Day 4 Summary

1. Day 4 Summary By Dr J. Ruanda, And Dr A.Msuya November 11, 2005

2. Day 4 Activities The day started with rapporteurs� report (Day 3 Summary) followed by the following presentations: Human Resource Capacity Building in the Districts: The Role of ZTC by Dr. B. T. Ndawi (PHC � Iringa). Experiences of CHMTs in the Implementation of CCHP in Meeting the Millennium Development Goals: Other Preventive Interventions (Oncho, Eye Care, Vector Diseases, LF, SHP) by Dr. G. Saguti, C. Dismas and Dr. U. Nyandindi, (MoH) The CCHP Preparation: Pro-poor and MDG Focused by Dr. I.F.M. Swai (Southern Zone CE) NHIF Performance Report as of 30th September 2005 by D.B. Humba (NHI)

3. Day 4 Activities Continue.. Factors Contributing to High Dropout of CHF Members in Nzega District by Dr. G. Mhina National Health Care Financing Workshop: Feedback and Way Forward by Dr. F. Njau (HSR-MoH) Improvement of Logistics management Towards Strengthening District Health Services by C. Mwaifwani (MSD) Supply of Drugs and Medical Supplies by J. S. Muhume (MoH) Implementation of Key Elements of Environmental Health Towards Meeting the MDGs by F. Magoma Managing Health Care Wastes in Health Facilities by E. Honest (MoH) Overview of the National Health Policy by J. Kelya (HSR-MoH) Plenary Discussions of all Presentations

4. Emerging Issues from Day 3 Summary (Rapporteurs� Report) It was clarified that the draft guidelines developed for management of the avian flu have been developed by the MoH, not WHO, as reported in the Day 3 summary. The planning tool developed by GTZ is called Comprehensive Council Health Planning Tool, not �GTZ Tool�.

5. Issues Emerging from Day 4 Presentations & Discussions Zonal Training Centres have a major role to play in developing human resource capacity in the districts by determining and supporting training needs and priorities based on problems; promoting health workers� competence through continuous education; designing, developing and providing tailor-made courses; scaling up different tools such as the DHA tool; conducting follow-up of trainees; facilitating operational research in capacity building activities; and supporting in-service training; among others. It was suggested that the role of ZTCs should be expanded to include other activities such as monitoring and evaluation.

6. Issues Emerging from Presentations & Discussions Continue� The presentation on �Experiences of CHMTs in the Implementation of CCHP in Meeting the Millennium Development Goals: Other Preventive Interventions�, emphasised the need to look beyond the �ATM� in addressing the health needs of Tanzanians, towards achieving the targets of the MDGs. Districts were urged to give due attention to both communicable and non-communicable diseases and ensure their integration into the CCHP. The Central level Ministry was also asked to co-operate fully with the councils in order to achieve effective integration of activities of vertical programmes into the CCHP. MoH should also be transparent about the funds directed into activities of vertical programmes at the district level.

7. Issues Emerging from Presentations & Discussions Continue� It was also observed that there is a big shortage of vector specialists, yet vector-born diseases are still a major problem in the county. Some of the vector specialists have found their way into other fields, partly due to lack of incentives such as scheme of service. It was reported that MoH is already working on a scheme of service for this field and plans are underway to strengthen the capacity of the vector specialist training school in Tanga to produce more specialists.

8. Issues Emerging from Presentations & Discussions Continue� Regarding the idea of �Pro-poor CCHP� preparation, it was explained that the CCHP process is enshrined within a broad Govt policy framework, which includes the Vision 2025, PRS- now NSGRP (MKUKUTA), National Health Policy, HSR, LGR, D-by-D, and other initiatives such the District Health Service Strategy; all of which are pro-poor. It was further explained that by effectively using tools such as the burden of disease profile in the planning process, it is possible to address up to 80% of the needs of the poor.

9. Issues Emerging from Presentations & Discussions Continue� NHIF Performance report as of 30th September 2005, shows major achievements in implementation of the Fund (increased membership; growth rate of 49%; increased number of beneficiaries; strong support from the Govt and international agencies; establishment of 7 Zonal Offices countrywide; establishment of a 5-year corporate plan covering the period 2005 � 2010; decrease in number of complaints by clients, and clean certificate of accounts for 3 consecutive years). NHIF is also the first in Africa to produce Actuarial Valuation Report certified by ILO. The report recommended enhancement of benefit package to include reading glasses with frame, increase in number and prices of drugs and medicine (price indexation), increase in the number of diagnostic tests from 15 items to 44 items, and increase in the list of drugs by 86 items). The Fund is already providing consultancy services to other countries such as Nigeria, Kenya and Uganda to establish similar health insurance funds.

10. Issues Emerging from Presentations & Discussions Continue� However, there are a number of challenges experienced in implementation the fund (provision of health services to rural areas, DMOs� failure to remit the NHIF reimbursed funds to dispensaries and health centres, emerging cases of stale cheques by gvt facilities, diversion of benefit cheques by providers, experience of stocks-outs by government facilities, and fraud cases). The identified possible causes of stale cheques include misplacement of cheques by providers/accountants, sending of the cheque to a wrong address, wrong payee instructions made by providers, laxity on the part of supervisors to ensure that cheques are banked on time, and remoteness of some of the health facilities where there are no banking facilities nearby.

11. Issues Emerging from Presentations & Discussions Continue� It has also been observed that most NHIF members especially in rural areas, are shifting from dispensaries and health centres, to district, regional or referral hospitals. This is mainly to do with quality of care. Apart from that, some members are still having problems with their IDs. In future NIHF intends to provide soft loans to service providers, for purchase of equipment, to help improve quality of health service delivery. The loan will be recovered gradually from the reimbursement funds. More information about NHIF can be found on its website at www.nhiftz.com

12. Issues Emerging from Presentations & Discussions Continue� The study of on factors contributing to high dropout of CHF members in Nzega District indicates that financial constraint among community members and lack of regular advocacy and sensitization; lack of drugs in government health facilities; and lack of transparency in activities; are the main reasons behind the dropouts. It was recommended that district councils should restructure annual fees to be able to attract more members along side with regular advocacy and sensitization; CHF management should conduct CHF activities in a transparent manner by involving community members; and health service providers in the local contracted health facilities should improve quality of services. However, it was observed that a lot has been achieved in Nzege District through the Fund and the experience should be used to strengthen CHF implementation in other districts as an a �complementary� funding option for health.

13. Issues Emerging from Presentations & Discussions Continue� It was reported that MoH is in the process of developing a National Healthcare Financing Strategy. The May 2005 workshop on health care financing is the first building block towards development of the Strategy. The initiative has been necessitated by the need to build upon the existing financing systems, cost health in MKUKUTA, improve resource allocation, strengthen public expenditure for health, strength complimentary funding options such as the User-fees and CHF, improve exemption waivers through community involvement; strengthen local capacity to handle cost sharing funds; and to utilise other source of funds such as NHIF and NSSF; among others.

14. Issues Emerging from Presentations & Discussions Continue� The Conference was informed that MoH is in the process of developing an Integrated Logistics System (ILS) through MSD, to enable facilities order medicines and hospital supplies together with items under vertical programmes such as STI/STD, Family Planning etc. The system is already being piloted in Iringa and Dodoma regions, since May 2005. An evaluation will be conducted to identify weaknesses and way forward. ILS is envisaged to make health facilities more accountable for utilization of medicines and supplies; remove a series of various order forms that were being used by programmes in ordering and reporting; enable efficient collection of data on demand for medicines and supplies that are a cornerstone for budget preparation; and minimize misuse and spoilage of medicines.

15. Issues Emerging from Presentations & Discussions Continue� Following the reports that there is widespread shortage of essential drugs and supplies at health facilities across the country due to inefficiencies of MSD, it was emphasised that MSD MUST give priority to live-saving drugs and other essentials supplies and improve stock status. On the other hand, DMOs were urged to enhance proper record keeping in health facilities to enable data collection on health commodities, ensure prompt submission of orders, and in case of any dissatisfaction with specific MSD services, they should not hesitate to write to DG - MSD with a copy to PS-MOH, attn: Director Hospital Services or Chief Pharmacist, for follow-up with MSD.

16. Issues Emerging from Presentations & Discussions Continue� It was observed that councils are not giving environmental health and sanitation due attention as a major component of health care. Hospital waste management is particularly a major problem. A situation analysis by MoH indicates that there are no clear plans and budgets for managing healthcare waste in the health facilities; no formal categorization of healthcare waste; no standardized safe ways of collecting sharps using standard containers; highly infectious waste not separated and pretreated before being disposed; waste management and infection prevention committees are not organized leading to haphazard management of HC waste; lack of knowledge and skills among health workers on the entire management of healthcare waste; etc. DMOs were urged to include environmental health, sanitation and hospital waste management in the CCHP and ensure their implementation towards improvement of environmental health

17. Issues Emerging from Presentations & Discussions Continue� The Conference was informed that MoH has reviewed the National Health Policy in order to accommodate six major changes that have come along with the heath sector reforms and other policy developments. These include cost sharing of health sector services; participation of private sector (Public Private Partnership); control of HIV and AIDS; planning that includes gender issues; decentralization by devolution to LGAs; and Reduction of poverty through MKUKUTA. The policy is can be readily accessed through MoH website. The necessary arrangements are being made to distribute hard copies of the document to the districts. The day ended at 2.45 pm unlike the previous days � a benefit of efficient time management!

18. Thank Very Much for Listening