Better Services for Better Health Tanzanian German

Transcription

Implemented by
Programme to
Support Health
Tanzanian German Programme
to Support Health
Annual Report 2013
Better Services for Better Health
Published by
Tanzanian German Programme to Support Health (TGPSH)
Deutsche Gesellschaft fuer Internationale Zusammenarbeit (GIZ) GmbH
76 Ali Hassan Mwinyi Road
Dar es Salaam, Tanzania
T +255 22 2122044/66/88
F +255 22 2122110
E tgpsh@giz.de
I www.giz.de/www.tgpsh.or.tz
Responsible
Dr. Inge Baumgarten (Programme Manager)
Overall Coordination
Ms. Vida Mwasalla
Text
GIZ Programme to Support Health
Design and layout
andreas korn visual communication, Dar es Salaam
Photos
© GIZ-TGPSH
© Dr. Holger Brockmeyer
© CCBRT/Dieter Telemans (coverpage top photo)
Maps: National Bureau of Statistics Tanzania, Census 2012
This edition
March 2014
As a federally owned enterprise, we support the German Government
in achieving its objectives in the field of international cooperation for
sustainable development.
Table of contents
Foreword2
About us 3
2013 Highlights at a glance
5
Our focus at a glance
6
Highlights by Thematic Area:
}Social Health Protection
7
}Quality in Health Services
9
}Decentralized Health Governance
12
}Cooperation with the Private Sector
14
}Strengthening Civil Society Organizations
19
List of publications and studies supported in 2013 22
Financial Summary – 2013
24
1
Foreword
Dear Reader,
2013 has been a successful and busy year. In this first annual report of GIZ Health in
Tanzania, we would like to introduce our services and share some of the 2013 highlights
with you.
As a federally owned enterprise, we support the German Government in achieving its objectives in the field of international cooperation for sustainable development. We provide
innovative solutions and capacity development in dialogue with our partners the Government of Tanzania represented by our counterpart the Ministry of Health and Social Welfare (MoHSW), the private sector and Civil Society Organizations (CSOs). We support the
government in progressively realizing its goal of universal health coverage. That is, to provide health services to the population of Tanzania which are of quality and are affordable,
accessible, and acceptable. As stated in the national health policy, 2003, “Every individual
has the right to health care and equitable distribution of health resources in the country”.
We operate in four regions of Tanzania, promoting capacity development in health in Mtwara, Lindi, Tanga and Mbeya. In Mtwara region, we support young people’s involvement
in health by joining forces with CSOs, private partners and local governments. Germany’s
highly acclaimed social protection system serves as a model for insurance schemes, while
local and global good practices create the basis for tailor-made, sustainable solutions
which meet the demands and capacities of the country system. We arrange training opportunities for Tanzanian professionals both on-the-job and abroad, and provide managers with effective capacity building in health courses.
To mention a few of 2013 achievements, at the policy level our contribution to the development of the health financing strategy, the “No Baby Left Out” initiative to reduce maternal and child deaths and user friendly documentation on retention addressing the Human
Resources for Health shortage particularly in Southern Tanzania.
In summary, we support sustainable change in health in Tanzania.
We hope you will enjoy the reading and look forward to extending our partnership and
cooperation!
Dr. Inge Baumgarten
Programme Manager
GIZ Health in Tanzania
2
About us
The United Republic of Tanzania and the Federal Republic of Germany launched the Tanzanian German Programme to Support Health (TGPSH) in 2003 in order to assist Tanzania‘s Health Sector Reform. In a Sector Wide Approach (SWAp) the German organizations
GIZ (technical cooperation) and KfW (financial cooperation) contribute to the joint programme, commissioned by the German Federal Ministry for Economic Cooperation and
Development (BMZ).
We work closely with a range of Tanzanian governmental and non-governmental institutions to improve overall health and to make health services more responsive to the needs
of clients. We provide policy, strategy and technical advice to public and private sector
institutions.
We work at national, regional and district levels, where we have contributed to enhanced
management capacities in health financing, quality improvement in the health system
and cooperation with the private sector and civil society organizations. We operate in four
regions of Tanzania (Lindi, Mtwara, Mbeya, and Tanga), promoting capacity development
in health. We offer services in five key areas of health systems strengthening:
}}Social Health Protection
}}Decentralized Health Governance
}}Quality in Health Services (focus on Sexual Reproductive Health and Rights)
}}Cooperation with the Private Sector
}}Strengthening Civil Society Organizations
Our objective
Important preconditions for equal and sustainable access to quality health
services are in place.
3
We work in line with the objectives of the Health Sector Strategic Plan (HSSP III), to improve the health and well-being of all Tanzanians, with a focus on vulnerable population
groups. We monitor progress towards our objectives through measures of success that are
consistent with the HSSP III.
In the four regions our contribution, in collaboration with our partners in health, reaches a population of approximately seven million which is, according to the 2012 census,
16 % of the Tanzanian mainland population. The regions have a large proportion (about
40 %) of poor people, a largely rural population of about 75 % and a majority of children
and youths: approximately 47 % under 15 years of age and 20 % in the age group 15–24
years.
Our services
}We offer tailor-made services
}We draw on a wealth of technical and regional expertise
}We implement practice-oriented know how
}We secure results in a partner-oriented, efficient and transparent way
}We are guided by the concept of sustainable development and human rights
Our mix of instruments
The term instrument is used here to refer to the means or inputs used by GIZ to
deliver services and human capacity development focuses on human resources
development for specialists and managers from partner organizations. To achieve
sustainable results we place managers and specialist personnel in the positions
outlined below.
}Technical Advisors (TAs) offer technical advisory services to key decision
makers at the national level. TAs are national and international specialists.
}National Experts (NEs) are employed by local organizations with co-funding
from GIZ to catalyze change and innovation.
}Development Advisors (DAs) assist at the regional level to develop capacities
in health management and health services and practical solutions to
implementation challenges.
}CIM Integrated Experts (CIM IEs) are international staff hired by local
organizations to assist in complex change processes. The specialist personnel
positions are co-funded by GIZ.
Our influence
Our contribution to the health sector complemented and coordinated by
the German Development Bank “Kreditanstalt für Wiederaufbau“(KfW) is a
comprehensive approach which has contributed to several achievements as
described in the next chapters.
4
2013 Highlights at a glance
5
Our focus at a glance
Social Health
Protection:
In Mtwara:
CHF support at regional
level, with focus in Masasi &
Tandahimba
In Lindi, Mbeya and Tanga:
at regional level, all councils–
Peer learning Community
Health Funds (CHF)
Sokoine
Regional
Hospital
Quality in Health
Services
(focus on SRHR):
Nyango
District
Hospital
In Mtwara:
Ligula Regional Hospital,
Tandahimba & Masasi district
hospitals
Nachingwea District
Hospital
In Lindi:
Sokoine Regional Hospital,
Nyangao-Lindi DC &
Nachingwea district hospitals
In Mbeya:
Mbeya Regional Referral
Hospital, Mbalizi & Rungwe
district hospitals
In Tanga:
Bombo Regional Referral
Hospital, Teule & Lushoto
district hospitals
Mbeya
Regional
Referral
Hospital
Mbalizi/Ifisi
District Hospital
Rungwe
District
Designated
Hospital
6
Decentralized Health
Governance:
In Mtwara:
CCHPs Masasi & Tandahimba
In Lindi:
CCHPs Lindi DC and
Nachingwea
In Mbeya:
CCHPs Mbeya DC and Rungwe
Lushoto
District
Hospital
In Tanga:
CCHPs Muheza and Lushoto
Ethics Bombo Regional
Hospital
Bombo
Regional
Referral
Hospital
Cooperation with
Private Sector:
Teule
District
Hospital
In Mtwara, Lindi, Mbeya and
Tanga:
All councils PPP advocacy and
Institutional framework
Strengthening Civil
Society Organization:
In Mtwara:
Masasi & Mtwara MC
In Lindi:
Family and youth festival in
cooperation with Femina HIP
In Mbeya and Tanga:
No focus
Ligula
Regional
Hospital
Masasi
Town
Council
Hospital
Tandahimba
Council
Hospital
7
Social Health Protection
We contribute to the development of an equitable and efficient Social Health Protection
(SHP) system paving the way towards Universal Health Coverage (UHC) in Tanzania. An
important aspect is to develop methods to reach the poorest in society and those who may
be disadvantaged in access to health services. We enhance capacity development for community health funds management, including financial management at the regional and
district levels.
National level
There was good progress in the development of the national health financing strategy
in 2013. A total of ten out of 11 policy option papers were produced, with financial and
technical inputs by GIZ. They cover various aspects of health system financing, e.g. health
insurance market structure, options for a minimum benefits package, inclusion of the
poor, public financial management, public private cooperation. These papers provide the
basis for informed and evidence based decision making and stakeholder consultation in
order to present the new health financing strategy in early 2014. We offered the required
expertise through the national technical working group health financing. In the Providing
for Health Initiative (P4H), an international network on SHP universal health coverage, we
facilitated coordination and cooperated closely with KfW and key development partners,
including Swiss Development Cooperation, USAID, WHO, and the World Bank
(www.who.int/providingforhealth/partners/en).
8
A national costing study provided more information about the practice for fee setting for
health services, the negotiation processes, and the costs charged by public and private
health service providers. Were presented to a broad range of stakeholders in March 2013
and were subsequently disseminated internationally and nationally through the P4H network.
Regions and Districts
Data management is crucial for any successful business operation. We provided an easyto-use database tool and hands-on training for health professionals responsible for data
management. This is essential for the Community Health Funds (CHFs) to apply for
matching funds from NHIF, to top up revenue generated from membership fees and thus
strengthen the financial capacity of CHF.
We increased enrolment into CHFs, through sensitization campaigns by TNCHF, the Tanzanian Network of CHF (TNCHF) and through partnerships with the private sector. For
example, PPPs with companies such as OLAM International Ltd and Biolands, which support CHF enrolment of their suppliers. More than 20,000 people – farmers, labourers and
their families – have been enrolled into CHF in 2013.
This high CHF enrolment rate of up to 20% within programme supported regions, has
been achieved in a short period where the private sector is participating as an active partner in health.
CHF group enrolment with farmers (BIOLANDS on cocoa farmers, Tanga Fresh on milk
farmers, Afri Tea & Coffee Blenders with tea farmers) was particularly successful. We managed to address the informal sector through partnerships where families were able to access quality health services.
Sensitization and CHF group enrolment
CHF enrolment with the dairies and farmers
9
Quality in Health Services
Focus on Sexual Reproductive Health and Rights
We support the implementation of the national quality framework. This includes:
}}Improved competency and skills of health staff in planning, implementation
and management as well as service delivery with particular focus on sexual and
reproductive health services (SRHR).
}}Improved communication and coordination between quality in health teams and
respective regional and council health administration (RHMT, CHMT).
National level
This year, we assisted the Ministry of Health and Social Welfare in the costing of the National Strategic Quality Improvement (NSQI) plan and the organization of the 3rd National Quality Improvement Forum (NQIF), which enabled medical professionals from all
over the country to share a broad range of experiences. We facilitated participation of 18
regional partners for networking and exchange. Our contribution is coordinated through
the National Quality Improvement Task Force.
10
Practice-oriented Solutions and Capacity Development
Newborn health care in Southern Zone – ‘No Baby Left Out’ programme
}}We offered capacity development to 119 staff from the maternity ward in Lindi
Regional Hospital to improve quality of services in neonatal resuscitation and newborn
care including kangaroo mother care and neonatology.
On job training for health
workers
}}A total of 799 newborns were treated in the neonatal ward in 2012-2013.The neonatal
mortality rate has decreased from 35/1000 (2011) to 20/1000 (2012) while the case
fatality rate decreased from 32% (2011) to 9% (2012).
}}An outreach programme was introduced in Lindi Municipality and the District Council
to enhance the capacity of service providers in the surrounding health facilities. 160
staff from 62 facilities participated, a total of 1,200 newborns were screened and 46
were referred. The outreach on-the-job training included three days capacity building
in basic newborn care, Kangaroo mother care, neonatal resuscitation, early diagnosis,
treatment and referral of sick newborns.
}}We entered into a partnership with Volunteer Services Overseas (VSO) on newborn
health and survival to enhance coordination among specialist professionals and
capacity development measures in the Southern Zone of Tanzania.
The following health facilities have upgraded their level of newborn care:
}}Nyangao hospital established a center for advanced neonatal care.
GIZ Health Programme
Manager Dr. Inge Baumgarten
(right) and the VSO Country
Director Mr. Jean van
Wetter (left) during signing
of a Memorandum of
Understanding
}}Masasi district hospital established a new ward for newborns with five nurses, two
nurse attendants, and one clinical officer trained on basic neonatal management,
hygiene improvement and infection prevention. In addition, eight health facilities in
Masasi joined in the ‘No Baby Left Out’ initiative.
Integrated Quality Approach
We provide tailored technical assistance for quality improvement in hospitals at the regional and council level. With a focus on results, our support to hospital management
started with an initial baseline assessment to determine quality improvement practices.
To do so, the coverage of Quality Improvement (QI) action plans and follow-up on recommendations stated in the plan was assessed. The results showed that, on average, only 22%
of the activities agreed upon in QI action plans had been fully and verifiably accomplished.
This compares to 23% of activities clearly unaccomplished,
11% partially accomplished,
and 44% reported to be accomplished but without verification.
In addition, we identified key
players (institutions, individuals) in the area of quality management in Lindi and Mtwara,
and deficiencies in SRHR at
hospital level in these regions.
New Pediatric ward in Lindi
11
Results included
}}32 key QI players from the regional hospitals and two district hospitals (public
and private) of Lindi and Mtwara respectively Computer Assisted hospital data
management seven work stations operational at Muheza DDH (using Afyapro
software).
}}7 system users and seven hospital management team members trained.
}}5 work stations operational at Lushoto District Hospital.
}}7 system users trained/retrained. Management team members to be trained at a
later stage.
}}Mbeya Regional Referral Hospital supported to install software for CAHMA at four
work stations (registration, cash point, accounts, main pharmacy and dispensing
unit). The system is expected to become operational in February 2014.
}}9 staff members trained in basic computer skills. They are able to work with the
computer system for hospital management and to store and retrieve patients’ data
on a timely basis. This results in reduced patient waiting time.
Social determinants in health: water, hygiene and sanitation
In 2013 we embarked on collaboration with the GIZ Water Programme, to support implementation of the new national strategy on water and sanitation by MoSHW, MoW and
MoEVT. Our focus is on practical solutions to the challenges faced by health facilities and
to raise awareness on important determinants of health. We conducted an analysis of water and sanitation problems in hospitals and health stations in Tanga region. We assisted
the ministries in raising awareness of health, hygiene and sanitation. During the international days, we reached over 800 people at the national celebration as well as in Muheza/
Tanga and Rungwe/Mbeya.
Jointly with the QI teams in selected health facilities, we developed, user friendly posters
addressing the key issues that require adherence to quality standards e.g sterilization of
hospital equipment. To view the posters, visit www.tgpsh.or.tz
Awareness raising through
local theatre groups
12
Decentralized Health Governance
We support the implementation of decentralization in health management and stewardship (DbyD) by strengthening capacities in health management. This includes financial
and human resources management of selected management teams and oversight bodies
at regional and council level. Our focus is on Council Health Management Teams (CHMTs),
Council Health Service Boards (CHSBs), Facility Governing Committees (FGCs) and Regional Health Management Teams (RHMTs).
National level
GIZ colleagues distributing
information materials during
the HRH conference
Tanzania has a critical shortage (over 50%) of health workers and suffers from slow implementation of its Human Resources for Health (HRH) Strategic Plan. The Ministry,
through the national Technical Working Group on Human Resources for Health, this plan
which ended last year. Through technical input on retention and proactive recruitment at
council level, we linked the review to practical HRH recruitment and retention solutions,
thereby tackling the inequitable distribution of health staff across the country.
In Spetember 2013, we supported the first National Conference on Human Resources
for Health: a platform for exchange on a vast range of experiences. Important recommendations were elaborated during this event to encourage the government strategy to
successfully address the challenges in human resources for health. The recommendations
included: implementing commitments in the area of production of skilled health workers;
13
financing HRH to operationalize the pay and incentive policy; promoting retention, productivity and quality of health services; and developing and implementing a Task Sharing
Policy on HRH.
Through our contribution to the national Technical Working Group Regional and District
Health Services, we arranged training opportunities for regional and council health managers. Among other actions, we supported the complex process of quality assurance in the
country-wide, bottom-up annual planning exercise 2013/14.
Due to the persistent challenge of attracting and retaining skilled health (staff in rural
areas of Lindi and Mtwara is a particular challenge), we supported Councils in proactive
initiatives which resulted in a hands-on ‘How to’ guide for council administrators to:
}}proactively recruit and retain staff
}}sponsor and form relationships with local students
}}proactively recruit local students into training institutions
A practical success example can be seen as explained below:
In August 2012, the Nachingwea council agreed to set aside some funds in the CCHP
for lobbying in the Health Training institutions. Subsequently, the health secretary
and his assistant visited the training institutions in Nachingwea, Masasi, Newala,
Lindi Municipal and Mtwara Municipality to attract new graduates for employment
in Nachingwea council. Their visit was a success: 34 new staff were recruited
and reported for work. The council paid these new staff their initial salaries and
other allowances from its own sources (Crops Fund), while waiting for the central
government to employ and include them in the wage bill. These workers have
significantly reduced the shortage of trained health workers.
We joined hands with the councils in Mtwara and Lindi rural to co-finance the upgrading
of Clinical officers to Assitant Medical officers. This led to increased skills for the provision
of better health care services. The District Health Management course, a certified modular
professional advancement opportunity, is now integrated into the Zonal Health Training
Institute’s curriculum. This course is tailored to improve health management skills and
practices within the District Health System. The targets of this course are the core members of the CHMTs. We developed this course jointly with the MoHSW the Prime Minster’s
Office , Regional Administration and Local Government (PMO-RALG) and facilitated its
accreditation by National Council for Technical Education (NACTE) in early 2013. It will be
offered from 2014 at Zonal Health Resource Centers in Tanzania.
Early 2013, we supported an international exchange forum on Capacity Building for Effective Health (CBEH) course with participants from Cambodia, Kenya, Vietnam and Tanzania. The CBEH course aims at strengthening capacities of national institutions to jointly
tackle health system challenges. The Tanzanian group developed a ‘Constraints Resolution
Manual’ for Hospital management to identify and solve constraints in human resources at
the health facility level. The manual was received with great interest by hospital managers
in Tanga and Lindi region and is available at www.tgpsh.or.tz
14
Cooperation with the Private Sector
The importance of the private sector for Tanzania’s health system is widely acknowledged.
About 27% of the country’s health care services are delivered by private providers, mostly
faith-based organizations. Inadequate cooperation between the government and private
sector is therefore a definite missed opportunity for improved services. However, for
partnerships to be efficient and effective, there is a need for more systemic approaches to
engagement.
In 2013, we continued our support of the government’s health sector reform processes
with activities aimed at strengthening cooperation between the government, private sector and civil society actors for the delivery of quality health services in the country.
National level
Enabling PPP policy and regulatory framework
With policy (2009), Act (2010) and regulations (2011) for PPP in place, GIZ has continued
to advocate and provide technical assistance through the national PPP-Technical Working
Group and other forums to streamline national policies into health sector guidelines for
the implementation of PPP. In 2013, we supported two stakeholders’ sessions that enabled
finalization of the health sector policy guidelines to be launched in December 2013.
}}In collaborative efforts to address financing barriers in health, an option paper was
developed. This indicated unexplored funding opportunities from both public and private
sectors and will inform the Health Sector Financing Strategy to be finalized in 2014.
15
}}Advocacy for PPP has been undertaken in all four regions (Lindi, Tanga, Mbeya, and
Mtwara) through the regional health forums which were organized by the Regional
Medical Offices. An information kit with all crucial PPP documents has been produced
and is ready for dissemination.
}}As part of additional advocacy and dissemination strategy for PPP, the resource center
has continued developing and distributing various IEC materials e.g. three editions of
the PPP Health Newsletter, posting articles on the Africa Health Journal etc.
Formalized dialogue mechanisms for exchange and positioning of private and
public actors
The absence of a sector-wide public-private dialogue in health inhibits effective multisectoral discourse on health system issues. In response to this, and in collaboration with
other stakeholders, GIZ has supported the formulation of a Public Private Health Forum in
Tanzania (PPHF) as part of efforts to build trust, facilitate an enabling
Public-Private Forum
policy environment, identify opportunities, and promote PPPs in
for Health in Tanzania
health. The PPHF’s board, a management organ, is chaired by the
government representative while
Forum Board
the private sector co-chairs the
Resource
board. The Board meets on quarCenter
Secretariat
terly basis in a rotational fashion. In
the first board meeting in September,
members agreed on the Terms of Reference and an action
plan for implementation is underway for the first annual
forum meeting in March 2014.
The federation of 32 health professionals’ associations in
Tanzania has also been formulated as part of efforts to organize and strengthen the private sector. Lead by TPHA, the
federation will assist in overseeing matters related to professional ethics and quality of health services.
PPP Health Forum Board
Increasing number of formal Public Private Partnerships
The importance of cooperation between the government and private sector in health increases when the interests of people, particularly the most vulnerable groups, are served.
Through GIZ support, 28 Health Service Agreements have been signed in Tanga, Mbeya
and Lindi within a span of six years. The assessment of service agreement implementation has shown, among other things, that hospital attendance rates in private facilities
increased when hospital costs were subsidized.
PPP Knowledge Management and Research
Through joint efforts among PPP partners, a PPP Resource Centre for Health has been
established. This serves as a center and platform for facilitating partnership dialogue, networking and exchange of resources, including innovative partnership ideas on a national
and regional scale. The resource center has driven the process of establishing the Public
Private Health Forum and the Federation of Professionals’ Associations in Tanzania.
Further research on PPP is being supported through the resource center by encouraging
students doing masters programmes to design and conduct PPP research: particularly in
health.
16
28 Service Agreements signed
in 4 GIZ support regions
Challenges
}}Transforming existing policy and guidelines for PPP into action remains an obstacle to
effective implementation.
}}Lack of strategic health financing, including sufficient access to finance for the private
sector, and gaps in leveraging the private sector’s contribution.
}}Inadequate number of skilled health professionals.
Outlook 2014
We will continue strengthening the PPP Business Models for financial sustainability and
will institutionalize the PPP dialogue forums at regional and district levels, from where
implementation will take place. Additionally, we will advocate for further leveraging of
the Private for Profit, and partner with the private sector in addressing the HRH crisis by
strengthening the training, recruitment and retention of health workers.
Support to Workplace Programmes in the Private Sector
Effective and sustainable workplace programmes need to respond to the actual health
risks of the workforce. In 2013, we provided technical assistance to the Association of Tanzania Employers (ATE) in its role as focal point for HIV&AIDS in the private sector. Our
assistance comprised:
Manual for Coordination
of Workplace Programme
for HIV/AIDS and Health
Promotion
}}Co-funding of the Private Sector HIV Coordinator at ATE since July 2012. The
coordinator is working hand in hand with ATE permanent staff to effectively
coordinate the HIV response of the private sector and to support private companies in
setting up workplace health programmes.
}}Development of a 2013-2015 Private Sector Strategic Plan for ATE and Tanzania Private
Sector Foundation (TPSF). This plan has been translated into an operational plan which
guides the work of ATE and TPSF and inspires private companies to mainstream HIV
and AIDS as stipulated in the national strategies i.e. the National HIV Policy and Multisectoral Strategic Framework.
17
}}Development of a comprehensive Workplace Manual
for Coordinators in cooperation with ILO and ATE.
The manual will serve as a valuable resource for WPP
coordinators and guide them when designing and
implementing comprehensive health promotion and
HIV/AIDS programmes within their workplaces.
Participants learned how to
use the Cost Benefit Analysis
Tool during a three day
training (November 2013).
}}Building capacity of key partners in the public and
private sector on the use of the Cost Benefit Analysis
Tool. The tool enables employers to visualize the
benefits of employee health interventions in terms of
productivity gains and cost savings. The tool will be
further promoted by GIZ and ATE and applied by private
companies.
In cooperation with ATE, GIZ has provided support to the development and implementation of HIV/AIDS and health promotion workplace programmes in private companies:
}}Amboni Sisal Estate Ltd and Lugongo Spinning Mill in Tanga: GIZ and ATE assisted
the development of HIV/AIDS and health policies as well as action plans for the
implementation of the workplace programmes.
}}Olam Tanzania Ltd cashew factory in Mtwara: Expansion of the workplace programme
from the factory in Mtwara Municipality to other Olam sites in Masasi District, training
of peer educators, enrollment of workers to CHF.
}}Aviv Ltd coffee plantation in Songea/Ruvuma: Signature of MoU between ATE, GIZ and
Aviv Ltd., implementation of monthly health information sessions, improvement of
facilities at workplace, provision of preventive items and organization of health day on
World AIDS Day.
Signing the Memorandum
of Understanding from left
to right: Director Dr. Aggrey
K. Mlimuka (ATE), Aviv Ltd.
representative Jeremy Dufour
and GIZ Health Programme
Manager Dr. Inge Baumgarten
18
Strengthening Civil Society Organizations
Focus on Global Fund and Youth
Our support to civil society organizations (CSO ) aims at strengthening their project management capacities so that they are able to mobilize resources, efficiently and transparently manage projects, and provide effective services to the population. We facilitate cooperation among CSOs and local government authorities so that a common voice of civil
society is expressed and considered in policy discussions and budget allocations. A special
focus is placed on civil society participation in the coordination of Global Fund grants in
Tanzania. Youth empowerment and advocacy for adolescent-friendly sexual and reproductive health services are integrated in all these activities.
Gender and HIV & AIDS
Training Manual
GIZ works closely with evaplan International Health at the University Hospital Heidelberg, which has extensive experience in the area of health and CSO capacity building in
Tanzania. The German Foundation for World Population (DSW) Tanzania, known for its
dynamic youth-to-youth experience, also participates.
National level
At the national level we facilitated the coordination of CSOs, in particular their participation in the Tanzania National Coordination Mechanism (TNCM) for the Global Fund
grants in Tanzania.
In order to establish how CSO networks currently coordinate their work and what support
might be needed, an analysis based on interviews with key CSO networks was conducted.
19
At a CSO workshop (November 2013), where the results were
discussed, stakeholders agreed that civil society representatives in the TNCM will take the lead in organizing a coordination mechanism and regular meetings of CSOs to discuss
issues around the Global Fund. GIZ will continue supporting
this process. The final report of the analysis and workshop is
available on the TGPSH website www.tgpsh.or.tz.
To expand the support to other non-governmental representatives in the TNCM, GIZ supported a meeting of non-state
CSO representatives
discussing about coordination
mechanisms during the GIZ
workshop
TNCM members (December 2013). During this meeting the
current understanding of their role as TNCM members and
the way it is put into practice was reviewed. The required areas of support were identified and will be addressed in 2014. The objective is to strengthen
the effectiveness of the TNCM by strengthening the capacities and coordination of the
different members.
By participating in TNCM meetings, Development Partners Group HIV/AIDS, TACAIDS
Technical Working Committee on HIV Prevention and the Technical Working Group on
Adolescent Reproductive Health, GIZ technical experts contributed to the development of
policies and strategies in coordination with other partners.
Numerous experiences and lessons learned have been documented for future use. They
are available as downloads on the www.tgpsh.or.tz:
}}Gender and HIV/AIDS Training Manual in English and Kiswahili.
}}Summary of 30 years GIZ support to Adolescent Reproductive Health.
}}Summary of how the GIZ health programme implements the human rights based
approach and right to health in its activities.
Youth festival in Lindi carried
out jointly by GIZ & Femina
HIP
20
Peer educators raising
awareness on health issues
for young people
Our CSO support centers on Mtwara Region where a number of economic and cultural
factors increase vulnerability, particularly amongst young people. The support, in cooperation with the consulting company evaplan and the NGO DSW Tanzania (a long-term
consultant in Mtwara region) started in October 2013. Since then the following activities
have been conducted:
}}During a CSO stakeholder workshop in Mtwara (October 2013) the key people from the
Local Government Authorities were brought together with CSOs from the region. They
were informed about the upcoming support and a mapping of CSOs and their activities
was carried out to inform the selection of partner organisations.
}}In November and December 2013, a capacity assessment of CSOs in Mtwara was
conducted to guide the selection of partnering CSOs and set a baseline of the project
management capacities that will be strengthened by our support.
}}To collect ideas to address the livelihood skills of young people and potential income
generating activities, a mapping of existing initiatives was conducted in Dar es Salaam
and Mtwara. Ideas for cooperation and exchange will be followed up in 2014.
In cooperation with the NGO Femina HIP, we reached out to young people in Lindi region
in November/December 2013:
}}A Family and Youth Festival gave young people the opportunity to express their views
on growing up and the challenges involved.
}}An orientation of peer educators among youth on Information Education and
Communication (IEC) materials (such as Fema Magazine) was not only a fun event, but
will also strengthen the quality of advice offered in youth groups.
}}Young people in Lindi participated in the collection and production of TV, radio and
print media. They thus enjoyed the opportunity to voice their ideas and wishes whilst
learning how print, radio and TV programmes are developed and raising their interest
in this potential field of work.
21
List of publications and studies
supported in 2013
Social Health Protection
1. Options for Health Insurance Market Structure – Jan Bultman & Anselmi Mushy
(GIZ/P4H).
2. Recommendations for Minimum Benefit Package – Grant Rhodes, Emmanuel
Malangalila, Daniel Ngowi (P4H/ Abt Associates).
3. Tanzanian Health Insurance Institutional & Organizational Assessment – Jan Bultman,
G. Mtei (GIZ).
4. Health Provider Autonomy, a District Focus – Hernan Fuenzalida, Meinolf Kuper (GIZ).
5. Inclusion of the Poor and Vulnerable – Manfred Stoermer, Flora Kessy, Theresa Widmer
(GIZ, SDC).
6. CHF Reform Options – Ulrika Enmar, G. Mtei (GIZ, SDC).
7. National Costing Study – MoHSW, Chris James, Mark Bura, Tim Ensor with inputs from
Sourovi De and Sarah Fox , GIZ.
Quality Health Services
1. Quality baseline Survey 2013, GIZ.
2. Tansania: Rehemas Babys – der Wert der Neugeborenen, Brockmeyer, Holger Dtsch
Arztebl 2013; 110(4): A–130/B–119/C–119.
3. The internal migration between public and faith-based health providers: a crosssectional, retrospective and multi-centre study from southern Tanzania – Tabatabai, P.,
H. Prytherch, I. Baumgarten, et al., published in the Tropical Medicine and International
Health 2013, it was first published online 04 April 2013, DOI: 10.1111/tmi.12107.
4. Public and Private Maternal Health Service Capacity and Patient Flows in Southern
Tanzania: Using a Geographic Information System to Link Hospital and National
Census Data, this article was published in the Global Health Action, January 2014
www.globalhealthaction.net/index.php/gha/article/view/22883.
5. “No Money, No Service” Community perspectives on health services experience, a study
to inform the Mid-Term Review of the Health Sector Strategic Plan III, Tanzania –
Crawford, S., Macha, J., Mutalemwa, P., (DANIDA, GIZ).
22
Decentralized Health Governance
1. Use of potential companies’ Corporate Social Responsibility (CSR) for financing
Retention of Health Workers – Dr. Honest Prosper Ngowi (GIZ).
2. Capacity assessment of Civil Society Organizations in Mtwara District Council for
health governance and accountability advocacy – Health Promotion Tanzania (GIZ).
3. Assessment of strengths and gaps in the context of CCHPs quality, preparation and
approval in 8 councils of Mtwara, Lindi, Mbeya and Tanga regions – Dr. Kahabi G.
Isangula (GIZ).
4. How to retain health care workers – a list of practical experiences from Tanga, Mtwara,
Lindi, Mbeya and Kigoma regions – Regional HRH Committees – Mtwara and Lindi
(GIZ).
5. Practical Guides based on Southern Tanzania Experiences with:
}}Proactive health staff recruitment and retention (GIZ).
}}Proactive student enrolment in Training Institutions (GIZ).
}}Quota, Sponsoring and Bonding of Students & Health Workers (GIZ).
Cooperation with the private sector
1. Assessment Study of the Service Agreement Tool and its implementation in TGPSH
supported regions GIZ, CSSC.
2. Health Care Financing Option Paper: Options for Improved Financing for public
private partnership to impact health service provision.
3. Strengthening the Capacity and Organization of TPHA to effectively respond to Public
Health Matters.
Civil Society Organizations
1. Mapping of initiatives to develop livelihood skills of young people (living with diseases
e.g HIV and those living with disabilities).
2. Analysis of selected National Coordination Structures of Civil Society Organizations
(in cooperation with TACAIDS and UNAIDS).
3. Manual for Workplace Coordinators on HIV and Health Promotion at the Workplace
(English and Kiswahili).
4. Gender and HIV Training Manual (English and Kiswahili).
5. Step-by-Step-Guide to strengthen advocacy for gender sensitive HIV programming in
Mtwara region (still to be finalized).
23
Financial Summary – 2013
Spendings in 2013 towards Capacity Development and Implementation in all Regions
The GIZ* Health Programme is active in four regions
of Tanzania (Lindi, Mbeya, Mtwara and Tanga) as well
as on the National level. In the year 2013, 1.4 Million
Euros were spent towards Capacity Development
and Implementation. The budget was divided as
follows.
■ Programme Coordination
4%
■ Social Health Protection
12%
■ Quality in Health Services
■ Decentralized Health Governance
37%
■ Cooperation with Private Sector
47%
■ Strengthening Civil
Society Organization
Region
National Level
Lindi
Mbeya
Mtwara
Tanga
TOTAL
Programme
Coordination
53.660
0
0
0
0
53.660
Social Health
Protection
331.564
82.141
55.859
41.275
19.552
530.391
Decentralized
Health Services
154.791
125.900
118.176
200.380
72.401
671.648
Private Sector
and Civil Society
129.800
3.401
10.576
7.891
10.699
162.366
Total
669.815
211.442
184.611
249.546
102.652
1.418.065
Population
47.780.000
864.652
2.707.410
1.270.854
2.045.205
Male
23651100
414.507
1.297.738
599.648
992.347
Female
24128900
450.145
1.409.672
671.206
1.052.858
8%
2%
19%
23%
50%
59%
3%
6%
64%
*As a federally owned enterprise, we support the German Government in achieving
its objectives in the field of international cooperation for sustainable development.
24
17%
30%
39%
10%
80%
19%
71%

Better Services for Better Health Tanzanian German

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