1. Tanzania Ministry of Health and Social Welfare Health Quality Assurance Division “ Quality assurance and service integration” Edwin Mkwama (BSc. N, MSc. Epidem.) MNCH/HIV integration stakeholders’ Annual meeting Giraffe Hotel, DSM 24 th -25 th September, 2014 1

2. Presentation Outline Background of HQA Integration definition Policy environment on integration Benefits of integration Frameworks of integration of health services Role of HQAD in integration of health services Challenges of integration Way forward 2

3. Background of HQA (1/2) Provision of Quality Health Care is one of the top Priority in the National Health Policy Ministry established Health Services Inspectorate Unit ( HSIU) in 1998. HQAD was established in 2012 (and HSIU promoted to be one of the four sections) 3

4. Background of HQA (2/2) Realizing MNCH and HIV are areas of concern; the Directorate oversees all issues related to quality of health services It encourages services integration where/when the client is point of interest It encourages Coordinated services integration to ensure quality is highly appreciated as well 4

5. Integration definition (1/2) “The organization and management of health services so that people get the care they need, when they need it, in ways that are user friendly, achieve the desired results and provide value for money.”(WHO, 2008) 5

6. Integration definition (2/2) Two main types of integration (MoH, 2003): Horizontal integration means “fusion” of care, as much as possible when the user is reached. Vertical integration means assuring the indispensable linkage between the different levels of care, from the national level to the community and individual through the district level. 6

7. Policy environment on integration National Health Policy 2007 TQIF second edition (2011-2016) Enhancing integration, sustainability and equity in health care National Health and Social Welfare Quality Improvement Strategic Plan (2013-2018) Integrated supportive supervision and mentoring guidelines and tools Integrated QI implementation guidelines and harmonized tools 7

8. Benefits of integration Services can be cost- effective, E.g. experience from Northern Tanzania by Evjen-Olsen et al., (2009) Limited health resources available can be used as efficiently as possible. Clients receive more comprehensive services for overlapping health needs. Integrating services, strategies and plans can improve not only equity, access and coverage, but may also enhance the quality and efficiency of care. 8

9. Frameworks of integration of health services (1/2) Four core elements emphasized: CLIENT CENTRED SERVICES At facility and community level HEALTH OPERATIONS Planning at organization or agency level HEALTH SYSTEM Coordination at national level INTERSECTORAL INITIATIVES Across development sectors (Source: PATH 2011) 9

10. Frameworks of integration of health services (2/2) Elements to consider for successful integration: Planning and budgeting Organization of health services Staffing Training Supervision Logistics Community outreach Referral services Monitoring, evaluation, and research 10

11. Role of HQAD in integration of health services Prepare and coordinate implementation of the integration of health services guidelines; Coordinate and conduct joint health services inspection and supportive supervision to RHMTs/CHMTs; Monitor and evaluate implementation of joint health services inspection and supportive supervision; 11

12. Challenges of Integration Funding for reproductive health services often comes separately from funding for HIV services. Health care workers need training in multiple disciplines. Perceived loss of autonomy Lack of agreement as to who is in charge 12

13. Way forward Ministry will review the Strategic Plan for Integration of health services draft -2003 Integration will be one the common agenda in the TWG-Quality Generate evidence base of value and extent of integration of various health interventions Need to take advantage of existing frameworks for analysis of integration of health interventions in health systems e.g. Atun et al., 2010 conceptual framework 13

14. REFERENCES Atun, R., Jongh, T., Secci, F., Ohiri, K. and Adeyi, O. (2010). Integration of targeted health interventions into health systems: a conceptual framework for analysis. Health Policy and Planning 25:104–111 Olsen, B. E., Olsen, Ø. E. and Kvåle, G. (2009). Achieving progress in maternal and neonatal health through integrated and comprehensive healthcare services – experiences from a programme in northern Tanzania. International Journal for Equity in Health 8:27 PATH (2009). PATH’s framework for health services integration URT-MoH (2003). Strategic Plan For Integration Of Health Services In Tanzania Final Draft World Health Organization (2008). Integrated Health Services: What and Why. Geneva: WHO Technical Brief No. 1. 14