Conclusions and Recommendations TRM Highlights Conclusions and Recommendations

Representation All key stakeholders – MOHSW, PMORALG, Private sector, NGOs, CSOs Regional and District health managers MOHSW Departments, Agencies, Programs Participation was good; discussions and perspectives frank and quality. Some sessions enjoyed intense exchange of views

Highlights Satisfactory immunization coverage Child mortality reduction surpassing target Sloth in reduction of Maternal mortality and neonatal mortality Persistently high stunting Facility deliveries 60% (compared to 80%) FP target (80%) will not be met (now 43%) High HRH gap calls for more effort in HSS and CBHC revitalization

National Average 7.4 DDSM 0.66 Key Human Resource (AMO, MO, Nurses/Nurse Midwife Laboratory staff) Per 10,000 Population by Region 2013 Kagera 5.2 Mara 6 Mwanza 7 Arusha 8.6 Geita 3.1% Simiyu 2.5% Kigoma 3.3% Kilimanjaro 14.8 National Average 7.4 Shinyanga 4,9% Manyara 7.3% Tabora 2.9% Singida 5.5 Dodoma 6.9 Tanga 6.7 Katavi 2.5% = Morogoro 7.9 Pwani 9.6 DDSM 0.66 DSM 13 Rukwa 4.7% Mbeya 10.1 Iringa 11.3 Lindi 8.3% Key 0 – 4.9% Njombe 10.9% 5.0 – 6.9% Ruvuma 7.2% 7.0 - 9.9% >10 Mtwara 6.5

Major Causes of Death are preventable Under five years Above five years 2/3rd of deaths due to Malaria Pneumonia Anaemia Underlying causes Malnutrition 45% of deaths due to HIV/ AIDS Malaria Tuberculosis Other causes NCDs

Key aspects for policy level attention Significant inequity in HRH distribution – adverse in West Data issues affecting robustness of information and evidence for decisions Limited availability of funds within the sector Universal coverage compels establishing One compulsory NHI with safeguards for the poor Clients charter – one of ways to mitigate against corruption

Aspects for policy level attention ctd Harmonization, integration, quality, efficiency are key guides (to avoid duplication, optimize resources, increase revenue, enhanced utilization) BRN aspects 4 work streams will form an integral part of HSSP IV Its principles (Prioritization, Equity, efficiency, accountability and quality) and themes should apply even beyond the targeted regions

TRM proposed SWAp Policy priorities 2015/16 BRN work streams - Equity (HR distribution) - Efficiency (Performance management) - MNCH BEmONC, CEmOC - Commodities and medicines security Community Health Health Care Financing Accountability Social Determinants of Health

Conclusion from panel discussions and closing session Partners would like to ensure GOT is supported in BRN A strong well-functioning health system is crucial considering looming threats (Ebola, Marburg) Revenue increase is possible PPP is an important entity to optimize

Conclusion ctd Evidence base needs attention: PMORALG working to have a system and Technical Team to support and monitor health plans MOHSW has major tasks at hand - new health basket MoU, HCF strategy, RBF model and HSSP IV DPs support commitment reaffirmed

Recommendations Extend efforts against leading causes of death Strengthen health systems for better RCHS Coordinated health promotion and well supported community based health Foster peer learning and sharing best practices (e.g Mbeya, Singida)

Recommendations ctd Reverse the observed decline in health sector budget Strengthen TWGs and governance Strengthen data quality, completeness, timeliness and analytical capacity

Thank you for your attention