United Republic of Tanzania INSTITUTIONALIZATION OF VAS IN TANZANIA

Transcription

1 United Republic of Tanzania INSTITUTIONALIZATION OF VAS IN TANZANIA Dakar, 6 April 2016

2 Background INSTITUTIONALIZATION OF VAS IN TANZANIA In Tanzania Twice-yearly VAS started since 2001 in June and December through Child Health Days VAS was integrated with Deworming in June 2004 Delivery mechanism include CHDs and routine The two interventions achieved coverage over 85% (Annual CHDs coverage reports, ) 1

3 Background cont INSTITUTIONALIZATION OF VAS IN TANZANIA The program received financial and technical support from partners including UNICEF, DFATD, USAID, HKI, MI and WHO Government provides human resource, logistical support, coordination, social mobilization, monitoring and reporting 2

4 Integration of VAS into health service delivery systems In 2008, the ownership of VAS was gradually shifted to Local Government Authorities (LGAs) Donor s fund for VAS was channeled through Health Basket Fund Advocated to regional and district decision makers and technical teams on mainstreaming VAS into their annual health plans and budgets LGAs started planning and budgeting for VAS through Comprehensive Council Health Plans (CCHP) operated under principles of Health Sector 3

5 Decision towards SWAp In Tanzania, VAS and Deworming was coordinated by a National Taskforce on VAS as an advisory body to the Government For the purpose of sustainability and community ownership, the VAS Task Force decided to decentralize VAS events to LGAs in planning and resource allocation Policies, guidelines and supplies availability are handled at national level 4

6 Advocacy for VAS VAS Task Force comprise members from multiple sectors, Government ministries, institutions, UN Agencies and national and international NGOs advised the Government to mainstream VAS into health sector annual plans and budget Zonal VAS annual reviews provided feedback, identified challenges and developed strategies for improvement In 2011 VAS zonal review meetings broadened to Zonal Planning and Budgeting for Nutrition where VAS was among nutrition specific interventions In 2012 created and rolled out Social mobilization Toolkit to improve knowledge of VAS and timing of events 5

7 Main Funded Budget line Items and source (FY2015) 17% 5% 8% Clearance of supplies (UNICEF) Distribution (Government) 13% 4% Advocacy and Communication campaign (UNICEF) Supportive supervsion (UNICEF/HKI/Govt) Supplementation (Govt) 53% Zonal planning and budgeting meetings (UNICEF/HKI/FHI360) 6

8 Logic on allocations of resources Amount and value of supplies Target population Delivery mechanism Number of staff engaged during service delivery Number of days planned for VAS distribution event Geographical distribution and infrastructure Hard to reach population Channels/means of communication 7

9 Factors impact sustainability Enabling environment: Policy and guidelines Availability and accessibility of adequate and quality supplies Level of Government support Leadership support Well defined coordination roles at all levels Ownership from national and local Government Planning & management Skilled and motivated service providers Supply chain management Community demand for VAS Monitoring, evaluation and feedback 8

10 Pre-conditions Availability of sufficient fund Effective use of Social and Behavior change communication strategy Demand creation to the community Availability of the trained frontline service providers on VAS Presence of well functioning supply chain management system Availability of support from the Government, partners and the community 9

11 Success All district councils include VAS in their annual plans and budgets VAS ownership by LGAs and Health Sector Reported coverage is consistently above 80% for over ten years Moving towards Child Health and Nutrition Month (CHNM) from VAS campaign and CHDs Piloted Integration of VAS at 6 month with routine health services Standardized planning and budgeting for VAS for Local Government Authorities (LGAs) Creation of standardized Social Mobilization Toolkit 10

12 % of VAS coverage Tanzania VAS coverage trend Round 1 Round 2 0 Years Source: Tanzania Food and Nutrition Centre 17

13 % of VAS coverage Tanzania VAS coverage trend % 61% 46% Years Sources: TDHS 2005, 2010; TNNS

14 Challenges Inadequate opportunities to integrate VAS into all existing contacts Inadequate of Micro-planning for VAS by district councils Inadequate social mobilization Delays in submitting coverage data reports Inadequate linkages between health facilities and the community they serve Inadequate human resource 13

15 100% National VAS Bottleneck Analysis Graph March % 60% 40% 68% 63% 92% 88% 20% 36% 0% Proportion of health facilities with no stockouts of vitamin A (200,000 IU) lasting more than one weeks in the last round Proportion of of Staff trained in vitamin A supplementation Proportion of Villages with access within 5 km of health facility providing Vitamin A supplementation Proportion of children 6-59 months who have received vitamin A supplementation during the previous 6 months Proportion of children 6-59 months who received 2 annual doses of Vitamin A supplementation Commodities HR Geographical Access Utilization Continuity- Quality 14

16 Threats Increase nutrition priorities within LGAs: Implementation of Parallel nutrition interventions/projects Change in donor s priorities Decreased level of U5MR in Tanzania Advancing from poor to middle income country 15

17 Opportunities Growing priorities of nutrition interventions as per Global SUN movement Institutionalization of Community Health Workers cadre in Tanzania Gradual shifting from VASD/CHDs to Child Health and Nutrition Month (CHNM) with package of interventions Development of National CHNM guideline by the Government 16

18 Ways forward Strengthen ownership of VAS through training and advocacy of frontline Health workers Conduct Micro-planning at district level to address bottlenecks identified from BNA Strengthen supply chain management Strengthen financing nutrition services including VAS through the Government Finalize development of national CHNM guideline 17

19 Thank you for listening