Summary Analysis of CCHPs 2014-2015: Compliance and Budget Allocation

1. Ministry of Health and Social Welfare & Prime Minister’s Office Regional Administration & Local Government SUMMARY ANALYSIS OF CCHPs 2014-2015 PLANS PRESENTED AT TRM- JAHSR 06.11.2014 Dr. Anna Nswilla Coord. District Health Services MOHSW

2. Outline of the presentation • Objectives of the Report • Compliance with CCHP Guidelines - • CCHP planning performance by region • CCHP Budget Ceilings/Ranges - Block Grants and Health Basket Fund • Allocation to Priority Health Interventions • Allocation to NEHIP • Resources to Essential Interventions • Resource allocation requirement Vs Expenditure Shares 2014/15 • Status of resources distribution • Sources of funds for funding CCHP 2014/2015 • Regional Distribution v proxy equity indicator • CHMT & Co-opted members • Challenges • Recommendations

3. Objectives of the Summary & Analysis of Plans • To check compliance with national guidelines on planning and reporting • Findings indicate compliance • To verify that planned activities address the councils’ identified priority health problems • To generate findings to be used by management and other stakeholders for decision making and actions A number of findings that can be acted on • To identify weak LGAs and RHMTs for further technical assistance to improve their CCHPs • Weakest LGAs have been identified for further support

4. Compliance with CCHP Guidelines • CCHP planning performance by region (final round assessment) • 162 Councils submitted CCHPs ; total funding of TZS 899,121,430,976. • Final pass rates are rising year on year; last year a 4th assessment was necessary; this year, all LGAs passed by Round 3; There is still much room for improvement as: • - only 14% of LGAs achieved a score of 90%+ ; - some LGAs scored as low as 25 in Round 1

5. Compliance with CCHP Ceilings/Ranges – Block Grants • The CCHP guidelines provide budget ranges & ceilings for alloc. of OC resources to cost centres & certain types of expenditure for both BG & HBF. • Largely in line with ranges although allocations to health centres and dispensaries are exceeded. However, councils should not be allocating BG to the VA/ CDH as they receive their allocation directly from the central government

6. Compliance with CCHP Ceilings/Ranges – Basket Fund • The councils largely followed these ranges and ceilings for the HBF. • Prioritising health centres/dispensaries over hospitals. • Where there is no VA/CDH in the district, the 10-15% amount is allocated to other cost centres. • Concern funds to support community initiatives are below range for BG & HBF. These must be initiated by the community – lack of awareness

7. Allocation to Priority Health Interventions • HRH, MNCH, CDC and medicines/equipment have consistently received high proportions of the available funding in the past three years. • Medicines and medical equipment is also incorporated into activities under other priority intervention areas.

8. Allocation to Priority Health Interventions

9. Trend of Allocation to Priority Health Interventions

10. Allocation funding share to NEHIP - 95% of non-specific delivery support share is contributed by personal emoluments (PE) - excluding PE: Essential Health Interventions = approximately 66% Interventions not addressing the Burden of Disease = 29% Non-specific delivery support = 5% ( SS,HRH mgt, HMIS,PPM, CHSB

11. Resources to Essential Interventions (32%) • - Essential interventions are largely funded through development partners • Global Fund (32%) • bilateral and multilateral partners (20%) • health basket fund (14%) • consist of MSD: =receipt-in-kind (12%) • locally generated sources also support essential interventions • User fees (9%); Others- NGOs 13%

12. Resource allocation requirement Vs Expenditure Shares 2014/15 • allocated according to the budget of disease calculated using data from District Health Profile – National Sentinel Surveillance System (NSS)- Health demographic Surveillance survey (HDSS)

13. Observations from the above findings • CHMTs are still facing difficulties in initial planning in line with guidelines and require significant support from regions and central to prepare adequate plans and progress reports • CHMTs have insufficient funds to meet their priority health needs – how will they now implement BRN within existing envelope? • NCDs, Environmental Health and Sanitation, Emergency preparedness and response, Health Promotion and Social Welfare, NTDs which all contribute to a preventive approach, are the least prioritised.

14. Sources of funds for funding CCHP 2014/2015 • PE accounts for almost half of all health funds at LGA level: Cost sharing is not providing the share that it could or that we expect (at 4.2% - anticipated is 10%) ; Growing Share are: • Health Block Grant; COS, CS; while, declining share are: HBF, GF, HSDG/MMAM, Receipt in kind, LGDG

15. Equitable Distribution of Resources – HBG • This chart shows the actual health block grant allocations (PE & OC) by region (blue) and what allocations would be if the resource allocation formula for the health basket fund was applied (red) as an indication of whether resources are being equitably allocated. • It’s the BRN regions which are receiving lesser than would be expected

16. Equitable Distribution of Resources… • This chart shows the actual available resources at district level by region for receipt-in-kind, Global Fund and Others this includes Bi/Multilateral partners and NGOs. This shows the great variation of resources available at the district level – implications for equity. • PER presentation noted yesterday that some regions are being neglected by donors while others have duplication of resources and RMNCH partner mapping & resource tracking study.

17. Total budget share per region 2014/2015

18. Observations from the above findings • Health budget is driven by HRH costs – implications? less Health OC to address other priority issues • Regions allocated less than equitable share of Block Grant largely overlap with regions identified in BRN as most in need – Singida, Tabora, Shinyanga, Rukwa, Kigoma, Kagera, Katavi, Simiyu • Donor efforts and resources could be better distributed - could a mapping of resources be useful if done? like the one done for RMNCH partner mapping and resource tracking study

19. CHMT & Co-opted members • The chart shows composition of the CHMTs & co-opted members reveals a high number of acting positions about 70 which affects decision making on implementation of activities – utilization of funds.

20. Challenges -Planning… • Complicated resource envelope: • Budget ceilings provided in October/November are indicative and subject to change during scrutiny • CHMTs are planning with expected CHF matching funds – these have not been paid out in the past 2 years • A number of factors lead to significant carry over funds at LGA level – these must be included in plans. Plans development completed in April • Receipt-in-kind must be monetised for the year ahead – leads to assumptions. Especially from NGOs, affects planning process and implementation

21. Challenges - Planning • CHMTs do not have the necessary skills to prepare CCHPs and to use PlanRep3, particularly newly recruited members • While training has been provided, retention of knowledge, and confidence to use skills is low • Institutionalise into ZHRCs to act as trainers • expand central team at District Health Services unit • Data quality and reliability is still a problem in many councils - do not correspond with HMIS data - link DHIS2, HRIS, HRC for POPSM and Epicor with the PlanRep.

22. Challenges - Findings • Distribution of resources (GoT & DP) is not equitable • Insufficient resources to adequately address the BoD • Curative – v – Preventive approach to healthcare • Complicated planning environment, particularly around resources – NGOs, differ timing with GoT, cannot be reflected in Epicor – not certain • challenging planning environment – release funds on time; address procurement processes (leads to carryover of funds);

23. Recommendations - Planning • Capacity building to the RHMTs and CHMTs on planning and reporting skills – introduce regional champions – those who perform best in trainings • Provide continuous capacity building for Central level (MOHSW and PMO-RALG) – broaden the team at MoHSW that can access and utilise PlanRep • MOHSW, in collaboration with PMORALG, to compile the suggestions for systems improvement from the LGAs and incorporate proposed suggestions to update PlanRep3 Micro (Health Sector), PlanRep3 Health Meso and PlanRep3 Health Macro – and upcoming PlanRep4 web base • PlanRep4 to be web-based, and linkage with EPICOR and DHIS2 to be ensured (mutual export and import of data) • Collaboration between MoHSW/PMO-RALG and POPSM to be strengthened

24. Recommendations - Findings • Consider mapping donor/NGOs resources to ensure a more strategic distribution of resources • Revise the procurement procedures for greater efficiency and timeliness • Address the issue of matching funds- it is budgeted by CHMTs –affects • BRN budget needs to consider the resource envelope available at LGAs - already overstretched

25. Policy issues considerations • Inadequate resources for regions to support CHMT to prepare adequate plans • Insufficient funds for CHMTs to meet their priority health needs • Least prioritised NCDs, Environmental Health and Sanitation, Emergency preparedness and response, Health Promotion and Social Welfare, NTDs which all contribute to a preventive approach • Equitable Distribution of Resources both HBG & HBF • Donor efforts and resources could be better distributed - could a mapping of resources be useful • Others from NGOs, affects planning process and implementation • challenging planning environment – release funds on time; address procurement procedures (leads to carryover of funds); • AHSPP noted– great regional variation in all of the health status, service and system indicators – can this be addressed through greater equity of resources? • It’s the BRN regions which are receiving lesser than would be expected

26. Thanks for your attention Discussion