Health Sector Strategic Plan (HSSP IV) Reaching All Households with Quality Health Care RMO/DMO Conference 2015

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Tobias Gilbert
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1 Health Sector Strategic Plan (HSSP IV) Reaching All Households with Quality Health Care RMO/DMO Conference 2015

2 The HSSP IV is about Increasing efficiency through more integration and capitalizing synergies Deepening D-by-D (fiscal decentralization +) Improving quality of services through Better performance Enhancing partnerships Priorities and where to gain more value for money 2

3 HSSP IV Overall objective: To reach all households with essential health and social welfare services, meeting as much as possible expectations of the population and objective quality standards applying evidence-based, efficient channels of service delivery. 3

4 Strategic Objectives 1. Attain objectively measurable quality improvement of primary health care services 2. Improve equity of access to services by focusing on geographic areas with higher disease burden and vulnerable groups. 3. Achieve active community partnership through intensified population interactions for better health and social well being 4. Applying modern management methods and innovative partnerships 5. Improve on social determinants of health through 4 inclusion of health protection and promotion

5 Strategic Decision: Emphasis on Community Health and Primary Prevention Health Promotion, Prevention and Basic Care in Community Health is key element of strategy to reach all people and to reduce costs of health and social welfare services 5

6 Strategic Decision : Enhanced Social Welfare at LGAs Create a full-fledged department at LGAs addressing:- 1. Operationalization of MVC action plan 2. Establishing social protection for persons with disabilities, MVCs and elderly persons 3. Establishing multi-disciplinary prevention and response services for victims of violence, abuse, neglect, exploitation and trafficking 4. Building capacity for Juvenile Justice and Correctional Services 5. Setting up accountability mechanisms for child protection 6

7 Strategic Decision: Emphasis on Quality Primary Care services Pursuing Star Rating and Improvement programme countrywide (achieve 80% of the PHC facilities 3 star at least) Essential National Package of Health Interventions to be agreed and provided BEmONC and CEmONC capabilities at all primary facilities 7

8 Critical support systems 1. Human resource for Health production, redistribution, fast track deployment, retention, P4P, accreditation and CPD recognition * Social Welfare workforce production plan implementation 2. Medicines and supplies availability 2. Maintenance and ppm (infrastructure, transport and equipment); new infrastructure in underserved areas, avoid duplication 3. Financing Universal and equitable access (single public insurance servicing MBP); efficient and effective use 8

9 Strategic Decision: Equity for populations and vulnerable groups More resources to Regions with higher burden of diseases More resources to Regions with lower levels of service delivery RMNCH has priority because of vulnerability pregnant mothers and children Adolescents (girls and boys) services Integration of health and social welfare services at district,ward &community level 9

10 Strategic Decision: Social Accountability Empowerment of communities to co-manage health facilities Decision making Powers of Governing Committees and Boards Transparency: community reporting on health facilities performance Client satisfaction as element in performance management 10

11 Strategic Decision: Performance as Basis for Operations Performance Management Systems Individual level Institution level Results Based Financing Level playing field Public and Private Facilities Monitoring of Performance Data for decision-making approach 11

12 Strategic Decision: Accommodate upcoming NCD needs Emphasis on prevention of NCDs Improve capacities of health staff in handling NCDs Integrate NCDs in diagnostic and treatment centres Strengthen treatment of advanced NCDs with innovative financing strategies 12

13 Strategic Decision: Health Financing Health Financing strategy aim for equitable access Universal health coverage Single National Health Insurer Implement Minimum Benefit Package (MBP) Advocate for more Government Resources Raising resources for health revenue, sin and other taxes Trauma fund, from road taxes insurances Revolving Funds; OOP payments Regulatory body: Price 13 control medicines

14 Strategic Decision: Governance Decentralisation by Devolution (to LGAs) Fiscal decentralisation to institutions Partnership PPP, private sector participation Public-Public Partnerships, networking Social accountability Increased inter-ministerial collaboration SWAp mechanisms 14

BRN is top priority in Health services or systems area RCHS Infrastructure Performance Improvement Commodities HRH implementation BRN costs included (constant across scenarios) Maternal and child

15 BRN is top priority in Health services or systems area RCHS Infrastructure Performance Improvement Commodities HRH implementation BRN costs included (constant across scenarios) Maternal and child health support activities (e.g. trainings, mass media, etc.) specified as priorities under BRN and expanded under OnePlan II Costs of facility upgrades and equipment for BeMONC and CeMONC Facility star rating assessment, fiscal decentralization, social accountability, and performance target activities as specified under BRN Costs related to commodities and quality improvement, including costs to address pilferages Staff redistribution costs and other priority BRN HRH activities Scale up BRN Countrywide after 2018 HSSP IV costs (TSH billions)

16 Fiscal Space for HSSP IV Resources for the HSSP IV Costs In five years TZS 11,300 billion (11.3 Trillion) In TZS 2,087 billion (2 trillion) available Vs 4,031b (4tr) needed per year. Increase to 2,503 billion (2.5 trillion) in Commodities represent 78%; HIV about 30 to 33% Financing gap from fiscal space analysis o Ambitious scenario (SNHI and Innovative fin) the financing gap will be TZS 515 billion (0.5 Trillion) in 2016/2017 growing to TZS 1,525 billion (1.5 Trillion) in 2019/2020 o Without SNHI and Innovative financing the gap is TZS 1,410 billion (1.4 Tr)in 2016/2017 and grow to TZS 2,453 billion (2.4 Tr) by 2019/

TZS Billions Scenario 2: Funding gap 6000 5000 Close the funding gap!

17 TZS Billions Scenario 2: Funding gap Close the funding gap! Scenario 2 costs Base, no SNHI, no innovative sources Base, no SNHI, with innovative sources SNHI scenario 1 SNHI scenario / / / / /20

18 Summary With innovative financing and continued growth in existing health insurance schemes, the Country can access trillion TZS per year* over 2015/16 to 2020/21 Without innovative financing, the range is trillion TZS p.a.* With innovative sources, health as a % of the GOT budget (excluding CFS) would average 15% from 2016/17 Without innovative financing, given declines in some onbudget sources and slow growth in domestic sources, the same average figure would be 10%

19 Implications With Scenario 2 we alleviate the financing gap BUT still remain with a gap in relation to total HSSP IV cost This has implication for level of ambition of the sector program targets Argument for fast tracking the HFS is stronger Emphasis on innovative cost cutting, synergies and value for money from coordination, Alignment & Harmonisation, integration Effective use of resources (fiscal decentralization, accountability, cost-effective interventions, resource mapping) 19

20 Quality the Core Thanks 4 ur attention Q Service Provision Q-People engagement Q Leadership 20

T H E NA I RO B I C A L L TO A C T I O N F O R C L O S I N G T H E I M P L E M E N TA T I O N G A P I N H E A LT H P RO M O T I O N

T H E NA I RO B I C A L L TO A C T I O N F O R C L O S I N G T H E I M P L E M E N TA T I O N G A P I N H E A LT H P RO M O T I O N 1. INTRODUCTION PURPOSE The Nairobi Call to Action identifies key strategies