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Background District Health Services Council Health Services Boards and Health

Facility Governing Committees (CHSB and HFGC)

Regional Referral Hospital Services Regional Level Support (RHMT) Progress made by the District and Regional

Technical Working Group Challenges Way Forward and Recommendations

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The Health Sector Strategic Plan III (2009-2015) features three strategies dealing directly with decentralization:

District Health Services Referral Hospital Services Central Level Support including RHMTThe TWG No. had four milestones to oversee

its implementation- Milestones No 1, 2,8, and 9

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Progress has been made in several areas, which includes the following:

Revision of CCHP guidelineRevision of CHSB guidelineReview of the reporting system

(incl. planrep and epicor)Revision of priority areas in the

National Essential Health Package

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Milestone No 1: the February 2007 CCHP guideline as well as the assessment tools were revised in line with Health Sector Strategic Plan III (2009- 2015), MKUKUTA and other agreed Sector strategies.

The CCHP guideline was pretested at the LGAs level by inclusion of the priority areas into their CCHPs for 2010/2011.

The review also took into account HSDW under MMAM, inclusion of Social Welfare services and Social Protection and certain audit issues.

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The CCH plans 2010/2011 and performance reports for FY 09/2010 have been reviewed and compiledMany were submitted late, with incomplete and inconsistency data. The findings highlighted the need to focus and

further strengthen the CHMTs and RHMTs to be able to analyse and reconcile data and translate the strategies and priorities defined in the HSSP III at district level.

In addition work is underway on the overall reporting system in order to achieve efficiency gains at all level (district, region and central) through improving the Planrep tools and its interface with Epicor.

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The revision of the priority areas in the Essential health package has resulted into increasing the priority areas from six to eleven.

The revision of the Essential Health Package guideline and target indicators will be finalized by 2011, using the findings of the Demographic Health Survey and in line with the MKUKUTA II monitoring table and revised Performance Assessment Framework (PAF) indicators.

Supervision reports lack consistency as such:- Few reports stated objectives of the supervision

visits Findings differ with the stated objectives 04/21/23 8

Milestone No 9 Guidelines for establishment of CHSB were

revised The Facilitator’s guide manual for orientation of CHSB members on their roles was also developed and pretested in six regions.

The overall training will be conducted based on LGAs request.

However, Ten out of 20 new LGAs were sensitized on understanding their roles and responsibilities.

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Milestone No 2 Twelve Regional Referral Hospitals (RRH)

developed annual health plans and Strategic plans supported by their respective RHMTs

others were able to develop their plans applying

skills acquired through initial HMT trainings. The status is as follows:

Staff Competence and experience varies between regions some regions

Managerial skills depend on the individual efforts hence management commitment varying between regions.

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The RRH plans were reviewed, and it was found to be of acceptable standard, however further training is required.

Weak planning skills and inadequate funding was found to be the big challenge facing the HMTs.

Activities which were planned in year 2009/2010 under the RRH services including training of Regional referral HMTs in strategic and annual planning were not implemented, because funds were disbursed late in June

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Milestone No 8 The government has approved　 eight　

RHMT core　members　 in　 the　 RS　Team. The RHMT activities and budget have been reflected in the RS MTEF 2010/2011.

RHMTs received allocation from basket fund timely. Block grant was so far released only for Regional hospitals and few regions allocated limited funds to RHMT for supervision only.

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The TC-RRHM in collaboration with the MOHSW conducted different interventions to strengthen capacity to Regional Health Management Teams.

In 2010/2011 all 21 RHMTs prepared their own Strategic Plans (SPs).

These SPs were reviewed and feedback was given to the regions.

Annual Planning templates for RHMT was developed and used for developing RHMT plans for 2010/11 reflecting ten core functions of the RHMT including supportive supervision to CHMTs. 04/21/23 13

RHMTs are able to compile and analyze data from CCHPs however , they still need further capacity building in report writing.

RHMT performance reporting template is to be developed to maintain uniformity of reporting implementation of their quarterly and annual performance.

In collaboration with TC RRHM, MOHSW has introduced the new system of incorporating Zonal Health Resource Centres staff in conducting Central Management Supportive Supervision to the regions since August 2010.

Further training and strengthening of the RHMT to perform their mandate of supporting CHMT and evaluating CCHPs and progress report will be a priority area for the TWG.

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The group has been very active since its inception.

It has met six times deliberating many issues pertaining to the delivery of the health services, issues concerning DHS, RRHs, RHMTs, CHSBs and HFGCs.

And other tasks assigned by TC SWAP/ BFC.

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Gap between expected range of services and actual services delivered

Shortage of skilled staff Old and dilapidated infrastructure and

equipment Financing gap between actual needs and

allocation Construction of health facilities Establishment of LGAs structures limiting

comprehensive planning for health services Variable pace among key hospital reform issues e.g.

governance and community oversight through boards and financial reforms.

Inadequate capacity building in planning, data analysis and reporting

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Orientation of the CHPTs and RHMTs on the revised CCHP guidelines.

Revised CCHP guidelines to be included in the Planrep software.

Update on reporting system – including planning and reporting tools

Review the National Essential Health Package guidelines and performance indicators

Train the regional referral hospital management teams, in planning, and managing hospital resources.

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Finalize Hospital plan format/template. Train and support CHMT and RHMT teams

in planning and reporting with the revised guideline.

Finalization of the RHMT assessment of CCHP reporting templates.

Finalization of CHSB guidelines. Finalization of RHMT performance

reporting template Allocate budget for implementation of the

above tasks/proposals

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Thanks for listening LGAs have not received funds todate

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