Health NKRA Focus Area HRH Distribution Health Commodities ... · Health NKRA Focus Area HRH...
Transcript of Health NKRA Focus Area HRH Distribution Health Commodities ... · Health NKRA Focus Area HRH...
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Agenda
Health NKRA Focus Area
HRH Distribution
Health Facilities
Health Commodities
RMNCH
Funding Situation
Anticipated Challenges
Moving Forward
AOB
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The focus areas of BRN Healthcare NKRA and the initiatives aims to achieve 4 broad outcomes for quick transformation
6 initiatives
6 initiatives
6 initiatives
4 initiatives
BRN Healthcare
HRH
RMNCH
Health facilities
Health commodities
80% of primary health facilities to be rated 3 Stars and above
100% balanced distribution of skilled health workers at primary level
100% stock availability of essential medicines
20% reduction in maternal mortality ratio and neonatal mortality rate in 5 regions
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Agenda
Health NKRA Focus Area
HRH Distribution
Health Facilities
Health Commodities
RMNCH
Funding Situation
Anticipated Challenges
Moving Forward
AOB
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100% balanced distribution of skilled health workers at primary level
Analysis of Postings done in FY 2014/15 1 q Analysis on funded Post received from
POSPM for FY 2015/16 • To conduct assessment and plan for
redistribution of staff • Noted challenge in the suggested posts,
communicated to POPSM and are currently working on it
q Approved funded posts – FY 2016/17 o To determine the needs from LGA’s ( per
facility ) and share with POPSM before 1st December 2015
o Communication made with PMORALG, tool sent to all regions & LGA’s to collect data on gaps per facility
HRH Analysis for 2015/16 and 2016/17 2 Total no %
Original Postings 8345
Posted after remedial plan 9,735 100%
Reported 8,312 85%
Not reported at all 1,423 15%
Reported and available 7,730 78%
Reported and left 582 7%
Prioritize application of employment permits to regions with critical shortage of skilled HRH
² Identified unmanned facilities through Star Rating ² Pre feasibility Study to be conducted in collaboration with PharmAcess on PPP model to
be used under HRH Initiative ² Results will be out by December 2015
PPP 3
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• On average, 4 regions improved Katavi, Kagera,
Mtwara & Mwanza • 3 regions became
worse from above to below 7.74 – Manyara, Lindi & Mbeya
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2015 Nurses
2015 Clinicians
2014 Nurses
2014 Clinicians
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Density of Clinician and Nurses per 10,000 Population After remedial plan
Before After Regions critically below 2014’s national average of clinicians and nurses density 9 10 Regions at borderline of 2014’s national average for clinicians and nurses density 4 1 Regions above 2014’s national average for clinicians and nurses density 12 14
7.74
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Situation in the first 9 Regions
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Katavi Simiyu Tabora Geita Kigoma Rukwa Shinyanga Kagera Singida
Density of HRH before and after remedial plan in 9 Regions
Density of HRH BF
Density of HRHAF
6.4
4.4
Baseline Nat. Aver 2014- 7.74
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Human Resource for Health Distribution
Enforcing retention & incentive policy at LGA
• Met POPSM to discuss implementation of Pay and Incentive policy (2010)
• Requested officially the Implementation Guideline for the 29 LGA’s
• To be used as basis to advice the LGA’s on the implementation
Ring Fencing of Subsistence
allowances • Met MOF directives given • Letter sent to PMORALG to request them
for follow up of permit for Fy 2015/16 • PMORALG to develop a budget and
submit official request for Ring fencing of subsistence allowances to MOF
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Redistribution of health workers • Developed 40 National WSIN • Develop National Standard to be used
during assessments • 1st Training for Dodoma and Ruvuma
Region – 8th November 2015
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Reinforce Orientations and induction for newly hired staff Letter was sent to PMORALG to remind LGA’s to plan and budget for orientation and induction of new staff
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Agenda
Health NKRA Focus Area
HRH Distribution
Health Facilities
Health Commodities
RMNCH
Funding Situation
Anticipated Challenges
Moving Forward
AOB
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Health Facilities Star Rating Assessment
• Star Rating Completed in Mwanza, Shinyanga and Geita Regions
• Plan in place to develop reporting template for the districts
• Start assessment's for Mara, Kagera and Kigoma Regions as from 8th November 2013, DSM in Dec 2015
• To complete BRN Region in Feb 2016
National Health Facilities User Satisfaction Level Scoring System • Developing a concept Note and plan is to
have stakeholders meeting in December • Plan to have it place by March 2015
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4 Opening of Accounts in lower Health Facilities • Until May 2015 only 3652 (64%) out of
5699 had opened bank Accounts • During Star Rating assessment – 96%
have opened bank accounts • PMORALG to conduct visits as from next
week
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Social accountability at the facility and community level
Work plan for 2015/16 completed Completion of guideline, Piloting and TOT training Rolling out to 77 LGA’s will be done
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All Star Rating Assessment Findings
2 Star Rating Mwanza Simiyu Shinyanga Total %
0 Star 151 70 40 261 36.8%
1 Star 161 71 147 379 53.5%
2 Star 37 12 17 66 9.3%
3 Star 1 0 2 3 0.4%
4 Star 0 0 0 0 0.0%
5 Star 0 0 0 0 0.0% Total Facilities 350 153 206 709
Target 280 122 165 709
0- 2 99.4% of alll facilities
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Agenda
Health NKRA Focus Area
HRH Distribution
Health Facilities
Health Commodities
RMNCH
Funding Situation
Anticipated Challenges
Moving Forward
AOB
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Health Commodities
Improving governance, accountability, and
sense of ownership of Health Commodities supply chain
• Toolkit for best prac0ces of health commodi0es implemented in Serenge0, Busega, Chato, Kwimba, Kigoma and Muleba districts.
• Concept note for resources mobiliza0on under development
• Revised dona0on guideline approved & to be disseminated
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To complement MSD in the procurement & distribuBon of medicines by engaging private
sector ² Tender evaluation and Board Adjudication is completed . The offering will be
announced any time from now ² MSD is in a procurement process to engage a consultant for conducting feasibility study on
local manufacturing Plant under PPP . ² MOF have sources funding for the study
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Strengthen management of MSD working capital work
• Prime vendor on MSD zonal basis is on going well
• Government strategic review of MSD is in progress under independent reviewer” DeloiFe” to see how best MSD can be strengthened
• The dialogue for signing of MOU among MOHSW(ver0cal program actors), MSD and MOF is on progress
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Health Commodities
Introduction of ICT mobile applications platform at lower level facilities for improved communication and data
management in supply chain Assessment of health facilities readiness to implement e-LMIS done in 6 districts (Serengeti, Busega, Chato, Kwimba, Kigoma and Muleba districts). ICT unit is working on analysis.
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Scale up 5S-KAIZEN-Total quality Management (TQM) initiatives to improve inventory
management from district level to lower health facilities level 5S -KAIZEN-TQM for health commodities manual and facilitators guide developed. Pending availability of funds, editing, pilot testing of the documents and translation into Kiswahili will be done prior to implementation
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Use of SMS to report stock outs and quality of health services by service
users and civil society ICT Planning is on going
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Agenda
Health NKRA Focus Area
HRH Distribution
Health Facilities
Health Commodities
RMNCH
Funding Situation
Anticipated Challenges
Moving Forward
AOB
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RMNCH
Expanding (CEmONC services at strategically selected health centers and hospitals to serve as satellite sites
Strategically selected dispensaries and health
centers to provide full fledge BEmONC • Assessment for BEmOC, CEmOC was undertaken • Identification of gasp per facility – Quality
Improvement plans done • Plans is to upgraded and constructed in one year • and CHW will be undertaken in 5 regions between
April-June 2015 • Identification of needs per districts ongoing
1 Mobilise Community Health Workers (CHW) to improve RMNCH services • Assessment of CHW conducted • Review of training materials (3 Wks
Training) will be conducted on 9th to 21st Nov ember 2015
• Work plan and Budget in place • Training to follow up in December
2015 • Appreciate the response to GOT
request on commitment • Request Support in Training CHW
Regional Satellite Blood bank
facilities supporting CEmOC • Reviewed Work plan • To operationalize Kigoma na Mara • Regional BB. • To construct Simiyu
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Develop integrated 360 Degree mass media campaign that can be multi sponsored through PPP • Conduct Rapid Assessment of Mass Media
needs at the 5 regions
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Initial Findings (2/3)
EmONC assessment completed in 5 RMNCH regions. Final results:
Region Number of CEmOC Facilities Number of BEmOC Facilities Baseline Target Gap Baseline Target Gap
Geita 2 12 10 13 56 43 Kigoma 4 23 19 9 100 91
Mara 3 22 19 25 113 88 Mwanza 7 34 27 13 123 110 Simiyu 1 14 13 4 61 57
Total 17 105 88 64 453 389
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IniBal Findings (3/3)
Community Health Workers (CHWs) • Mapping was completed in Simiyu and Kigoma regions in July 2015, while the
mapping for the other 3 regions of Mwanza, Mara and Geita was completed in Aug. Full Results :
Region Target for
CHW Baseline of
CHWs # of New CHW to
be trained
Geita 5,386 1,598 3,788
Kigoma 4,358 1,424 2,934
Mara 3,973 2,074 1,899
Mwanza 5,543 4,318 1,225
Simiyu 3,924 3,390 534
Total 23,184 12,804 10,475
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Agenda
Health NKRA Focus Area
HRH Distribution
Health Facilities
Health Commodities
RMNCH
Funding Situation
Anticipated Challenges
Moving Forward
AOB
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Funding Situation
Funding source
Budget Estimated Funds Disbursed % Expenditure %
DANIDA 1,196,745,000 613,530,318 51% 613,530,318 100%
World Bank 1,194,364,440 1,194,364,440 100% - 0%
Basket Funds 6,919,123,000 632,575,000 (funds from fy 2014/15) 9% 632,575,000 100%
UNICEF 432,567,900 432,567,900 100% 432,567,900 100%
Irish Aid 356,293,000 356,293,000 100% 356,293,000 100%
Government- Others Charges
1,578,673,048 35,028,925 2% 35,028,925 100%
11,677,766,388 3,264,359,583 28% 2,069,995,143 63%
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• Coordinator District Health Services and System Strengthening,
• Participated in the development of CCHP Plan guideline
• Activities for Fy 2016/17 included in the guide
CCHP Preparation
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Agenda
Health NKRA Focus Area
HRH Distribution
Health Facilities
Health Commodities
RMNCH
Funding Situation
Anticipated Challenges
Moving Forward
AOB
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Anticipated challenges in implementation & mitigation measures
Anticipated challenges
Shortage of funds to implement all the initiatives
Delayed disbursement to the Ministry, implementing agencies and to the LGAs
Buy-in from all stakeholders for smooth implementation
Suggested mitigation measures
Integrate budget into MTEF through government funding; identified funding gaps to be negotiated from the partners for respective LGAs To streamline the disbursement of funds at central level to LGA
Continuous communication and syndication with all levels of stakeholders to galvanize support for BRN, Advocacy at national level Have an interim MDU members,
Very very helpful - However, they have also to attend other issues Continuous communication with PDB
to fill the posts Election year – Competing priorities In some cases have to wait work on
issues that do not require implementation
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Agenda
Health NKRA Focus Area
HRH Distribution
Health Facilities
Health Commodities
RMNCH
Funding Situation
Anticipated Challenges
Moving Forward
AOB
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Moving forward Complete baselining exercise and finalize the KPI and targets for BRN for the 3-year timeframe 1
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Frequent communication between MDU-PMORALG, PDB and Project Implementers on implementation details, updates and issues.
Source for additional funding required to fund the gap for unfunded & underfunded initiatives
What we would like from you
A Full support and commitment from in realizing the implementation & to inform and escalate to MDU & PDB on any issues, roadblocks and risks
Finalization of KPI’s & Start Tracking the results
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Onboarding PMORALG staff – MDU & health department – 10 – 12 December
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Healthcare NKRA contact details
Dr. Linda Ezekiel Director, Social Sector [email protected] 0754290499 Abdul Muiz Abdul Aziz Healthcare NKRA [email protected] 0687966998
Azlin Niza Ismail Social Sector [email protected] 0785447843 Nasrul Yusuf Healthcare NKRA [email protected] 0785447381
Dr. Adeline Saguti-Nyamhiwura Ministerial Delivery Unit [email protected] 0753545166
Dr. Rosina S M Lipyoga Ministerial Delivery Unit [email protected] 0754294554
MDU
Interim MDU
PDB Team
Dr. Joseph Hakororo MDU Liaison [email protected] 0767314190
Mr. Andrew Makoi MDU Liaison [email protected] 0754260883
Mr. William Reuben MDU Liaison [email protected] 0784254572
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BEMOC & CEMOC Assessments Results
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InsBtuBonal Delivery
50.6 62
.7
60.9
107
71.6 81
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46.4
85.9
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11.6
28.4
10.7
58.8
27.6
22.6
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25.2
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% Delivery in HF
% Delivery in fully funcBonal EMONC HF
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Causes of Maternal Deaths in Study Zones
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Hemorrhage 29%
Obstructed labour 13% Sepsis
7%
Hypertensive disorders
8%
Anemia 12%
Abor0on 19%
Other indirect causes 4%
Malaria 8%
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In which HF level were maternal deaths occurring (Figures in %)?
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37.8
21.4
6.7
68.8
21.2
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46.0
13.5
39.3
75.3
8.7
6.1
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54.0
48.6
39.3
18.0
22.4
72.7
92.4
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0 10 20 30 40 50 60 70 80 90 100
Geita
Kagera
Kigoma
Mara
Mwanza
Shinyanga
Simiyu
Tabora
Dispensary
Health Centre
Hospital
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Asante Sana