Health Sector Strategic Plan 2015-2020 (HSSP IV)

Reaching All Households with Quality Health Care

RMO/DMO Conference 2015

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

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

13

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

14

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

323.1

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 2015-16 TZS 2,087 billion (2 trillion) available Vs 4,031b (4tr) needed per year.

Increase to 2,503 billion (2.5 trillion) in 2019-20

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 2019/2020

16

Fiscal Space for HSSP IV

Scenario 2: Funding gap

0

1000

2000

3000

4000

5000

6000

2015/16 2016/17 2017/18 2018/19 2019/20

TZS

Bill

ion

s

Scenario 2 costs

Base, no SNHI, noinnovative sources

Base, no SNHI, withinnovative sources

SNHI scenario 1

SNHI scenario 2

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

19

20

Thanks 4 ur attention

Quality is @ the Core

Q-People engagement

Q Leadership

Q Service Provision