1. OPERATIONAL MAPPING OF HEALTH SERVICE PROVISION IN THE SOUTHERN ZONE OF TANZANIA Management Team Meeting Richard Nkwera Dr. Oberlin Kisanga 15 th November 2011 Findings and Recommendations

2. Outline 2  Background and Objective  Methodology  Findings  Issues and recommendations  Way forward

3. Background and Objective 3  Gain insight of the Public and Private health services: in Lindi, Mtwara and Ruvuma  through assessment of location  service availability in view of rationalization potentials.  output and potential of health facilities  Transparency improvement among regional /zonal stakeholders for improved PPP  Service Rationalization: support informed Partnership decision making among:  location,  capacity and potential of health services (following key health problems),  physical infrastructure and catchment area  human resources and staff perspectives at governmental and private facilities

4. Background: Study Area 4 4

5. Methodology 5  17 facilities physically visited others through regional/district respondents  Data assessment on district and hospital facility level  Quantitative  Questionnaires  Qualitative  Open ended questions  Focus group discussions  Desk review 5

6. Findings  Reference is made in respect to: Lindi Mtwara Ruvuma  At the level of: Regional District /Council Hospital  Facility level

7. Health Facilities 7  Strong role and presence of faith based sector  MMAM requirement is almost three times of the available facilities (e.g. 181 to 496 Mtwara)  High number of health facilities - low number of skilled health workers  Over reliance of medical attendant – quality of services

8. Equipment and Infrastructure  Availability of beds Rural hospitals have higher number of patients because of large catchment area and geographical location leaves patients with limited choice of hospital The study recorded 2651 public and FBO inpatient hospital beds (public: 1,602; FBO: 1049) In Lindi Region, for example, the faith-based sector operates 45% beds and Mtwara region in fact 63% of the beds are in faith-based hospital  Water and power supply: Water – most facilities use piped Electricity – mostly use of generator  General purpose Equipment – average - available and working X-ray Oxygen Theater Ambulance Refrigerator etc.  Communications – limited internet access

9. Support Services  Laboratory Services Basics (malaria) tests available Advanced lab services – not available (sending samples for days)  Blood transfusing Services available, though interruption reported to some districts in a period of three months (eg. Ruangwa and Liwale) In all districts except for Tandahimba D.C relatives/friends or donors from the district are the main sources of blood donations, while Tandahimba the main type of donors are volunteers.

10. Patient disease specific interventions  Maternal and Child health interventions Available at all facilities  Malaria services – available Presumptive IPT for Malaria during pregnancy  HIV and AIDS, SRH and STI Services Average: No SRH services targeting adolescents needs Roman catholic facilities lack contraceptives HIV counseling and testing – available ART services – satisfactory (availability) Overall SRH commodities - satisfactory

11. Human Resources  Density of medical doctors is very low Ranging from 0.03 to 0.6 per 10,000 population  Backbone of services: midlevel cadres (AMO/CO - ENs)  Non professional: high number of Medical attendants  Specialists: nine (9) in the mapped area  Staff movement: from FBO to public

12. Human Resources Back bone of Health Services

13. Training  Per facility: All health workers in each hospital received at least one training At least one laboratory staff member trained in the diagnosis and treatment of malaria is less than 20% of facilities across the districts surveyed in Lindi and Mtwara Region. At least one health worker in each hospital received the following trainings: HIV and AIDS Mother and Child Health Reproductive Health Malaria Infection control Tuberculosis Drug Management Health Information Management System

14. Training Training Potentials:  High potential of the present institutions to cater for HRH development but No strategy for local demands.  shortage of tutors on top of the attrition due to retirement and disease burden is a challenge facing all the institutes e.g. in COTC Lindi, there are four tutors and two will be retired by year 2009/2010.  Recruitment of new tutors has not moved in proportion to student enrolment in most institutions.  Capacity to handle increased numbers of students and manage the condensed curriculum aimed at meeting MMAM targets is questionable as workload increase with no additional tutors

15. Partners Support  Presence - variety of stakeholders  Low coordination  Overlap esp. in HIV/A support  No support management plan  Mismatch between resource input with available Management capabilities.  Lindi  Clinton Foundation (CHAI) (HIVAIDS)  EGPAF – Care and Treatment  AGOTA  USAID  BIOSHAPE – HIV/AIDS Care and Treatment  BMAF – Staff support  Mtwara  JICA  BMAF  UNICEF  CHAI  EGPAF  Action Aid  Ruvuma  JICA  DANIDA  ITIAPOCUNICEF

16. for normal delivery from wards to assessed health facility Patients Movement (GIS)

17. 17 Lindi Region

18. 18 Mtwara region

19. 19 Tunduru District

20. Recommendations  Service provision Where patients go to receive services? (avoid resource consuming duplication extensively explore the opportunities to invest in private service providers) Recruit more national specialists to assure sustainability (as the majority of medical specialists identified in the study area were expatriates working on a short-contract basis) Improve coordination of the few specialists available in the zone  Resources availability / facilities management  Human resources: Retention measures should apply to both – public and private Increase the availability of Assistant Medical Officers and maintain the relatively sound densities of enrolled nurses and clinical officers The need for a more comparable system. (Districts use different staffing norms when calculating deficits for their Comprehensive Council Health Plans) Health Training Institutions should have strategy to cater HRH local demands  Public and Private collaboration: Enforcement of PPP

21. Way forward 21  Have TGPSH feedback  Linking stakeholders to these results  Building capacity of: Regional referral HRH  Government – informed decision making What is available

22. ASANTENI