1. RMNCH Trust Fund
DPG-H meeting
6 January 2016

2. Presentation Outline Background information Second phase
UNLSCo
Key achievements
Second phase
Processes in development of RMNCH Trust Fund Programme
RMNCH Trust Fund supported interventions
Progress updates
December 2, 2018
Tanzania RMNCH

3. The Commission’s recommendations support clear objectives for under-utilized life-saving commodities across the RMNCH Continuum of care
Reproductive health
Female Condoms
Implants
Emergency Contraception
Maternal Health
Oxytocin 
Misoprostol 
Magnesium sulfate 
Newborn Health
Injectable antibiotics 
Antenatal Corticosteroid (ANCS)
Chlorhexidine
Resuscitation Equip.
Child Health
Amoxicillin
Oral Rehydration Salts
Zinc
Country Plans to increase access to commodities and services
and
Accelerate achievement of
MDGs 4 & 5
1.   Shaping global market
2.   Shaping delivery markets
3.   Innovative Financing
4.   Quality strengthening
5.   Regulation efficiency 
6.   Supply and awareness
7.   Demand and awareness 
8.   Reaching women and children
9.   Performance and accountability
10. Product innovation

4. URT RMNCH Plan: Focus Areas
Reproductive health
Female Condoms
Implants
Emergency Contraception
Maternal Health
Oxytocin 
Misoprostol 
Magnesium sulfate 
Newborn Health
Injectable antibiotics 
Antenatal Corticosteroid (ANCS)
Chlorhexidine
Resuscitation Equip.
Child Health
Amoxicillin
Oral Rehydration Salts
Zinc
Country Plans to increase access to commodities and services
and
Accelerate achievement of
MDGs 4 & 5
5.   Regulation efficiency 
6.   Supply and awareness
7.   Demand and awareness 
9.   Performance and accountability

5. Key Achievements: UNLSCo
Registration of all UNLSC commodities with exception of the Chloehexidine which was not adopted by the country as the recommended treatment neonatal cord sepsis care.
Increased awareness of UNLSC through sensitization of different stakeholders involved in supply chain including; manufacturers, supply agents, procurement agencies so that more dossier are being submitted for assessment and registrations

6. Key Achievements: UNLSCo
Reduced possibility of the stock outs by having the estimated quantity based on current consumption and service delivery data.
ILS Gateway software expansion was successfully completed in June The system now has the capacity to report on a greater number of commodities, than the 20 that are currently being reported on.
The eLMIS has now been rolled out nationally, across all districts. The system is being interfaced with the ILS Gateway to facilitate an easier user experience by ensuring all key data are available within the same website

7. Key Achievements: UNLSCo
Service providers are able to send and receive the mobile reminder /alert on the stock status and hence to take the appropriate action through ILS gateway.
Training on the ILS among different stakeholders involved in the RMNCAH service provision from higher management level to service providers at the health facility.
Reviewed of requisition and reporting form i.e. R&R form to incorporate all UNLSC has been done to enable ordering and reporting of the commodities

8. Key Achievements: UNLSCo
Reviewing and updating various RMNCH documents to incorporate newly introduced commodities and best practice in our national documents/guidelines to inform the service providers on the new recommendations:
pSTG and Essential Medicine for the Paediatrics and Adolescents
IMCI chart booklets
FP procedure manual to accommodate newly introduced FP methods including Implanon NXT
Revised EmONC guideline/Job aids
Clinical mentorship guideline and Learning Resource Package to guide on integrated Clinical mentorship approach
Production of ABCC prototype materials based on the KAP study to increase demand for LSC

9. Key Achievements: UNLSCo
Availability of the first National EmONC Needs Assessment Report has provided better information and baselines for the new RMNCAH intervention and other possible coming investment on the gaps. The report will be very useful for the health sector to ensure availability and access to improved quality of care.

10. SECOND PHASE
December 2, 2018
Tanzania RMNCH

11. National progress towards MDGs 4 & 5
Mortality data through 2012 (Source:Countdown2015)
The Tanzania Under—five child mortality rate and Maternal mortality ratio are declining, but are still high. Newer UN estimates show an Under-five mortality rate of 52 for 2013.
(Note: Updated 2013 child mortality data from “The UN Inter-agency Group for Child Mortality Estimation, 2014”)
2013 child mortality data was released in late 2014:
Under-five mortality rate (U5MR)= 52 deaths per 1000 live births
Infant mortality rate (IMR) = 36 deaths per 1000 live births
Neonatal mortality rate (NMR) = 21 deaths per 1000 live births
December 2, 2018
Tanzania RMNCH

12. RMNCH Coverage Gaps (Source: MTR Roadmap)
Coverage indicators
Good Progress
Poor Progress
Pre-pregnancy
1 ANC
ITN
TT2+
PMTCT
CPR
Adolescent BR
During pregnancy
4 ANC
During birth and postnatal
SBA
Facility Delivery
EmONC capacity (Facility)
PNC within 48 hours
Initiation of BF
Childhood
EBF (6 Months)
Paediatric ART
December 2, 2018
Tanzania RMNCH

13. RMNCH Priorities in Sharpened One Plan
Family Planning
Care at Birth, Post Partum and Postnatal
Commodity security and accountability mechanisms on RMNCH Services
Accountability and Transparency
December 2, 2018
Tanzania RMNCH

14. BRN Healthcare
The RMNCH work stream is the most expensive to deliver, comprising over half (58%) of the total budget for BRN HealthCare
December 2, 2018
Tanzania RMNCH

15. RMNCH Country Engagement PROCESS
Tanzania
RMNCH Country Engagement PROCESS
December 2, 2018
Tanzania RMNCH

16. BRN Phase 2 Roll-out Plan: July 2015 – June 2018
Special Focused regions (RMNCH)*
Mara
Kilimanjaro
Manyara
Tanga
Lindi
Mtwara
Ruvuma
Iringa
Morogoro
Pwani
Dodoma
Singida
Rukwa
Mbeya
Kigoma
Tabora
Shinyanga
Kagera
Mwanza
Geita
Simiyu
Arusha
Katavi
Njombe
Health Commodities,
Health facilities Intervention programme+& Star rating assessment
Note :
(*) The 5 Special Focused regions overlaps
(+) The intervention programme covers kigoma, katavi, tabora, singida, geita shinyanga, simiyu, Mwanza, Kagera, Mara, Pwani & Dar Es Salaam in Phase 2
Zanzibar
Dar Es Salaam
SOURCE : BRN Healthcare Lab (2014)

17. RMNCH TRUST FUND SUPPORT
December 2, 2018
Tanzania RMNCH

18. 24 month timeline of Cashboard
Tanzania RMNCH Country Engagement Timeline
Consultation Process
Literature review, Stakeholder Interviews
Proposal Review
26 Jan 2015
29 Jan 2015
24 Feb 2015
9 Mar 2015
March 2015
June 2015-September 2016
Funds Disbursement and Implementation timeline 1 2 3 4 5 6
Stakeholder Meeting 1
Stakeholder Meeting 2
Head of Agencies Meeting
Proposal Submitted

19. Gap Analysis of Sharpened One Plan (Consultations with Heads of Department, MOHSW ) Venue MOHSW/RCH, 28th January 2015
Working sessions with departmental heads at MOHSW wo tease out programmatic and financial gaps in Sharpened One Plan.
December 2, 2018
Tanzania RMNCH

20. Initial RMNCH Priority Funding Gap; US$36.6million (28th January 2015)
The initial prioritized RMNCH budget was US$ 36.6m

21. Stakeholder Workshop to Refine RMNCH Priorities Venue Best Western Peninsula Hotel 29th January 2015
Key stakeholders were MOH and implementing partners. Proposed RMNCH were re-prioritized.
December 2, 2018
Tanzania RMNCH

22. Stakeholder Workshop to Map Current RMNCH Implementation Partners in Tanzania Venue Best Western Peninsula Hotel 24th February 2015
Key stakeholders were MOH and implementing partners. Proposed RMNCH were re-prioritized.
December 2, 2018
Tanzania RMNCH

23. December 2, 2018
Tanzania RMNCH

24. December 2, 2018
Tanzania RMNCH

25. Tanzania’s Interventions Proposal to RMNCH Trust Fund
 Priority RMNCH Intervention
Examples of specific activities
Health Service Delivery
Capacity building for provision of EmONC services
Procure and distribute 50 ambulances to strengthen referral system
Train, Rehabilitate, and equip 8 CEmONC sites
Support blood transfusion services, including establishment of blood satellite sites in Kagera & Shinyanga, and purchase of laboratory reagents for screening.
Establish and equip adolescent youth friendly information, education and counseling corners in health facilities.
Health Workforce
Strengthen human resource capacity for provision of RMNCAH Services
Print and disseminate guidelines and job aids (MPDSR, ANCs job aids)
Train, supervise, and mentor health service providers at facility and at community level ( 9/12 Community Medical Attendants).
December 2, 2018
Tanzania RMNCH

26. Tanzania’s Proposal to RMNCH Trust Fund
 Priority RMNCH Intervention
Examples of specific activities
Health Information Systems
Strengthen capacity of HMIS to capture information on Maternal, Neonatal & Child health (MNCH) indicators, including Family Planning (FP) & nutrition.
Customize integrated RMNCH supervision tool into electronic data base
Customize MPDSR forms into DHIS2 electronic data base
RMNCH/HMIS/ DHIS2 data quality auditing at national level and Lake and Western zones
Essential Medicines and Health Products
Ensure availability of essential equipment and commodities for MNCH including FP .
Procure and distribute RMNCH Commodities
Procure equipment for EmONC, KMC Care, and Newborn care
Leadership and governance
Support for coordination of implementation of this proposal
Procure coordination and monitoring vehicles for zonal & 2 regional offices (Geita and Simiyu)
Support coordination services at MOHSW and RCH sector
December 2, 2018
Tanzania RMNCH

27. RMNCH proposal activities, selected examples
Priority area
RMNCH proposal activities, selected examples
Synergy with BRN HealthCare, selected examples
Family Planning
Training and supervision of CHWs (for integrated RMNCH services)
Initiative 17: Community Health Workers for MNCH
Maternal Health
Upgrade of CEmONC sites; Procurement of ambulances
Initiative 7: Implement Star-rating System
Initiative 19: CEmONC Services Expansion
Initiative 20: BEmONC Services Expansion
Newborn Health
Training on KMC, NR, ENC
Cross-cutting
Establishment of regional satellite blood banks; M&E/HMIS activities; Essential medicines and equipment; Program Management
Initiative 11: Improve governance and accountability
Initiative 21: Regional Satellite blood bank facilities
December 2, 2018
Tanzania RMNCH

28. Intervention Description..1
1.1.1 Establish and equip AYF – RH/FP information, education and counseling corners in health facilities
1.1.2 Repackage, print and disseminate RH/FP YFS National Training Package
1.2.3 Facilitate formation of community based RH/FP outlets for information , education and counseling to mobilize youth for YF RH/FP services (through youth peer educators, lay-counselors, religious leaders folk-media, VEO + WEO) in Lake and Western Region
1.2.1 Train CHWs/Community Medical Attendants (9 month training)
1.2.2 Train CHWs/ CMA on integrated community based MNCH services (3 weeks)
1.2.4 Conduct supervision to CHWs and the outreach teams at worksites (8 regions in Lake and Western)
December 2, 2018
Tanzania RMNCH

29. Interventions Description..2
2.1.2 Antenatal corticosteroid job aids for facilities / providers (including wall charts) printed
2.1.3 Finalize guidelines for Maternal Perinatal Death Surveillance and Response
2.2.1 Upgrade CEmONC sites to fully functional CEmONC status
Establish clinical mentorship program for staff at upgraded CEmONC facilities
2.3.1 Procurement of ambulances
2.3.2 Maintenance of ambulances
3.1.1 Conduct Kangaroo Mother Care training in all district hospitals in Lake and Western Zone
3.1.2 Neonatal resuscitation training
3.1.3 Essential Newborn Care training
December 2, 2018
Tanzania RMNCH

30. Interventions Description..3
4.1.1 Orient facility in-charges on pediatric Standard Treatment Guidelines. Orientation of officers in charge of facilities (Lake and Western zones)
Procure EmONC equipment
Establish blood collection satellites in Kagera and Shinyanga
Provide supportive supervision to zonal offices (Lake and Western)
Coordination and oversight of cross cutting RCH functions. Salaries, Benefits and capacity building including short courses (Coordinator and Driver )
Coordination and oversight of cross cutting RCH functions. Overhead (fuel, communication, transport, and allowances)
Coordination and oversight costs for UN managing agent
December 2, 2018
Tanzania RMNCH

31. Interventions Description..4
Procure RMNCH Commodities (to meet national need)
Kangaroo Mother Care equipment procurement
Neonatal rescusitation equipment procurement
Procure equipment for newborn care at referral hospitals
Print adequate RHCS client cards number 5
December 2, 2018
Tanzania RMNCH

32. Interventions Description..5
Purchase four vehicles for MOHSW Zonal offices for coordination activities ( Lake and Western), and two coordination vehicles for Geita and Simiyu
Customization of the intergrated RMNCH supervision tool into electronic data base
Customization of MPDSR forms into DHIS2 electronic data base
RMNCH/HMIS/ DHIS2 data quality auditing at national level and Lake and Western zones
Procure laboratory reagents (blood transfusion) (to meet 1% of quantification of national need)
December 2, 2018
Tanzania RMNCH

33. Zanzibar Interventions Description..1
FP & ASRH Capacity building
Cross-Cutting (HSS) - HMIS, Storage and distribution costs for medical supplies and equipment, Procure office equipment and capacity building.
Maternal Health - Procure equipment & vehicles and capacity building)
December 2, 2018
Tanzania RMNCH

34. Asanteni
December 2, 2018
Tanzania RMNCH