Christian Social Services Commission

ACHAP MEETING

Strengthening PPPs and Inter-faith

partnerships for Universal Health Coverage

Dr. Josephine Balati

25th February 2015

OUTLINE

• Introduction

• Functions of CSSC

•PPP Background and Rationale

•PPP Policy, Framework and

•Success and Challenges of

Strengthening PPP

•Partnership for UHC

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Christian Social Services Commission

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• Established in 1992 jointly by the Christian Council of

Tanzania (CCT) and the Tanzania Episcopal Conference

(TEC).

• Mandated to chart out a common action, within the policies

and the laws of URT, aimed at expansion, improvement

and development of the provision of the health and

education services

CSSC • For Health - work with a network of over 897 church health

facilities including 101 hospitals whereby 2 are Referral &

Consultant Specialized hospitals (KCMC and BMC), 37

District/Council Designated hospitals (CDHs), 59 Voluntary

Agency hospitals (VAHs), a total of 101 Health Centers and

697 Dispensaries. In addition, a network of 67 Health

Training Institutions).

• For Education - work with a network of 255 church

Secondary Schools and 52 Seminaries; 132 vocational

training Centers; 21 Teachers Colleges and 17 University

Colleges.

Introduction

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Christian Social Services Commission

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• Vision: An enlightened and well educated community that

is enjoying quality life and is free from diseases of poverty.

• Mission: CSSC strives to support delivery of social

services by church institutions in Tanzania through

collaboration and partnership, advocacy, lobbying, capacity

building and selected interventions, with the compassion

and love of Christ.

CSSC

Objectives:

• Contribute to the physical, mental, social and spiritual

development of the Tanzania people through facilitation the

provision of quality social services to all the people regardless

of color, race, creed

• To foster promotion, improvement and expansion of

Education, Health and other social services all over Tanzania.

Introduction Cont...

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Functions of CSSC

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Participate effectively in the formulation of

policies and/or present comprehensive

policy proposal to the government and

in so doing observe the policies for

such service as outlined by the

Government

Facilitate strategies to improve

planning, financing, coordinating,

orgniasing, expanding, or maintain

quality social services in health and

Education sectors

Harmonise or reconcile Churches policy

relavant to social services in Education

and health sectors

Administer, manage and monitor the use

of finances borrowed, granted,

generated or allocated through the

commission to support facilities

Facilitate monitoring of social

sectors programmes

designed by the Churches

Provide essential support

Church institutions providing

health and education services.

Strengthen technical services in Education

and Health sectors through reach and

consultancy services

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Coordination of Service Delivery

• CSSC head office is located in Dar-es-Salaam.

•CSSC operations are being coordinated through five Zonal Policy Forum (ZPF)

Offices:

Eastern zone, Southern zone, Northern zone, Lake Zone and Western zone

respectively.

•Each office is managed by a Zone Chairperson – A Bishop, Zone Manager, 2

health coordinators and 2 Education coordinators, an accountant/cashier, office

management secretary and a data clerk.

•Each Zone office is responsible for coordinating the health and education

facilities in respective zone and also link with respective dioceses. In additional the

ZPF are responsible for representing the churches, liaising and working closely

with the Regional and District health/education teams, other stakeholders in

respective Regions and Districts.

• Zone Offices coordinates and conduct member churches ZPF meeting, FBO Facility

technical meetings and, interfaith and PPP meetings.

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Zones and Offices

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Lake Zone

Western Zone

Southern Zone

Eastern Zone

Northern Zone

Lake Zone: Shinyanga

Mwanza, Simiyu, Geita,

Mara,Kagera

Northern Zone:

Arusha,K’njaro,Manyara

Eastern Zone:Dodoma,

Morogoro, Tanga, Dar,

Z’bar isles &Coast

Southern Zone:

Mtwara,Mbeya,

Lindi, Rukwa, Iringa,

Njombe, Ruvuma & Katavi

Western Zone:

Kigoma,Tabora,

Singida

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Background - PPP in the health

•Public and Private Health sectors have been providing health

services in Tanzania before and after independence.

•The public sector was the main provider

•The Government imposed restrictions on private health care

services delivery in 1977.

•The Government re-introduced private Health Service practices

in 1991

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Rationale - PPP in the health

•Demand for health services has increased, due to increased

population growth

•New policies promote increased participation of the private

sector in provision of health services.

•Inadequate public fund –Only 10.3% (2012/13) of total

government budget is allocated to health sector

•Need to complement government efforts.

•Need to leverage private sector resources

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The Private Sector Contributes

at all Health Service Levels

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PPP Policy, Legal Framework and Strategies

The Government has developed enabling policies and

environment as an effort to strengthen the delivery of health

services in Tanzania. Some of the key policy documents include;

•National Development vision 2025

•National Strategy for Growth and Poverty Reduction-MKUKUTA

•National Health Policy (2007)

•Health Sector Strategic Plan (HSSP III) of 2009-2015

•Primary Health Service Development Programme (PHSDP) of 2007-2017

•Tanzania five year development Plan 2011/12-2015/16

•Human Resource for Health Strategic Plan (2003-2013)

•Health Sector PPP Policy Guideline (2012/3)

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Strengthening PPP in the health sector

•Public-Private Partnerships (PPPs) in the health services delivery are part of

the implementation of health care programmes under the MoHSW and NGOs

which covers reproductive and child health, HIV and AIDS, Malaria, TB,

Health Basket funding support systems and management information system.

•Achievements for PPPs depend on existence of strong policies, laws, norms

and procedures (regulatory framework).

•The PPP Act No.18 (2010) and its Regulations (2011) provides the

institutional framework for the implementation of PPP Agreements between

the public and private sector; sets rules, guidelines and procedures for

governing public private partnership (PPP)

•Despite the good intention of key stakeholders to strengthen PPPs in the

health sector, there are still strong dissatisfactions in several areas. These

include knowledge gap in regulatory framework, coordination, financial

support, stakeholders’ commitment, human resource capacity and utilisation,

access to essential drugs to mention a few.

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The Regulatory Framework for PPPs

Success and constraints

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Policy Doc/Area Success Constraint

National Strategy for

growth and poverty

reduction (2007-2017)

Makes PPPs mandatory Lack support instruments for managing

PPPs

National Health

Insurance Fund

Better access to services through

public- private arrangements

Conflicting interests , Dishonesty,

Distrust , Bureaucracy

Service Agreement (SA) 67 FBO hospitals have signed

SA,

-Inadequate adherence to terms of the

SA (financing, HR, Medical supplies,

capital development and sharing of

plans) both government and FBOs.

-SA linked to Basket Fund only instead

of actual services provided.

-Very few private for profit facilities have

signed SA

-inadequate fund for Implementation of

exemption policy

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PPP Coordination

Success and constraints

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Organ/structure Success Constraint

Health Boards and Health

Facility Governing

Committees

Public and private sector

stakeholders meet & share

experiences, discuss and make

decision on issues related to health

services

-Effectiveness depends on

personalities

-In some regions the participation

of the private sector for profit is

very limited

-Limited awareness

-- Mistrust

- Lack of feedback

APHFTA (Association of

Private Health Facilities in

Tanzania)

Coordinates activities of member

private hospitals including training

- It is a speaking voice of private

practitioners

Some practitioners are not aware

of the role of APHFTA/ or not a

member

CSSC

-Coordinates and regulates the

functions of church (Catholic &

Protestant) based health facilities

-Networks with the government and

other private service providers

-The choice of the types of PPPs

is influenced by Christian based

ethics and code of conduct

-Some FBOs are not aware of the

role of CSSC/ or not member

churches

Others

The ministry of health and social

welfare has a management and

coordinating unit for PPP TWG,

The National PPP Forum

Roles and responsibilities are not

well known to some stakeholders,

Not all groups represented

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PPP Commitment and accountability

Success and constraints

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Area Success Constraint

Commitment on resources

Health Basket Fund

-Not enough, non adherence to the

allocation formulae

- The private is not involved in

decision making

- dependency on Treasury

Bed Grant

- Only for faith based service

providers - Not adequate compared

to actual costs

Staff Grant Cover few staff only

Trust There is hope that trust among partners

will improve

Generally both the private and

government officials mistrust each

other

PPP facilitation

-Some officials have good

understanding of the PPP concept,

policy and guidelines

-Provide cooperation and spearhead

PPP

-Low responsiveness of some

officials

-Unnecessary bureaucracy

- Lack of clear understanding the

concept, transparency and

facilitation of participation

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Human Resource - Capacity and Utilization

Success and constraints

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Area Success Constraint

Staff Secondment

Some doctors work in church based

service providers through secondment

-No effective monitoring of the quality

of staff

-No harmonisation of reward systems

- Increasing staff turnover

Staff Salaries

The government pay salaries for

seconded staff in FBO facilities

(Designated and Referral hospitals)

-Staff outside secondment receive

different (low amount) of pay

-Relatively poor reward for staff

employed by faith based service

providers

-Inability to attract and retain

qualified staff.

Capacity

Some qualified doctors working in

government hospitals get part time jobs

in private hospitals. This improves

capacity of the private sector

These doctors have more than one

master. This reduces efficiency,

commitment and accountability

Patients have to bear the costs

Training Joint Training, there training offered by

government as well as private sector

Not systematically planned /well

coordinated; sometimes depend on

personal relationships and

networking

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Partnership for Universal Health Coverage

•Universal Health coverage is an agenda for action.

•One of the key objective of Health Sector Strategic Plan III which has just ended

was to mobilise adequate resources and ensure the sustainability of resources for

the health sector. To that end, government budget, donor funding, as well as

household contributions were all targeted as sources of funding to reduce the budget

gap.

•There is a need to reduce the budget gap in the health sector by mobilising

adequate and sustainable financial resources; a need to reduce reliance on

external/donor support; need to complement the government efforts and need to

leverage private sector resources.

•The Draft Health Financing Strategy is in place and the government continue to

engage various stakeholders to review and contribute their inputs before finalizing

the document.

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Way Forward • Increase understanding of advantages of PPPs through increased

advocacy for PPPs at all levels

•Strengthen PPP implementation to improve the provision of health and

social welfare services

•Build capacity of Public and Private providers to identify, negotiate and

develop PPPs for health at all levels

•Strengthen forum for policy dialogue for PPPs at all levels

•Monitor and track PPPs in the sector at all levels

•It is important that local authorities develop strategies for reducing donor

dependency by setting budget allocation from their own revenues special for

supporting public- private sector partnerships.

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Thank you for your Attention – ASANTE SANA

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