Health NKRA Focus Area HRH Distribution Health Commodities ... · Health NKRA Focus Area HRH...

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1 Agenda Health NKRA Focus Area HRH Distribution Health Facilities Health Commodities RMNCH Funding Situation Anticipated Challenges Moving Forward AOB

Transcript of Health NKRA Focus Area HRH Distribution Health Commodities ... · Health NKRA Focus Area HRH...

Page 1: Health NKRA Focus Area HRH Distribution Health Commodities ... · Health NKRA Focus Area HRH Distribution Health Facilities Health Commodities RMNCH Funding Situation Anticipated

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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

9.3

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

0.00

1.00

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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

.9  

46.4  

85.9  

51  

11.6  

28.4  

10.7  

58.8  

27.6  

22.6  

14  

25.2  

0  

20  

40  

60  

80  

100  

120  

%  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 %)?

29  

0  

37.8  

21.4  

6.7  

68.8  

21.2  

7.6  

35  

46.0  

13.5  

39.3  

75.3  

8.7  

6.1  

28  

54.0  

48.6  

39.3  

18.0  

22.4  

72.7  

92.4  

37  

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