CSSC initiative to scale up Human Resources for Health Discussion on options for HRH Grant management and support to FBO health training institutes Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

Introduction CSSC wishes to explore feasible options to fund the scaling up the number of qualified health professionals through the FBO health training institutes in Tanzania (34). With Cordaid support, a team of 2 consultants; (1) assess the potential of a CSSC HRH funding scheme and (2) assist with the preparation of a HRH proposal to support HRH scaling up. Time frame of the assessment; April-June Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

Issues to address Situation analysis; HRH situation, HRH training institution availability, HRH ongoing and expected initiatives. Assessment of selected CSSC health training institutions; management systems, distribution, cadres trained, tutors, intake students, potential for scaling up, support modalities, linkages to ZTCs. Feasibility CSSC Grant management capacity. HRH proposal for FBO sector. Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

Reason for the CSSC initiative? Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

There is a momentum... Christian Health Associations (CHAs) in Africa aim to expand their resource mobilisation and grant management capacity on behalf of their members (Bagamoyo 2007, Kampala 2009) so that they can achieve more impact in the health sector. The HRH policy framework ( ) has outlined the key priorities. Objective 5 and 6 aim at private sector engagement (scaling up and research/studies). HRH support initiatives in Tanzania can bring synergy and increase the resource base (e.g. MOH, DANIDA (PPP), TCP/Intrahealth, Nuffic (ZTC support), Touch Foundation (Lake Zone). Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

What are the statistics? Training Facility (114) Public SectorPrivate for profit FBOs Universities133 Allied health colleges 4577 Nursing colleges Nurse tutor training 101 Total63 (55%)12 (10%)39 (34%) Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

HRH Strategic Plan data Public training institutions (2006) required 1,711 staff but only had 449 staff. A gap existed of 1,262 staff/trainers (74% gap). Private training institutions (2006) required 756 staff but only had 288 staff. A gap existed of 469 staff/trainers (62%). Total shortage of staff in training institutes was 1,731 people (68%). Not clear for which cadres the tutor shortages were. How do we know how many tutors to train? Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

HRH Strategic Plan data In 2006, Tanzania had 1,339 doctors including 455 (34%) in the private sector (2006). Most doctors seem to work in the public sector. Period produced 23,747 graduates. The GOT hired only 16%. Not clear: (1) What were number of graduates per cadre and coming from public or private institutions ?; (2) where was the 84% of the graduates employed? All in the private sector? Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

HRH Nurse graduation data (all public and private institutions) YearNursesNurse Tutors 20081,508No data yet (no intake) 20061, ,5000 (not intake) 20041, ,7000 (no intake) 20021, No data No data No data No data24 Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

FBO training institutes? Rom. Catholic ELCTAnglicanMennoniteAIC Categories of FBO health training schools AMO (1)Nursing /Midwives (12) Clinical Officer (4)Nursing (11) Laboratory Assist (2)Occupational health (1) Medical Laboratory (2)Pharmaceutical assist (1) Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

What do we know so far? Between no significant increase of graduated nurses and nurse tutors. Bugando just started with establishment nurse tutor training (intake start Sept 09). MOH supports FBO training institutes with Tshs 30,000/=-40,000/= per student per year. FY 2008/ FBO institutes received Tshs 140,000,000/= in total (Tshs. 4,117,647/$USD 3,167, per institute/per year). FBOs largely generate their own funding. Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

What kind of information do we need from the FBOs? Mapping info: location, region, district, linkage to ZTC, type of training provided (pre service/in service/diploma/certificate), denomination, resource base. Number of tutors available to train per cadre. Annual intake of students per cadre and annual graduation of students (Private and/or public students?). Tuition fee per student per year plus unit cost per student/per year (based on all inclusive costs e.g. staff, utilities, food, etc). Facilities (class rooms, accommodation, equipment). Expansion options (x students more per year) and expansion costs (e.g. BOQs). Quality of training provided? Accreditation NACTE? Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

How to increase intake students? Mechanisms? What criteria to use of increase of students per cadre? District needs? FBO hospital needs? GOT needs? Allocation criteria? How to fund the increase of students? Direct to FBO training institutes? Direct to FBO hospitals that will select the student and that will bond the student? Via districts? Via 5 CSSC Zonal offices? Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

Much more info is required... Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

CSSC as a Grant Manager: Feasible? CSSC has started an ID/OD/HRM/HRD process. Assessments have been done and documents are in place for approval. Finance department is tuned to regular finance management mechanisms. First grant management initiatives have started with Global funding and Malaria grant (USAID). Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

How to position and capacitate CSSC as a Grant manager? HRH is an entry point but expansion for other programmes is the long-term vision. A CSSC pre-grant assessment is required to assess whether international criteria can be reached. What capacity is required at CSSC central and zonal levels? Where to locate a GM unit in CSSC? Capacity needs to be enhanced in the areas: Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

GM Capacity areas GM Expertise and certified staff. GM tuned management systems (responsive to GM requirements) Adequate finance, disbursing, auditing and reporting systems. Expertise in capacity building to HTI grantees (proposals, finance systems, accountability, reporting). Resource mobilisation capacity for new grants. Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

Who can provide the GM expertise? CSSC Company partly in house? In house TA (LT)? Other option? Out- Source? Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

Options to move forward Identify an organisation that can fund and/or implement a pre-grant assessment in order to identify the specific capacity needs for CSSC. Identify a firm/organisation that can provide the required GM capacity building over a longer period of time (e.g. DLT, EDI) at CSSC central and zonal level for all elements (or for a fast track and longer-term track modality). Prepare a TOR and budget for the GM support modality and identify potential donor agencies who could support this specific component. Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

Explore the following issues 1.Which support/assistance can CSSC generate for; (1) HRH FBO mapping/data collection; (2) FBO training institution quality assessment; (3) Costing studies for training institutions (e.g. Unit price per student, skills labs and infrastructure); (4) Pre grant assessment; (5) GM unit capacity building in CSSC and; (6) first proposal to scale up the training of students? 2.Is there a need for more training institutes and for which cadres? 3.Preferred funding mechanisms: subsidies (full/partly/%), loan system, output based, performance based? Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

What can be done at this stage? Prepare a first proposal to start up with the HRH initiative (By June 2009). Explore the issues in the former slide through a systematic approach and consultation process with the CSSC partner group. Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal

Let’s weigh the options... Presentation prepared by Patricia Schwerzel CSSC/Cordaid/ETC Crystal