PBF EXPERIENCE IN TANZANIA

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Mbeya

Rukwa

Tabora

Ruvuma

Iringa

Singida

Dodoma

Kigoma

Shinyanga

Kagera

Arusha

Mwanza 139

Mara

Morogoro

Mtwara

Lindi

Kilimanjaro

Tanga 162

Pwani Dar es salaam

Kusini 109 Mjini Magharibi

Kusini PembaKaskazini Pemba

Mainland Zanzibar

Background

• Area: 926,000 sq km

• Population = 40 mil(2002).

• Capital: Dodoma

• > 120 tribes.

• Language: Swahili(English)

• Regions: 25

• 133 councils.

• Health facilities: 5,618 (2009)2

Health indicators

• Maternal Mortality- 578/100.000 live births

• UMR- 81/1000 live births (TDHS 2009/10)• IMR-51/1000 live births ( TDHS 2009/10)• NMR -26/1000 live births (TDHS 2009/10)

• CPR 36% all methods, 27.4% modern methods. (TFR 5.4)• HIV/AIDS prevalence 6%

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Health Services System in Tanzania

Community Health ServicesCommunity Health ServicesCommunity Health ServicesCommunity Health Services

DispensariesDispensariesDispensariesDispensaries

Health CentersHealth CentersHealth CentersHealth Centers

District HospitalsDistrict HospitalsDistrict HospitalsDistrict Hospitals

RegionalRegional HospHosp..RegionalRegional HospHosp..

Specialize/Specialize/Consultant Hosp.Consultant Hosp.

National HospitalsNational Hospitals

Specialize/Specialize/Consultant Hosp.Consultant Hosp.

National HospitalsNational Hospitals

Referral Referral systemsystem

Community/ HouseholdCommunity/ Household

District CouncilDistrict Council

Regional SecretaryRegional Secretary

Ministry of HealthMinistry of Health

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The Current Situation

• The Ministry embarked in Health Sector Reform in 90’s and re organize its structure by decentralizing Primary health services-District level.

• Allocation formula based on Population 70%, land size 10%, Under five mortality 10 % and Poverty 10%.

• District Health Management Teams (DHMT) were established with semi-autonomous authority– Develop Comprehensive District Health Plans where by Pay for

Performance is one of the mandatory activity in the Operation Plan5

Current situation cont

Financial support comes from:

1. Central Government

2. Donors ( Health Basket funds).

3.Council own sources and

4. Other supplementary sources i.e. Cost sharing, Community Health funds(CHF),NHIF.

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Current situation cont…

• The Ministry implement its roles through National Strategy Strategy For Growth and Reduction of Poverty For Growth and Reduction of Poverty

• National Health Policy and five year Health Sector Reform Strategic Plan(2009-2015).

• Primary Health Service Development Programme (MMAM) (2007-2017).

• Monitoring of Health Sector Performance.

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Opportunities to introduce PBF

• Existing systems at all levels.• PBF piloting site - Rungwe District.

Training:• 12 Faith based organizations (FBOs).• 3 Public owned H/F• CHMT and HMT members (5).• Council Management team (2).

Key stakeholders:• Christian Social Services Commission (CSSC),

• KCMC,CORDAID. 8

Challenges….

• Not in line with the existing National policies.– Employment policy,– Procurement Act.– Local government financial Act /regulations.– Inadequate financial management capacity skills

at the low level (Health centers and Dispensaries).

• Inadequate data collection system (HMIS)

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Way forward

• PBF Advocacy should start at the National Level to downward.

• Capacity building of health workers on financial management (Public & Private).

• Policy review to match with PBF principles.

• Improve on HMIS

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ASANTENI – ZIKOMO - THANKS