Joint External Evaluation of the Health Sector in Tanzania: Draft ...

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System-Wide Recommendations for HSSP3 Only recommendations with medium and longer-term implications for the development of HSSP3 are provided here in the executive summary. An extensive list of detailed evaluation recommendations is included in the final chapter of the report. 1. The GoT and Development Partners should maintain the SWAP programming format to structure their cooperation in the health sector in Tanzania during HSSP3 along with detailed adjustments and improvement aimed at streamlining review and decision making structures and processes as specified in later recommendations. 2. An HBF and direct GoT grants to councils for the operation of health services based on a transparent resource allocation formula should remain a feature of the sector during HSSP3. 3. HSSP3 should be used to consolidate the achievements of HSSP2 and to address identified constraints related to already agreed reforms, rather than embarking on new ones. 4. HSSP3 should retain the strategic priorities of HSSP2, but include concrete steps to considerably accelerate progress in both hospital reform and public private partnership as set out in the detailed recommendations below. 5. Effective action to reduce maternal mortality and improve delivery services, including emergency obstetric care, should be a stated strategic priority of HSSP3. 6. Improving equity of access should be a cross-cutting theme of HSSP3. MOHSW should strengthen its capacity to review and modify policies and programmes with a view to improving equity and taking action to remove barriers to access. This should include establishing a focal point within the ministry whose mandate will include all aspects of equity, including gender equity. 7. HSSP3 should include specific strategies to improve efficiency of service delivery both in PHFs and hospitals, by increasing the productivity of health sector personnel and better matching staffing levels to work loads. 8. A Health Inspectorate (for which legislation has been prepared) should be established. The Health Services Inspectorate Unit in the MOHSW should be strengthened and regional offices should be established. The MOHSW should consider the option of transforming the RHMT into regional health inspection units. 16
1 Evaluation Approach and Methodology 1.1 Evaluation Focus and Key Issues Background and Objectives of the Evaluation At the April 2006 Joint Annual Health Sector Review (JAHSR), the Ministry of Health and Social Welfare (MOHSW) pointed out that any contemplated external evaluation of the health sector in Tanzania should be coordinated with the national health sector planning process to provide useful input in the development of the Third Health Sector Strategic Plan (HSSP3) covering the years 2008-15. Development Partners (DPs) and the Government of Tanzania (GoT) had been discussing for some time plans to undertake a joint evaluation of the sector in light of the eight-year history of support through a sector-wide approach (SWAP). As a result of the convergence of planning for an external sector evaluation and the need to provide input to the development of HSSP3, an international tender was issued calling for proposals to conduct a joint external evaluation of the health sector in Tanzania. The tender was awarded in November 2006 to a consortium comprised of COWI A/S (Denmark), EPOS Health Consultants GmbH (Germany) and Goss Gilroy Inc. (Canada). The evaluation was carried out from December 2006 to September 2007. The Terms of Reference (TOR) of the joint evaluation provide a clear statement of its overall and specific objectives. Overall Objective The overall objective of the Joint External Evaluation is to provide solid evidence about the relevance and effectiveness of the joint development work in the health sector. The purpose is to demonstrate results, and show “what works” and “what made/makes the difference” in order to learn from experience and to link evidence to policy and strategic development. Specific Objectives 1. Evaluate the performance of the health sector in the period 1999-2006 against the Millennium Development Goals (MDGs) and the objectives of the PRSP/MKUKUTA 1 in general and HSSP1 (1999-2002) 2 and HSSP2 (2003- 2008) 3 in particular in light of the needs of the Tanzanian population. 2. Evaluate partnership in terms of cooperation modalities, harmonisation, alignment and dialogue between the Government, the DPs and other stakeholders over the same period. 1 National Strategy for Growth and Reduction of Poverty (NSGRP)/MKUKUTA. Vice President’s Office, United Republic of Tanzania. 2005. 2 The Health Sector Reform Programme of Work: July 1999 – June 2002. Ministry of Health, United Republic of Tanzania. 1999. 3 Second Health Sector Strategic Plan (HSSP) (July 2003 – June 2008). Ministy of Health. United Republic of Tanzania. 2003. 17
Page 1 and 2: Joint External Evaluation of the He
Page 3 and 4: 9 Health Care Financing............
Page 5 and 6: Abbreviations ACT Artemisinin-based
Page 7 and 8: MTEF Medium Term Expenditure Framew
Page 9 and 10: Executive Summary During the 1990s,
Page 11 and 12: Achievements Under Health Sector St
Page 13 and 14: their overall spending has risen si
Page 15: National ownership has been strengt
Page 19 and 20: The evaluation developed a document
Page 21 and 22: udgeting and expenditures at counci
Page 23 and 24: 1.4 The Evaluation Team A team of e
Page 25 and 26: • Weak Health Management Informat
Page 27 and 28: 3.2 Relevance of External Support E
Page 29 and 30: However, the decentralisation proce
Page 31 and 32: Finally in regard to CHSBs, members
Page 33 and 34: The process of preparing the annual
Page 35 and 36: feature more largely in health plan
Page 37 and 38: 5 Changing Roles of the Central Min
Page 39 and 40: cooperation should work at differen
Page 41 and 42: 3. health inspectorate (at present
Page 43 and 44: The HSSP2 did include most of the p
Page 45 and 46: Regional Hospital, Mwanza) of drugs
Page 47 and 48: 7 Central Support Systems Conclusio
Page 49 and 50: new public facilities very near tho
Page 51 and 52: Vertical Programmes The inefficienc
Page 53 and 54: udget, or assist HFs in using cost-
Page 55 and 56: MSD’s Monopoly and Alternative So
Page 57 and 58: topics. The limitation of these sou
Page 59 and 60: HRH management capacities, increase
Page 61 and 62: less likely to migrate (page 48). O
Page 63 and 64: The district case studies were not
Page 65 and 66: individual targets, there is no obj
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Table 2: Overview of Main Sources o
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during the evaluation period, most
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sustainable in the medium term give
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9.4 Budget Performance Overview A k
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of cost sharing and risk pooling me
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therefore important that an exempti
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10 Public Private Partnership Concl
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The Technical Review presented the
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The district self-assessments and d
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11.1 Achievements in Extending HIV/
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• Post-Exposure Prophylaxis (PEP)
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11.3 The Challenges of Integrating
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12 Service Quality, Access and Equi
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services 99 . Of the groups partici
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Equity Issues and MOHSW The issue o
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Table 6: Progress Against Targets I
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With regard to tuberculosis, MOHSW
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14 Development Partnership Conclusi
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More recently, the MOHSW has been a
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The DPG Health meetings have addres
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considerable resources have been ch
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informants felt that the presence o
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still only part of the picture and
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15 Main Evaluation Conclusions Chap
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egional offices should be establish
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inspectorate, regulation of the pri
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process of drugs procurement and su
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Recruitment and Deployment 77. Coun
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108. Depending on the activity leve
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Annex 1 Evaluation Terms of Referen
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personnel from 50% to 80%, and vari
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the involvement and thus the owners
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4.3 Intended Users/Audience of the
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esults of existing quantitative sur
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• Assess the efficiency of inputs
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o Interrelation in terms of availab
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o Ability of the target population
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o Adequacy of objectives and strate
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Abdallah, S., Mwihumbo, T., Ndangal
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Government of Tanzanina Terms of Re
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Annex 3 Documents Reviewed 147
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Garrett, L (2007) The Challenge of
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Government of Tanzania (2004) Tanza
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Government of Tanzania (April 2003)
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Humba, Emmanuel (2005) Social Healt
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WHO (2001) Macroeconomics and Healt
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MOHSW Harun Kasale, lead consultant
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Association of Private Health Facil
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Annex 5 Financial Charts and Models
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Chart 5: HIV/AIDS Financing Aid Not
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Financial Flow Models Flow of Funds
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Name District: ………………
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