Recommendations and findings from RHMT training on PlanRep3 and CCHP Guidelines For DPG-H 03 September 2014 Swiss Agency for Development and Cooperation (SDC) Embassy of Switzerland in Tanzania

Introduction The CCHP is an annual health and welfare tool for planning, budgeting, implementation and reporting Why CCHPs are important?  Planning / implementing health services in distrcits, according to their needs.  Accountability: It is a prerequisite for a functioning district health system and empowers LGAs through decentralization by devolving decision making powers  Monitoring: channelling of funds; Trigger document for HBF

Timeline according to CCHP Guidelines 2011

PlanRep PlanRep is the Local Government Planning and Reporting Database. It is designed to assist LGAS in planning and budgeting, tracking of funds received, physical implementation and expenditure. It contains the tools required for preparing CCHPs. PlanRep an initiative of PMORALG and MoHSW and is designed by UCC. PlanRep Micro is specifically designed for LGA purposes; PlanRep Meso for consolidating information at regional level and PlanRep Macro for analyzing data at central level. EPICOR EPICOR is the accounting software currently in operation in the majority of LGAs.

Introduction Problem situation RHMTs are mandated to support CHMTs in the preparation of CCHPs and are to prepare summary analysis before forwarding to MoHSW and PMO-RALG however – Relevant capacities of RHMTs very low – No software available at regional level to consolidate data and analyze CCHPs  Result is a delayed Summary and Analysis of CCHPs in ‘poor’ quality Objective of the training Training of RHMTs and central level (MoHSW, PMO-RALG & ZHRC) on – CCHP Guidelines (planning, budgeting, reporting) – PlanRep3 Meso (new!) and Micro

200 participants from 25 regions trained

RHMT recommendations Financials  PMO-RALG should provide DMOs access to Epicor 9.05 and should be authorized to approve transactions and should have access to resp. bank account (currently they have to wait for reports from the District Treasurer).  This was stated as one of the reasons for large carried over funds (block grant and HBFs)  The MOHSW in collaboration with PMO-RALG should develop a system that will control and monitor the utilization of medicines and supplies at health facilities.  Most of funds carried over (block grant & HBF) are for procurement of out-of-stock items from MSD due to bureaucratic procurement process and MSD delay to issue out of stock report  PMORALG should harmonize PlanRep3 and Epicor 9 to exchange budget and expenditures.  MOHSW in collaboration with PMO-RALG should issue a guideline to RHMTs on the CHF coordination at regional level. All HFs should open CHF deposit accounts so the funds can be used for their intended purpose.

RHMT recommendations (continued) Recruitment and responsibilities  PMO-RALG should issue a circular that will give RMOs administrative authority over DMOs and CHMTs instead of the current structure that gives only the mandate to provide technical advice on health issues. These have been causing many directives given to CHMTs not worked out on the grounds that they do not have administrative authority.  PMO-RALG in collaboration with MOHSW should set performance criteria that will monitor DMOs performance and RMOs should be involved to give their recommendations before DMOs confirmed for appointment as they are immediate supervisors of DMOs (concerns were made that some DMOs have been appointed despite being registered of poor performance).  The MOHSW should avoid sending staff with no capacity to perform supportive supervisions at council or regional level (concerns were raised regarding people directly recruited from schools to perform supervisory functions who do not know how the health system works).

RHMT recommendations (continued) Continuous capacity building  MOHSW should organize the same training for RHMT co-opted members to raise the numbers of knowledgeable staff  The RHMTs should set aside budget for capacity building among CHMT and co-opted members with knowledge gap on computer applications.  The RHMTs recommend CCHP and PlanRep3 training to be planned in future for 14 days instead of 9 days to enable the participants to do more practices and internalize the knowledge gained.

RHMT recommendations (continued) Health facilities and staff houses  PMO-RALG and MOHSW should issue a circular to direct the councils to include placenta pit, incinerator, toilets, sewage/drainage systems, water system, electrical wiring in the BOQ for construction of health facilities. It was sited that most of the facilities were constructed without the above amenities (to some extent also applies for staff houses).  PMO-RALG in collaboration with MOHSW should issue directives to councils that all health facilities completed should be equipped with furniture and medical equipment instead of continuing with construction of health facilities that remain dormant.  The MOHSW in collaboration with POPSM should issue recruitment permits specifically for councils with health facilities that has been completed and equipped but they are not operating due to lack of staff.  The PMO-RALG in collaboration with MOHSW should recruit skilled biomedical technician who will be responsible to service and repair medical equipment  The MOHSW, PMORALG and MOF should review the performance and modality to support regional referral hospitals as the government funding is not sufficient to run the regional hospitals.

1) «value-for-money»: Good CCHPs – better plans – stronger health services delivery at LGAs level 2) CCHPs and new upcoming initiative  to be included in BRN health lab 3) CCHPs delay and quality – systemic issue  need for a DP to follow-up 4) Roles and responsibilities MoHSW / PMO-RALG Main messages

Ahsanteni