,000

Train 100 Health Officer at Diploma level

DPA Health Officer Trained

Number of Health Officer Trained

20 20 20 20 20 12,000

Train 40 Lab Technician at Advanced Diploma in Laboratory Technology (3 years )

DPA Trained Laboratory Technologist

Number of Laboratory Technologist Graduated

10 10 10 10 120,000

Train 40 Pharmaceutical Technician

DPA Pharmaceutical Technician trained

Number of Pharmaceutical Technicians trained

10 10 10 10 10 120,000

SUB TOTAL 1,252,000

SHORT COURSES - DISTRICT HOSPITAL

ACTIVITIES MAIN ACTOR

OUT PUT INDICATOR TIME FRAME COST

Y1 Y2 Y3 Y4 Y5 120,000Train 30 Hospital leadersfor 10 weeks on planning, budgeting, marketing, management and computer skills.

DCs Trained Hospital leaders

Number of Hospital leaders trained.

6 6 6 6 6


Train 20 Hospital leaders for 6 weeks on community participation to enable them integrate with community. (Doctors, Nurses, PHO, Pharmacist, Social worker, Health secretary ).

DCs Trained Hospital staff on community participation

Number of Hospital leaders trained

4 4 4 4 4 20,000

Train 3 personal secretaries annually for 6 months in office management and computer skills.

DCs Trained personal secretaries

Number of personal secretaries trained.

3 3 3 3 3 25,000

Conduct 2 days Advocacy training on HSR for 150 community leaders and health workers.

DCs Trained community leaders and Health workers

Number of community leaders and Health workers trained.

30 30 30 30 30 15,000

Train 12 medical recorders and 3 Health secretaries for 1 month on data base computer processing and information technology.

DCs Trained medical recorders and Health secretaries

Number of Medical recorders and health secretaries trained

3 3 3 3 3 10,000

Train 6 kitchen staff for 6 weeks to acquire catering skills to provide quality food for the patients.

DCs Trained medical recorders and health secretaries

Number of kitchen staff trained

2 2 2 5,000

Train 9 staff from Nursing, PHO and Social worker cadres for 4 weeks on counseling skills

DCs Trained Nurses, PHO and Social workers.


3 3 3 10,000

Train 6 Accounts and supplies staff for 4 weeks on financial and materials management.

DCs Trained account and supply staff

Number of account and supply staff trained

2 2 2 10,000


Provide 3 weeks refresher course on resource centre for 6 library staff.

DCs Library staff attended refresher course

Number of library staff receive refresher course

2 2 2 5,000

Train 25 staff from various Technical Health cadres for 10 weeks on research methodology

DCs Trained technical health cadres on research methodology.

Number of Technical staff trained.

5 5 5 5 5 50,000

Provide 6 weeks training to 30 Medical offices, Nursing officers in charge, Hospital secretaries and Heads of deportments/ Sections on Human resource planning and management for 10 weeks.

DCs Trained health staff


6 6 6 6 6 50,000

Provide on job training on new technology, procedures and emerging diseases for 100 staff from all health cadres.

DCs On job training provided

Number of Health staff provided with on job training

20 20 20 20 20 10,000

Sub total 330,000

LONG COURSES: DISTRICT HOSPITALSActivities Main Actor Output Indicator Time Frame Financial

Resources –USD

Y1 Y2 Y3 Y4 Y5Provide Post Graduate Studies ( MMED) to 3 medical Officer Incharge of the District Hospitals

DPA Trained Medical Officers in charge


1 1 1 36,000


Provide 2 year training for 5 AMO in the fields of Anesthesiology, Ophthalmology, Radiology and Dermatology to work in the District Hospitals

DPA AMOTrained


1 1 1 1 1 60,000

Up grade 12 Medical Doctors to become specialist in pediatrician Obs/Gyne, Orthopedic, Surgeon and general surgeon

DPA Upgraded Medical Doctors

Numbers of Medical Doctors up graded

2 3 3 2 2 144,000

Train 3 Dental Officers at Degree level in Dental Surgery for District Hospitals

DPA Trained Dental Officers

Number of Dental Officers trained

1 1 1 12,000

Train 2 ADO at Advanced Diploma level in Dental Services

DPA Trained ADO Numbers of ADOs trained

1 1 8,000

Train 3 Dental Technician at Advanced Diploma level in Dental Technician

DPA Trained Dental Technicians

Number of Dental Technicians trained

1 1 1 12,000

Train 4 Dental Therapist at Diploma level

DPA Trained Dental Therapist

Numbers of Dental Therapist trained

1 1 1 1 16,000

Train 4 Health Secretary at Advanced Diploma level (3 years )

DPA Health Secretary trained

Number of Health Secretary trained

1 1 1 1 36,000

Up grade through training 6 Typist to personnel Secretary position

DPA Personnel Secretary Trained

Numbers of Personnel Secretary Trained

2 2 2 18,000

Train 12 Medical Recorders in the Diploma

DPA Trained Medical Record

Numbers of Medical Record

3 3 3 3 36,000


in Medical Record TrainedTrain 4 Social workers on Diploma in Social Welfare

DPA Trained Social Workers

Numbers of Social Workers Trained

2 2 16,000

Train 3 librarian in Certificate in library services

DPA Trained Librarians

Numbers of Librarians Trained

1 1 1 8,000

Train 4 Pharmacist at 1st Degree level

DPA Trained pharmacists

Numbers of Librarians Trained

2 2 48,000

Train 6 Pharmaceutical Technician at Advanced Diploma Level

DPA Trained Pharmaceutical Technician

Numbers of Pharmaceutical Technician Trained

2 2 2 54,000

Train 6 Hospital technician at Certificate level

DPA Trained Hospital Technician

Numbers of Technicians trained

2 2 2 18,000



Train 6 Physiotherapists on Advanced Diploma in physiotherapy

D PA Trained Physiotherapist

Number of Physiotherapist trained

2 2 2 54,000

Train 6 occupational therapists at certificate level in occupational therapy

DPA Trained Occupational Therapist

Number of Occupational therapists trained.

2 2 2 18,000

Train 4 Orthopedic Technicians at Advanced Diploma level in Orthopedic Technician

DPA Trained Orthopedic Technician

Number of Orthopedic Technicians Trained

1 1 1 1 36,000

Train 10 Public Health Nurses Grade A at Advanced Diploma level in PHNA

DPA Trained Public Health Nurses

Number of Public Health Nurses Trained

5 5 30,000


Train 8 Nursing Officer on Advanced Diploma /BSS in specialized Nursing Discipline

DPA Nursing officer trained

Number of nursing officers trained

2 2 2 2 24,000

Train 6 PHNB at certificate level

DPA PHNB Trained Number of PHNB Trained 2 2 2 6,000

Train 16 Nurses to specialized in pediatric Nursing at Advanced Diploma level

DPA Pediatric Nurses trained

Number of Pediatric Nurses trained

4 4 4 4 48,000

Train 10 Nurses to specialize in Theater Nurses at Advanced Diploma level

DPA Theater Nurses trained Number of theater Nurses

trained

2 2 2 2 2 120,000

SUB TOTAL 858,000

SHORT COURSES FOR DHMTs

ACTIVITY MAIN ACTOR

OUT PUT INDICATOR TIME FRAME COST

1 2 3 4 5Train DHMT members on information management skills budgeting and budget control, Human Resources planning and management

Director Preventive Services

Trained DHMT Members

Number of DHMT members trained

12 12 12 12 12 157,800


(10 weeks).Office management skills (6weeks)



Number of DHMT Members Trained

12 13 12 13 12 52,150

Research methodology skills (6weeks)




12 12 12 12 12 107,400

Counseling skills (6weeks) Director Preventive Services



12 12 12 12 12 107,400

Community participation skills (4weeeks)




12 12 12 12 12 82,200

Up date courses related to technical professional matters


Updated Course Number of courses updated

12 12 12 12 12 107,400

SUB TOTAL 614,350

LONG COURSES FOR - DHMTs

ACTIVITY MAIN ACTOR

OUTPUT INDICATOR TIME FRAME COST

1 2 3 4 5Train 10 AMOs at degree level and MPH and promote them to DMO(1) MD: 8000 x 3 x 10(2) MPH: 9000 x 2 x 10

Director, Preventive Services

Trained DHMT members

Number of AMOs trained

2 2 2 2 2 420,000

Upgrade 10 District Nursing Officers with Advanced Diploma/BSc Nursing2000 x 3 10

Director, Preventive Service

Upgraded DHMT members

Number of District Nursing Officers upgraded

2 2 2 2 2 60,000


Train 10 District Health Secretaries at Advanced Diploma Level


Trained District Health Secretaries

Number of District Health Secretaries trained

2 2 2 2 2 60,000

Train 10 District Environmental Health Officers at Advanced Diploma level


Trained District Environmental Health Officers

Number of District Environmental Health Officers trained

2 2 2 2 2 60,000

Sub-total 600,000

SHORT COURSES FOR ZONAL HEALTH MANAGEMENT TEAMS (ZHMT)

ACTIVITY MAIN ACTOR OUT PUT INDICATOR TIME FRAME COSTY1 Y2 Y3 Y4 Y5

Train ZHMT members on :-

Human resources planning and management, information management budgeting and budget control and computer skills (10 weeks)


Trained ZHMT members

Number of ZHMT members trained

6 6

31,560 Research

methodology (6 weeks)



Number of ZHMT members trained 2 3 3 2 2 21,480

Community participation (4

Director Preventive


Number of ZHMT members trained 3 2 2 3 2 16,440


weeks) Services Counseling (6

weeks)Director Preventive Services



2 3 2 2 3 21,480

Office management (6weeks)




3 3 3 3 3 10,430

Updated courses related to technical processional matters(6weeks)


Up dated Course Numbers of Courses updated

2 3 2 3 2 21,480

SUB TOTAL 122,870


LONG COURSES FOR ZONAL HEALTH MANAGEMENT TEAMS (ZHMT)ACTIVITY MAIN

ACTOROUT PUT INDICATOR TIME FRAME COST

Y1 Y2 Y3 Y4 Y5Train 2 Zonal Medical officers on Masters in Public Health (MPH)

DPA Trained Zonal Medical officers

Number of Medical officers trained

1 1 24,000

Train 2 Nursing officers on Msc in Nursing

DPA Trained Zonal Nursing officers

Number of Nursing officers trained

1 1 24,000

Train 2 Health Secretaries at Masters level in Health Administration

DPA Trained Health Secretaries

Number of Health Secretaries trained

1 124,000

Train 2 Environmental Health officers at Advanced diploma/Degree to serve as Zonal Environmental officers.

DPA Trained Environmental officers

Number of Environmental officers trained

1 1 48,000

Provide M.P.H. training to 10 medical officer to works MDOs

DPA Trained District Medical Officers

Number of District Medical officers trained

2 2 2 2 2 120,000


Train 10 Nursing officer at advanced diploma/Bsc to work as district nursing officers

DPA Trained District Nursing Officers

Number of District Nursing officers trained

2 2 2 2 2 80,000

Train 10 Health officers at advanced diploma /degree in environmental health level to serve as district environmental health officer

DPA Trained District Environmental Officers

Number of District Environmental Health officers trained

2 2 2 2 2 80,000

Train 10 Health Secretaries at Advanced Diploma/Degree level in health Administration to serve the District

DPA Trained Health Secretaries

Number of Health Secretaries trained

2 2 2 2 2 80,000

SUB TOTAL 480,000

TOTAL for 4.2.2 4,653,720

PRIORITY AREA 4.2.3: RETENTION


OBJECTIVE 4.2.3.1: To create conducive working environment to MOHSW staffSTRATEGY 4.2.3.1.1 Develop a system for job satisfaction



Introduce Credit Schemes.

Review salary structure.

Introduce rewards and recognition system based on performance.

Introduce SASE.

Develop & advocate career ladder & open system of promotion to HRH.

DPF&A

“

“

“

“

“

Credit schemes introduced

Salary structure reviewed.

Reward and recognition system introduced.

SASE introduced.

HRH career ladder developed

Type of credit schema

Salary Structure document

Reward and recognition system document

SASE document

Types of HRH career ladder in place.

X

X

X

X

X

10,000

7,500

10,000

7,500

5,000

TOTAL for 4.2.3 40,000


PRIORITY AREA 4.2.4: QUALITY CARE AT ALL LEVELS

OBJECTIVE 4.2.4.1: To build management and organization capacity in line with HSR/ZPRPSTRATEGY 4.2.4.1.1: Ensure provision of minimum standard of health services at all levels



Recruit consultant to develop guidelines for minimum service standard per level of health care

Train 50 Health Management Team member on minimum services standards

DPF&A Consultant recruited.Guidelines developed.

Training conducted

Consultant Report

Number and type of team members trained

X

X X X X X

5,000

25,000

SUB TOTAL 30,000


STRATEGY 4.2.4.1.2: Develop and implement a comprehensive participatory performance approach and evaluation system



Conduct 10 days work shop to develop performance appraisal tool based on Job Description, professional ethics and civil services regulations.

Conduct 5 training sessions for appraisers and appraisees on the tools, processes and outcome of performance appraisal.

Conduct 2 days meeting assign responsibility and schedule performance to appraisal audit team.

Conduct 5 meetings to advocate the system to the stakeholders.

DPF&A

“

“

“

Performance appraisal tools developed.

Training conducted.

Responsibility assigned.

Advocacy conducted.

Appraisal tool document

Report of the training sessions

Report of the meeting.

Report of the meetings conducted.

X

X

X

X

X

X X X

10,000

15,000

10,000

10,000

SUB TOTAL 45,000

TOTAL for 4.2.4 75,000


PRIORITY AREA 4.2.5: HRH DATA BASE

OBJECTIVE 4.2.5.1: To strengthen the HRH information system (data bank)STRATEGY 4.2.5.1.1: Update and integrate PIS into HMIS to meet the planning, management and development needs of HRH



Retrain 10 Unit staff to advanced level.

Procure equipment and Supplies (Soft and Hard ware)

Establish net work system on HRH data base (Intra net and inter net)

Conduct 5 days workshop to develop guidelines for collection and usage of data. Printing of Guidelines

DPF&A Retrained Unit staff

Equipment and supplies procured

Network established.

Guidelines developed

Number of skilled personnel trained.

Equipment and supplies in place.

Types of network system established.

Document of the Guidelines

X

X

X

X

X

X

X

X

X

X

X

X

X

X

15,000

20,000

25,000

10,000

TOTAL for 4.2.5 70,000


PRIORITY AREA 4.2.6: CAPACITY BUILDING FOR THE COLLEGE OF HEALTH SCIENCES

OBJECTIVE 4.2.6.1: To upgrade the knowledge and skills of college staffSTRATEGY 4.2.6.1.1: Provide short and long courses for college staffShort courses

Activities Main Actors

Output Indicators Time Frame Financial Resources

–USDY1 Y2 Y3 Y4 Y5

Train 1 tutor for 4 weeks on human resources, planning and Development

CHS Tutors trained Number of tutors trained

1 3,000

Train 2 tutors in Management Information System CHS Tutors trained Number of tutors trained

1 1 6,000

Train 16 tutors for 4 weeks in Computer Sciences CHS Tutors trained Number of tutors trained

3 3 4 3 3 48,000

Train 1 tutor for 4 weeks in planning, budgeting and budgetary control


1 3,000

Train 8 tutors in planning, monitoring and evaluation CHS Tutors trained Number of tutors trained

1 2 2 2 1 24,000

Train 3 tutors for 4 weeks in community participation skills


1 1 1 9,000

Train 5 tutors for 4 weeks in research methodology CHS Tutors trained Number of tutors trained

1 1 1 1 1 15,000

Train 1 tutor for 4 weeks in health learning materials CHS Tutors trained Number of tutors trained

1 3,000

Train 2 tutors for 4 weeks in Development of IEC materials


1 1 6,000

Train 2 supporting staff for 4 weeks in higher personnel CHS Staff trained Number of staffs trained

1 1 4,000

Train 2 supporting staff for 4 weeks in Office Management

CHS Secretaries trained

Number of staffs trained

1 1 4,000


Train 2 Managers on Health Management Institution cause 3 month

CHS Manager trained

Number of manager trained

1 1 6,000

Train 1 tutor for 4 weeks in information and management CHS Tutors trained Number of tutors trained

1 6,000

Train 1 tutor for 4 weeks in Health Economics CHS Tutors trained Number of tutors trained

1 6,000

SUB TOTAL 143,000

Long coursesActivities Main

ActorsOutput Indicators Time Frame Financial

Resources – USDY1 Y2 Y3 Y4 Y5Train 10 tutors in Diploma in Health Personnel Education


2 2 2 2 2 90,000

Train at degree level, 8 Nurse tutors in nursing specialties


2 2 2 1 1 96,000

Train at degree level 2 Environmental Health tutors in Public Health


1 1 24,000

Train at degree level 2 Medical Laboratory tutor in med, lab. Sciences


1 1 24,000

Train at degree level 2 pharmaceutical tutors


1 1 24000

Train at degree level 1 dental tutor in dentistry


1 12,000

Train at degree level 2 CHN tutors in community health


1 1 10,000

Train at Masters level 1 Nurse tutor in Nursing


1 7,000

Train at Masters level 1 EHO tutors in Public Health


1 7,000


Train at Masters level 1 Medical Laboratory tutor in medical laboratory science


1 7,000

Train at Masters level 1 pharmaceutical science tutor in Pharmacy


1 7,000

Train at Masters level 1 dental tutor in dentistry


1 7,000

Train at Masters level 1 CHN tutor in community participation skills


1 7,000

Train at Masters level 1 tutor in Medical Education

CHS Tutor trained Number of tutors trained

1 7,000

Train at Diploma level 1 supporting staff in accountancy

CHS Accountant trained

Number of accountants trained

1 9,000

Train at Diploma level 1 support staff in stores management

CHS Store keeper trained

Number of store keepers trained

1 9,000

Train Manager at degree level in management/administrative officer

CHS Administrative Officer trained

Number of staffs trained

1 12,000

Train at degree level 1 Librarian in library services

CHS Librarian trained

Number of librarians trained

1 12,000

SUB TOTAL 281,000


OBJECTIVE 4.2.6.2: To make the College recognized by NACTE and other learning institutionsSTRATEGY 4.2.6.2.1: Comply with the conditions set by NACTE


Output Indicators Time Frame Financial ResourcesY1 Y2 Y3 Y4 Y5

Recruit 17 tutors with the required qualifications

CHS Tutors recruited Number of tutors recruited

1 X

Provide equipment necessary for communication system

CHS Equipment for communication System provided

Number of communication equipments

X 10,000

Monitor and evaluate periodically training provided

CHS Evaluation & evaluation done

Monitoring and Evaluation reports

X X X X X 25,000

SUB TOTAL 35,000

STRATEGY 4.2.6.2.2: Improve curriculumActivities Main


Resources – USDY1 Y2 Y3 Y4 Y5Commission consultant to review current curriculum

CHS Consultant commissioned

Consultant Report 1 5,000

Conduct 3 days workshop to discuss consultancy report

CHS Workshop conducted

Workshop Reports 1 6,000

Prepare curriculum of 12 courses CHS Curriculum prepared

Curricula documents 1 5,000

SUB TOTAL 16,000


OBJECTIVE 4.2.6.3: To ensure access to essential equipment to meet the demands of the collegeSTRATEGY: 4.2.6.3.1: Purchase the required supplies


Output Indicators Time Frame Financial Resources –USDY1 Y2 Y3 Y4 Y5

Purchase 10 computers with accessories

CHS Computers purchased

Number of computer purchased

5 5 15,000

Purchase Stationeries ( Package ) CHS Stationeries purchased

Report of stationery purchased

1 1 1 1 1 20,000

Purchase learning equipments for all cadres DDA DEHS DGNM DGNP+CO DPT DCM

CHS Equipment purchased

Number of purchased learning equipment

X X X X X 220,000

SUB TOTAL 255,000

OBJECTIVE 4.2.6.4: To increase college incomeSTRATEGY 4.2.6.4.1 Introduce short courses on commercial basis


Output Indicators Time Frame Financial Resources – USDY1 Y2 Y3 Y4 Y5

Commission consultant to conduct market survey on marketable courses

CHS Market Survey conducted

Number of Market Survey done

X 5,000

Conduct 3 days workshop to discuss the Consultant’s report

CHS Workshop conducted

Number of Workshop conducted

X 3,000

Conduct 14 days workshop to Prepare curricula for marketable courses

CHS Curricula prepared Number of Workshop conducted

X 10,000

SUB TOTAL 18,000


STRATEGY 4.2.6.4.2: To introduce cost sharing


Output Indicators Time Frame Financial Resources –USDY1 Y2 Y3 Y4 Y5

Conduct 10 days study to determine peoples’ ability to share the cost

CHS Study conducted Numbers of Studies Study conducted

X 10,000

Conduct 14 days workshop to Prepare the cost sharing guideline and disseminate it

CHS Number/types prepared

Number of Guideline prepared

X 10,000

SUB TOTAL 20,000

OBJECTIVE 4.2.7.2: To increase the quality and standard of work performance

STRATEGY 4.2.7.2.1: Develop and implement participatory performance and performance appraisal system


Output Indicators Time Frame Financial Resources-USDY1 Y2 Y3 Y4 Y5

Develop performance appraisal tool based on Job Description, professional ethics and civil services regulations

CHS Performance appraisal tool developed

Types of Appraisal developed

X 5,000

Train appraisers and those to be appraised on the tools, processes and outcome of performance appraisal.

CHS Training conducted Number of staff trained

X X X X 10,000


Assign responsibility and schedule performance to appraisal audit team.

CHS Responsibilities assigned

Audit teams schedule assigned responsibility

X X X X 4,000

Advocate the system to the college staff

CHS Advocacy done System advocated

X X X X 5,000

SUB TOTAL 24,000

STRATEGY 4.2.6.5.2: Adapt current schemes of serviceActivities Main


Resources – USDY1 Y2 Y3 Y4 Y5Conduct 5 days meeting to Review the current schemes of services

CHS Review conducted Numbers of meeting

X 3,000

Conduct 5 days workshop to Prepare schemes of services for cadres that do not have

CHS Schemes of services reviewed

Types of Schemes prepared

X 5,000

SUB TOTAL 8,000

OBJECTIVE 4.2.6.6: To introduce incentive packagesSTRATEGY 4.2.6.6.1: Consolidate salary and allowances


Output Indicators Time Frame Financial Resources- USDY1 Y2 Y3 Y4 Y5

Conduct 5 days meeting to Analyze the current salary structure

CHS Current salary structure analysed

Number of meeting

X 5,000

Conduct 14 days workshop to Review the salary scales

CHS Salary scales reviewed

Number of workshop

X 8,000

SUB TOTAL 13,000


STRATEGY 4.2.6.6.2: Develop a system for job satisfaction



Introduce rewards and recognition system based on performance

CHS Reward and recognition system introduced

Number of staff Reward

X 5,000

SUB TOTAL 5,000

OBJECTIVE 4.2.6.7: To establish an integrated HMISSTRATEGY 4.2.6.7.1: Procure the necessary equipment and train staff



Conduct 2 weeks needs assessment survey

CHS Survey conducted Survey Report X 5,000

Purchase equipment needed 20,000

Train 2 staff to manage HMIS CHS Staff trained Number of staff trained

2 15,000

Expand the current network system CHS Network expanded Number of rooms with network

X X X X X 20,000

SUB TOTAL 60,000TOTAL for 4.2.6 878,000


PRIORITY AREA 5.8: MNAZI MMOJA AS A REFERRAL HOSPITAL

Objective 4.2.7.1: To transform MMH into a functional semi-autonomous Referral institutionStrategy 4.2.7.1.1: Formulate policy, laws and regulations for transforming MMH into a semi-autonomous hospital

Activities Main Actor Output Indicator Time Frame FinancialResources –USDY1 Y2 Y3 Y4 Y5

Conduct advocacy campaigns for MMH semi- autonomy

Hospital director

Conducted advocacy campaign

Number of advocacy campaigns conducted

X 2,000

Conduct 10 days policy formulation w/shop for MMH

Hospital director

Workshops conducted

Numbers of workshop conducted

X 15,000

Conduct 3 days meeting to table policy document to relevant authority for discussion and endorsement

Hospital director

Endorsement Meeting conducted

Numbers of meeting conducted

X 500

Formulate an act to translate and reinforce the policy

Hospital director

MMH act enacted Numbers of Act formulated

X 1,500

SUB TOTAL 19,000


Strategy 4.2.7.1.2: Strengthen managerial and technical capacity of MMH.

Activities Main Actor Output Indicator Time Frame FinancialResources -USDY1 Y2 Y3 Y4 Y5

Conduct 7 days workshop to Formulate management tools [i.e. staffing guidelines; administrative/management; motivation schemes, performance /monitoring and evaluation guidelines,].

Hospital DirectorDHS

Management tools formulated

Type of Management tool formulated

X X 10,000

Train 10 departmental staff on formulated guidelines.

DHS Staff trained on formulated of guidelines

Number of trained staffs X 5,000

SUB TOTAL 15,000


Objective 4.2.7.2: To increase the quality and standards of working environments for better staff performance and service delivery

Strategies 4.2.7.2.1: Formulate employee performance evaluation guideline and staff promotion schemes. Activities Main actors Output Indicators Time Frame Financial

Resources - USD

Y1 Y2 Y3 Y4 Y5Conduct tripartite [labour commission, trade union, hospital administration] consultative meeting for the formulation of staff performance and promotion guidelines

DCS Consultative meetings conducted

Report of the Consultative Meetings

X X 10,000

Conduct two days appraisal workshops on performance and promotion guidelines.

DCS Numbers of workshop conducted

Workshop report X 5,000

Train sectional head on performance and promotion guidelines

DCS Trained sectional head

Number of sectional head trained

X X X X 8,000

Produce and distribute performance and promotion guidelines

DCS Guideline distributed

Guidelines document

X X X X 2,000

SUB TOTAL 25,000


Strategy 4.2.7.2.2: Develop career path and career advancement plans

Activities Main actors Output Indicators Time Frame FinancialResources -

USDY1 Y2 Y3 Y4 Y5

Conduct staff’s needs assessment

Head Admin & finance

Needs identified Assessment report.

X X X X 5,000

Design HR career path and advancement plans.

Head Admin & finance

Career path and advancement plans developed

HR career path/plans document

X X X X 5,000

Advocate for the developed plans

Hospital Director Advocate on career developmentPlan done

Advocacy Report X X X X 3,000

Educate HCW on career path. Medical superintendent

HC W educated on career path

Number of HCW educated

X X X X 3,000

SUB TOTAL 16,000


OBJECTIVE 4.2.7.3.: To build capacity of health care workers to deliver quality health care.STRATEGYS 4.2.7.3.1 Develop a special training programme for core medical staffs on different specialties


USDY1 Y2 Y3 Y4 Y5Review and update cadre specific training needs

DCS Training needs updated

Types of training needed

X X X X X 2,000

Prepare comprehensive training plan

DCS Comprehensive plan in place

Training plan X X X X X 20,000

Prepare booklet [directory] on training for cadre specific priorities

DCS Training directory in use

Training directory X X X X X 1,000

Solicit funds for training DCS Funds solicited Number of types of advocacy sessions

X X X X X 20,000

Affiliate with interested training institutions

DCS MMH affiliated to training institution

Number of training affiliations.

X X X X X 5,000

Organise long term training of care workers to various institutions (see below)

DCS Health care workers trained

Number of trained HCW

X X X X X 400,000

SUB TOTAL 448,000


INTERNAL MEDICINE

CADRE NO IN TRAINEE QUALIFICATIONTIME FRAME

1 2 3 4 5

Neurologist 1 MMED 1

Dermatologist 1 MMED 1

Endocronologist 1 MMED 1

Physician 1 MMED 1

Chest & TB Specialist 1 MMED 1

MO 16 Doctor of Medicine 4 3 3 3 3

Counselor 1 Counseling 1

Nursing Officer 4 Nursing and Management with Computer Skills

1 1 1 1

Nurse Psychiatrist 4 Advanced Diploma in Psychiatric Nursing

2 2


OBS/GYNAECOLOGY


1 2 3 4 5

Gynaecologist 2 MMED 1 1


AMO 6 Advance Diploma in clinical Medicine 1 2 1 1 1

Clinical Officers 3 Diploma in Clinical Medicine 1 1 1

Nursing Officer 4 Advanced Diploma in Midwifery 1 1 1 1

RADIOLOGY


1 2 3 4 5

Radiologist 1 MMED 1

MO 4 Doctor of Medicine 1 1 1 1

FSW GYNER


1 2 3 4 5

Nurse Midwife 2 Advanced Diploma in Midwife 1 1

PATHOLOGYCADRE NO IN TRAINEE QUALIFICATION TIME FRAME


1 2 3 4 5

Pathologist 2 MMED in Pathology 1 1


Laboratory Technologist 2 Advance Diploma in Lab Science

1 1

ORTHOPAEDIC

CADRENO IN

TRAINEEQUALIFICATION

TIME FRAME1 2 3 4 5

Orthopedic surgeon 2 MMED 1

MO 2 Doctor of Medicine 1

Orthopedic Nurse 4 Advanced Diploma in Orthopaedic Nursing

1 1 1 1 1


DENTAL

CADRENO IN


TIME FRAME1 2 3 4 5

Specialist Dental surgeon

2 MMED in Oral Surgery 1 1

Specialist Dental surgeon

1 MMED in Paedontist 1 3

Dental surgeon 4 Doctor in Dental surgery 1 1 1 1

Dental Technicians 2 Advanced Diploma in Posthodontics 1 1

Dental Attendant 3 Diploma/ Certificate 1 1 1

PHARMACY


1 2 3 4 5

Pharmacist 5 Bachelor of Pharmacy 1 1 1 1 1

Pharmaceutical Technician

13 Diploma in Pharmaceutical Technician

4 3 3 3

Specialist Pharmacist 2 M Pharm. In Hospital pharmacy. 1 1


ENT DEPARTMENT


1 2 3 4 5

ENT Surgeon 2 Mmed 1 1

MO 2 Medical Doctor 1 1

OPTHTHALMIC


1 2 3 4 5

MD Ophthalmology 2 Mmed 1 1

MO 4 Medical Doctor 1 2

Ophthalmic Nurse 2 Advanced Diploma in Ophthalmic Nursing

1 1

Optician 1 Optician Certificate 1


PHYSIOTHERAPY


1 2 3 4 5

Specialist Physiotherapist

2 MMED 1

MD Occupation therapist

2 Advance Diploma in Occupation Therapy

1 1

Physiotherapist 6 Advanced Diploma in Physiotherapy 1 2 3

Speech therapist 2 Advance Diploma in Speech Therapist 1 1

Orthopaedic Technician Nurse

7 Orthopaedic Technician 3 2 2

ANAESTHESIA


1 2 3 4 5

Anaesthetist 2 Mmed in Anaesthezia 1 1

MO 2 Doctor of Medicine 1 1

Anaesthetic AMO &Nurse

9 Advance Diploma/Diploma in Anaesthesia

2 1 2 3 1

THEATRE

CADRENO IN


TIME FRAME1 2 3 4 5

Theatre Midwife 17 Advanced Diploma in Theatre Management 3 5 2 3 4


PAEDIATRIC


1 2 3 4 5

Paediatrician-MD 2 Mmed in Paediatrict 1 1

Neonatologist MD 1 Mmed in Neonatology 1

MO 2 Doctor of Medicine 1 1

Paediatric Nurse 24 Advanced Diploma in Paediatric Nursing

5 5 5 5 4

SURGICAL DEPARTMENT

CADRE NO IN TRAINEE QUALIFICATION TIME FRAME1 2 3 4 5

Urologist 2 Mmed in Urology 1 1

Paediatric Surgeon 1 Mmed in Paediatric Surgery 1

MO 4 Doctor of Medicine 1 1 1

Nurse Midwife 2 Advanced Diploma in Nursing 1 1


Strategy 4.2.7.3.2: Design a special workplace education programme


USDY1 Y2 Y3 Y4 Y5Design department-specific on job Continuing Education [CEU] training programmes

Medical superintendent

Departmental CEU programmed designed

Number of departments with CEU.

X X X X X 5,000

Facilitate distance learning education

Medical superintendent

Distance learning in place

Number of HCW enrolled in distance

X X X X X 2,000

Create documentation center Medical superintendent

Functional documentation centre in use

Number of HCW accessing documentation services.

X X X X 100,000

Set up a newsletter editorial board

Hospital Director Newsletter editorial board in place

Well functional board in place

X 3,000

Produce MMH newsletter and other learning materials

Hospital Director Newsletter and other learning materials produced

Number of newsletters produced

X X X X 20,000

Sub total 130,000

TOTAL FOR 4.2.7 653,000


PRIORITY AREA 4.2.8: MONITORING AND EVALUATION

OBJECTIVE 4.2.8.1 To monitor and evaluate the HRH Medium Term Plan implementation processSTRATEGY 4.2.8.1.1 Develop a standardized tool for monitoring and evaluation of the HRH Medium Term Plan

implementation



Conduct 5 days workshop to develop monitoring and evaluation guidelines.

DPA M&E guidelines developed.

Types of guidelines developed

X 5,000

Conduct 3 days meeting to review HRH Medium Term plan annually and at mid-term.

DPA HRH master plan reviewed annually and midterm.

Number of Meeting X X X X X 30,000

TOTAL for 4.2.8 35,000

Grand Total 6,438,220


ANNEX II (a)HRH SITUATION AS AT JUNE 2003

(a) CORE MEDICAL OCCUPATIONS AT PRIMARY LEVEL (PHCUs and PHCCs)

No OCCUPATION REQUIRED CURRENTLY IN POST DEFICIT/ SURPLUS

1 Medical Officer 4 0 4

2 Clinical Officer 126 25 101

3 Hospital Secretary 4 0 44 Public Health Officer 122 3 119

5 Nursing Officer 0 32 +32

6 General Nurse 0 30 +30

7 Nurse/Midwife 17 36 +18

8 Comm. H. Nurse 122 45 77

9 Public H. Nurse B 260 48 212

10 MCHA 0 147 +147

11 Psychiatric Nurse 0 22 +22

12 Pharm. Technician 130 13 117

13 Lab. Technician 130 16 114

14 Dental Therapist 21 1 20

15 Assist. Dental Officer 4 0 4

16 Health Assistant 0 73 +73

17 Ass. Medical Officer 4 0 4

18 Medical Recorder 12 0 12


19 Radiographer 4 0 4

20 Mortuary Attendant 16 0 16

21 Pub. Health Nurse A 0 7 +7

22 Health Orderly 143 202 +59

23 Social worker 3 0 3

TOTAL 1128 700 428


ANNEX II(b)

CORE MEDICAL OCCUPATIONS AT THE SECONDARY LEVEL (DISTRICT HOSPITALS)

No OCCUPATION REQUIRED CURRENTLY IN POST

DEFICIT/SURPLUS

1 Medical Officer i/c 3 1 2

2 Medical Officer 3 3 03 AMO 15 4 114 Medical Specialist 12 0 125 District Envir. Officer 10 8 26 Dental Officer 3 0 37 Assist. Dental Officer 3 1 28 Dental Technician 3 0 39 Dental Therapist 3 2 110 Health Secretary 3 0 311 Medical Recorder 12 0 1212 Pharmacist 3 1 213 Pharm. Technician 9 3 614 Laboratory Technician 12 23 +1115 Lab. Technologist 3 2 116 Health Technician 3 0 317 Health Orderly 57 0 5718 Radiographer 3 7 +419 Radiographic Assistant 3 0 320 Physiotherapist 9 3 621 Occupational Therapist 3 0 322 Orthopaed. Technician 3 0 323 Nursing Officer 105 116 +1124 Public H. Nurse A 12 3 925 Public H. Nurse B 6 2 4


26 Pediatric Nurse 12 0 1227 Ophthalmic Nurse 6 7 +128 Theatre Nurse 12 2 1029 Pub. Health Officer 3 0 330 Pharm. Auxiliary 6 0 631 Laboratory Attendant 6 0 632 Medical Attendant 9 0 933 Mortuary Attendant 6 6 034 Psychiatric Nurse 48 48 035 Social Worker 3 0 3

TOTAL 411 244 167


ANNEX II(c)

CORE MEDICAL OCCUPATIONS AT THE TERTIARY LEVEL(MNAZI MMOJA HOSPITAL)


DEFICIT/SURPLUS

1 Medical Superintendent 1 1 02 Assist Medical Sup. 1 1 03 Hospital Secretary 1 1 04 Matron 1 1 05 Assist. Matron 1 2 +16 Med. Specialist (TB) 9 4 57 Medical Officer 39 11 288 Therapt. Counselor 1 0 19 Nurse A 19 12 710 Nurse Assist 14 9 511 Radiologist 4 4 012 Radiographic Specialist 3 3 013 Radiographer 2 8 +614 Med. Ass (Accup) 2 2 015 Health Orderly 7 7 016 ENT Specialist 2 1 117 Psychiatry Nurse 1 0 118 Pharmacist 5 2 319 Pharm. Technician 15 2 1320 Pharm. Auxiliary 3 24 +2121 Pharm. Production 0 2 +222 Dental Surgeon 4 2 223 Dental Specialist 3 0 324 Assist. Dental Officer 4 1 325 Dental Technician 4 2 2


26 Dental Attendant 4 1 327 Med. Dent. Recorder 2 2 028 Specialist (obs) 5 3 229 Medical Officer 6 3 330 Assist. Med. Officer 12 7 531 MCHA 0 4 +432 Ophthalmologist 2 1 133 Ophth. Cat. Surgeon 6 3 3

34 Ophth. Clin. Surgeon 6 3 335 Ophth. Clin. Officer 0 4 +436 Ophth. Nurse 10 2 837 Optician 2 1 138 Production Assist 3 2 139 M.A Ophth. Orient 0 1 +140 Orthopedic Nurse 12 0 1241 Gen. Pathologist 2 0 242 Microbiologist 1 0 143 Immunologist 1 0 144 Parasitologist 1 0 145 Hematologist 1 0 146 Lab. Technologist 18 9 947 Clinical Bioch. 1 0 148 Lab. Scientific. Off. 10 1 949 Lab. Technician 21 37 +1650 Lab. Assistant 1 17 +1651 Surgical Specialist 5 4 152 Clinical Officer 0 14 +1453 Psychiatry Nurse 9 8 154 Nurse/Midwife 121 108 1355 SN/MW 20 19 156 SN/PSY 6 3 357 Hosp Orderly 59 115 +56


58 Anesthetist 4 2 259 Nurse(Anesth.) 9 9 060 Theatre Nurse 8 2 661 Spec. Psychiatrist 2 1 162 Nursing Officer 49 17 3263 Comm. Psy. Nurse 1 1 0

TOTAL 566 494 72


ANNEX II(d)

CORE OCCUPATIONS AT THE GOVERNMENT CENTRAL LABORATORY


DEFICIT/SURPLUS

Chief Chemist Office1 Chief Chemist 1 0 1

Food & Drugs Control2 Food Scientist 3 2 13 Nutritionist 2 0 24 Microbiologist 1 0 15 Chemist 2 0 26 Chemical Lab. Tech 2 1 17 Pharmacist 1 0 18 Pharmaceut. Tech 1 0 19 Pharmaceut. Assist 1 0 110 Laboratory Assist 1 0 111 Food Technician 2 2 0

Chemical Management and Environmental Control

12 Chem.& Pr. Eng. Ch 1 1 013 Chemist 2 0 214 Chem. Lab Tech 2 1 115 Medical Lab Tech 1 0 116 Laboratory Assist 1 0 1

Forensic Science Service17 Forensic Chemist 2 0 218 Toxicologist 1 0 119 Chem. Lab. Techn 1 1 020 Medical Lab. Tech 1 0 1


21 Laboratory Assist 1 1 0Technical Services (Instrumental Analysis)

22 Chemist (Instr. Analysis) 1 0 123 Engineer (Electronic) 1 0 124 Engineer (Electric) 1 0 125 Technician (FTC) 1 0 126 Computer Technologist 1 0 127 Laboratory Techn 1 0 128 Laboratory Assist 1 0 129 Health Orderly 3 1 2

TOTAL 40 10 30


ANNEX II(e)

CORE OCCUPATIONS AT THE COLLEGE OF HEALTH SCIENCES


DEFICIT/SURPLUS

1 Principal 1 0 12 Chief Academic Officer 1 1 03 Chief Admin. Officer 1 0 14 Librarian 2 0 25 Medical Officer 1 0 16 Anesthetist 1 0 17 Pharmacist 2 0 28 Dental Officer 1 0 19 Assist. Dental Officer 1 0 110 Assist Med. Officer 1 0 111 Med. Lab. Scientist 2 0 212 Env. Pub. H. Nurse 4 2 213 Nursing Officer Psych 3 1 214 Nursing Officer MW 8 8 015 Nursing Officer PHN 3 1 216 Comm. H. Nurse

Specialist2 0 2

17 Medical Sociologist 1 0 118 Epidemiologist 1 0 119 Parasitologist 1 0 120 Health Officer 2 1 121 Nutritionist 1 0 122 Sanitary Engineer 1 0 123 Pub. H. Nurse Specialist 1 0 124 Theatre Man. Specialist 1 0 125 Emerg Med. Specialist 1 0 1


26 Med. Ethics Specialist 1 0 127 Warden 2 2 028 Accountant 1 0 129 Store-keeper 1 1 030 Secretary 2 0 2

TOTAL 51 17 34


ANNEX 2(f)

CORE OCCUPATIONS AT THE MOHSW

NO POSITION REQUIRED CURRENTLY IN POST

DEFICIT

1 PPF&A 1 1 02 HRH Officer 1 - 13 HRH Planning Officer 1 - 14 DAO 1 - 15 Training Officer 1 - 16 CEO 1 1 07 HMIS 1 1 08 Statistician 1 1 09 Epidemiologist 1 - 110 Research 1 - 111 HDPP 1 1 012 PBF 1 - 113 PAM 1 - 114 H & Acc 1 - 115 Accountant 2 - 216 Supplies Officer 1 - 117 Maintenance 1 1 018 Biomedical 1 - 119 Garage 1 - 120 Estate 1 - 121 DHS 1 - 122 Zonal Health Coordinator. 2 - 223 Zonal Public Health Off 2 - 224 Zonal Public Health N 2 - 225 Zonal Health Secretary 2 - 226 Zonal Health Manager. Off 2 - 2


27 Programme Manager 8 5 328 District Medical Officer 10 - 1029 District Public H Officer 10 - 1030 District Public H Nurse 10 - 1031 District Health Secretary 10 - 1032 DHMSO 10 - 1033 DSWDA 1 - 134 SWO 4 2 235 DSAO 1 - 136 Counselor 2 0 237 Educator 2 0 2

TOTAL 100 13 87


ANNEX IIIEXPECTED NUMBER OF GRADUATES FROM THE COLLEGE

OF HEALTH SCIENCES 2004/05 – 2008/09

Cadre 2005 2006 2007 2008 2009

GNM 23 13 13 16 12

GNP 10 8 9 11 10

MLT 30 0 0 0 0

EHO 0 16 15 17 16

CHN 0 0 0 0 0

CO 10 18 16 15 17

PHNB 0 20 16 17 18DENTAL ASSISTANT 0 8 10 8 8

Total 73 83 79 84 81

GNM = General Nurse/MidwifeGNP = General Nurse (Psychiatry)MLT = Medical Laboratory TechnicianEHO = Environmental Health OfficerCHN = Clinical Heath NurseCO = Clinical OfficerPHNB = Public Health Nurse B


ANNEX IV(a ) SUMMARY OF DEFICIT AND SURPLUS 1st LINE PHCU UNGUJA AND PEMBA

S/N CADRE UNGUJA PEMBA TOTAL

DEFICIT

SURPLUS DEFICIT SURPLUS DEF SURP

1 Clinical Officer 8 0 44 0 52 0

2 Community Health Nursing (CHN) 5 1 30 0 35 1

3 General 1Nurse 1 5 0 5 1 10

4 Psychiatric Nurse 0 1 0 13 0 14

5 Nurse Midwife 8 0 0 5 8 5

6 Public Health Officer 11 0 45 0 56 0

7 Public Health Nurse ‘B’ 17 0 60 0 77 0

8 Maternal and Child Health Aider 0 17 0 39 0 56

9 Pharmaceutical Auxiliary 0 4 0 0 0 4

10 Pharmaceutical Technician 11 0 45 0 56 0

11 Health Assistant 1 5 0 22 1 27

12 Health Orderlies 0 4 0 17 0 21

13 Laboratory Assistant 0 1 0 1 0 2

14 Laboratory Technician 10 0 0 0 10 0

15 Dental Therapist 11 0 0 0 11 0

TOTAL 83 38 224 102 307 140


SUMMARY OF DEFICIT AND SURPLUS AT 2ND LINE PHCU UNGUJA AND PEMBA ANNEX IV(b)

S/N

CADRE UNGUJA PEMBA TOTAL

DEFICIT

SURPLUS DEFICIT SURPLUS DEF SURP

1 Clinical Officer 1 9 0 8 1 17

2 Community Health Nursing (CHN) 1 5 0 4 1 9

3 General 1 Nurse 4 0 2 0 6 0

4 Psychiatric Nurse 0 1 0 13 0 14

5 Nurse Midwife 3 7 0 8 3 15

6 Public Health Officer 0 12 0 7 0 19

7 Public Health Nurse ‘B’ 0 14 0 13 0 27

8 Maternal and Child Health Aider 21 0 12 0 33 0

9 Pharmaceutical Auxiliary 4 0 0 0 4 0

10 Pharmaceutical Technician 0 12 0 5 0 17

11 Health Assistant 9 0 3 0 12 0

12 Health Orderlies 0 12 0 8 0 20

13 Laboratory Assistant 3 0 0 0 3 0

14 Laboratory Technician 0 12 0 8 0 20

15 Dental Therapist 0 12 0 8 0 20

16 Watchman 1 0 0 0 1 0

17 Microscopist 9 0 3 0 12 0

18 Pharmaceutical Assistant 3 0 0 0 3 0

TOTAL 53 88 29 61 82 149


ANNEX IV (c)

SUMMARY OF DEFICIT AND SURPLUS FOR PHCCs LEVEL UNGUJA AND PEMBA

S/N CADRE UNGUJA PEMBA TOTALMAKUNDUCHI KIVUNGE MICHEWENI VITONGOJI

DEFICIT SURPLUS DEFICIT SURPLUS DEFICIT SURPLUS DEFICIT SURPLUS DEFICIT SURPLUS1 MEDICAL OFFICER 1 0 1 0 1 0 1 0 4 02 A.M.O 1 0 1 0 1 0 1 0 4 03 CLINICAL OFFICER 0 0 0 2 0 0 1 0 1 24 A.D.O 1 0 1 0 1 0 1 0 4 05 HOSPITAL

SECRETARY1 0 1 0 1 0 1 0 4 0

6 NURSING OFFICER 0 3 0 8 0 2 1 0 1 137 PHNB 3 0 4 0 5 0 4 0 16 08 HEALTH OFFICER 0 23 0 15 0 8 7 0 7 469 LAB TECHNICIAN 0 0 0 1 0 0 2 0 2 110 PHARM

TECHNICIAN2 0 2 0 2 0 2 0 8 0

11 MEDICAL RECORDER

3 0 3 0 3 0 3 0 12 0

12 DRIVER 0 2 1 0 0 0 1 0 2 213 TRAINED COOK 1 0 1 0 1 0 1 0 4 014 KITCHEN ATTEND 3 0 0 0 0 0 2 0 5 015 LABOURER 2 0 2 0 2 0 2 0 8 016 WATCHMAN 0 0 0 0 2 0 1 0 3 017 SECRETARY 0 0 1 0 1 0 1 0 3 118 ACCOUNTANT 1 1 1 0 1 0 1 0 4 019 CASHIER 1 1 1 0 1 0 1 0 4 020 MORTURY ATTEND 1 0 1 0 1 0 1 0 4 021 DHOBI 1 0 1 0 0 0 0 1 2 122 LIBRARIAN 1 0 1 0 1 0 1 0 4 023 SOCIAL WORKER 1 0 1 0 1 0 1 0 4 024 HEALTH OFFICER 1 0 1 0 1 0 1 0 4 025 RADIOGRAPHER 1 0 1 0 1 0 1 0 4 0

26 PHARM. ASSISTANT 0 0 0 0 0 1 0 1 0 227 DENTAL THERAPIST 0 0 0 0 0 0 0 0 0 0


28 PHARM. AUXILLARY

0 2 0 0 0 0 0 1 0 3

29 HEALTH ASSITANT 0 0 0 0 0 0 0 1 0 130 MICROSCOPIST 0 0 0 0 0 0 0 1 0 131 TYPIST 0 0 0 0 0 1 0 1 0 232 CLERK 0 0 0 2 0 1 0 4 0 733 GARDENER 0 2 0 2 0 1 0 1 0 634 RMA 0 0 0 0 0 0 0 1 0 1

35 CHN 1 0 1 0 0 0 1 0 3 036 MCHA 0 1 0 2 0 3 0 0 1 5

37 LAB ASSITANT 0 0 0 0 0 1 0 2 0 3

TOTAL 27 34 27 32 27 18 40 14 122 97


SUMMARY OF DEFICIT AND SURPLUS FOR SECONDARY LEVEL(DISTRICT HOSPITAL) ANNEX IV (d)

NO CADRE MKOANI WETE CHAKE TOTAL

DEFICIT SURPLUS DEFICIT SURPLUS DEFICIT SURPLUS DEFICIT SURPLUS

1 General Surgeon 1 0 1 0 1 0 3 0

2 Orthopedic Surgeon 1 0 1 0 1 0 3 0

3 Obs/Gynae specialist 1 0 0 0 0 0 1 0

4 Physician 1 0 1 0 0 0 2 0

5 M.O General 1 0 0 0 0 1 1 1

6 Dental Officer 1 0 1 0 1 0 3 0

7 AMO General 0 0 0 0 1 0 1 0

8 AMO Anesthesia 0 0 1 0 1 0 2 0

9 AMO Ophthalmic 1 0 1 0 1 0 3 0

10 AMO Radiology 1 0 1 0 1 0 3 0

11 AMO Dermatology 1 0 1 0 1 0 3 0

12 ADO 1 0 1 0 0 0 2 0

13 Dental Therapist 1 0 1 0 0 0 2 0

14 Dental Therapist 1 0 0 0 1 0 2 0

15 Pharmacist 1 0 0 0 1 0 2 0

16 Pharmacist Technology 3 0 3 0 1 0 7 0

17 Lab. Technologist 1 0 0 1 0 0 1 1

18 Lab. Technician 0 3 0 3 0 7 0 13

19 Lab. Assistant 2 0 0 0 0 1 3 0


20 Radiographer 0 2 0 2 0 0 0 4

21 Lab. Attendant 0 1 0 1 0 1 0 3

23 Radiog. Attendant 1 0 1 0 1 0 3 0

ANNEX IV (d) continued

CHAKE

NO CADRE MKOANI WETE TOTAL


24 Health Officer 1 0 1 0 1 0 3 0

25 Physiotherapist 3 0 1 0 2 0 6 0

26 Occup. Therapist 1 0 1 0 1 0 3 0

27 Orthopedic Technologic 1 0 1 0 1 0 3 0

28 Nurs. Off. General 13 0 4 0 7 0 24 0

29 PHN ‘A’ 3 0 3 0 3 0 9 0

30 PHN ‘B’ 2 0 2 0 0 0 4 0

31 Peadric nurse 2 0 1 0 1 0 4 0

32 Othalmic Nurse 0 1 1 0 1 0 2 1

33 Theatre Nurse 2 0 1 0 1 0 4 0

34 Health Secretary 1 0 1 0 1 0 3 0

35 Account 1 0 1 0 1 0 3 0

36 Account Asst. 1 0 1 0 1 0 3 0

37 Personal Secretary 1 0 1 0 1 0 3 0

38 Registry Asst. 1 1 2 0 2 0 4 1

39 Supplies Officer 1 0 1 0 1 0 3 0


40 Medical Recorder 4 0 4 0 4 0 12 0

41 General Tech 0 0 1 0 0 2 1 2

42 DHOBI 0 2 0 2 1 0 1 4

43 Mortuary Attend. 2 0 2 0 2 0 6 0

44 Office Attend 0 0 1 0 1 0 2 0

ANNEX IV (d) continued

TOTALNO CADRE MKOANI WETE CHAKE


45 DRIVER 0 0 0 2 0 3 0 5

46 Watchman 0 1 0 5 0 0 0 6

47 Trained Cook 2 0 1 0 2 0 5 0

48 Kitchen Attend 0 0 0 3 0 4 0 7

49 Supplies Asst. 1 0 1 0 1 0 3 0

50 Social Worker 1 0 1 0 1 0 3 0

51 Librarian 1 0 1 0 1 0 3 0

52 Laborers 0 5 2 0 2 0 4 5

53 Clinical Officer 0 2 0 11 0 5 0 18

54 CHN 0 0 0 0 0 0 0 0

55 Pharm. Asst. 0 3 0 3 0 0 0 6

56 Pharm. Auxillary 0 1 0 5 0 6 0 12

57 Pharm. Attendt. 2 0 2 0 2 0 6 0


58 General Nurse 0 15 0 10 0 4 0 29

59 Cashier 0 0 0 0 0 0 0 0

60 Typist 0 1 0 1 0 1 0 3

61 MCHA 0 3 0 1 0 3 0 7

62 Clerk 0 2 0 0 0 7 0 9

63 Assistant Nurse 0 0 0 2 0 0 0 2

64 Ophthalmic Asst. 0 0 0 1 0 0 0 1

65 Microscopist 0 1 0 1 0 0 0 2

66 Shoe market 0 0 0 0 0 1 0 1

Annex IV (d) continued

NO CADRE MKOANI WETE CHAKE TOTAL


67 Tailor 0 0 0 1 0 0 0 1

68 Telephone Operator 0 0 0 0 0 1 0 1

69 Opth. Co 1 0 0 1 1 0 2 1

70 Co. Officer Anaeth. 0 0 0 1 0 1 0 2

71 ENT. Nurse 0 0 0 1 0 1 0 2

72 Anaethesia Nurse 0 0 0 1 0 1 0 2

73 Messenger 0 1 0 0 0 1 0 2

74 Gardener 0 3 0 2 0 0 0 5

Total 67 49 52 61 57 51 176 161


ANNEX VIMMEDIATE AND INTERMEDIATE GAP FILLING PLAN AND CRITERIA USED TO DETERMINE IMMEDIATE AND

INTERMEDIATE GAPS TO BE FILLED

No. HRH GAP IMMEDIATE PLANS INTERMEDIATE PLANS1. No equity in the distribution of human

resources for the PHC and secondary level health services. There is a deficit in some facilities and surplus in some facilities

Re-deployment/re-allocation of the staff as soon as possible

Posting of the newly employed staff should ensure equity in the distribution of staff

Training bond should include employment aspect

Build staff houses in the rural health facilities

2. Shortage of staff in the health facilities Recruit where there is extreme shortage of health workers

Plan to annually recruit a certain percentage of staff for all technical cadres and priority should be for PHCU and PHCC.

3. Health Management workers are lacking qualifications in the primary and secondary health care levels (both in the management team and at the facility level). Only acting staff are doing the job without management skills

Organize tailor made short courses in collaboration with institutions, e.g. University of Mzumbe that offers training in Health Administration. The institute may offer a 2 – 3 months or even six weeks short courses to equip the acting staff with management skills for better performance.

Plan and budget for 2 – 3 candidates to join University of Mzumbe for the degree in health services administration annually.

Plan and budget for 2 or more acting health secretaries to attend certificate course in health administration tenable at the University of St. Augustine, Mwanza

4. Lack of HRH information system, making HRH planning, management and decision making process difficult

Initiate steps to collect, process, analyse, interpret and store HRH data for better decision making on matters related to planning, management and training of HRH

Plan and budget to establish a comprehensive computerized HRH data base system

Prepare HRH monitoring guidelines to ensure updating of the data and sustainability


5. Lack of high-level manpower. Staff inventory compared to the agreed staffing level indicates that high level manpower is lacking e.g. pharmacists, dental officers, specialist doctors and health management staff

Initiate process of filling the gaps. Prepare a training plan that gives priority to the high level manpower, otherwise quality will not be achieved

Plan and budget for training high level manpower

Solicit sponsors if the government cannot fund.

6. Patients’ medical records not well recorded or not recorded at all at the primary health care facility and therefore it becomes difficult to assess workload or conduct operational research. The primary and secondary facilities are lacking trained medical recorders who are well equipped with skills in patient records

Initiate proper patient medical record system

Recruit trained medical recorders from KCMC School of Medical Records.

Prepare tailor made courses for the current staff keeping medical records as a temporary measure while preparing for recruitment

Plan and budget for training at least 3 – 5 medical recorders at KCMC School of medical records

Plan and budget for recruitment of at least 3 trained medical recorders annually.

7. Most of the in charge of health facilities, hospital, district and zonal health management teams currently in the post are lacking management and computer skills

Conduct or provide short courses in management and computer skills to the management team members

Plan and budget for the training on management and computer for the management team members and in charge of the health facilities

8. Majority of the surplus staff in the health facilities are untrained staff

Work out a retrenchment and reallocation plan

Retrench surplus untrained staff to allow the government save money for recruiting qualified trained staff. Reallocate accordingly

9. Lack of identification of training needs assessment and training plan for middle level technical staff

Identify training needs for various cadre and prepare training plan for health workers

Conduct training needs assessment after every two years

Ensure availability of training plan. Training plan to ensure equity in the opportunities of training to the available staff and therefore minimizing complaints.


CRITERIA USED TO DETERMINE IMMEDIATE AND INTERMEDIATE HRH GAPS TO BE FILLED

Situational analysis report and data, which indicated that there is extreme shortage of staff in some health facilities while in other facilities there is overstaffing.

Field report: Team C visited the following health facilities i.e. Gamba, Kivunge, Sebleni, Mahonda, Chumbuni and Mwembeladu to assess the actual staff available and the workload. The report obtained reveals that in some facilities there is a shortage of staff in relation to the workload.

Equity Principle: Health is a basic need to a human being. Due to this fact, every community should enjoy equity in the distribution of health services including other resources like human resource, drugs and supplies

The concept of quality care provision as the major objective of the Health Sector Reforms: Quality health care cannot be achieved without having the right number of human resource with right skills at the right place, time and at affordable cost.

Basic and essential health care package at each level requires a well-organized team with all the necessary skill mix.

The staff inventory, when compared with the prepared staffing level for primary and secondary levels indicates deficit and surplus to all PHCU, PHCC and District Hospital.


ANNEX VI

REDEPLOYMENT OF STAFF AT PRIMARY, SECONDARY ANDTERTIARY LEVELS OF HEALTH CARE

(a) Reallocation of Existing Surplus at the

i. Primary Health Care Level

Cadres Total Number to be reallocatedClinical Officer 3Psy Nurse 7Nurse Midwife 24General Nurse 5PHN A 3Lab. Tech 1Dental Therapist 1Nursing Officer in charge/ Matron 13

ii. Secondary Health Care Level

Cadres Total Number to be reallocatedClinical Officer 18Laboratory Technician 14Radiographer 4Radiographer Assistant 1General Technician 2


iii. Tertiary Health Care Level

Cadres Total Number to be reallocatedRadiographer 6Clinical Officer 14Laboratory Technician 16Laboratory Assistant 16Pharmaceutical Auxiliary 10

(b) Retrenchment of Existing Surplus at the


Cadre Total Number to be retrenched

Health Orderly 100



Health Orderly 67



Health Orderly 56Pharmaceutical Auxiliary 16


(c) Upgrade Training of existing Staff at the


Cadre Total Number to be upgradedLaboratory Assistant 12General Nurse 29MCHA 7Pharm. Assist 3Nurse Assistant 2Ophtalmic Assistant 1Pharm. Auxilliary 10Microscopist 2Ophtalmic Clinical Officer 1Anaeth. Clinical officer 2Anaethetic Nurse 2ENT Nurse 1Optician 2


Cadre Total Number to be upgradedLaboratory Assistant 12General Nurse 29MCHA 7Pharm. Assist 3Nurse Assistant 2Ophtalmic Assistant 1Pharm. Auxilliary 10Microscopist 2Ophtalmic Clinical Officer 1


Anaeth. Clinical officer 2Anaethetic Nurse 2ENT Nurse 1Optician 2


Cadre Total Number to be upgradedMatron 1Medical Recorder 2Pharmaceutical Auxiliary 5MCHA 4Ophthalmic Clin. Officer 4Pharmaceutical Production 2M.A Ophth. Orient 1Nursing Officer 2Laboratory Technician 4

(d) New recruitment of Staff at the


Cadre Total Number to be recruitedClinical Officer 96CHN 76PHN B 187Pharm Technician 117Health Officer 103Lab Techn 25Dental Therapist 25Health orderly 7


Nurse midwife 1Medical Recorder 10Radiographer 4Social worker 4


Cadre Total Number to be recruitedGeneral Surgeon 2Opth. Surgeon 3Gynecologist 1Physician 2Dentist 3AMO General 1AMO Anesthesia 2AMO Opthal 3AMO Radiology 3AMO Dermatology 3AD Officer 2Dental Tech 3Dental Therapist 1Pharmacist 2Pharm Thechn 7Health Officer 3Physiotherapist 6Occu. Therapist 3Nursing Officer 24PHN A 9PHN B 4Paed Nurse 4Oph Nurse 1


Theater Nurse 4Lab Attendant 6Hospital Secretary 3Mortuary Attendant 6Medical Recorder 12Social Worker 3


Cadre Total Number to be recruited

Hospital Secretary 1Hospital Surveillance Officer 4Cardiologist 1Gastroenterologist 1

NB: Compiled from the recommendations on Redeployment made by Team B and C (Situation Analysis)


ANNEX VII

NON CITIZEN WORKERS

Pemba Zone Abdalla Mzee Hospital 7 Chinese Dr.Wete Hospital 4 Cuban Dr.Chake Chake Hosp. 5 Russian Dr. & Rotary Dr. TOTAL 16.

Unguja Zone Mnazi Mmoja Hosp 10 Chinese Dr.

2 1 Pediatrician Egyptian1 Physician

2 1 Neurologist 1 Radiologist Russian

1 Japanese Physiotherapist1 Korean (Lab Tech).3 Cuban Physicians1 Nigeria(Microbiologist Md)1 VSO U.K CHN Psy

21Chinese ( Anesthesiologist 1, Radiologist 1, Obs/ Gyn 1, Endocrinology 1, Surgeon 1, Accupuncture moxibustion 1, ENT 2, Nursing 1, Cardiologist 1).

Social Welfare Department 2 TOTAL 2

TOTAL UNGUJA AND PEMBA 39


ANNEX VIII

HUMAN RESOURCE FOR HEALTH CAREER DEVELOPMENT BY CADREPHCU/PHCC AND DISTRICT HOSPITAL

No. Cadre 1st Upgrading 2nd Upgrading 3rd Upgrading 4th Upgrading 5th Upgrading 6th Upgrading1 Surgical Specialist PhD 2 Orthopedic Surgeon PhD 3 Obs/Gynae Specialist PhD 4 Medical Officer Masters PhD 5 Dentist Masters PhD 6 AMO- General MO Masters 7 AMO – Anesthetist MO Masters 8 AMO – Ophthalmology MO Masters 9 AMO – Radiology MO Masters 10 AMO – Dermatology MO Masters 11 ADO DO Dental Surgeon 12 Dental Assistant ADO DO 13 Clinical Officer AMO MO 14 CHN Adv. Diploma Bsc. Nursing 15 Dental Technician Degree Masters 16 Pharmacist Mpharmacist PhD

17 Pharmaceutical Technician Pharmacist MPharm

18 Pharmaceutical Assistant Pharm.Tech Pharmacist 19 Pharmaceutical Auxiliary Form IV Ph. Assistant Ph. Tech.20 Laboratory Technician Advanced Dip Lab. Degree 21 Laboratory Assistant Lab Technician Adv. Diploma Lab.


22 Radiographer Masters PhD

23 Radiographic Assistant Diploma Radiology Adv. Diploma In Radiology

24 Physiotherapist Advanced Diploma 1st degree 25 Orthopaedic Technician Advanced Diploma 1st degree

26 Social Worker Masters PhD 27 Health Officer Masters PhD 28 Health Assistant Diploma Advanced Diploma 29 Specialist Nurses (Paed,

Ophth, theatre)1st degree Masters

30 Nursing Officer Advanced Diploma Bsc. Nursing 31 General Nurse Diploma Advanced Diploma 32 PHN "A" 1st degree Masters 33 PHN "B" Diploma Advanced Diploma 34 MCHA Certificate PHNB Diploma 35 Medical Recorder Assist Dip. Medical Records Advanced Diploma

36 Accountant Advanced Diploma CPA 37 Cashier NABOCE NAD 38 Secretary OMASEC Diploma 39 Librarian Diploma 1st Degree


ANNEX IXMINISTRY OF HEALTH & SOCIAL WELFARE –ZANZIBAR

THE CURRENT ORGANIZATION CHART

MINISTER

DEPUTY PRINCIPAL SECRETARY

CHIEF GOVT. CHEMIST

DIRECTOR SOCIAL WELFARE

DIRECTOR DRUG ABUSE CONTROL

DIRECTOR OFPLANNING & ADMIN

DIRECTOR OF PREVENTATIVE SERVICES

DIRECTOR OF HOSPITAL SERVICES

EXECUTIVE COMMITTEE

COORDINATING OFFICER PEMBA

LEADERSHIP COMMITTEE

BOARDSDEPUTY

MINISTER

PRINCIPAL SECRETARY

NURSING

PHARMACY

MEDICAL

PHL id CPIU (ADB)


ANNEX X

MINISTRY OF HEALTH & SOCIAL WELFARE –ZANZIBARPROPOSED ORGANIZATION CHART

LEGISLATIVE BOARDS

MINISTER

CHIEF GOVERNMENT CHEMIST

HEALTH COORDINATOR

PEMB

EXECUTIVE COMMITTEE

MEDICAL

PRINCIPALSECRETARY

CHSPHARMACY NURSING

DIRECTOR POLICY, FINANCE& PLANNING

DIRECTOR SOCIAL WELFARE& DRUGS ABUSE

DIRECTOR HEALTH SERVICES

LEADERSHIP COMMITTEE

DEPUTY MINISTER

DEPUTY PRINCIPAL SECRETARY


ANNEX XI

ROPOSED ORGANOGRAM FOR THE DIRECTORATE OF

PLANNING AND ADMINISTRATION

DIRECTOR PLANNING, FINANCE & ADMIN

CHS

HMIS& RHUMAN RESOURCE DIVISION

HEALTH DEVELOPMENT POLICY AND PLANNING

FINANCE & ACCOUNT

MAINTENANCE

HR Planning Policy & PIS

Training

Personnel Administration

C/Education

Epidemiology Statistic

Research

Planning budgeting & Monitoring financy

Policy Legislation monitoring

Account & Salaries

Supplies &Store

Biomedical

Garage

Estate & BuildingHealth

Financing

FHRP (ADB )

DMU


ANNEX XII

JUSTIFICATION FOR A REORGANISED MINISTRY OF HEALTH

Introduction

The roles of each directorate which justify the posts and optimum number of personnel needed to perform for better results are mentioned hereunder:

The role of the Ministry of Health and Social Welfare has been rationalized by determining the core functions which are promotive, curative, preventive and Human Resource Development. These functions are considered to be the basis for having four directorates in the Ministry. Each directorate has specific roles and responsibilities that contribute to the achievement of the Ministry’s goal.

Directorate of PFA

A critical core department responsible for the coordination of health activities across the Ministry, designing and formulating sound health policies, programs and plans that direct the functioning of the Ministry for the efficient and effective delivery of quality health services. Its roles include among others:

o Budgeting and soliciting funds from the public and development partners as well as ensuring proper use of the funds.o Designing and coordinating policy and programme implementation.o Ensuring the availability, development and effective utilization of quality and well balanced HR across the health systemo Maintaining and providing updated and accurate health information and HR information to facilitate timeliness of decision

making.o Ensuring the availability of adequate physical infrastructure, furniture, equipment, materials and transport for the smooth

running health services.o Cooperating with regional and international stakeholders in the health sector for the purpose of sharing and transferring

knowledge and experience.o Ensuring availability of necessary material resources needed for rendering of services


These broad roles define the tasks and the type of HR required for the department. The department is structured into divisions and sections to specify tasks and skills required to perform outlined those tasks. Both the workload and marginal productivity of labour were considered to determine the number of posts and employees needed for each section.

Department of Social Welfare and drugs abuse

This department deals with the promotion of social development of the vulnerable sections of our society including orphans, disabled, the aged people and drug addicts and children who are living under difficult circumstances. Its main roles include:

o Caring for the aged people, orphans and children living under difficult conditions.o Ensuring availability of facilities, equipments and materials for caring of these groups.o Compensating those employees who have sustained injuries or deaths at work places or during the course of work.o Counseling and rehabilitating addicts and sensitizing the communities from dangers of using illicit drugs, thus reducing the

drug related harm and the number of persons involved in drug abuse.o Liaising with other sections and NGOs concerned or interested in taking care of the disadvantaged and vulnerable groups

Directorate of Health Services

This directorate assumes the core activities of the Ministry, i.e preventive, promotive and curative services in a more integrated approach.

Its main role is to coordinate the activities of the two zonal Health Management Teams – that is coordination of both curative and preventive services rendered by the two zones – Pemba and Unguja Health Management Teams, together with the health facilities at primary and secondary levels so as to ensure integrity of the entire health system. Major diseases prevention programmes shall be coordinated with an emphasis towards integration under this directorate.


Government Chemist

This Office provides laboratory services to almost all sectors of our community. It carries out technical and scientific laboratory tests for foods, chemicals, dangerous drugs and verifies their quality for human consumption and provides advice for the necessary policy and legal actions to be taken.

Semi Autonomous Institutions

In the process of implementing HSR through decentralization, the Ministry has initially selected three (3) organisations that will operate as semi autonomous institutions. These include Mnazi Mmoja Referral Hospital, the College of Health Sciences and the Central Medical Stores. They will have their own Directors and communication with the Ministry will be done through the Principal Secretary as shown in new proposed organogram.


ANNEX XIII

CONSULTANT’S ASSESSMENT REPORT

The terms of reference required the consultant to study the work that had already been undertaken in the areas of planning and training and development programme/Strategies and to assess the extent of their accomplishment. The consultant’s observations are as follows:

PLANNING

Task Groups A, B, C and D that had been formed by the Ministry of Health and Social Welfare early in 2003 to prepare the Situation Analysis had done a commendable job of taking stock of the existing HRH as at June 2003 by occupation, level of education and level of facility. They had gone further to prepare the staffing level for the different levels of health facilities for the core medical staff and peripheral staff using the health needs, service targets and human resource/population ratio approaches. Through this exercise it was found that there was a significant deficit of staff in some occupations and a surplus in some others. The teams worked out a redeployment proposal for the surplus staff and suggested ways of filling the identified gaps. The proposal for redeployment of excess staff whose skills were still needed was to reallocate to facilities that had shortages of such skills and for those whose skills were no longer needed, the recommendation was to retrench them. As for filling the gaps, the suggestion was to make new recruitments or upgrade the existing staff through training.

While much was done to develop the staffing level, more needs to be done to refine the staffing level criteria, especially for specialised occupations at the secondary and tertiary levels of health facilities and for the College of Heath Sciences. The staffing level proposals could have been used to project the HRH additional requirements for the coming five years of the plan if information on the anticipated health facility expansion, staff attrition rates and the current number of non-citizens working on contract terms was available. Due to the shortage of this information, the plan has focused on filling the existing HRH gaps. Separate studies need to be conducted to come up with the missing information, if not for the current plan then for the subsequent plans so that forecasts on additional HRH requirements are made.

The proposals on the redeployment of excess staff through reallocation and retrenchment have financial implications. So far, no estimates have been made to determine how much the exercise will cost financially. If the proposals will be implemented, there will be a need to work out the cost.


TRAINING AND DEVELOPMENT PROGRAMME/STRATEGIES

In this area, each Work Group managed to prepare short and long term training plans for the relevant levels of health facility basing on the Situation Analysis findings. Full time institutionalised training was the dominant approach that was suggested. Socialisation or orientation programmes were proposed for those who will be newly recruited. Task Group C pointed out that staffs that do not have the required qualifications were holding some posts. A training programme was proposed for them to upgrade their skills. In order to retain those who are already in service, interventions have been proposed to have a career development plan, to create conducive working environment and to develop a system of job satisfaction.

Before embarking on the proposed training plans, it will be necessary to carry out a thorough training needs assessment and to revisit the cost of training because it appears that the cost of some programmes have been overestimated and some have been underestimated.

Succession planning is very important for organisations. But it can only be implemented if organisations have information about the age structure of their work force, academic qualification and length of service. It will be necessary to create a data base of this information and update it from time to time so that it can be used to introduce succession planning.


zanzibar human resource for health 5 year development plan final version1

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