Health Promotion Experience of HPSS Project Dodoma, Tanzania

1. Health Promotion Experience of HPSS Project Dodoma, Tanzania Participatory Methods for Identification of Determinants of Well-being and Community Action Planning: Piloting Multiple Approaches and Strategies for Health Promotion, in Dodoma Region, Tanzania Presented at the Culture Health & Wellbeing international conference in Bristol, UK 24-26th June,2013 Presented by: Ally-Kebby Abdallah

2. Introduction to Dodoma Region • Located at the center of Tanzania • Semi-arid region with many tribes; Gogo, Rangi and Sandawe are the major tribes, there are other small ethnic groups, like Maasai, Bargaig etc. • Dodoma has seven districts.

3. HPSS: A project “Health Promotion and System Strengthening” (HPSS) Project Funded by SDC, mandated to Swiss TPH Implemented in Dodoma Region (7 districts) Preparation Phase: June 2010 to May 2011 Phase 1 of implementation: June 2011 – Jan. 2015 Phases 2 and 3 envisaged for 2015 - 2020

4. Objectives of the HPSS Purpose: Access to, quality and utilization of health resources and services in Dodoma Region are improved and delivered by an effective and well governed health system. Objectives: 1. The population of Dodoma Region has developed and carries out health promotion activities which are suited for improving their health status 2. The health system in Dodoma Region is strengthened in its capacities to provide appropriate and quality health care

5. WorkingAreas of the HPSS Components: Health Promotion, Health System Strengthening, Operational Research Working Areas: Community based health promotion activities Health financing Drug Management support Maintenance and Infrastructure Management support Operational Research Mainstreaming of project activities on gender, HIV/AIDS, social inclusion

6. A Systemic Approach for Improving Health

7. HP Expected Outcomes Outcome The population of Dodoma Region has developed and carries out health promotion activities which are suited for improving their health status Outputs Institutional structures (government and non-government) for supporting community activities in health promotion are strengthened and made functional Communities are supported to define and operationalize thematic areas for health promotion.

8. Problem Analysis History of HP Approach in Tanzania Expert led approach Top down High cost Community passive Lack of ownership (maintenance / sustainability) Not in line with the Ottawa Charter

9. Basel 2013 Piloting Approaches in Dodoma Prevention, health promotion and health education • represent complementary strategies to improving a population’s health. • cannot be separated • many countries use a combined approach to reduce risk and promote health

10. Basel 2013 The Concept of Health Promotion

11. Basel 2013 Health Promotion Approach Addresses an issue at several levels and addresses several of the five key action areas

12. Basel 2013 The Ottawa Charter 1986: defined Health Promotion Build Health Public Policy Create Supportive Environments Strengthen Community Actions Develop Personal Skills Re-orient Health Services • a process of enabling people and groups to increase control over, and to improve their health and quality life

13. Transformation of Approaches Under the HPSS Mandate Apply community empowerment processes through PRA whereby communities identify health concerns and plan solutions Training of Health Promotion Officers/ CBOs/CHWs etc TWG meetings: platform for experience sharing and discussion of HP technical matter Develop plans and Guide: disseminate existing GoT policies Influence regional and district authorities’ planning Use experience and operational research results to influence region to orient health services

14. Conducted Participatory Health Problem analysis and Planning for Community Action for Health Promotion in all wards of Dodoma Region. Participatory Process on Identifying Health determinants and needs

15. Problem Identification Processes • Community Stories • Health Problems in Community

16. Problem Analysis • Invite community members to mention/list health/diseases that affecting the community and write them down. • Divide the group into sub-groups (men, women and if possible young and old) • Facilitate the groups to present findings in plenary.

17. Problem Analysis Tools • Different analysis tools used by facilitators

18. Title of Presentation Enabling the voting process • Then draw up these priorities on a large sheet of paper • Give each member of the group 3 stones, pieces of paper or leaves as votes

19. Facilitate • As people record their priorities, remain nearby to answer any questions as needed.

20. Tribes and age set community • Very hierarchical societies: young and old/ women and men Education and wealth Status level • Poor Vs better off • Educated-service providers

21. Count the votes • Discuss the results of the ranking with the group • Record any further information

22. Participatory Approaches addressing Culture Barriers Gender and engagement in process • disaggregated by gender and age groups for effective identification and discussion. • Male facilitator for male groups; female facilitator for female groups.

23. Participatory Approaches addressing Culture Barriers Gender and engagement in process • disaggregated by gender and age groups for effective identification and discussion. • Male facilitator for male groups; female facilitator for female groups.

24. Results/Outcome • Participatory processes for identifying community health problems, causes, and priority setting for action planning has been conducted and completed in over 200 villages of Dodoma region. • The exercise revealed the following; • Malaria is still a number one community concern in most villages. • Water bone diseases (especially typhoid and diarrhea) rank number two in most villages. • Eye and skin infection are ranked third in the majority of villages. • HPSS has developed a more rapid and cost effective method compared to traditional PRA approaches.

25. PRA Benefits of the Approaches • Communities empowered to understand & act on their health concerns. • Determinants of health from the communities are well understood • Communities has managed to identify own resources (manpower with skills and materials) • Specific health needs identified by different social groups. • Cultural barriers addressed • Community ownership of interventions

26. Community Plan

27. Preliminary Results from the Communities • Orientation of 175 Actors (CHWs, School Teachers) on Community approaches for health Promotion. • Trained 5 College Lecturers on Health Promotion • Trained 3 member staff of NGOs • 10 regional and district Officers • 18 food stall owners prosecuted over poor hygiene 19,270 people reached by CHWs and CDO/HOs in 14 villages 2 working group meetings conducted so far: Agreed regional HP strategy • Provision of subsidized latrine slabs • Chlorinated and protected water sources in villages

28. Challenges Global/national trend in resource allocation to biomedical and curative strategies rather than holistic HP approaches and prevention Limited support from key decision-makers Lack of HP infrastructure Ensuring sustained commitment to health promotion principles and approaches Ensuring implementation of participatory methodologies Proactive ownership and future development of health promotion course by the Zonal Training Centre Identifying suitable indicators for measuring effectiveness Reduction in CCHP fund for CAH (from 5-10% to 2-5%)

29. Asante Sana!