OPERATIONAL MAPPING OF HEALTH SERVICE PROVISION IN THE SOUTHERN

ZONE OF TANZANIA

Management Team Meeting

Richard NkweraDr. Oberlin Kisanga

15th November 2011

Findings and Recommendations

Outline2

Background and Objective

Methodology

Findings

Issues and recommendations

Way forward

Background and Objective3

Gain insight of the Public and Private health services: in Lindi, Mtwara and Ruvuma

through assessment of location service availability in view of rationalization

potentials. output and potential of health facilities

Transparency improvement among regional /zonal stakeholders for improved PPP

Service Rationalization: support informed Partnership decision making among: location, capacity and potential of health services (following key health problems), physical infrastructure and catchment area human resources and staff perspectives at governmental and private facilities

Background: Study Area

4

4

Methodology5

17 facilities physically visited others through regional/district respondents

Data assessment on district and hospital facility level Quantitative

Questionnaires

Qualitative Open ended questions Focus group discussions

Desk review5

Findings

Reference is made in respect to: Lindi Mtwara Ruvuma

At the level of: Regional District /Council Hospital

Facility level

Health Facilities7

Strong role and presence of faith based sector

MMAM requirement is almost three times of the available facilities (e.g. 181 to 496 Mtwara)

High number of health facilities - low number of skilled health workers

Over reliance of medical attendant – quality of services

Equipment and Infrastructure Availability of beds

Rural hospitals have higher number of patients because of large catchment area and geographical location leaves patients with limited choice of hospital

The study recorded 2651 public and FBO inpatient hospital beds (public: 1,602; FBO: 1049)

In Lindi Region, for example, the faith-based sector operates 45% beds and Mtwara region in fact 63% of the beds are in faith-based hospital

Water and power supply: Water – most facilities use piped Electricity – mostly use of generator

General purpose Equipment – average - available and working X-ray Oxygen Theater Ambulance Refrigerator etc.

Communications – limited internet access

Support Services

Laboratory Services Basics (malaria) tests available Advanced lab services – not available (sending

samples for days) Blood transfusing

Services available, though interruption reported to some districts in a period of three months (eg. Ruangwa and Liwale)

In all districts except for Tandahimba D.C relatives/friends or donors from the district are the main sources of blood donations, while Tandahimba the main type of donors are volunteers.

Patient disease specific interventions Maternal and Child health interventions

Available at all facilities

Malaria services – available Presumptive IPT for Malaria during pregnancy

HIV and AIDS, SRH and STI Services Average: No SRH services targeting adolescents

needs Roman catholic facilities lack contraceptives HIV counseling and testing – available ART services – satisfactory (availability) Overall SRH commodities - satisfactory

Human Resources

Density of medical doctors is very low Ranging from 0.03 to 0.6 per 10,000 population

Backbone of services: midlevel cadres (AMO/CO - ENs)

Non professional: high number of Medical attendants

Specialists: nine (9) in the mapped area

Staff movement: from FBO to public

Human Resources

Back bone of Health Services

Training

Per facility: All health workers in each hospital received at least

one training

At least one laboratory staff member trained in the diagnosis and treatment of malaria is less than 20% of facilities across the districts surveyed in Lindi and Mtwara Region.

At least one health worker in each hospital received the following trainings:

HIV and AIDS Mother and Child Health Reproductive Health Malaria Infection control Tuberculosis Drug Management Health Information Management System

Training

Training Potentials: High potential of the present institutions to cater for HRH

development but No strategy for local demands. shortage of tutors on top of the attrition due to retirement

and disease burden is a challenge facing all the institutes e.g. in COTC Lindi, there are four tutors and two will be retired by year 2009/2010.

Recruitment of new tutors has not moved in proportion to student enrolment in most institutions.

Capacity to handle increased numbers of students and manage the condensed curriculum aimed at meeting MMAM targets is questionable as workload increase with no additional tutors

Partners Support

Presence - variety of

stakeholders

Low coordination

Overlap esp. in HIV/A support

No support management plan

Mismatch between resource

input with available

Management capabilities.

Lindi Clinton Foundation (CHAI)

(HIVAIDS) EGPAF – Care and Treatment AGOTA USAID BIOSHAPE – HIV/AIDS Care and

Treatment BMAF – Staff support

Mtwara JICA BMAF UNICEF CHAI EGPAF Action Aid

Ruvuma JICA DANIDA ITIAPOCUNICEF

for normal delivery from wards to assessed health facility

Patients Movement (GIS)

17

Lindi Region

18

Mtwara region

19

Tunduru District

Recommendations

Service provision Where patients go to receive services? (avoid resource consuming duplication

extensively explore the opportunities to invest in private service providers) Recruit more national specialists to assure sustainability (as the majority of

medical specialists identified in the study area were expatriates working on a short-contract basis)

Improve coordination of the few specialists available in the zone Resources availability / facilities management

Human resources: Retention measures should apply to both – public and private Increase the availability of Assistant Medical Officers and maintain the

relatively sound densities of enrolled nurses and clinical officers The need for a more comparable system. (Districts use different staffing

norms when calculating deficits for their Comprehensive Council Health Plans) Health Training Institutions should have strategy to cater HRH local demands

Public and Private collaboration: Enforcement of PPP

Way forward21

Have TGPSH feedback

Linking stakeholders to these results

Building capacity of: Regional referral HRH

Government – informed decision making What is available

ASANTENI