Health Sector Strategic Plan (HSSP IV) Reaching All Households with Quality Health Care JAHSR TECH NOV 27,2015 Dr. Oberlin M. E. Kisanga-Head/HSRS 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 The HSSP IV is about 2 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. HSSP IV Overall objective: 3 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 inclusion of health protection and promotion Strategic Objectives 4 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 Strategic Decision: Emphasis on Community Health and Primary Prevention 5 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 Strategic Decision : Enhanced Social Welfare at LGAs 6 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 Strategic Decision: Emphasis on Quality Primary Care services 7 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 Critical support systems 8 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 Strategic Decision: Equity for populations and vulnerable groups 9 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 Strategic Decision: Social Accountability 10 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 Strategic Decision: Performance as Basis for Operations 11 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 Strategic Decision: Accommodate upcoming NCD needs 12 Professional Councils Shall Update Existing Policy guidelines on Medical and Professional ethics and monitor Compliance and Professional Associations Shall Promote Professional Standards, Commitment, Attitudes and ethics. Pr.Associations shall organise and Conduct Regular CPD activities in line with national CPD guidelines The Federation of Tanz. Health Professional Associations shall be the Voice of all the professionals. Professional Councils and Associations 13 NIMR,IHI, the Eight Medical Universities have demonstrated joint efforts in Health and Social Welfare research. National Health and SW Research Priorities identified and Documented. Take note of the 5 Strat Objectives. Joint efforts are encouraged to address total National research priorities Utilisation of Research findings for policy decision making a crucial element Open Access Policy for available information advocated Strategic Direction: Operational Research and Surveys 14 MOHSW,COSTECH, ACCADEMIC INSTITUTIONS to create condusive environment to maximise research and capacity dev. for local pharmaceutical industries. Facilitate PPP in local production of Right Priced quality pharmaceutical products Single Maximise Tanzanian Medicinal plants research and protect Intellectual property. Strategic Direction: Accommodate Research and production 15 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 control medicines 16 Strategic Decision: Health Financing 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 Strategic Decision: Governance 17 BRN is top priority in implementation Health services or systems area BRN costs included (constant across scenarios) HSSP IV costs (TSH billions) RCHS Maternal and child health support activities (e.g. trainings, mass media, etc.) specified as priorities under BRN and expanded under OnePlan II Infrastructure Costs of facility upgrades and equipment for BeMONC and CeMONC 59.3 Performance Improvement Facility star rating assessment, fiscal decentralization, social accountability, and performance target activities as specified under BRN 25.0 Commodities Costs related to commodities and quality improvement, including costs to address pilferages 21.9 HRH Staff redistribution costs and other priority BRN HRH activities 14.6 Scale up BRN Countrywide after 2018 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/ Fiscal Space for HSSP IV Scenario 2: Funding gap Close the funding gap! Summary With innovative financing and continued growth in existing health insurance schemes, the Country can access 3 3.5 trillion TZS per year* over 2015/16 to 2020/21 Without innovative financing, the range is 2 2.5 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 on- budget sources and slow growth in domestic sources, the same average figure would be 10% 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) Implications 22 CCHP 2016/17- October Mainstreaming Health and Social Welfare programs into CCHP Interventions, activities and Indicators. RMOs,DMOs sensitisation September 2015 Mainstreaming to MOHSW -MTEF and PMORALG Health Workplans SWAp Code of Conduct Updated. HSSP IV Common Management Arrangement- underway. HSSP IV Implementation Arrangements 23 24 Thanks 4 ur attention Quality the Core Q-People engagement Q Leadership Q Service Provision