1. DISTRICT SUPPORT AND QUALITY MANAGEMENT Overall component objective ‘ To support provision of efficient and comprehensive health services which respond to the people ’ s needs ’. –Ministry of Health and social welfare –4 regions – Tanga, Mbeya, Lindi, Mtwara –25 Districts

2. DHQM specific objective To enable the district health services in Mtwara, Lindi, Tanga and Mbeya regions to provide efficient and comprehensive health services which respond to the people ’ s needs

3. Achievements Support at National level –develop national guidelines for establishment of Comprehensive Council Health Plans (CCHPs) –Develop Tanzania Quality Improvement Framework Regional level –Establishment and training Regional QIT –Data processing using PHC tool –Support to develop health care technical services system –Quality in health care conference

4. Achievements … Support to districts –develop annual CCHPs –improve data collection, processing and analysis in the sector using PHC Tool –Computer training of CHMTs –Assistance in specific activities aiming at reducing IMR and increase professionally monitored deliveries

5. Achievements … Health facility level –Establish and train QI Teams (14 district and 4 regional hospitals –Hospital performance and self assessment tool –Refurbishment and equipment to facilities (Mtwara and Tanga) –Health care waste management

6. Challenges Quality improvement is not given priority by managers Uncoordinated development of quality improvement tools and approaches by different stakeholders The human resource for health crisis Insufficient financing of health services Communities not taking active role in quality improvement measures

7. Future outlook Strong commitment to support improvement of quality of supervision Health care technical services with a focus on maintenance of health infrastructure and equipment To workout and implement mechanisms to sustain developed quality improvement structures and tools

8. Questions for discussion What would you consider as the main issues of quality improvement in decentralized public and private health services? Pertaining to financial assistance, which tools can be considered as the most important to create conducive environment for development of a district health system?