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Health Sector Strategic Plan 2015-2020 (HSSP IV)
Reaching All Households with Quality Health Care
RMO/DMO Conference 2015
Increasing efficiency through more integration and capitalizing synergies
Deepening D-by-D (fiscal decentralization +)
Improving quality of services through
Better performance
Enhancing partnerships
Priorities and where to gain more value for money
The HSSP IV is about
2
To reach all households with essential health and social welfare services,
meeting as much as possible expectations of the population and objective quality standards applying evidence-based,
efficient channels of service delivery.
HSSP IV Overall objective:
3
1. Attain objectively measurable quality improvement of primary health care services
2. Improve equity of access to services by focusing on
geographic areas with higher disease burden and vulnerable
groups .
3. Achieve active community partnership through
intensified population interactions for better health and social well being
4. Applying modern management methods and innovative partnerships
5. Improve on social determinants of health through
inclusion of health protection and promotion
Strategic Objectives
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Health Promotion, Prevention and Basic Care in Community Health is key element of strategy to reach all people and to reduce costs of health and social welfare services
Strategic Decision: Emphasis on Community Health and Primary
Prevention
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Create a full-fledged department at LGAs addressing:-
1. Operationalization of MVC action plan
2. Establishing social protection for persons with disabilities, MVCs and elderly persons
3. Establishing multi-disciplinary prevention and response services for victims of violence, abuse, neglect, exploitation and trafficking
4. Building capacity for Juvenile Justice and Correctional Services
5. Setting up accountability mechanisms for child protection
Strategic Decision : Enhanced Social Welfare at LGAs
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Pursuing Star Rating and Improvement programme countrywide (achieve 80% of the PHC facilities 3 star at least)
Essential National Package of Health Interventions to be agreed and provided
BEmONC and CEmONC capabilities at all primary facilities
Strategic Decision: Emphasis on Quality Primary Care services
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1. Human resource for Health production, redistribution, fast track deployment, retention, P4P, accreditation and CPD recognition
* Social Welfare workforce production plan implementation
2. Medicines and supplies availability
2. Maintenance and ppm (infrastructure, transport and equipment); new infrastructure in underserved areas, avoid duplication
3. Financing – Universal and equitable access (single public insurance servicing MBP); efficient and effective use
Critical support systems
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More resources to Regions with higher burden of diseases
More resources to Regions with lower levels of service delivery
RMNCH has priority because of vulnerability pregnant mothers and children
Adolescents (girls and boys) services
Integration of health and social welfare services at district ,ward &community level
Strategic Decision: Equity for populations and vulnerable groups
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Empowerment of communities to co-manage health facilities
Decision making Powers of Governing Committees and Boards
Transparency: community reporting on health facilities’ performance
Client satisfaction as element in performance management
Strategic Decision: Social Accountability
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Performance Management Systems Individual level
Institution level
Results Based Financing
Level playing field Public and Private Facilities
Monitoring of Performance
Data for decision-making approach
Strategic Decision: Performance as Basis for Operations
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Emphasis on prevention of NCDs
Improve capacities of health staff in handling NCDs
Integrate NCDs in diagnostic and treatment centres
Strengthen treatment of advanced NCDs with innovative financing strategies
Strategic Decision: Accommodate upcoming NCD needs
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Health Financing strategy
aim for equitable access
Universal health coverage
Single National Health Insurer
Implement Minimum Benefit Package (MBP)
Advocate for more Government Resources
Raising resources for health
revenue, sin and other taxes
Trauma fund, from road taxes insurances
Revolving Funds; OOP payments
Regulatory body: Price control medicines
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Strategic Decision: Health Financing
Decentralisation by Devolution (to LGAs)
Fiscal decentralisation to institutions
Partnership
PPP, private sector participation
Public-Public Partnerships, networking
Social accountability
Increased inter-ministerial collaboration
SWAp mechanisms
Strategic Decision: Governance
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BRN is top priority in implementation
Health services or systems area
BRN costs included (constant across scenarios)
HSSP IV costs (TSH
billions)
RCHS Maternal and child health support activities (e.g. trainings, mass media, etc.) specified as priorities under BRN and expanded under OnePlan II
323.1
Infrastructure Costs of facility upgrades and equipment for BeMONC and CeMONC
59.3
Performance Improvement
Facility star rating assessment, fiscal decentralization, social accountability, and performance target activities as specified under BRN
25.0
Commodities Costs related to commodities and quality improvement, including costs to address pilferages
21.9
HRH Staff redistribution costs and other priority BRN HRH activities
14.6
Scale up BRN Countrywide after
2018
Resources for the HSSP IV – Costs In five years TZS 11,300 billion (11.3 Trillion)
In 2015-16 TZS 2,087 billion (2 trillion) available Vs 4,031b (4tr) needed per year.
Increase to 2,503 billion (2.5 trillion) in 2019-20
Commodities represent 78%; HIV about 30 to 33%
Financing gap from fiscal space analysis o Ambitious scenario (SNHI and Innovative fin) the financing
gap will be TZS 515 billion (0.5 Trillion) in 2016/2017 growing to TZS 1,525 billion (1.5 Trillion) in 2019/2020
o Without SNHI and Innovative financing the gap is TZS 1,410 billion (1.4 Tr)in 2016/2017 and grow to TZS 2,453 billion (2.4 Tr) by 2019/2020
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Fiscal Space for HSSP IV
Scenario 2: Funding gap
0
1000
2000
3000
4000
5000
6000
2015/16 2016/17 2017/18 2018/19 2019/20
TZS
Bill
ion
s
Scenario 2 costs
Base, no SNHI, noinnovative sources
Base, no SNHI, withinnovative sources
SNHI scenario 1
SNHI scenario 2
Close the funding gap!
Summary
With innovative financing and continued growth in existing health insurance schemes, the Country can access 3─3.5 trillion TZS per year* over 2015/16 to 2020/21
Without innovative financing, the range is 2─2.5 trillion TZS p.a.*
With innovative sources, health as a % of the GOT budget (excluding CFS) would average 15% from 2016/17
Without innovative financing, given declines in some on-budget sources and slow growth in domestic sources, the same average figure would be 10%
With Scenario 2 we alleviate the financing gap BUT still remain with a gap in relation to total HSSP IV cost
This has implication for level of ambition of the sector program targets
Argument for fast tracking the HFS is stronger
Emphasis on innovative cost cutting, synergies and value for money from coordination, Alignment & Harmonisation, integration
Effective use of resources (fiscal decentralization, accountability, cost-effective interventions, resource mapping)
Implications
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