1. Health Promotion Experience of HPSS Project Dodoma, Tanzania Participatory Methods for Identification of Determinants of Well-being and Community Action Planning: Piloting Multiple Approaches and Strategies for Health Promotion, in Dodoma Region, Tanzania Presented at the Culture Health & Wellbeing international conference in Bristol, UK 24-26 th June,2013 Presented by: Ally-Kebby Abdallah

2. Health Promotion Component Introduction to Dodoma Region  Located at the center of Tanzania  Semi-arid region with many tribes; Gogo, Rangi and Sandawe are the major tribes, there are other small ethnic groups, like Maasai, Bargaig etc.  Dodoma has seven districts. 2

3. Health Promotion Component HPSS: A project “Health Promotion and System Strengthening” (HPSS) Project  Funded by SDC, mandated to Swiss TPH  Implemented in Dodoma Region (7 districts)  Preparation Phase: June 2010 to May 2011  Phase 1 of implementation: June 2011 – Jan. 2015  Phases 2 and 3 envisaged for 2015 - 2020

4. Health Promotion Component Objectives of the HPSS  Purpose: Access to, quality and utilization of health resources and services in Dodoma Region are improved and delivered by an effective and well governed health system. Objectives: 1. The population of Dodoma Region has developed and carries out health promotion activities which are suited for improving their health status 2. The health system in Dodoma Region is strengthened in its capacities to provide appropriate and quality health care

5. Health Promotion Component Working Areas of the HPSS Components: Health Promotion, Health System Strengthening, Operational Research Working Areas: Community based health promotion activities Health financing Drug Management support Maintenance and Infrastructure Management support Operational Research Mainstreaming of project activities on gender, HIV/AIDS, social inclusion

6. Health Promotion Component A Systemic Approach for Improving Health

7. Health Promotion Component HP Expected Outcomes Outcome The population of Dodoma Region has developed and carries out health promotion activities which are suited for improving their health status Outputs 1.Institutional structures (government and non- government) for supporting community activities in health promotion are strengthened and made functional 2.Communities are supported to define and operationalize thematic areas for health promotion. 7

8. Health Promotion Component Problem Analysis History of HP Approach in Tanzania  Expert led approach  Top down  High cost  Community passive  Lack of ownership (maintenance / sustainability)  Not in line with the Ottawa Charter 8

9. Health Promotion Component Basel 2013 9 Piloting Approaches in Dodoma Prevention, health promotion and health education represent complementary strategies to improving a population’s health. cannot be separated many countries use a combined approach to reduce risk and promote health

10. Health Promotion Component Basel 2013 10 The Concept of Health Promotion

11. Health Promotion Component Basel 2013 11 Health Promotion Approach Addresses an issue at several levels and addresses several of the five key action areas

12. Health Promotion Component The Ottawa Charter 1986: defined Health Promotion  a process of enabling people and groups to increase control over, and to improve their health and quality life 12 Basel 2013 1.Build Health Public Policy 2.Create Supportive Environments 3.Strengthen Community Actions 4.Develop Personal Skills 5.Re-orient Health Services

13. Health Promotion Component Transformation of Approaches Under the HPSS Mandate 13 Apply community empowerment processes through PRA whereby communities identify health concerns and plan solutions TWG meetings: platform for experience sharing and discussion of HP technical matter Use experience and operational research results to influence region to orient health services Influence regional and district authorities’ planning Develop plans and Guide: disseminate existing GoT policies Training of Health Promotion Officers/ CBOs/CHWs etc

14. Health Promotion Component Participatory Process on Identifying Health determinants and needs  Conducted Participatory Health Problem analysis and Planning for Community Action for Health Promotion in all wards of Dodoma Region. 14 DistrictsBahiChamwino Dodoma Urban Kondoa and Chemba KongwaMpwapwa Developed Plans 204033512630

15. Health Promotion Component Problem Identification Processes  Community Stories  Health Problems in Community 15

16. Health Promotion Component Problem Analysis  Invite community members to mention/list health/diseases that affecting the community and write them down.  Divide the group into sub-groups (men, women and if possible young and old)  Facilitate the groups to present findings in plenary. 16

17. Health Promotion Component Problem Analysis Tools  Different analysis tools used by facilitators 17

18. Health Promotion Component Enabling the voting process  Then draw up these priorities on a large sheet of paper  Give each member of the group 3 stones, pieces of paper or leaves as votes 25 October 2015 Title of Presentation 18

19. Health Promotion Component Facilitate  As people record their priorities, remain nearby to answer any questions as needed. 19

20. Health Promotion Component Tribes and age set community  Very hierarchical societies: young and old/ women and men Education and wealth Status level  Poor Vs better off  Educated-service providers 20

21. Health Promotion Component  Count the votes  Discuss the results of the ranking with the group  Record any further information

22. Health Promotion Component Participatory Approaches addressing Culture Barriers Gender and engagement in process  disaggregated by gender and age groups for effective identification and discussion.  Male facilitator for male groups; female facilitator for female groups. 22

23. Health Promotion Component Participatory Approaches addressing Culture Barriers Gender and engagement in process  disaggregated by gender and age groups for effective identification and discussion.  Male facilitator for male groups; female facilitator for female groups. 23

24. Health Promotion Component Results/Outcome  Participatory processes for identifying community health problems, causes, and priority setting for action planning has been conducted and completed in over 200 villages of Dodoma region.  The exercise revealed the following;  Malaria is still a number one community concern in most villages.  Water bone diseases (especially typhoid and diarrhea) rank number two in most villages.  Eye and skin infection are ranked third in the majority of villages.  HPSS has developed a more rapid and cost effective method compared to traditional PRA approaches. 24

25. Health Promotion Component PRA Benefits of the Approaches  Communities empowered to understand & act on their health concerns.  Determinants of health from the communities are well understood  Communities has managed to identify own resources (manpower with skills and materials)  Specific health needs identified by different social groups.  Cultural barriers addressed  Community ownership of interventions 25

26. Health Promotion Component Community Plan 26

27. Health Promotion Component Preliminary Results from the Communities 27 19,270 people reached by CHWs and CDO/HOs in 14 villages  Provision of subsidized latrine slabs  Chlorinated and protected water sources in villages  Provision of subsidized latrine slabs  Chlorinated and protected water sources in villages  18 food stall owners prosecuted over poor hygiene 2 working group meetings conducted so far: Agreed regional HP strategy

28. Health Promotion Component Challenges Global/national trend in resource allocation to biomedical and curative strategies rather than holistic HP approaches and prevention Limited support from key decision-makers Lack of HP infrastructure  Ensuring sustained commitment to health promotion principles and approaches  Ensuring implementation of participatory methodologies  Proactive ownership and future development of health promotion course by the Zonal Training Centre  Identifying suitable indicators for measuring effectiveness Reduction in CCHP fund for CAH (from 5-10% to 2-5%)

29. Health Promotion Component Asante Sana!