Tanzanian German Programme to Support Health Monitoring and Evaluation Susanne Pritze-Aliassime

2 Indicators programme level (8) based on national Strategy for Growth and Reduction of Poverty (MKUKUTA) 7 March 2016Monitoring and Evaluation- overall programme Infant mortality drops from 58 per 1,000 live births in 2007/2008 to 50 per 1,000 live births in Child mortality (under fives) drops from 94 per 1,000 live births in 2007/2008 to 48 per 1,000 live births in Maternal mortality drops from 578 per 100,000 live births in 2008 to 265 per 100,000 live births in The percentage of medically assisted births rises from 51 % in 2008 to 80 % in The contraceptive prevalence rate rises nationally from 20 % in 2004/2005 to 30 % in The percentage of pregnant 15 – 24-year olds testing HIV-positive drops from 6.7 % in 2008 to 5 % in The percentage of the population covered by some from of social health insurance rises from 9 % in 2008 to 30 % in 2015 All health services have an adequate number of health workers by 2017 (more than 80,000 staff in total across the country).

3 Indicators Component level (17) The percentage of young women and men (aged ) who have a comprehensive understanding of HIV/AIDS rises from 39.2 % of young women and 41.5 % of young men (in 2008) to 45 % and 47 % respectively. The percentage of women and men (aged 15 – 49) who have a comprehensive understanding of HIV/AIDS rises in all regions by 10 % (baseline 2008: Lindi: women %, men 67.3 %; Mtwara: women 52.4 %, men 54.2 %; Tanga: women 42.2 %, men 37.9 %; Mbeya: women 32.4 %, men 44.7 %). The percentage of women of reproductive age using modern contraceptive methods (contraceptive prevalence rate) rises by a minimum of 4 %: in Lindi to 34.1 %, in Mtwara to 29.9 %, in Mbeya to 27.5 % and in Tanga to 33.0 %. The number of employees reached by HIV/AIDS workplace programmes rises in the five ministries and authorities supported from 5 % in 2007 to 60 % in 2013, and in the four programme regions from 5 % in 2009 to 50 %. The Permanent Secretary, MoHSW, has at his disposal a coordinated strategy for the consistent medium- and long-term financing of the health sector. 30 % of the population of the programme regions are covered by some form of social health insurance (baseline 2008: 9 %). The percentage of all financial resources in the programme regions that are managed in a transparent fashion in line with national guidelines rises by a minimum of 10 % per annum (starting from a level of 35 %; this figure has been calculated on the basis of basket audits and district audits conducted via the NAO). The time taken to provide funding at district level in the programme regions is cut from the 20 days required at present to less than five days. In the programme regions, every public health facility has direct access to the funds it needs to allow it to provide its services (percentage of health facilities with their own bank account rises from the current level of 11.8 % to 100 %). The number of unfilled vacancies drops by 20 % (baseline 2008/2009: 1,193 unfilled vacancies) The percentage of employees of the health services who have successfully completed a course of advanced training at the Zonal Health Training Institutes rises by 25 %. A minimum of 75 % of the District Medical Officers (of which there are currently 31) in the programme regions are doctors or Assistant Medical Officers (AMOs) holding a Master of Public Health (MPH). Annual audits indicate rising quality in particular in the following areas: patient and staff satisfaction, administration and maintenance (baseline figure and target will be stipulated in the first report). In all districts it will be documented that the annual planning has been drawn up taking into account the suggestions made by private service providers (currently the case in 50 % of districts). A service agreement has been concluded with at least 60 % of private church service providers in the programme regions and the provisions are being implemented. In the Southern Zone the number of referrals from public to non-profit facilities and vice versa rise (baseline to be identified during the first year of programme implementation). 80 % of the Community Health Service Boards and 30 % of the Health Facility Governing Committees in the districts of the programme regions are operating in line with regulations (qualitative analysis of random samples taken from memos of meetings 7 March 2016Monitoring and Evaluation - overall programme

4 Approach  Continuous and systematic collecting, analysing and using of information in order to improve the performance of TGPSH  Providing continuous information on whether TGPSH is proceeding as planned focussing strongly on results (RBM)  Covering all programme needs (reporting to BMZ and internal steering of progress) 7 March 2016Monitoring and Evaluation - overall programme

5 Activities - ( bullet pts key activities) Develop a framework, in which the programme monitoring takes place (components and overall programme) Assign responsabilities and train accordingly to ensure regular update of monitoring system Regularly analyse national and internal programme data and provide feedback on progress Support writing reports to BMZ and other stakeholders on programme progress Support preparation of programme progress Review 7 March 2016Monitoring and Evaluation overall Programme

6 Challenges Complexity of TGPSH Different levels and different geographical areas of interventions Dependency on foreign sources of data (HMIS, TDHS.....), that are collected following own schedule Dependency on inputs of staff members to “feed” the system and keeping up motivation to do so 7 March 2016Monitoring and Evaluation- overall programme

7 Next steps Analyse new incoming data in regards to TGPSH goals, objectives and strategies Define a framework for the TGPSH monitoring system and put it in place (consultancy planned for first week of November) Support the preparation of the joint reporting to BMZ in terms provision of actual data 7 March 2016Monitoring and Evaluation- overall programme