Tanzanian-German Programme to Support Health (TGPSH)

1. Tanzanian-German Programme to Support Health (TGPSH) Phase 1: Jan 2003 – Dec.2006 Inception. Phase 2: Jan.2007 –Dec. 2009 Consolidation (Dr. O. M.E. Kisanga-National TGPSH Co-ordinator )

2. Programme Goal • Contributes to improve the health and well-being of all Tanzanians with a focus on those at most risk and to encourage the health system to be more responsive to the needs of the people <shared national goal>

3. Programme background • Fusion of Historic German Development Co-operation Projects in health and related field *Family Health Project *HIV control *Reproductive health and • DED • CIM,INwent • KFW

4. The Programme aims at: • Enhanced structural effects (Decentralisation, PPP, Transp financial Management) • Facilitating introduction of cross-sectoral / overarching issues into Progr components (Gender, Youth, Civil Society, governance structures-CHSB, FGCs) • Increased economic efficiency through flexible use of resources (instruments, personnel, others)

5. Programme Dimension • National level : MOHSW,MOE,TACAIDS • Regions level: Lindi, Mtwara, Mbeya, Tanga, (Dodo) • Operational level: 28 Districts of the 4 regions

6. Features of the Programme 1.Contribution to Sectoral programmes (HSR,SWAP,HSSP,LGR,NSF-AIDS) 2. The cross-sectoral dimensions (MAC,RCH,DEC,HRH) 3.Multi-level approach(link micro, meso and macro) 4.Co-operation with different stakeholders 5 A Combination of Complementing Instruments of GDC (Financial-(kfW), Technical (GTZ,DED, Inwent,CIM)

7. The Programme Components • HIV / AIDS • Reproductive Health • Social Security & Health Financing • Human Resources for Health • District Support and Quality management • Public Private Partnership

8. Fighting HIV/ AIDS Key issues: • Multisectoral and comprehensive approach Expected results : • An increasing percentage of the population takes advantage of available preventive health care and uses the services of multisectoral AIDS control, provided by public services and civil society organizations

9. Reproductive Health Key issues: • Safe Motherhood • Community-based services • Focus on youth • Advocacy • Peer education and extracurricular activities Expected Results : The population, in particular adolescents, has access to information about sexual and reproductive health as well as to high quality reproductive health services

10. Health Financing Key issues: • Increase government share and household spending on health • Relate to macro-economic and poverty reduction strategies • Improve management of scarce financial resources (value for money) Expected results Procedures of Social Security and Health financing are used more successfully.

11. Human Resources for Health Key issues: • Capacity Building through Human Resources Development • Zonal Training Centre are an opportunity for scaling up „best practice“ • Electronic networking (MOHSW, MUCHS, ZTC) for distance learning and coaching Expected results • Quality and quantity, of human resources of the relevant health facilities improved

12. District Health & Quality Management Key issues: • Quality – a responsibility for health workers • Comprehensive Council Planning for resource management • Orientation towards performance and outcome • Growing concern on client-satisfaction Expected results: The decentralized health services in the regions deliver efficient, comprehensive services according to needs

13. Public Private Partnership Key issues: • Support establishment and functionality of PPP Forums at all levels • Contractual approach as a strategic tool: service agreements • Support of faith based health care providers through CSSC Expected Results The cooperation of public and private health services, in particular the faith-based , are institutionalized and supported by the national agenda of the government

14. Implementation results-process • HIV/AIDS Control Competence centre-Mbeya-address Community/multisectoral concerns • Adolescent and mothers health improved through advocacy and contraception • MPH improve DMOs and RMOs perfomance • Planning tools improve financial accessibilty • CHF contributes to improved service provision • Improved Public and private co-operation improves moth &Child access to quality services

15. Implementation Results Contribution to national Indicators: • Infant mortality from 99 (2002) - 68/1000 (04/05) • Decreased child mortality (147(02) to 112 (04/05) • Increased number of deliveries under skilled supervision (36 % to 59% (2008)

16. Implementation Results Assessed in Supported Regions • Increased deliveries under skilled supervision Tanga: 35% to 64% Mbeya: 37% to 44% Mtwara: 28% to 37% Lindi: 49% to 54%

17. Implementation Results • Contribution to adressing MDGs —27/31 outputs • Contribution to addressing MKUKUTA-poverty reduction and Human right - 28/31 outputs • Gender equity (Male involvement in PMTCT, Peer ed, CHF enhancement) -26/31 outputs

18. Challenges: • HRH –the number ,the capacity the motivation • The need for an effective policy back-up • The Resistant Maternal Mortality • Health is rather a human right not confined to providers • Reform is a process; perfection means turning over a critical number of stones to make a way.