the high burden country initiative (hnci): meeting the demand for fully competent rch providers in...

7/29/2019 The High Burden Country Initiative (HNCI): Meeting the Demand for Fully Competent RCH Providers in the United Public of Tanzania

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THE HIGH BURDEN COUNTRY INITIATIVE (HBCI): MEETING THE

DEMAND FOR FULLY COMPETENT RCH PROVIDERS IN THEUNITED REPUBLIC OF TANZANIA

Dr. Neema Rusibamayila

Assistant Director, Preventive Health Services RCHTanzania Ministry of Health and Social Welfare


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Background on the HBCI

September 2010: launch of Global Strategy forWomens and Childrens Healthby the UN SecretaryGeneral

September 2011: Greentree meeting to discuss

strengthening implementation of critical MNHinterventions

HBCI initiative proposed for the 8 countries making upnearly 60% of the global maternal and newborn mortality

burden

First step: comprehensive national needs assessment toreview availability and status of human resources with

midwifery capabilities at the community level


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HBCI technical working group

UNFPA, WHO, UNICEF, UNAIDS, Global

Health Workforce Alliance (GHWA),

ICM, FIGO, ICS Integrare, Jhpiego, Royal

Tropical Institute (KIT) and University of

Southampton

Secretariat: ICS Integrare


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What is the appropriate midwifery workforce,

and how is it to be deployed, to equitably deliverMNH interventions at scale and quality, and what

(including costs) needs to be in place to achieve

universal access?


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Tanzania HBCI Effort

Assessment conductedbetween April andSeptember 2012

Desk review Technical mission

Identification of information

gaps Collection of data to fill the gaps

Analysis of data

Stakeholder verificationworkshops


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Areas assessed Essential interventions for MNH and utilization.

Access, equity, quality, efficiency and utilization of MNHservices.

Midwifery workforce. Production and performance of themidwifery workforce.

Work environment. Enabling working environment tomaximise and sustain the midwifery workforcescontribution to MNH.

Management and policies. Management system and

policies, leadership and partnerships to maximise andsustain the midwifery workforce

Financing. Financial resources for providing adequatefinancial incentives and developing costed plans to

maximise and sustain the midwifery workforce


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Key findingsEssential MNH interventions and utilization

11 categories of health workers comprise the midwiferyworkforce each with specific competencies, thoughsome overlap

No one specific cadre competent in the full set ofmidwifery competencies and dedicated to frontline care

Though the scope of the nurse/midwife and clinical officerallows them to provide at the least the 7 basic EmOCsignal functions, their working environment and/orpractical training is insufficient to allow them to do so


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Key findingsMidwifery workforce

Equitable distribution ofworkforce in recent years

Recruitment anddeployment processes are

still issues in ensuringRCH services areequitably delivered vacancy rates estimatedbetween 40% to 86%

Lack of full midwiferyskills in at least one ofthe cadres challengesequitable coverage

The RCH workforce in Tanzania


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Key findingsWork environment

Distribution of facilitiesseems to align with areaswhere most pregnanciesexpected, though not

conclusive However, insufficient staffing

with appropriate balance ofRCH competencies

Need for strengtheningreferral, commodity andequipment systems, and tofind ways to improve staff

motivation

Health facilities by expected pregnancies


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Key findingsManagement and policies

Targets, policies,strategies, standards,guidelines, information

systems, donors andimplementing partnersare in place and aligned

Implementation of theseis needed to improveavailability of staff,equipment andcommodities 0

5000

10000

15000

20000

25000

30000

35000

40000

45000

2010 - current number

of facilities

2017 - total number of

facilities requiredunder MMAM

Staffing needsaccording to the 2012draft staffing guidelines- Total number of EN,ANO, CO, AMO andMO ]working in the

RCH unitsNumber of EN currentlyavailable in the RCHunits (48% of EN isworking in the RCHunits)

Number of ANOcurrently available inthe RCH units (34% ofANO is working in theRCH units)

Number of CO currentlyavailable in the RCHunits (11% of CO isworking in the RCHunits)

Staffing needs for the RCH units inTanzaniaaccording to the DPSG.


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Key findingsFinancing

Fragmented health financing system government now working interministerially

on Health Financing Strategy

Government health expenditure is roughly7% of the total health expenditure (THE),with THE for RH estimated at 18% of THE

Health insurance initiatives expanding


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Projected staffing needs and supply

8000

10000

12000

14000

16000

18000

2015 2020 2025

Supply of EN

Supply of ANO

Supply of CO

Supply of AMO

Supply of MO

Total staffing needs


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Projected supply as proportion of projected needRural vs. urban

BASELINE SCENARIO

Coverage of staff requirements

RURAL RCH units2015 2020 2025

EN 39% 40% 39%

ANO 407% 423% 416%

CO 42% 42% 40%

AMO 66% 73% 77%

MO 46% 66% 81%

Coverage of staff requirements

URBAN RCH units

2015 2020 2025

EN 143% 130% 113%

ANO 1474% 1380% 1215%

CO 118% 104% 90%

AMO 207% 207% 195%

MO 1170% 1504% 1651%


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Suggested solutions Eight policy options identified for costing comprising issues

related to production, deployment and equipment availability

Scenario: application of the eight policy options

Coverage of staff requirements RURAL RCH units 2015 2020 2025

EN 77% 86% 96%ANO 97% 107% 111%

CO 88% 92% 98%

AMO 78% 92% 101%

MO 54% 80% 99%

Coverage of staff requirements URBAN RCH units 2015 2020 2025EN 128% 129% 129%

ANO 162% 161% 149%

CO 110% 104% 99%

AMO 108% 115% 113%

MO 543% 719% 800%


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Projected cost and impact

Total amount required from 2014 through2025 is an estimated USD $2,057,760,586

This estimate excludes relocation/transfer

allowances for newly posted workers

This estimate does not take into account annualinflation

Using LiST, estimated that up to 259,000lives could be saved by 2025


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Assessment conclusions

Total number of projected pregnancies 2015-2025 is42,898,166

If the 8 policy options are implemented from 2013, this

will save 2,000-6,400 maternal lives and 11,800-30,000newborn lives; and prevent 900-2,900 stillbirths

Total cost between 2014 and 2025 is USD

$2,057,760,586

By 2025, 129,000-259,000 lives could be saved at thecost of USD $48 per pregnancy


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Next steps for Tanzania

Finalize draft report

Call for stakeholder meeting to review report

findings and proposed solutions and makerecommendations for discussion with the Ministerof Health and Social Welfare

Develop a joint action plan (departments within

the Ministry of Health and Social Welfare, as wellas other relevant Ministries) for roll-out ofproposed solutions


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Acknowledgements

Institutions: The Ministry of Health and Social Welfare,ICS Integrare, Royal Tropical Institute (KIT),UNFPA/Tanzania, UNICEF/Tanzania, WHO/Tanzania,USAID/Tanzania, AMCA and Jhpiego/Tanzania

Authors: Neema Rusibamayila, Maryjane Lacoste, DunstanBishanga, Petra ten Hoope-Bender, Christel Janssen, KathyHerschderfer, Mariam Khan, Rutasha Dadi.


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