1. Technical Review Meeting DAY ONE RECAP 6 NOVEMBER

2. TRM OBJECTIVE 15 th Joint Annual Health Sector Technical Review Meeting Reviewing progress made since the JAHS –TRM last review and raising and discussing issues in preparation for the policy meeting

3. THE CMO WELCOME ADDRESS 1.Purpose of TRM: “Reflect on progress we made, challenges we are facing jointly. Set milestones for the coming years for better HSW services in the country, promoting partnership and team spirit, sharing information and avoid duplication and move forward”. 2.Noted: (a)The double burden of communicable and non-communicable disease, (b) high mortality rates and (c ) challenges of human resources for health. 3. Three high priority areas mentioned: Need for a strong Health Systems, (b) Evidence of measuring impact and Access to essential care.

4. The MOHSW PS OPENING REMARKS TRM was a platform where technical discussions are held, areas of focus and preliminary agreements are worked out and finally issues requiring policy decisions are taken up at the Policy Meeting. He noted that the sector is faced with a serious resource gap which dictates the distance between what we can do and what we cannot do. The Global economic crisis is worrying; we can only hope and appeal that this crisis should not add to an already existing resource gap. He said essential strategies to deal with the resource gap echoed as; strengthen the existing and develop new financing mechanisms to secure additional funding to the sector. As well as exploring alternative financing mechanisms,

5. 6 PRESENTATIONS AND 1 PANEL DISCUSSION Annual Health Sector Performance Profile Report 2013/2014 Big Results Now National Health Accounts 2011/2012 + Preliminary Public Expenditure Review 2013/2014 Perceptions on Petty Corruption in the health sector Health sector Strategic Splan IV preparations

6. Performance Profile  Targets not likely to be met; The Health Facility delivery target of 80% ( 2013 was 61%), early ANC booking target 80% (2013 was 35%) FB coverage 80% target of 2015 (43% in 2013) MMR target of 265/100000, (was 432 HSSP III 2015 target). The % U5 severely stunted the target of 20% for 2015 (TDS 2010 was 42%)  Malaria consistently the leading cause of admission over the last three years  Malaria, pneumonia and anaemia accounted for two thirds of reported U5 deaths in 2013  HIV/AIDS, Malaria and TB account for 45% of deaths among 5 years and above

7. AREAS DISCUSSED Lack of reliable population denominations projections: Observed that the NBS has not yet published official projections, therefore the “best estimate” denominators were used projections based on the census 2012 data for Regions and LGAs, Specific age groups (U1, U5, WRA) pending the publication of official projections The MOHSW follows and link up with NBS to release the population denominators even for regional and districts use.

8. Quality of HMIS data was note yet good In part due to under and delayed reporting and insufficient capacity for data analysis. SPD has been used to triangulate the data and information, since it was more reliable compared to HMIS which uses the passive system. Discussion: Work together with key stakeholders for HMIS so as to chart out how to minimize challenges and improve data quality and sharing. On sharing of data, allow the MOHSW to share analyzed data and the not raw data, encourage and take advantage of the use of eHealth

9. the U5 severely stunting Under 5 year Children Stunting was still a major problem: noted that the Nutritional issue was a multisectoral one and involved many other factors beyond the MOHSW. The importance of nutritional assessment at the entry of the child in the hospital was noted HW should appreciate the problem beyond acute or emergency phase and confirmed diagnosis

10. low ANC subsequent visits There is a need to improve quality of services i.e. have a complete service package for the visits. Strengthening Supportive supervision, Ensure that the regional and district teams do not conduct the same activities, but once a regional team visits the facility the district team should go to follow up the implementation

11. Big Results Now (BRN) The issue of funding the BRN was raised and noted that most of the resources exists, what is required is re-aligning the existing funding envelope to address BRN budget. The government may be ready to increase the budget HRH for BRN: Utilisation of the current permit including internal redistribution of existing human resource (Shifting permit): Some aspects of Community Health Workers are covered under BRN, this may include their costs. There is a need of clarity Noted that even other program areas can utilize the BRN approach

12. National Health Accounts  Development partners dependency; i.e. Donors are the main financiers of health sector, ( 48%)- Health financing strategy today may address this  Government Health Expenditure (GHE) has remained at the average of 7% of Total Government Expenditure. Need to increase this  On CHF, CHF window is not maximized, it was noted that there are regional variations (Mbeya and Singida doing well) Mbeya experience was shared.  CHF window is not utilized for urban poor although there are many poor people. Still waiting for TIKA to become fully operational

13. PETTY CORRUPTION  The facility governance committees are not known to the clients and are non functional- so ensure that health facility governing committees have necessary independence, authority, competencies, and financial resources.  Communities should know their rights- so establish a client service charter with service entitlements and standard rates  Form Integrity committee guidelines to protect the integrity. While strengthen monitoring of rules by providing citizens with a mechanism to make anonymous complaints.

14. Health Sector Strategic Plan IV Progress for developing HSSP IV was going on well, and the way forward is:  Intensive TWG Involvement in HSSP IV as they contribute to their technical area of  Team leader to visit Tanzania monthly to discuss progress with TWGs  Comment: Time lines were too close and spillover during December where some people may take leave.  Focus is the Big results now

15. Doc ID 15 Big Results Now By 2017/18 HRH Distribution Performance Management Health Commodities Special Focus MNCH  100% of the 9 Critical Regions to reach the 2014 National Average for Density of Clinicians and Nurses per 10,000 population  70% reduction in the number of Dispensaries without Skilled HRH  90% utilization of Employment Permits for the 7 cadres of Clinicians and Nurses  100% on-time delivery of ordered items  50% of locally generated funds used for health commodity procurement across all Councils by 2015/16  100% of health facilities commodities audit issues resolved & 0% stock wastages  Quality improvement initiatives & ICT platform to manage inventory at 100% of HFs  80% of health facilities elevated to 3 Stars and above by June 2018.  80% of LGAs have functioning social accountability mechanisms by June 2017  80% of health facilities achieve financial autonomy by June 2017  80% of health facilities have attained 75% customer satisfaction and above by June 2018  20% reduction of maternal mortality and neonatal mortality rates in 5 regions by 2017/2018

16. Policy priorities-still emerging Pursue BRN objectives (4 areas, main direction for the coming HSSP IV 1) Distribution of HRH; 2) Performance of HRH; 3) Commodities and supplies; and 4) MNCH. Other areas that can use BRN approach Social determinants of health (health promotion and environmental health) Universal health insurance for most vulnerable people The balance between NCD and other diseases, when considering that 50% for only three diseases