Report on analysis of CCHP and RHMT reports and plans

Transcription

1 Report on analysis of CCHP and RHMT reports and plans 10 th TECHNICAL REVIEW MEETING FOR 2009 HELD AT UBUNGO BLUE PEARL HOTEL ON 15 TH TO 17 TH SEPTEMBER, 2009 Anna Nswilla Coordinator District Health Services

2 Report presentation Introduction Objectives of the CCHP analysed report Methodology Findings Progress report January-March 2009 Financial report Technical Report

3 Report presentation.. Comprehensive Council Health plan 2009/10 General issues observed during the assessment using the assessment criteria Human resources Various funding sources for CCHP Health facilities status Water and Sanitation status MDGs related performance Budget allocated for RCHS activities RHMT plans General observations & recommendations

4 Introduction The report is a products of 21 RS/RHMTs assessment reports of Comprehensive Council Health Plans 2009/2010 and third Quarter progress report (Jan Mar 2009) from 132 LGAs The central level compiled the reports using the RS/RHMTs regional reports, Verification of RS/RHMT the data RS/RHMT from 4 th to 20 th May 2009 (6 members Reporting formant template availed the RS/RHMT

5 OBJECTIVE OF THE CCHP ANALYSED REPORT 2009/2009 Broad objectives To assist LGAs to come out with cooperative plans that will improve the quality of health service delivery through proper management of allocated funds to the LGAs.

6 Specific objectives To asses annual comprehensive Council Health Plans for the year 2009/2010 To identify regions and hence Council that need further Technical assistance to improve their plans and progress reports. To assess for compliance to the criterion in respect of completeness, consistency, accuracy, relevance in measuring the desired results of addressing identified priority health problems and status of implementation of CCHPs through the technical progress report. To get approximately the picture on the resource envelope for funding the CCHP 2009/10 activities.

7 Specific objectives To get an overview on status of Human resources (Establishment/ requirement, available and deficit). To assess the status of health facilities (Total number available, good condition, minor and major repair and new construction). To get a picture on the implementation of MDGs related performances To assess the accessibility to water and Sanitation services To determine the budget allocated to RCHS activities and CHSB & HFGC. To find out whether the RS/RHMTs has managed to assess the LGA s CCHP and produce a quality report. To assess RS/RHMT plan

8 METHODOLOGY Data extracted from CCHP plans and reports from all councils (132) and RHMT reports from 21 regions The team analysed the data and compiled the report The gathered data was initially entered into the Microsoft Excel 2007 for editing and cleaning, Later was exported to the Statistical Package for Social Scientists version 11 (SPSS 11) for further analysis to produce percentages and cross tabulation. Graphing was prepared using Microsoft Excel 2007 and afterward Microsoft Word 2007 was used to prepare the final report.

9 FINDINGS PROGRESS REPORT (JANUARY MARCH 2009)

10 Criteria for performance Report Max pass point Minimum pass point Technical Financial Combined Report

11 Criteria for performance The combined and summarized technical and financial scores indicate that Iringa, Shinyanga and Singida regions have done remarkably well. Other regions Manyara, Dodoma, Arusha and Morogoro have scored above minimum passing point (52.5) Regions which performed below minimum pass point (52.5) were Rukwa, Tabora and Kagera.

12 An aggregated financial and technical reports performance per region

13 Financial reports There is a bit improvement in the preparation of quality reports, however, some weakness and challenges have been observed during assessment these were-: There were no explanation on C/F activities, Reported achievements were miscalculated, BYD was either not apportioned correctly or not understood, Executive summary was not matching, Annex 7 and A/C return was not correctly done,

14 Financial Report

15 Reports.. Ministries should not be seen to abdicate from the primary responsibilities of supporting the regions in planning and financial management. Need urgent call and attention to the seemingly weak regions of Rukwa, Tabora and Kagera. There is a need to look for options which will work for the weak, strengthening the average performers and encouraging those who are doing well to continue to be able to do so.

16 Performance of regions on technical report

17 Technical All Councils are doing well in the technical report with an average of 80% and above. But there are some weaknesses. Delay of disbursement of basket funds. We need to note the delays as one factor undermining the performance of the LGAs and this is beyond their means.

18 Challenges Reasons given for partial implementation of activities and those not done were mainly Price fluctuations. Delay of funds from Government and partners, Long tendering procedures for procurement of goods and services, Lack of delay of facilitators for training activities Out of stock for some of important supplies and equipment ordered from MSD

19 Challenges. Shortage of skilled human resources for health Frequent change of health sector accountants in councils No one is taking trouble to cost Council contribution so that can be expressed in monetary terms as receipt in kind. These reasons are generic to all LGAs and the public systems in general. Require central intervention and this is urgently needed and also in a consistent manner.

20 COMPREHENSIVE COUNCIL HEALTH PLANS (CCHPS) 2009/10 General issues planned assessment score criteria Presentation by score for each Council and this information was then critically analysed. At the initial stage the data was analysed at the council level in order to identify areas which need further action. Afterward, the information was summarized per regions for deep analysis so as to enable one to clearly trace the performance of CCHP in regions level.

21 CCHP 2009/10 performance per region Arusha Mara Dodoma Mtwara K'jaro Mbeya Iringa Shinyanga Morogoro Kagera Lindi Singida Kigoma Tanga Ruvuma Tabora Mwanza Manyara Coast Dsm Rukwa

22 Observations from the CCHP The result has revealed that Rukwa region has performed below the minimum pass point (70), Arusha regions managed to attain above 90 pass point. The rest of regions have performed well, ranging between 90 and 70 points as clearly indicated in the figure above

23 Observations from the CCHP Main reasons which led to the above observations include: Plan Rep2 is not fully compatible with planning guide Low capacity in planning skills among members of CHMT CHMT not working as a team In some councils, CHMT not involved in preparations of CCHP plans. Majority of CHMT are on acting positions

24 What to do? Capacity building on preparation of CCHP reports, Plan Rep, management and planning. Intensive supportive supervision To confirm all those members who are acting Appoint qualified people to manage the relevant positions.

25 Human resources Cadre Establishment Available Deficit %Deficit Specialist Doctors % Nurse/ NW/PHN II 20,373 9,241 11, % Radiographer % Clinical Officers 11,316 5,655 5, % Pharmacist/Technician % AMO/ADO 2,407 1,295 1, % Health Officers 1, % Lab. Techn. Lab % Ass, Clinical officers/ MCHA % Medical Doctors % Nursing Officers/ PHNA 6,559 4,381 2, % Health Secretaries % Others\ Medical Attendants 24,154 18,891 5, % Total 70,277 42,553 27, %

26 Summary of health workers shortages in different cadres in the country Specialist Doctors, Nurse/ NW/PHN II, Radiographer, Clinical Officers and Pharmacist/Technician are the cadres with greatest shortage Available number is 50% or below of the establishment. regions with the high deficit Mtwara (62.6%), Lindi (60.4) and Kigoma (57%). Regions with low percent of health workers deficit include Dar es Salaam (6%), Manyara (20%) and Shinyanga (31.9).

27 The issue of Health workers shortage is real; it needs urgent crisis management mode. It cannot be resolved by routine measures. need medical and health care. Human resource plan? We can see huge projects for roads, agriculture and water. We need a programme for health and we need to start with the MMAM.

28 Health workers deficit per region Region Establishment Available Deficit %Deficit Mtwara 2,380 1,416(37.4%) 1, Lindi 3,166 1,253(39.6%) 1, Kigoma 2, , Tanga 2,114 1,023 1, Mbeya 5,116 2,495 2, Tabora 2,604 1,495 1, Kagera 4,311 2,643 2, Ruvuma 3,770 1,931 1, Arusha 3,337 2,221 1, Iringa 3,960 2,179 1, Dodoma 2,792 1,583(56.7%) 1, Coast 2,624 1,889(57.0%) 1, Rukwa 1,960 1,135(37.9%) Morogoro 2,322 1, K'njaro 4,835 3,030 1, Mara 3,127 1,991 1, Singida 2,143 1, Mwanza 8,300 5,433 2, Shinyanga 4,378 2,983 1, Manyara 2,024 1,

29 Percent of human Resources Deficit in each region

30 Sources financing the CCHP 2009/10

31 Main sources of funding for the CCHP Abbreviation BG (PE&OC) BF CS COS HSDW LG GF RK PLAN TZ JRF OTHERS CHF NHIF PMTCT Meaning Block Grant (PE & OC) Basket Funds Cost Sharing Council Own Source Development Grant (HSDW) (Health sector Development Window) Local Govt Development Global fund R6/R3/R4/6 Receipt In Kind PLAN TZ Joint Rehabilitation Fund Others Community Health Funds National Health Insurance Funds Prevention Mother to Child Transmission

32 PE & OC

33 Allocation of PE and OC Funds in LGAs in summarized manner per region

34 Allocation of PE and OC Funds in LGAs in summarized manner per region... Regions where big cities and towns are located acquire the high allocation of fund as compared to others. Regions: Mwanza (8.2%), Shinyanga (7.2%), Dar Es Salaam (7.0%), Kilimanjaro (6.0%), Mbeya (5.9%), Tanga (5.8%) and Dodoma (5.7%).

35 Allocation of PE and OC Funds in LGAs in summarized manner per region... purely peripheral regions and disadvantaged with distance and infrastructure managed to receive less funds compared to other regions, Regions: Lindi (2.5%), Mtwara (2.8%), Ruvuma (2.9%), Rukwa (2.9%) and Kigoma (3.1%). The low budget itself shows that rural areas are mainly affected by shortage of staff as it is the PE which determines the volume of the allocation of the BG.

36 How to resolve We need to address the issue of the human resource crisis. The importance of implementing MMAM is once again underlined by this report. The Urban Rural Divide as it currently stands, is an indicator of the population density and the resource allocation formulae address this by the inclusion of poverty index, burden of disease and the distribution mileage of the supplies. The population variable targets the need, thus equity is observed.

37 Percents of total fund allocated to LGAs in summarized manner per region

38 Health facilities status U Health facilities status

39 Percent of health facilities available

40 Percent of health facilities availabl Govt./ FBO/ Parast Private Type Total DDH VA atal Hospital Health Centers Dispensar ies Grand Total 3, ,618

41 Percent of health facilities availabl The total number of health facilities was 5,618 as per this study, 212 Hospitals in the country equivalent to 3.8 percent. Health Centres (9.4%) and Dispensaries (86.8%). This is an evident that dispensaries are the main sources of health services delivery where there are lack of qualified staff and inadequate resources such as drugs. This underlines the government move to ensure there is a dispensary to every eligible village. The MMAM programme.

42 Percent of health facilities availabl Region Govt./DDH FBO/ Volu. Parastatal Private Total Dsm Iringa Mbeya Ki'njaro Morogoro Tanga Shinyanga Mwanza Dodoma Arusha Kagera Ruvuma Mara Kigoma Rukwa Tabora Singida Mtwara Coast Manyara Lindi Total

43 Percent of health facilities av The analysis has indicated that, various health facilities are located in the municipals such as DSM, Iringa, Mbeya, Kilimanjaro, Morogoro, Tanga, Shinyanga and Mwanza regions. The regions with a small numbers of health facilities include Lindi, Manyara, Coast, Mtwara and Singida.

44 Number of Health Facilities in each region

45 Number of Health Facilities in each region Government own majority (69%) of health facilities, (31%) of health facilities were owned by FBO/VA (14.1%), private sectors (14.0%) and parastatal (2.5%). District designated Hospitals (DDH) do add up to the part of district hospitals for those council where there is no government hospital.

46 Number of Health Facilities in each region It is important to highlight the shift of the % of health facilities ownerships. It is no longer 60:40 ratios as usually stated. It is 69:31 in favor of the public ownerships. This is important finding for planning and resource allocation purposes. The negotiations between the FBOs and the Government have to take note of this shifting of ownerships, to make the facts and the arguments sound in the records. The FBOs own 14.1% of the facilities.

47 Health facilities ownership the shifting paradigm

48 Health facilities proposed for maintenance and rehabilitation

49 Health facilities proposed for rehabilitation and reconstruction

50 HFs for rehabilitation and reconstruction

51 HFs to be constructed

52 HFs to be constructed The report has indicated that in general, the proposed HFs to be constructed are dispensaries (55%), Health Centers (44%) and hospitals (1%).

53 Population leaving within 5 km from Health facilities LGA Total Population Population < 5 KM % Population < 5 KM Mtwara 1,054, , Ruvuma 1,322, , Ki'njaro 1,592, , Morogoro 1,599, , Mbeya 2,486,639 1,461, Coast 872, , Iringa 1,566, , Mwanza 3,426,848 1,873, Dodoma 2,166,958 1,177, Lindi 685, , Kagera 1,827, , Shinyanga 4,018,993 2,012, Manyara 1,160, , Mara 1,746, , Rukwa 1,982, , Arusha 2,190, , Singida 1,296, , Tabora 2,764, , Grand total 33,762,253 16,409,

54 Population leaving within 5 km from Health facilities Approximately (48.6%) half of the population is living within 5 km in Tanzania Mainland as per available data by May According to the data obtained during the assessment, regions which have low percent of its population living within 5kms from the health facilities include Tabora (19.5%), Singida (21.5%), Arusha (26.4%), Rukwa (39.1%), Mara (44.2%) and Manyara (48.2%), these regions have drop below nation average. We also know sick people and women in labour even the 5 kms are a hassle to be traveled. Currently the situation is more than 10 km for the rural areas. This is not equitable and we need to correct this.

55 Water and Sanitation The assessment has depicted that the 35.2% of population in Tanzania have not yet attain the level of having latrines acceptable standards. Kilimanjaro, Dar es Salaam and Mbeya regions are the only regions where more than 75% of populations have latrines of acceptable standards. Manyara, Tabora and Arusha regions are below national average and even having less than 50% of populations having latrines of acceptable standards ( national av 64.5%.) Regions below this national average are Coast, Singida, Mtwara Kigoma, Kagera and Mara.

56 Population having acceptable latrines per region Ki'jaro Dsm Mbeya Morogoro Iringa Shy'nga Rukwa Dodoma Tanga Mwanza Ruvuma Lindi Coast Singida Mtwara Kigoma Kagera Mara Arusha Tabora Manyara

57 . Clean water According to this assessment, in Tanzania, 59% of populations have access to clean and potable water. Regions only at most 50% of its population have access to clean water are Tabora (38.6%), Mara (39.6%), Lindi (42.8%), Singida (46.1%) and Manyara (49.8%).

58 Population that has access to clean and potable water Mbeya Ki'jaro Kagera Dodoma Tanga Arusha Mo'goro Coast Iringa Ruvuma Dsm Rukwa Shy'nga Kigoma Mwanza Mtwara Manyara Singida Lindi Mara Tabora

59 Population that has access to clean and potable water We would like to end this section by calling the attention of the senior management on the importance of water and sanitation for the health facilities and our daily work. The households and the community are looking for our examples. If the dispensaries and other health facilities are not clean and sanitary we lose the mandate to carry our IEC for the same. To maintain the credibility and the mandate let us lead by example.

60 Millennium Development Goals (MDGS) Performances

61 Top ten Councils with high cases of malaria in Tanzania Mainland by June 2008

62 Malaria cases Councils with high cases of malaria (above 70%) were Kilosa, Kigoma, Kishapu and Maswa by June The rest of councils which were among the top ten with malaria cases were Hai, Ulanga, Nanyumbu, Kibaha, Handeni anad Masasi

63 Top 15 councils with low malaria cases

64 Top 15 councils with low malaria cases Top ten councils with low cases of malaria (below 1.2%) were Kinondoni Municipal, Bukoba Municipal, Longido and Ileje

65 Tetanus Toxide 2 (TT2)

66 Tetanus Toxide 2 (TT2) The data has extracted from sample of 93 councils during CCHP plans evaluation. The result has indicated that the number of pregnant women received TT2 has drop from 81% in 2007 to 79% in 2008

67 Infant Mortality Rate (IMR)

68 Infant Mortality Rate The IMR is very high (> 40 per 1000 babies) in Musoma, Shinyanga, Kibondo and Bukombe District Councils. These are among the top 4 councils with high Infant Mortality Rate among big ten Councils IMR < 2, include Handeni DC, Tanga CC and Mtwara MC. The other councils believe to have low IMR <5)

69 Councils with low rate of IMR 2008

70 Immunization coverage (%) DPTHB3 OPV0 Measles

71 Immunization coverage (%) 2008

72 Immunization coverage (%) 2008 The general analysis has indicated that, immunization coverage were very high almost 100% in Iringa MC and Mbeya CC. Other Councils with high coverage >90% are indicated in figure below.

73 Immunization coverage (%) 2008

74 Immunization coverage (%) 2008 the ten councils from the bottom were observed (positioned between average coverage of 77% and 67%), this were Karatu, Tanga, Misenyi, Babati, Igunga, Bukombe, Kishapu, Simanjiro, Tabora and Kiteto councils in ascending order.

75 Top ten Councils with low coverage of Immunization 2008

76 Budget allocated for reproductive and child Health (RCHS) activities The data collected from this assessment has clearly indicated that 6.2% of total budget allocated to the councils is for RCHS activities (122) councils; some of the councils did not include the RCHS data in the CCHP reports. RCHS activities includes ANC, Obstetrics, postnatal, FP, IMCI, Immunization, etc).

77 Budget allocated for reproductive and child Health (RCHS) activities The assessment has clearly indicated that councils from Kigoma and Mtwara, Morogoro, Iringa, Ruvuma, Rukwa, Coast, Mwanza, Dodoma and Singida regions did allocate more that 5% of the total budget Dar Es Salaam, Tabora, Mbeya, Tanga, Mara and Manyara regions councils allocated less that 5% of the total ceiling.

78 Fund allocated for RCHS services against total ceiling RCHS budget 5.9% Total Allocation 94.1%

79 Fund allocated for RCHS services against total ceiling As per this assessment, it is estimated that approximately 6% of total budget for CCHP plans has been allocated for RCHS budget. These tables and data are from all 21 regions in Tanzania mainland, and 132 LGAs submitted by the management authorities. We consider these figures to be more authentic than any other study could show. It is a holistic approach. Regardless who prepared the report/plan.

80 REGIONAL HEALTH MANAGEMENT TEAM (RS/RHMT) ANNUAL PLANS 2009/2009

81

82 General Observations Most of the councils lack data in their plans especially those related with diseases.( Performance Indicators). Some councils presents their data in numbers / percentages of decimal points where its not relevant to be in such format. Budget figures differ in Executive summary with that in the Main budget summary and in the Sources of financing tables. RS/RHMTs didn t scrutinize critically the LGAs plans.

83 General Observ. Some Council does not have support from other funding sources Some council didn t show all the resources in their plans such as the budget for HSDW. Some councils didn t budget for RCHS activities Some LGAs didn t budget for P4P, while some budgeted under Basket funds. ( They were told to rectify the plans through the RSRHMTs.

84 General Observ Some council failed to link Planrep outputs. Delay of funds and shortage of human resources is still a problem. Inadequate/lack of supportive supervision makes LGAs relax. RHMT failed to budget for P4P due to lack of other sources support the RHMT plans.

85 Recommendations More capacity to LGAs interms of close supervision by RHMTs and central level Coaching and mentoring Capacity on data management and clear information on how the data should be corrected. To review the budget allocation especially to those LGAs with no other source of funding where there is mainly Basket and Block Grant sources, while their performance is poor.

86 Recommendations Post qualified health staff who are able to be confirmed immediately after the probation period. RHMT to be allocated the budget from Block Grant and also find other opportunities from other sources. More resources at the central level to support weak regions and their LGAs.

87 Thanks for your attention