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

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SWAP Sector-Wide Approach TA Technical Assistance TACAIDS Tanzania Commission for AIDS (Prime Minister’s Office) TCU Tanzania Commission for Universities TDHS Tanzania Demographic Health Survey TEHIP Tanzania Essential Health Initiative Project TFDA Tanzania Food and Drug Authority TFNC Tanzania Food and Nutrition Centre THIS Tanzania HIV Indicator Survey TIKA Tiba Kwa Kadi (urban expansion of the CHF) TMAP Tanzania Multi-Sectoral AIDS Programme TNMC Tanzania Nurses and Midwives Council TOR Terms of Reference TRCH Tanzania Reproductive Child Health Survey TSPA Tanzania Service Provision Survey (2006) TZS Tanzanian Shilling U5MR Under Five Mortality Rate UNICEF United Nations Children's Fund USD United States Dollar VCT Voluntary Counselling and Testing VHC Village Health Centre VP Vertical Programme WHO World Health Organization WPF World Food Programme ZTC Zonal Training Centres 8
Executive Summary During the 1990s, the health sector in Tanzania faced a period of comparative stagnation and even decline. According to reports in the latter part of the decade, local health services were characterized by severe shortages of essential drugs, equipment and supplies and deteriorating infrastructure and were also plagued by poor management, lack of supervision and lack of staff motivation. The sector also faced stagnating or deteriorating hospital care. There was little cooperation or coordination in health service delivery between the public sector, Faith Based Organizations (FBOs), and private service providers. The health sector was severely under-funded, with public health sector spending at USD 3.46 per capita. There was also little coordination of support to the health sector by Development Partners (DP). The Government of Tanzania (GoT) and DPs responded to this situation together in a process which can be traced back to a joint planning mission convened by the GoT in middecade. By 1999, this process resulted in the first major health sector strategic plan, the Health Sector Program of Work (POW) and an agreement between the GoT and DPs that support to the health sector would take place in the framework of a Sector Wide Approach (SWAP). The POW and subsequent Health Sector Strategic Plan 2 (HSSP 2) articulated a process of health sector reform aimed at addressing the recognizable deficiencies in the sector and achieving specific goals and targets in health as set out in the Millennium Development Goals (MDGs) and the National Strategy for Growth and Reduction of Poverty (NSGRP)/MKUKUTA). The POW and HSSP2 identified priority areas of strategic intervention intended to contribute directly to achieving the health sector goals. These included: • Strengthening district health services; • Transforming the role of the central Ministry of Health and Social Welfare (MOHSW) into a facilitative policy organization; • Reforming and strengthening regional and national referral hospitals; • Improving central support systems; • Dealing more effectively with issues in human resources for health (HRH); • Improving the level, appropriateness and sustainability of health care financing; • Promoting public private partnership (PPP); • Adopting and implementing a national strategy for combating HIV/AIDS as an explicit element of HSSP2 in 2002; and, • Improving GoT and DP relations to improve harmonisation and alignment of external and Tanzanian resources in a more effective partnership for health. Evaluation Focus and Approach The evaluation focused on four thematic areas: 1. The relevance of health sector strategic and implementation plans to achievement of the MDGs in health and to MKUKUTA health sector goals and targets, and the appropriateness and relevance of external support; 9
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: MTEF Medium Term Expenditure Framew
Page 11 and 12: Achievements Under Health Sector St
Page 13 and 14: their overall spending has risen si
Page 15 and 16: National ownership has been strengt
Page 17 and 18: 1 Evaluation Approach and Methodolo
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
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less likely to migrate (page 48). O
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The district case studies were not
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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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