1. Christian Social Services Commission CHF Best Practices Workshop 31 st Jan – 2 nd February 2007 The Place of CSSC in Services contracting FBOs PLACID NGILIULE Planning and Coordination Officer

2. Background of CSSC  Established as an ecumenical body in 1992 for facilitating delivery of social services. This was an outcome of the 1991 historical conference of Bishop and other Leaders of the Catholic and Protestant Churches

3. Background of CSSC The conference was prompted by prevailing social economic crisis during the 1980 s through caused mainly by break of EAC (1977), Uganda was (1979/80) Oil crisis 1979/80; collapse of coffee boom 1977/1978; drought, and the outbreak of HIV/AIDS. The conference saw the urgent need for more cooperation in provision of Health and Education services among churches and in turn with the government.

4. CSSC Vision An enlightened and well educated community that is enjoying quality life and if free from diseases of poverty.

5. CSSC Mission Statement CSSC strives to support delivery of social services through partnerships, lobbying and advocacy in a manner that will ensure transparency, quality, equity availability and accessibility with Compassion and Love of Christ.

6. CSSC Main Objectives CSSC was established to meet the following objectives: (i)To contribute to the physical, mental and spiritual development of the Tanzania people through facilitating the provision of quality social services to all the people regardless of colour, race and creed. (ii)To foster promotion, improvement and expansion of education, health and other social services all over Tanzania.

7. CSSC Main Roles Policy Advocacy/ Lobbing work for conducive polices; pro poor policies Capacity Building CSSC operates through a network of over 80 diocese, over 600 health facilities, about 200 secondary schools spread all over the country.

8. Financing the FBO’s Health Sector in Tanzania Cost sharing as : (i) User fees since 1930s through: Out of pocket payment – cash and carry system (ii) Prepayment insurance scheme. Cost sharing accounts for 10 – 50% of recurrent costs; depending on economic profile of the catchments area, quality of service, quality of facility leadership/management and staff. Government subsidies – bed and staff grants; staff secondment and vertical programme funding e.g. TB and Leprosy, Maternal and Child Health (MCH) expanded program of immunization services; HIV/AIDS account for 29-81 percent of cost in most hospitals. Donations through bilateral arrangement with traditional partners externally and locally. In some FBO’s facilities donations account for anything up to 45 percent of overall hospital income. Income generation activities such as agricultural related activities, tailoring, grain milling etc. Missionaries and volunteers help to lower costs of facilities

9. Issues and Challenges Inadequate capacity by communities to pay user fee charges due to high poverty levels. Inadequate government subsidies to hospitals. Inadequate remuneration package to health personnel hence exodous of staff in search of green pastures elsewhere. Support from traditional partners steadily decreasing and becoming more and more unpredictable. Flows in the implementation of government exemption policy (poor patients, elderly patients 60-65 and above, HIV/AIDS patients, patient with chronic condition, TB, diabetes, cancer, heart diseases and others, Children under 5 years, Pregnant women)

10. Issues and Challenges Some implication: an example of Bunda DDH 60 -75 percent of all outpatient are children under 5 years, 30-40 percent of hospital beds are occupied by HIV/AIDS patients. Debt problems: Mvumi hospital reported an average debt owned to the hospital by patients of over T.Shs. 3.6 million each year between 2002 – 2005. Some estimate that about 60-80% of patients are exempted. Inadequate management systems Availability of reliable costing data to make informed decisions Inadequate data base to clearly define CHF situation in FBO facilities

11. CSSC has a strategic role to play in the contracting Process for CHF’s CHF is crucial source of funding/financing quality health care Advocating for streamlining and improving the implementation of the existing financing frameworks especially the Community Health Funds given its immense potential to reach the poor majority of Tanzanians. Advocating for improvement in the quality of health care delivery to FBO facilities. Scale up and sustain capacity building in the key management functions including Human Resource Management,Financial Management and Planning etc. Advocate FBO facilities and Religious leaders to support micro- financing initiatives for community empowerment Facilitate capacity building in income generating skills/entrepreneurship skills for running a small business improved agricultural projects and link them with financial agencies for small loans and support with seed money for income generating activities.

12. CSSC has a strategic role to play in the contracting Process for CHF’s Conduct operational research to identify bottleneck and look for solutions Advocate church leaders and FBO facilities to scale up sensitization campaigns to communities regarding the benefit of CHF and try to create a sense of community ownership of the scheme. Fac12ilitate capacity building for FBO facilities staff in CHF procedures including processing required documentation and data. Advocate Church FBO and religious leaders to clearly understand and appreciate the concept and benefits of CHF including the matching contributions from WB and practice according to government policy.

13. Thank you for your attention