FEEDBACK FROM RMO/DMO MEETING HELD ON 8 th -12 th SEPTEMBER, 2014 IN MOROGORO Joint Annual Health Sector Review 6 th November 2014

OUTLINE The Theme Background Reasons of choosing the Theme Strategies to improve hospital revenue collection Achievements and Impact of increased revenue Meeting resolutions 2

THE THEME The Theme of the meeting was: “Increasing revenue collection in public health facilities without increasing costs of services provided” 3

BACKGROUND Sources of fund for health facilities include: Block grant Health basket fund Cost sharing (User fee, CHF, TIKA, NHIF, NSSF, other Health insurance schemes and Projects funding, programs and Development Partners, Receipts in kind) 4

BACKGROUND… In many facilities there is financial shortage which is attributed by:  Inability of the Government to allocate adequate funds  Inadequate collection of user fees  Poor management of collected funds  Low capacity for the facilities to identify other sources of fund. 5

BACKGROUND… With shortage of fund there is unreliable and poor delivery of quality health and social welfare services leading to increase in morbidity, unaffordable referrals to a higher centre, Increase mortality and unfavourable situation in social welfare services. Improvement of revenue collection through different strategies will improve health and social welfare services’ delivery. 6

REASONS FOR CHOOSING THE THEME  The Theme was used to sensitize and direct the health facilities’ managers to use different strategies to increase their revenue collection 7

REASONS FOR CHOOSING THE THEME… The few hospitals which increased their revenue collection without increasing the cost of services, did this through: Leadership accountability Collective responsibility Creativity and innovation Training of staff responsible for revenue collection Close supervision Motivation of staff 8

STRATEGIES TO IMPROVE HOSPITAL REVENUE COLLECTION Some facilities increased their revenue collection up to 7 Times by using the following strategies:  Introduction of the computerized system which enabled them to track revenue collections and expenditure  Establishment of Block Payment system for all services  Motivation of staff  Close monitoring by the Regional Referral Hospital Management Team on receipts, control and monitoring of payments 9

STRATEGIES TO IMPROVE HOSPITAL REVENUE COLLECTION  Transparency in financial income and expenditure done in monthly HMT meetings  Reorientation of staff on filling NHIF forms  Minimize Cash Collection stations  Involvement of Health Facility Governing Committees, Council Health Service Boards and Hospital Advisory Boards in planning, decision making, monitoring and evaluation, appraisal 10

HOSPITAL AVERAGE MON- THLY REVENUE COLLECTION (Tzs) October 2011 AVERAGE MON- THLY REVENUE COLLECTION (Tzs) September 2014 STRATEGIES USED Mbeya ZRH60,000,000420,000,000 Introduction of computerized system Tumbi RRH13,500,00084,000,000 Introduction of computerized system Dodoma RRH16,449,00042,212,467 Reorientation to staff on filling NHIF forms and close monitoring Mbeya RRH7,000,00021,000,000 Establishment of Block Payment system for all services Morogoro RRH 10,000,00042,400,000 Introduction of computerized system MNH ACHIEVEMENTS 11

IMPACT OF INCREASED REVENUE Medicines, reagents and supplies become more available Improved Quality of Health Services and patients’ attendances Continuous refunding of internal and external debts, payment on delivery Staff paid their dues, hence motivated 12

Other issues discussed…. In addition to revenue collection presentations there were other topics presented and discussed as follows: Overview of health status and performance Social Welfare Services Shortage of funds to finance social welfare activities Reproductive, maternal, new born and child health Preparedness and response to Ebola hemorrhagic fever in Tanzania

Other issues discussed… NCDs –Cervical cancer prevention at KCMC –NCDs risk factors steps survey findings –National NCD programme implementation status Improvement of medicines and medical supplies availability in health facilities by MSD PPP PPP coordination and practice in Shinyanga, Katavi and Arusha Implementation of e-Health strategy

Meeting resolutions IssueResolution Improving hospital revenue collections through use of ICT There is a need to scale-up the computerized system to the remaining Zonal, Regional and council hospitals so that they are able to improve provision of quality health services The MOHSW to develop a guideline to establish ICT countrywide. Regions and Councils should start preparing to use ICT in health care provision by putting in place the necessary requirements for ICT eg. computer, local network system. Increase motivation of all staff for sustaining the achievement attained. Regular training of staff on revenue collection Improve management of collected revenues Shortage of medicines, medical supplies, reagents and equipment Inrease MSD financial power to purchase and improve accountability and monitoring of received medicines and commodities. 15

Meeting resolutions IssueResolution Strengthening health care technical services and planned preventive maintenance of equipment and buildings Council/ regions should: Set aside budget for maintenance of medical equipment Budget for biomedical technicians hospital PE Make use of available seven zonal ECTS workshops Delays and failure to implement health sector activities in the councils. PMORALG should consider to reopen account number 6. Closure of this account has led to delays and failure to implement health sector activities in the councils. Poor of constructing on plans of health facilities MOHSW to review architectural drawings for health facilities before starting construction 16

Meeting resolutions IssueResolution Reliable/ accurate data from health facilities RMOs, DMOs, RSWO and DSWO should ensure data that is submitted to MOHSW from there regions/ councils is accurate and is submitted timely Shortage of funds for provision of health services All council/regions to strenghen ‘own sources’ revenue collections, and increase the percentage share of own sources contributions in financing health sector activities in councils. High cost of treating RTA injuriesMOHSW should hold discussions with involved stakeholders to on the importance of the vehicles insurances to also pay for the cost of treating patients involved in accidents. Preparedness and response to Ebola hemorrhagic fever in Tanzania All regions should establish isolation wards that will be used in case of an occurance of Ebola outbreak. The isolation wards should be in accordance to WHO standards. 17

Thanks for your attention