brn healthcare lab · mhealth overview of brn healthcare system healthy tanzanians reproductive...
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BRN Healthcare Lab
Summary of Lab Output
4th December 2014
1
June 2016
Healthcare NKRA in the next 3 years
80% of primary health
facilities to be rated 3 Stars
and above
100% balanced distribution
of skilled health workers at
primary level
100% stock availability of
essential medicines
20% reduction in maternal
mortality ratio and neonatal
mortality rate in 5 regions
2,623 dispensaries+ will have at least
one skilled HRH
22.5 million Total OPD Visits (of
which 7 million are under-5 years old)
to benefit in improved Health services
2,418 health facilities are now
ranked 3 stars or above
June 2018
(*) health facilities at selected underserved regions, out of 3,023
health facilities
(+) Dispensaries in 13 underserved regions
June 2018
1.5 million mothers are now reminded
periodically on their Pre-natal and post
natal care visits through mHealth SMS
follow up system
Blood collection doubled to 90,000
units from previously 35,000 units
June 2015
6,760 health facilities to be
rated from Star 1 – 5
December 2017
6,760 Health facilities now with 100% Stock
availability of all essential medicines
1,813 health facilities* are now
ranked 3 stars or above
5,408 health facilities now has their
own bank account
June 2017
90 Health facilities now manned
by skilled private HRH through
PPP arrangements
December 2015
150 dispensaries now have
at least one skilled HRH
70% of graduated students are now
bonded and serves in health facilities
2
Without a healthy population, Tanzania risks NOT achieving
TDV2025’s aspirations…
USD 272.6 mn1
losses to GDP
420,000 total
mortality
A portion of USD 431 mn2 spent
on treatment could be used for
development purposes…
Sources:
WSP, WHO,IHME, GBD 2010, MoHSW Midterm review, MoF, team analysis
Note :
(1) Based on WSP’s studies on average annual lost due to premature deaths, productivity
losses due whilst sick or assessing healthcare and loss in national income due to burden of
chronic diseases. The 5 key diseases encompassed Diarrehea, LRI, infectious diseases,
NTD, Malaria, Diabetes, Cardio & circulatory diseases, etc.
(2) MoF’s 2013/14 Budget allocation based on annual average exchange rate at TSH 1618
per dollar
3
2014 onwards
Without Healthy population,
Tanzania will NOT achieve its
aspiration
1999
Tanzanian Government launched
Tanzanian Development Vision 2025
and healthcare has been one of the
primary focuses
2000 - 2013
Various Healthcare-centric
programmes were developed
over the years aiming to
achieve TDV 2025’s goal
2013
Current results 50% of
HSSP III’s plans are NOT
on-track
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egestas.
Many programmes and plans are in place but have not yield favorable results,
it’s a long journey to achieve Tanzania’s Aspiration
HSSP
Mkukuta
MTR 2013
2000 – 2013
The Healthcare sector
is not doing well
among the peers...
2014 onwards
Long way to catch up to
catalyse the effort in achieving
the aspired productive & healthy
Tanzanian population by 2025
Doc ID
Governance, Community and Civil Societies, Organizations & Private Sectors
5 Aspiration 1
TBD
6
Gov Structure
Aspiration 2
TBD
HSSP III R
ep
rod
uc
tive
& C
hil
d
He
alt
h
Ma
lari
a, H
IV/A
IDS
, T
B &
Oth
er
infe
cti
ou
s d
ise
as
es
No
nc
om
mu
nic
ab
le
Dis
ea
se
s &
In
juri
es
He
alt
h F
ina
nc
ing
He
alt
h S
ys
tem
Po
lic
ies
He
alt
h S
erv
ice
De
live
ry –
i.e
. C
om
mo
dit
ies
He
alt
h W
ork
forc
e
Healthcare NKRA focuses on 2 sub-sector of Health system under HSSP III
& A Special Focus on MNCH…
Health System Mortality & Morbidity
Special
Focus
SOURCE : BRN Healthcare Lab (2014)
5
6 initiatives
6 initiatives
6 initiatives
4 initiatives
The components of BRN Healthcare
BRN Healthcare
HRH
RMNCH
Health facilities
Health commodities
6
Overview of BRN Healthcare System
Healthy Tanzanians
Reproductive & Child
Health Infectious Diseases
Non-communicable
Diseases & Injuries Others
Human Resources for Health Health Commodities Health Facilities
Prioritise utilisation of
employment permits
Provide skilled HRH
through PPP/Private
sector engagement
Redistribution of
health workers
within regions
Improving health
commodities supply chain
Strengthen management of
MSD working capital
complement MSD in procurement &
distribution of medicines by engaging
private sector
Star-Rating
System
Fiscal decentralisation to
health facility level
Optimising
the pool of
new recruits
Synchronize
recruitment
process at
central level
Empowering
LGAs in HR
management
Social
accounta-
bility
Performance
targets &
contracts
ICT mobile
application
platform
SMS
reporting
system
Scale up 5S-
Kaizen TQM
initiatives
Special focus: RMNCH
CEmONC
BEmONC
Community Health Workers
mHealth (SMS) and Maternal CHW
application through PPP
Regional Satellite Blood bank
facilities supporting CEmONC
Develop integrated 360° mass media
campaign that can be multi
sponsored through PPP
7
Human Resource for Health 1
Prioritize allocation of employment
permits to regions with critical
shortage of skilled HRH
Provide skilled HRH through
PPP/Private sector engagement
Redistribution of health care
workers within the regions
Optimising the pool of new recruits:
Reinforce bonding policy
Introduce Compulsory
attachments for Clinicians and
Nurses
100% of the 9 Critical Regions to
reach the National Average for Density
of Clinicians and Nurses per 10,000
population
SOURCE : BRN Healthcare Lab (2014)
70% reduction in the number of
Dispensaries without Skilled HRH
16 Regions to implement HRH
redistribution between their own
districts & attain 100% reduction in no.
facilities without Skilled HRH
70% of government sponsored
students will be bonded to serve at
public facilities
6 compulsory attachment status for 6
cadres confirmed & 100% students
undergoing compulsory services
100% balanced distribution of skilled
health workers at primary level
8
Health Facilities 2
Assess, rate and develop specific
facility improvement plans for 1-
and 2-Star primary level health
facilities
Implement fiscal decentralization by
devolution from council level to
health facility level
Increase social accountability at
the facility and community level
to address local health
priorities/concerns
Introduce the use of performance
targets and contracts at the primary
facilities to address and enforce
staff accountability in delivery of
quality health services
80% of health facilities at identified
regions are elevated to level 3 &
above by 2017/18
SOURCE : BRN Healthcare Lab (2014)
80% of health facilities achieve
financial autonomy by June 2017
80% of LGAs have functioning social
accountability mechanisms by June
2017
80% of health facilities have attained
75% customer satisfaction and
above by June 2018
80% of primary health facilities to be
rated 3 Stars and above
9
Health Commodities 3
Governance:
Improving governance, accountability,
and sense of ownership of Health
Commodities supply chain to eliminate
frequent occurrence of stock-out
Finance & Business Model:
Strengthen management of MSD working
capital for sustainable availability of
medicines and medical supplies
Procurement & Distribution:
To complement MSD in the
procurement & distribution of
medicines by engaging private sector
Inventory Management:
Scale up 5S-KAIZEN-Total quality
Management(TQM) initiatives from
district level to lower health facilities
level
100% Health Facilities audited and
supervised by CHMT, 0% proportion of
facilities found with commodities pilferages
SOURCE : BRN Healthcare Lab (2014)
Establish baseline for current ratio, acid test
ratio & % Margin recovery
15 number of call off orders to prime
vendors & 15 signed contracts by 2015,
90% of medicines supplied against call off
orders by 2015
85% of dispensaries and health centres
adhering to good storage standards, 80%
of lower level health facilities submitting
accurate consumption reports to MSD
ICT
Introduce use of SMS to report on stock
outs and quality of health services by
service users and civil society
50% of stock-out complaints solved by
2015/16, 100% of stock-out complaints
solved by 2016/17
80% of primary health facilities to be
rated 3 Stars and above
10
RMNCH 4
Expanding CEmONC services at
strategically selected health centers and
hospitals to serve as satellite sites
Strategically selected dispensaries and
health centers to provide full fledge
BEmONC (7 signal functions).
Mobilise Community Health workers to
improve RMNCH services
Regional Satellite Blood bank facilities
supporting CEmONC
Reduction of maternal mortality ratio from
453 to 291 (per 100,000 live births) and
neonatal mortality rate from 20 to 10 (per
1000 live births), by 2017/2018
SOURCE : BRN Healthcare Lab (2014)
100% quality (measured be agreed
Standards Base Management Tool) of
services in facilities selected for provision of
a continuum of care package which
includes FP, ANC, BEmONC, PNC
Utilize community based initiatives to
improve RMNCH awareness to 100% and
uptake by 50% at community level by
2017/18
Establish centres and mobilize blood
donors and distribute safe blood to those
in need especially pregnant women and
new-born as close as to where they receive
CEmONC services by 100%.
Enhanced awareness and outreach
through mHealth (SMS) and Maternal
CHW App through PPP
Increase childbirth by skilled birth
attendant to 80%
80% of primary health facilities to be
rated 3 Stars and above
11
Key:
• Regions with HRH distribution, HF,
commodities & RMNCH initiatives
• Regions with HRH distribution, HF &
commodities initiatives
• Regions with HF & commodities
initiatives
*assessment is done across all mainland
regions
Dar Es Salaam
Mara
Kilimanjaro
Manyara
Tanga
Lindi
Mtwara Ruvuma
Iringa
Morogoro
Pwani
Dodoma Singida
Rukwa
Mbeya
Kigoma
Tabora
Shinyanga
Kagera
Mwanza
Geita Simiyu Arusha
Katavi
Njombe
Harmonising the implementation plans at the most under-served regions
Source(s): BRN Healthcare Lab 2014
Doc ID
12
Healthcare NKRA require TZS 185 Billion spread across 3 years
Budget requirement to implement BRN Healthcare 2014/15 – 2017/18
Budget allocation by years, TZS (Billion)
SOURCE : BRN Healthcare Lab (2014)
TOTAL
185.1
2017/18
50.5
34.3
16.2
2016/17
49.1
35.8
13.3
2015/16
75.3
43.0
32.2
2014/15
(Additional)
0.8
0.5
0.3
2014/15
(realocate)
9.5
9.3 0.1
RE
DE
123
62
Development Expenditure
Recurrent Expenditure
Doc ID
13
Where ~80% of Total budget requests of TZS 185 Bn are primarily
anchored on PMO-RALG…
TOTAL
185
123
62
2017/18
50
34 16
2016/17
49
36 13
2015/16
75
43
32
2014/15
(Add)
1
0 0
2014/15
(realocate)
9
9 0
9%
6%
6%
Private Sector
MSD
MOHSW
PMO-RALG
80%
Budget requirement to implement BRN healthcare’s
4 work streams 2014/15 – 2017/18
Breakdown of Budget allocation by Implementation
Agencies
Budget allocation by years,
TZS (Billion)
% Budget allocation
Bulk of the budget request aims to upgrade existing health facilities to
BEmONC, CEmONC standards
100% = TZS 185 Billion
RMNCH HRH
Distribution
TOTAL
185
Health
Facilities
(Performance)
107
Health
commodities
31 32 14
Budget allocation by programmes,
TZS (Billion)
RE DE
Doc ID
President
Transformation & Delivery Council
NKRA Steering Committee Chair: Hon. Dr. Seif Suleiman Rashid (Minister of Health and Social Welfare) Secretariat:
Ministerial
Delivery
Unit
(MDU)
Members:
• Dr. Donnan Mbando (PS MoHSW)
• TBD (CMO, MoHSW)
• Dr. Servacius Likwelile (PS MoF)
• Mr. Omari Issa (PDB CEO)
• HMDU
• Mr. Jumanne A. Sagini (PS PMO-RALG)
• Dr. Deo Mtasiwa (DPS PMO-RALG)
• Mr. Mwaifani (MD MSD)
President’s Delivery
Bureau (PDB)
Interministerial Technical
Committee Meeting
To be determined by MoHSW
• RCHS, MoHSW
• PMO-RALG
RMNCH
• PSU, MoHSW
• MSD
• PMO-RALG
Health
Commodities
• DAHRM, MoHSW
• PMO-RALG
Health
Facilities
• DAHRM, MoHSW
• POPSM
• PMO-RALG
Human Resources
for Health
Implementers Project Owner – MOHSW
HEALTHCARE NKRA Governance Structure
Doc ID
Asante