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October 31, 2019
This publication was produced for review by the United States Agency for International Development. It was
prepared by the Public Sector Systems Strengthening (PS3) Activity located in Dar es Salaam, Tanzania, under
Contract AID-621-C-15-00003 with USAID/Tanzania. The USAID/Tanzania Public Sector Systems Strengthening
Activity (PS3).
PUBLIC SECTOR SYSTEMS STRENGTHENING
(PS3) IN TANZANIA
ANNUAL REPORT
OCTOBER 1, 2018– SEPTEMBER 30, 2019
2
The USAID/Tanzania Public Sector Systems Strengthening (PS3) Activity’s overarching goal is to support the
Government of Tanzania to strengthen the public system to promote the delivery, quality, and use of services,
particularly for underserved populations. Led by Abt Associates, PS3 is implemented in partnership with Benjamin
William Mkapa Foundation, Broad Branch Associates, IntraHealth International, Local Government Training Institute,
Tanzania Mentors Association, University of Dar es Salaam, and Urban Institute.
October 2019
Contract No: AID-621-C-15-00003
Submitted to: Elizabeth Williams, Contracting Officer Representative
Cover Photo: Michael Mrossso, a Pharmacist from Makorola Health Centre attending patients using GOT and
PS3 strengthened systems (Photo: Athuman Pemba- ICTO Tanga City Council).
DISCLAIMER The contents of this report are the sole responsibility of the PS3 Activity and do not necessarily reflect the views
of USAID or the United States Government.
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CONTENTS
ACRONYMS.................................................................................................................... 4
EXECUTIVE SUMMARY AND QUARTERLY ACHIEVEMENTS ........................ 9
INTRODUCTION ......................................................................................................... 15
1. INFORMATION SYSTEMS ........................................................................ 16 1.1 Strengthening Public Sector-Wide Information Systems ................................. 16 1.2 Sector-Specific Information Systems ............................................................... 21 1.3 Management of Strengthened Information Systems ........................................ 24 1.4 Strengthen System Interoperability, Data Access and Use .............................. 26
2. FINANCE ....................................................................................................... 28 2.1 Support Development of National Health Insurance Architecture ................... 29 2.2 Strategic Purchasing and Shift to Output-Based Payment ............................... 30 2.3 Strengthen Service Provider Financial Management ....................................... 32
3. HUMAN RESOURCES................................................................................. 38 3.1 HR Planning and Distribution .......................................................................... 38
4. GOVERNANCE AND CITIZEN ENGAGEMENT ................................... 44
5. OPERATIONS RESEARCH ........................................................................ 49
6. INSTITUTIONALIZATION FOR SUSTAINABILITY ............................ 50
7. COLLABORATIONS ................................................................................... 52
8. COMMUNICATIONS AND KNOWLEDGE MANAGEMENT .............. 53
9. MONITORING AND EVALUATION......................................................... 55
10. CHALLENGES .............................................................................................. 59
11. PROGRAM MANAGEMENT ..................................................................... 60
List of Tables and Figures
Figure 1: Three System Dynamics ................................................................................................... 15 Figure 2: Overview of Information Systems (IS) Component Structure ............................... 16 Table 1: National GOTHOMIS Installation .................................................................................. 21 Figure 3: Percent of regions’ total health facilities with GOTHOMIS installed ................. 22 Figure 4: GOTHOMIS Requirement gathering illustrations and participants...................... 23 Table 2: PORALG Help Desk Tickets Received per System from July 1, 2018 to April
12, 2019 ................................................................................................................................ 24 Table 3: GOT and PS3 progress toward system interoperability............................................. 26 Figure 5: screen shot of the public portal/dashboard currently under development. .......... 28 Figure 6: New Intersection of PFM and Sector Service Purchasing/Provider Payment .... 29 Figure 7: Two sides of DHFF ........................................................................................................... 30 Figure 8: FFARS mobile app dashboard at PORALG level ..................................................... 34 Figure 9: Integrated Approach to HRM ........................................................................................ 38 Table 4: Year 4 Activities to Integrate WISN plus POA into GOT Systems ....................... 39 Table 5: Nationwide implementation of new teacher OPRAS goals/template .................... 42 Table 6: Development of e-OPRAS ............................................................................................... 43 Table 7: Phase 1 LGA using CM system: FY2017/18 vs FY2018/19 ............................... 45 Table 8: GIAMIS Development Plan .............................................................................................. 49 Figure 10: Phases in DeL course development ............................................................................. 51 Table 9: PS3 Collaborations with USAID and Development Partner Projects................... 52 Figure 11: PS3 Results Framework ................................................................................................. 55 Figure 12: Nutrition compact indicator scorecard on iMES ..................................................... 57 Figure 13: PS3 Regional Clusters .................................................................................................... 60
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ACRONYMS
ACCGEN Accountant General
API Application Programming Interface
ARDS Agriculture Routine Data System
ASDP Agricultural Sector Development Program
ASPIRES Agriculture Sector Policy and Institutional Reform Strengthening
BEMIS Basic Education Management Information System
BL Baseline
BMF Benjamin William Mkapa Foundation
CAG Controller and Auditor General
CBMIS Central Budget Management Information System
CDC Centre for Diseases Control and Prevention
CDD Community Development Department
CDR Council Development Report
CFR Council Financial Report
CHF Community Health Fund
CHSSP Community Health and Social Welfare System Strengthening Program
CM Complaints Management
COA Chart of Accounts
DC District Commissioner
DEC Development Exchange Clearinghouse
DeL Distance e-Learning
DFF Direct Facility Financing
DFID Department for International Development
DHFF Direct Health Facility Financing
DHIS2 District Health Information System 2
DICT Department of Information Communication and Technology
DIFT Directorate of Inspectorate and Financial Tracking
DLG Department of Local Government
DLS Department of Legal Service
DP Development Partners
DQA Data Quality Assurance
DRA Department of Regional Administration
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eGA e-Government Agency
eLMIS Electronic Logistics Management Information System
ENGINE Enabling Growth through Investment and Enterprise
e-OPRAS electronic Open Performance Review and Appraisal System
EPI Expanded Programme on Immunization
EQUIP Education Quality Improvement Programme
EU European Union
FFARS Facility Financial Accounting and Reporting System
FY Fiscal Year
GF RSSH Global Fund Resilient and Sustainable Systems for Health
GFG Good Financial Governance
GHSC Global Health Supply Chain Project
GIZ Tanzania German Programme to Support Health
GOT Government of Tanzania
GOTHOMIS Government of Tanzania – Hospital Management Information System
GWF Government Website Framework
HBF Health Basket Fund
HCMIS Human Capital Management Information System
HFS Health Financing Strategy
HIM Health Information Mediator
HIS Health Information System
HIV Human Immunodeficiency Virus
HLG Higher Local Government
HMIS Health Management Information System
HP+ Health Policy Plus
HPSS Health Services Support Project
HR Human Resource
HRH Human Resources for Health
HRM Human Resource Management
HSSP Health Services Support Project
IAG Internal Auditor General
IAGD Internal Auditor General Department
iCHF Integrated Community Health Fund
6
ICT Information and Communication Technology
IGFT Intergovernmental Fiscal Transfer
iMES Integrated Monitoring and Evaluation System
IMTC Inter-ministerial Technical Committee
iOS iPhone Operating System
IPRS Implementing Partners Reporting System
IPSAS International Public Sector Accounting Standards
IT Information Technology
JICA Japan International Cooperation Agency
KCMC Kilimanjaro Christian Medical University College
LAN Local Area Network
LANES Literacy and Numeracy Education Support
LGA Local Government Authority
LGRCIS Local Government Revenue Collection Information System
LGTI Local Government Training Institute
LLG Lower Local Government
M&E Monitoring and Evaluation
MBP Minimum Benefit Package
MC Municipal Council
MCSP Maternal Child Survival Program
MNIS Multisectoral Nutrition Information System
MOALF Ministry of Agriculture, Livestock, and Fisheries
MOEST Ministry of Education, Science and Technology
MOFP Ministry Of Finance and Planning
MOHCDGEC Ministry of Health, Community Development, Gender, Elderly and Children
MSD Medical Stores Department
MSH Management Science for Health
MTEF Medium Term Expenditure Framework
MUHAS Muhimbili University of Allied Health Services
NFT National Facilitation Team
NHA National Health Accounts
NHI National Health Insurance
NHIF National Health Insurance Fund
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NICMS National Integrated Case Management System
OC Other Charges
OPRAS Open Performance Review and Appraisal System
OR Operations Research
OSR Own Source Revenue
OUT Open University of Tanzania
P4H Providing for Health
PAG Policy Analysis Group
PE Personnel Emoluments
PEFA Public Expenditure and Financial Accountability
PFM Public Finance Management
PFMRP Public Financial Management Programme
PHC
PIRS
Primary Health Care
Performance Indicator Reference Sheet.
POA Priority Optimization Analysis
POPSM President’s Office Public Service Management
PORALG President’s Office, Regional Administration and Local Government
POS Point of Sales
PS3 Public Sector Systems Strengthening
PV Prime Vendor
R&R Request and Requisition
RBF Results-Based Financing
RMNCH Reproductive, Maternal, Newborn and Child Health
RS Regional Secretariat
RSLT Result
SDC Swiss Agency for Development and Cooperation
SIS School Information System
SNHI Single National Health Insurance
TA Technical Assistance
TASAF Tanzania Social Action Fund
TB Tuberculosis
TC Town Council
TGT Target
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TMA Tanzania Mentors Association
TSC Teachers’ Service Commission
TV Television
TWG Technical Working Group
UDSM University of Dar es Salaam
UHC Universal Health Coverage
UN United Nations
UNICEF United Nations Children's Fund
USAID United States Agency for International Development
USD United States Dollar
WDC Ward Development Committee
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EXECUTIVE SUMMARY AND QUARTERLY
ACHIEVEMENTS
The purpose of the USAID Public Sector Systems Strengthening Activity (PS3) is to support the
Government of Tanzania (GOT) to strengthen national systems to promote the delivery, quality,
and use of public services, particularly for underserved populations. PS3 is a five-year USAID-
funded activity that strengthens Local Government Authority (LGA) systems to promote
inclusive and evidenced-based planning, management, and implementation of services across
sectors, including health, education, and agriculture. PS3 is led by Abt Associates in partnership
with Benjamin William Mkapa Foundation (BMF), Broad Branch Associates, IntraHealth
International, Local Government Training Institute (LGTI), Tanzania Mentors Association (TMA),
University of Dar es Salaam (UDSM), and the Urban Institute. This annual report covers the
project period of October 1, 2018 to September 30, 2019.
Year 4 Activities and Achievements
Use of PlanRep in Routine Work: The second year of PlanRep implementation (Year 4) was
critical for solidifying system acceptance and use by LGA and facility staff in their day-to-day work.
PORALG and PS3 refined the PlanRep system based on user experience, assisted PlanRep users
to develop FY2019/20 plans and budgets, and enabled implementation of FY2018/19 plans and
budgets. A focus was on assisting Regional Secretariats (RS), LGAs, and facilities to strengthen
specific budget functions in the overall planning process including: 1) budget scrutinization to
ensure total budget does not exceed Ministry of Finance and Planning (MOFP) ceilings making all
budgets more realistic; 2) develop and implement a new PlanRep budget reallocation module and
corresponding user guide for FY2018/19, making it easier for users to perform mid-year plan
revision and budget reallocation to adapt to changes in priorities or environment and budgets;
and 3) strengthen fiscal year end processes such as performing bank reconciliations and preparing
the carry-over FY2018/19 budget to help LGAs and facilities retain funds not spent by the end of
the fiscal year, which historically would have been returned to treasury and reallocated.
A Year 4 achievement was President’s Office, Regional Administration, and Local Government
(PORALG) realignment of roles and relationships and increased ownership of PlanRep
system. During the first year of PlanRep implementation (FY2018/19), PORALG/ Department of
Information, Communication and Technology (DICT) took the lead on technical aspects of
system operation, maintenance, management, and refinement. In the second year (FY2019/20),
PORALG/Department of Policy and Planning (DPP) stepped up to perform its legal responsibility to lead planning and budgeting across PORALG, RS, LGAs and facilities in concert with MOFP.
DPP ownership is progress towards institutionalization for sustainability--a better balance of
information technology and program management to improve planning and budgeting for all public
sectors and services delivered to citizens.
Defining public sector service outputs: PlanRep is core to strengthening multi-sectoral
planning, budgeting, and management of public services based on the service outputs delivered to
citizens. FY2019/20 inclusion of a PlanRep nutrition objective with its corresponding 12 service
outputs has the potential to substantially improve multi-sectoral nutrition planning and budgeting.
PORALG Nutrition Coordination Unit (NCU), Ministry of Health, Community Development,
Gender, Elderly and Children (MOHCDGEC), development partners (DPs), and PS3 improved
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FY2019/20 nutrition plans and budgets by orienting RS/LGA staff responsible for implementing
nutrition plans and conducting a nutrition budget scrutinization workshop. Evidence from budget
scrutiny demonstrated that PlanRep enables better differentiation between nutrition and non-
nutrition activities as it revealed the nutrition budget to be Tanzanian Shilling (TZS) 16.7 billion
which is substantially different from the TZS 50 billion based on nutrition public expenditure
estimates. In addition, it demonstrated LGA competency in aligning activities with service outputs
as only 8% of activities did not match service outputs.
In Year 4, GOT and PS3 supported refinement of gender service outputs and gender
disaggregation of resource allocation to enable LGA Community Development Departments
(CDD) to better plan, budget and implement gender activities. Four gender service outputs have
been defined to ensure gender mainstreaming in all sectors: gender mainstreaming across sectors;
women’s access to labor saving technologies; women’s participation in decision making; and
gender based violence services. PlanRep now enables analysis of LGA alignment to national
priority gender policies. An analysis of LGA budget allocations to gender based violence service
outputs shows a substantial increase in the budget from 0.340 billion TZS in FY2018/19 to 3.3
billion TZS in FY2019/20.
Integrated Monitoring and Evaluation System (iMES): In Year 4, PORALG, e-
Government Agency (eGA), sector ministries and PS3 developed the Integrated Monitoring and
Evaluation System (iMES) which is a cross-sectoral web-based system or database being built on
DHIS2 platform. Selected information from cross-sectoral and sector-specific interoperable
systems flowing through Muungano Gateway will be exported and stored in iMES, together with
information from other systems hosted outside of PORALG. It will be key to maximizing access,
use, and analysis of information, and also to production of timely and relevant reports
contributing to improved management and service delivery. Development of a public
portal/dashboard began and will be completed early in 2020, allowing the general public to access
and use data authorized by PORALG.
Direct Health Facility Finance (DHFF): In Year 4, MOHCDGEC, PORALG, numerous DPs
(both health basket funders and projects), and PS3 improved data quality for primary health care
per capita payment adjustors (need, performance, equity), and calculated facility payments from
health basket fund (HBF) that MOFP transferred directly to the bank accounts of 5,459 health
centers and dispensaries in all 185 LGAs. Results-based financing (RBF) is a key block in the
unified DHFF purchasing framework as it provides direct and powerful fee-for-service incentives
on top of the core output-based payment systems to stimulate service delivery improvements in
the large public sector health delivery system. In Year 4, MOHCDGEC, PORALG, DPs, and PS3
supported RBF by building capacity, improving data quality linked to interoperable systems
extended to facility level, and analyzing RBF data including invoicing and payment processes.
PORALG, MOHCDGEC, DPs and PS3 also supported activities to improve how facilities spend
funds to procure inputs to produce service outputs including drafting and reviewing a new DHFF
Management Framework and starting to harmonize spending guidelines across revenue sources
and funds flows.
Financial Accounting and Reporting System (FFARS): Extending PlanRep and FFARS to
facility level establishes the two basic business management bookends of planning/budgeting and
accounting to increase transparency, autonomy, and accountability and improve management and
service delivery for 24,229 health facilities and schools. PORALG Help Desk and PS3 provided
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user support and refined FFARS based on user experience. In Year 4, FFARS mobile application
(app) was deployed and service providers are slowly adopting it. The mobile app is accessible
through android mobile phones and tablets. It contains all the features in the web-based system
and facilities that have electricity, computers, or internet challenges are free to use the FFARS
mobile app. At the start of FY2019/20 (July 1, 2019), interoperable FFARS, Medical Stores
Department (MSD) Epicor-9 accounting system, and Electronic Logistics Management
Information System (eLMIS) were deployed following a technical development collaboration of
ICT and business process experts from PORALG, MOHCDGEC, MSD, Global Health Supply
Chain Project (GHSC) and PS3. Budget funds allocated by MOFP to MSD are visible in FFARS
thus improving the ability of facilities to procure medicine and other supplies using DHFF funds.
Interoperability also will improve MSD procurement planning, as they will be able to monitor
stock-outs across all facilities, and hence be prepared for procurement requests coming from the
facilities.
WISN plus POA: Workload Indicators Staffing Need (WISN) plus Priority Optimization
Analysis (POA) in Tanzania continued to have a significant impact on the way new staff are
distributed to health facilities. In Year 4, PS3 mentoring activities supported LGAs to use WISN plus POA to request, distribute, and redistribute staff. The key Year 4 activity was integration of
WISN plus POA into GOT systems including placement on the District Health Information
System (DHIS2) platform, and making it interoperable with other GOT systems such as the Heath
Management Information System (HMIS). By the end of Year 4, programming development was
complete and system testing was in process. In Year 5, a fully automated WISN plus POA system
will be deployed at the LGA level for use in real time to inform staffing requests, allocation,
distribution, and redistribution decisions in a cost-effective manner. This significant achievement
will make Tanzania the first country in the world to automate and integrate WISN plus POA into
government systems.
Teacher’s OPRAS Goals: A Year 4 GOT and PS3 achievement was introducing a new way
to set teacher’s Open Performance Review and Appraisal System (OPRAS) goals. Setting
teacher’s goals is now standardized and grounded in teachers’ job descriptions and competencies
(instead of based on LGA strategic plans, which was confusing and unrealistic). Cascade training
delivered by expert teams from President’s Office Public Service Management (POPSM), Public
Service Commission, PORALG, Teachers Service Commission (TSC), LGAs, and PS3, the new
OPRAS teacher goals and templates reached all 185 LGAs. Each LGA then cascaded the training
and templates to all heads of schools who trained all teachers in each school. GOT and PS3
follow-up mentoring visits showed an average of 92% of teachers in visited schools completing
OPRAS forms using the new goals and template.
Improve Sharing of Information with Citizens: In Year 4 GOT and PS3 continued to
support RS/LGAs to use their websites to share information with citizens and improve internal
communication and management. Year 4 monitoring showed that approximately 75% of RS/LGAs
updated their website within 40 days. More intensive mentoring and monitoring in PS3 26 Phase
I LGAs contributed to an increase of 45% in the number of website visitors from 72,709 in 2018
to 105,435 in 2019.
Collaboration and Institutionalization for Sustainability: In Year 4, PS3 continued to
collaborate to its comparative advantages with USAID and other DP projects including both
budget support and technical assistance projects. PS3 maintained very good relationships with
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GOT partners and prioritized immediate institutionalization of strengthened systems into
technical operations and management processes. Institutionalization is complex, but GOT and
PS3 have a clear goal in mind: by the end of the project, all responsible LGA and facility staff will
take ownership and pride in their work as they use the strengthened systems and management
processes on a daily basis to perform their routine work. In Year 4, efforts were accelerated by
empowering LGA and facility staff to use the strengthened systems, realigning institutional roles
and relationships to solidify ownership, and starting to incorporate theory and practice into pre-
service education (resource tracking and FFARS) and continuing education (LGTI distance e-
learning courses for LGA councilors and new staff orientation).
Other activities during Year 4 included:
In Information Systems, GOT and PS3 further refined PlanRep, FFARS, LGA Epicor 10.2
accounting system, FFARS, and Local Government Revenue Collection Information System
(LGRCIS) based on user experience, and also improved their interoperability and reports. A
Year 4 technical priority was making four health information systems (HIS) interoperable to
support extending only one HIS to facility level, and improve facility management including
expending DHFF funds to procure inputs and produce service outputs. By the end of Year 4, GOT Health Management Information System (GOTHOMIS), HMIS/DHIS2, e-LMIS, and NHIF
claims management had successfully sent data to each other via the PORALG and MOHCDGEC
data mediators. PORALG and PS3 institutionalized management and maintenance of LGA local
area networks, and improved operation of the Help Desk that uses a customized web-based
system to create tickets allowing technicians to enter, support, track, document and respond to
RS and LGA user questions, issues, and requests.
In Finance, high level GOT dialogue on single NHI accelerated and shifted to a new policy of
merging Worker’s Compensation Fund with NHIF and iCHF, consistent with GOT intent to
reduce overlapping or fragmented social protection programs (an actuarial study is in process).
GOT also reaffirmed its intent to establish one insurance pool to provide equal access to a
standard Minimum Benefit Package for all citizens including the poor and underserved. PS3
provided technical assistance to the MOHCDGEC to finalize National Health Accounts analyses
for financial years 2013/14, 2014/15, 2015/16, and to write reports. Progress on interoperability
of other systems (e.g. PlanRep, LGRCIS, Epicor, and FFARS) created an opportunity to automate
LGA Council Financial Reports (CFRs). In Year 4, the automatic generation of LGA CFRs began.
In HR, based on POPSM request, PS3 supported development of e-OPRAS that will be made
interoperable with redesigned Human Capital Management Information System (HCMIS) to
address OPRAS challenges and improve performance management. PS3 continued to deepen its
HR management activities to help ensure that new staff are supported to perform well in their
positions. Activities included mentoring 26 Phase I LGAs on customized HR retention strategies
and improving personnel records management. TSC and PS3 solidified use of e-Office for GOT
official correspondence and storage/maintenance of confidential teacher files, including personnel
records, and TSC began to enter these confidential files into e-Office.
In Governance, the primary PS3 intervention to strengthen committee functioning is mentoring
LGAs to benchmark, identify and then address problems and gaps. A Year 4 benchmarking
activity identified that committee minutes are inadequate, and PORALG and PS3 responded by
developing a simple, standardized and automated template to record meeting minutes stored on
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LGA websites (it awaits PORALG management approval). Additionally, POPSM’s assessment of
the complaints management system at the service provider level in four LGAs led to a request
to develop national TV programs and related video clips to inform citizens about the complaints
management system. This was largely completed in Year 4 following USAID approval. A GOT
decision related to the cost and limitations of the licensed Teammate internal audit system led
MOFP/Internal Auditor General (IAG), PORALG, Public Finance Management Reform Program
V (PFMRP V) and PS3 to begin development of the secure web-based Government Internal Audit
Management Information System (GIA-MIS). The system will perform internal audit business
processes, and equip internal auditors with necessary knowledge and skills on audit processes
and procedures.
Support Functions: This year, the Operations Research (OR) component conducted a facility
study. It is a deep qualitative study digging into the dynamics of change in health facility and school
management and governance related to DFF and extension of PlanRep and FFARS to facility level.
A total of 708 respondents produced 6,372 responses that were coded, classified, and analyzed.
A draft facility study report was completed in August 2019, is currently under USAID review, and
will be finalized in Year 5. In Year 4, PS3 OR component contributed to a number of small assessments or analyses directly linked to program implementation including automation of LGA
CFRs, and PlanRep service output and budget analyses for nutrition and gender. The OR
component also supported initial design of results analysis to be developed in Year 5 including
budgets in PlanRep, revenue in LGRCIS and GOTHOMIS, LGA expenditures in Epicor, facility
expenditures in FFARS, and small analyses documenting efficiency gains.
In M&E, PS3 M&E plan priorities were completing Year 3 indicator analysis, submission of results
(in the first quarter of Year 4), as well as Year 4 M&E plan indicator data collection. M&E
supported technical component teams to follow-up on indicators and results with a view to
inform and refine system strengthening interventions. PS3 engaged with MOHCDGEC, PORALG
and LGAs to assess progress related to LGA performance in collecting and reporting on gender
disaggregated data. PORALG, other government stakeholders, UNICEF, other DPs, USAID and
PS3 worked to automate nutrition compact indicator data collection, and develop technical links
and interoperability between nutrition information systems and iMES to increase efficiency, access
and use of high quality nutrition data. Previously, nutrition coordinators had to manually extract
compact indicator data for all 185 LGAs, a tedious and time consuming process.
In Communications, PS3 submitted all contractual deliverables and continuously improved
internal communications and knowledge management. The team also continued to support all
PS3 interventions requiring communication expertise. For example, PORALG and PS3 developed
PlanRep and FFARS tutorials that users can reference when they encounter an on-the-job
challenge using the system. At the end of Year 4, PS3 began to collaborate with USAID/Tanzania
and USAID/Washington to develop the key communication messages that PS3 will use to
disseminate information about the outcomes achieved through PS3, as well as larger lessons on
how to implement systems level changes effectively. A major output of the partnership between
PORALG and PS3 has been the production of a joint newsletter known as Mifumo Yetu (Our
Systems) which produced four editions this year on PlanRep, GOTHOMIS, Government Web
Framework (GWF) and FFARS. Mifumo Yetu is disseminated widely through all sectoral
ministries’ websites, RS/LGA websites and to other stakeholders.
14
Program implementation challenges: In Year 4, the majority of PS3’s challenges related to
integration of strengthened systems into GOT functional and sectoral/program operations
(“business process owners” in Tanzanian terminology). Most of the issues are related to the
inherent nature of organization or human behavior change as the way public sector services are
managed and delivered is transformed. Very few of the challenges are related to the systems
themselves as they are desired by stakeholders and efficiency gains and management
improvements have been broadly recognized. GOT and PS3’s productive relationship has been
enhanced by identification, communication and resolution of behavior change management issues,
specifically those related to realignment of roles and relationships.
Program management: After reaching its peak program implementation intensity in Year 3
and early Year 4, PS3 settled into a new activity level plateau consistent with evolution in the
type of activity and progression through close-out phases. PS3 continued to invest in management
improvements and obtaining efficiency gains to maximize the impact of USAID funding. PS3 also
continued to strengthen communication and relationships between technical and management
teams, national and regional/LGA teams, across components, and across partners to ensure the
project is responsive not only to USAID but also to the GOT stakeholders, ultimately maximizing PS3 impact and sustainability.
15
INTRODUCTION
The purpose of the USAID Public Sector Systems Strengthening Activity (PS3) is to support the
Government of Tanzania (GOT) to strengthen national systems to promote the delivery, quality,
and use of public services, particularly for underserved populations. PS3 is a five-year USAID-
funded activity that strengthens Local Government Authority (LGA) systems to promote
inclusive and evidenced-based planning, management, and implementation of services across sectors, including health, education and agriculture. PS3 is led by Abt Associates in partnership
with Benjamin William Mkapa Foundation (BMF), Broad Branch Associates, IntraHealth
International, Local Government Training Institute (LGTI), Tanzania Mentors Association (TMA),
University of Dar es Salaam (UDSM), and Urban Institute.
This quarterly report covers the project period of April 1-June 30, 2019.
Implementation Strategy and Sequencing
Two basic assumptions drive the PS3 implementation strategy: 1) it is very difficult to improve
service delivery without sufficient human and financial resources at the service delivery level; and
2) service delivery is strengthened by facilities’ autonomy to manage their information, plans,
finances, staff, service outputs and outcomes.
To that end, PS3 is working to establish the following three system dynamics which are critical
to delivery, quality, and use of public services, particularly for underserved populations:
▪ Interoperable systems to facilities: Providing lower
local government and facilities (schools and health
facilities, among others) systems which work, and are
interoperable with other essential public management
systems, makes facilities visible across all public sectors
and all levels of government. The interoperability also
improves the facilities autonomy, transparency, accountability, efficiency, and management practices.
▪ Money to facilities: Changing the way money is
allocated to facilities, so facilities receive financing directly
based upon their outputs, helps the facilities improve the
management and delivery of services to the population.
▪ Public workers to facilities: Using evidence to prioritize which facilities receive staff ensures equal service workload. It also increases efficiency, equity, and management of
delivered services.
In order to move human and financial resources to facilities and to increase facility autonomy,
PS3 works within four system functions: 1) Information Systems, 2) Finance, 3) Human Resources,
and 4) Governance and Citizen Engagement. To support these functions, PS3 also conducts
Operations Research.
Figure 1: Three System Dynamics
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1. INFORMATION SYSTEMS
Information systems improve Local Government Authority (LGA) and facility public sector
service delivery by catalyzing efficiency gains, reducing costs, streamlining processes, improving
management, leveraging technology, and innovation, and placing useful and relevant information
in the hands of decision-makers and citizens. As systems are extended to the facility level,
Government of Tanzania (GOT) and PS3 empowers providers with autonomy and accountability to manage public services, resulting in more transparent resource allocation, better quality data,
and evidence-based decision-making, and maximized public sector service outputs, outcomes and
impact. As shown in Figure 2 and described in the sections below, in Year 4 GOT and PS3
focused on sector-wide systems, sector-specific systems, system management and maintenance,
and system interoperability and data access and use.
Figure 2: Overview of Information Systems (IS) Component Structure
PS3 Monitoring and Evaluation (M&E) indicator results on timely reporting for Council Financial
Report (CFR), Council Budget/ Medium Term Expenditure Framework (MTEF), and Council
Development Report (CDR), and multi-sectoral dashboard systems are shown in the table below
(all IS interventions). Additional work related to continuous refinements needs to be done to
improve submission of reports on time, but the 100% result reflects that production of three key
cross-sectoral reports is now inherent in the operation of strengthened systems. Multi-sectoral
dashboards are also built and produced into systems. For example, a link between Local
Government Revenue Collection Information System (LGRCIS) and websites exists for all LGAs
as the website front page contains a dashboard (Dashibodi) with a link to LGRCIS. Refer to
http://www.mwanza.go.tz/
# Indicator Name BL Y1 RSLT Y2 TGT Y2 RSLT Y3 TGT Y3 RSLT Y4 TGT Y4 RSLT
3.3.5 % LGAs submitting complete reports on time 43.8% 36.8% 40.0% 40.9% 50.0% 39.6% 50.0% 100.0%
4.4.3 % LGAs with multi-sectoral dashboard systems 0.0% 0.0% 10.0% 0.0% 10.0% 0.0% 80.0% 100.0%
1.1 Strengthening Public Sector-Wide Information Systems
A PS3 comparative advantage is its ability to work in the open cross-sectoral space to reduce
system fragmentation, increase efficiency, and improve basic management and service delivery
functions across all public sectors at the LGA and facility level. Strengthening the foundation of
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standard management functions, systems, and processes is a basic need required for all public
sectors and service providers or facilities.
1.1.1 Implement Redesigned PlanRep to Improve Planning and Budgeting
In Year 3, the redesigned web-based PlanRep was first used by all 185 LGAs and 24,229 public
health facilities and schools to develop, review, and approve plans and budgets for Tanzania’s
fiscal year FY2018/19. For the first time ever, Tanzania has a functioning nationwide, sector-wide,
centralized web-based planning, budgeting, and reporting system used by all 185 LGAs – a game
changer for public service delivery in all sectors and all levels of government. The successful
system launch was the culmination of partnership between President’s Office, Regional
Administration and Local Government (PORALG), Regional Secretariats (RS), LGAs, President’s
Office Public Service Management (POPSM), e-Government Agency (eGA), Ministry of Finance and Planning (MOFP), sector ministries, development partners (DPs) and PS3.
Results for PS3 M&E plan PlanRep indicator are shown in the table below.
# Indicator Name BL Y1 RSLT Y2 TGT Y2 RSLT Y3 TGT Y3 RSLT Y4 TGT Y4 RSLT
3.3.1.a PlanRep redesign completed 0 0 0 1 Complete 1 Done
3.3.1.b % targeted LGAs using redesigned PlanRep 0.0% 0.0% 0.0% 0.0% 50.0% 100.0% Done
P-5 % of targeted LGAs who submit LLG plans
into PlanRep 28.0% 100.0%
Year 4, the second year of PlanRep implementation, was critical for deepening system acceptance
and use. Therefore, key Year 4 activities focused on providing additional technical support system
users to prepare for and execute the FY2019/20 planning and budgeting cycle, as well as to better implement FY2018/19 plans and budgets.
This support including assisting RS, LGAs, and facilities to utilize the PlanRep budget reallocation
module and corresponding user guide for FY2018/19, making it easier for users to revise plans
and reallocate budgets. It also increased the flexibility to adjust to changes in current year
priorities. After budget reallocations were approved, PORALG and PS3 supported exportation
of approved budgets to Epicor and Facility Financial Accounting and Reporting System (FFARS)
through system interoperability via the Muungano Gateway information mediator, while also
refining PlanRep internal logic and processes.
PORALG and PS3 supported LGAs and facilities to prepare for fiscal year end, such as performing
bank reconciliations and preparing the carry-over FY2018/19 budget. This process was key in
helping LGAs and facilities retain funds not spent by the end of the fiscal year, which historically
would have been returned to treasury and reallocated.
During the first year of PlanRep implementation (FY2018/19), PORALG/Information
Communication and Technology Directorate (DICT) took the lead on technical aspects of system
operation, maintenance, management, and refinement. In the second year (FY2019/20),
PORALG/Department of Policy and Planning (DPP) stepped up to perform its legal responsibility
to lead planning and budgeting across PORALG, RS, LGAs and facilities in concert with MOFP.
The ownership of DPP represents substantial progress towards institutionalization for
sustainability. It is part of a long process of shifting focus from system ICT aspects to system
management, including alignment of PlanRep roles and relationships to improve planning, and
budgeting for all sectors, programs, and services delivered to citizens.
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In Year 4, PORALG/DPP, PORALG/DICT, MOFP and PS3 performed a two-step process to
inform RS, LGAs and facilities about PlanRep, Epicor and FFARS refinements and kick-off
FY2019/20 planning and budgeting: 1) all RS and LGA planning officers attended a PORALG and
MOFP joint workshop to receive guidance and be empowered to lead the planning and budgeting
process in their respective regions and LGAs; and 2) GOT and PS3 cost-
shared for 26 regional refresher
trainings conducted in December 2018.
This training was delivered by joint
PORLAG and PS3 experts - 13 teams
of four people each that included a
coordinator, PlanRep expert, Epicor
expert, and FFARS expert. These
teams worked with regional and LGA
planning officers. Orientation focused
on five regional officers and nine LGA
officers and content areas included
system refinements and planning and budgeting policy, guidelines and process. Following, the
joint PS3/PORALG teams supported all RS, LGAs, and facilities to successfully enter plans and
budgets for FY2019/20 in the PlanRep system and supported the automated FY2019/20 plan
review and approval process including budget scrutinization to ensure that the completed budget
entered in PlanRep matched ceilings provided by MOFP.
Level Representatives
Regional Officers Assistant Administrative Secretary - Planning and Coordination, Assistant
Administrative Secretary - Local Government, Information, Communication and
Technology Officer, Regional Health Secretary, Regional Social Welfare Officer
LGA Officers Planning Officer, ICT Officer, Treasurer, Human Resource Officer, Medical Officer,
Health Secretary, Social Welfare Officer, Education Officer – Primary, Education
Officer – Secondary
In Year 4, focus was placed on making refinements to PlanRep based on first year experience, strengthening interoperability and improving reports. This included extending user matrices to
facility level, creating user interfaces to enter information on implementation of planned activities,
and reviewing and improving service outputs for all sectors (see Finance Component). PORALG,
MOFP, and PS3 engaged in dialogue on design of PlanRep and Central Budget Management
Information System (CBMIS) resulting in agreement on specific MOFP requirements for PlanRep
and the format of budget ceilings, including parameters such as sources of funds.
Further in Year 4, PORALG, LGA representatives, University of Dar es Salaam (UDSM), in their
role as contractor for District Health Information System (DHIS2), and PS3 engaged in dialogue,
designed and began development of PlanRep and Health Management Information System (HMIS)
interoperability. This included the identification of data elements to be exchanged between the
two systems, the mapping of data and facility codes, and programming of the interoperability. In
Year 5, PORALG, UDSM, and PS3 will complete development, testing, and deployment of PlanRep
and HMIS interoperability which is particularly important to LGA and facility health sector plan
development.
National PlanRep facilitators from PORALG and PS3
instructing some of Kigoma Ujiji MC Officials during the
PlanRep refreshers training
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PS3 and PORALG also supported RS and LGAs to use PlanRep to produce standard reports for
the first time through mentorship and training. Reports produced included: legally mandated
LGA CFR and CDR reports as well as a wide range of financial reports (e.g. expenditure against
approved budget by cost center, development allocations and expenditures by sector,
expenditures by funding source, own source revenue in major groupings, transfers, and borrowing). Support for report production reinforced prior training, and addressed some RS
and LGA staff that remained unclear on how to utilize PlanRep reports functionality. Based on
user inputs, small improvements were made to both format and content of a number of standard
official reports. The resulting on-time report submissions and improved availability of quality
information helped to solidify acceptance and use of PlanRep.
As described in Box 1, LGAs are reporting
that the system is resulting in substantial
administrative cost savings and improved
reports. Dialogue continued between
PORALG/DICT and functional, program
and sector departments (business owners
or users) to ensure reports are produced
as necessary. For example, ICT and
Department of Health engaged in dialogue
on production of comprehensive council
health plan (CCHP) official reports and
how to request and develop customized reports. PS3 also provided technical support to develop
additional reports specific to nutrition programs.
1.1.2 Strengthen LGA Epicor Accounting System
On July 1, 2018, GOT launched a strengthened LGA Epicor accounting system. In Year 3,
PORALG, RS, LGAs, MOFP, SoftTech, and PS3 revised LGA chart of accounts (COA) and
strengthened the LGA Epicor accounting system. This included adding service provider codes to
extend booking of expenses to the facility level, shifting to Epicor 10.2 version and reconfiguring
it, making Epicor interoperable with other systems (e.g. PlanRep, LGRCIS, FFARS), and deploying
strengthened Epicor system in all 185 LGAs for use in FY2018/19.
Results for PS3 M&E plan LGA Epicor accounting system indicator are shown in the table below
# Indicator Name BL Y1 RSLT Y2 TGT Y2 RSLT Y3 TGT Y3 RSLT Y4 TGT Y4 RSLT
3.3.2 % service providers in LGAs with Epicor
codes
0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 90.0% 100.0%
In Year 4, PORALG and PS3 performed user support and troubleshooting for the Epicor go-live
exercise. This included ensuring all budget types (approved, carryover, supplementary) were
exported to Epicor and FFARS, and to allow PlanRep, Epicor and FFARS to exchange actual
revenue and expenditure data. This included the configuration of Epicor and FFARS to exchange
actuals, enabling budget execution and used in the preparation of quarterly reports. In Year 4, a
data cleaning and verification exercise was also completed, in which teams compared expenditure
data exchanged between PlanRep, Epicor and FFARS through Muungano Gateway along with
reviewing budget classifications, funds source and accounting codes in Epicor and PlanRep general
ledger. Finally, PORALG and PS3 provided technical assistance to LGAs to prepare for both the
Box 1: PlanRep saves money, manages expenses and
improves reports in Njombe TC
“With new PlanRep, we saved 10 million in planning and
budgeting process. With the money saved, we shifted
priorities to improve Council development projects.
PlanRep gives us easy access to accounting information
(Epicor 10.2) and helps improve reports including Action
Plan Reports, Council Development Reports, and Council
Procurement Reports.”
Illuminata Mwenda Njombe TC Director
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FY2018/19 year-end closing of accounting books/development of financial statements, and
opening of the accounting system for FY2019/20.
A second major Year 4 activity was the refinement of interoperability and integration of PlanRep,
LGRCIS, Epicor and FFARS. This included integrating Epicor and FFARS for making facilities
visible in the LGA Epicor accounting system. Epicor was improved to accommodate the FFARS COA, meaning that FFARS can send a summary of actual revenue and expenditure transactions
to Epicor. The data sent will create general ledger journals in Epicor to summarize revenue,
expenditures, and bank adjustments. As a result, every transaction made in a facility will have a
corresponding transaction in LGA Epicor accounting system in summary form. System-wise, this
is an important achievement, as previously users had to create month-end dummy bank
adjustments to acknowledge the expenditure done at facility level. After the integration work,
bank adjustment dummy entries are no longer required.
As part of these activities, PORALG and PS3 continued to identify and address operational system
issues. For example, when users created their budgets in PlanRep and were sent to Epicor and
FFARS, users identified that the wrong sub-budget classes, fund sources, and Government Finance
Statistics (GFS) codes were used. Users reported this to PORALG which investigated, reversed
transactions and fixed related system performance problems. The process of finding, responding
to, and fixing operational issues and bugs is a critical aspect of actual system implementation and
creates ownership, more efficient system operation, and institutionalization for sustainability.
1.1.3 Use of Local Government Revenue Collection Information System
GOT and PS3’s main revenue collection activity is supporting strengthening LGRCIS, including
extending the system to a mobile application for efficiency gains and taxpayer convenience. GOT
requires LGAs use automated systems to collect taxpayer revenue and LGRCIS, a centralized
system housed at PORALG, is one of the approved tax collection systems. PORALG and World
Bank developed a LGRCIS mobile application for android-based smart phones and smart point of
service (POS) machines. On average there are about 83 POS per LGA and 16,088 countrywide
(both mobile and POS machines). The LGRCIS mobile application is contributing to increased
revenue collection in LGAs by increasing both gross revenue through covering more revenue
collection points, and net revenue by reducing the administrative costs of collecting revenue.
Results for PS3 M&E plan LGA own source revenue (OSR) indicator are shown in the table below.
The level of Year 4 increase is surprisingly large but does appear to reflect a growing trend. It’s
a complex indicator with a lot of variation across years due to factors such as definition of LGA
OSR, changes in types of taxes or fees, and inconsistency on when revenue is booked.
Nevertheless, evidence is mounting that LGA OSR is increasing and there’s at least a correlation
between strengthening the LGRCIS system and increasing revenue collection.
# Indicator Name BL Y1 RSLT Y2 TGT Y2 RSLT Y3 TGT Y3 RSLT Y4 TGT Y4 RSLT
4.3.3 % change in absolute level of LGA OSR 20.5% 10.6% 4.0% 3.7% 5.0% 16.0% 5.0% 35.0%
In Year 4, PORALG, RS, and PS3 continued to support all 185 LGAs to improve use of LGRCIS mobile application through mentoring or on-the-job training, use of simple job aids,
troubleshooting and further refining the system based on user experience. PORALG and PS3
also focused on strengthening interoperability of LGRCIS, PlanRep, and Epicor to ensure the
availability of information to manage LGA business operations and produce required reports. In
addition, through both the PORALG Help Desk and LGA level mentoring, PS3 continued to
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support troubleshooting to improve use of LGRCIS to collect revenue, and incorporate revenue
analysis into overall LGA management.
1.2 Sector-Specific Information Systems
1.2.1 Extend Health Information Systems to Facility Level and Link to
Strengthening Health Financing and Management
The process of extending health
information systems to health facility level
has begun in Tanzania. Like strengthening
cross-sectoral systems (e.g. PlanRep,
Epicor, FFARS), it reflects GOT policy of
extending systems to facility level and
making them interoperable to increase
efficiency, equity and transparency, and
improve management and service delivery.
GOT has made the decision that all public
health facilities will use Government
Health Operations Management Information System (GOTHOMIS) to improve clinical practice
and service delivery; support health statistics, analysis and evidence-based decision-making;
increase efficiency; submit clinical information to National Health Insurance Fund (NHIF) for
financial and claims management; and ensure interoperability with both cross-sectoral public
management systems and other health systems including vertical programs. In Year 4, GOT and
PS3 focused on deploying and continuously improving GOTHOMIS and its interoperability with
other systems key to improving health management and service delivery.
As described in Box 2, GOTHOMIS is already reaping benefits from increased efficiency.
PORALG, LGAs, facilities, and PS3 deployed GOTHOMIS to health facilities in a PORALG, LGA,
facility, and PS3 cost-share (see Local Area Network section). As of September 30, 2019, a total
of 457 health facilities had installed GOTHOMIS including 135 dispensaries, 221 health centers, 76 district hospitals, and 26 regional referral hospitals as shown in Table 1. Figure 3 shows with
percentage installation by region. This figure does not include the 17 District Designated
Hospitals installed and using GOTHOMIS.
Table 1: National GOTHOMIS Installation
Facility Level # Facilities # Installed Coverage (%)
Dispensary 5,050 135 3%
Health Center 544 221 41%
District Hospital 78 76 97.4%
Regional Referral Hospital 28 26 93%
Total 5,700 457 8.1%
Note: There are 17 designated district hospitals using the system (the table has only public
facilities), totaling 473 facilities using GOTHOMIS
Box 2: GOTHOMIS increases efficiency of health
service provision to Nanyamba TC clients
“Before installation we had time-consuming movement of
patient files and registrars searching patient files manually
in the cabinet first before proceeding to other departments
to get services, thus delaying health services to clients. But
after installation of GOTHOMIS, the system replaces
movement of manual client files and reduces registry
department tasks, and it has also reduced bureaucracy and
patient queue.”
Dr. Peter Kyaborati TC Medical Officer
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Figure 3: Percent of regions’ total health facilities with GOTHOMIS installed
Creating interoperability between GOTHOMIS, HMIS, electronic logistics management
information system (eLMIS), and NHIF claims management was a Year 4 technical priority. It is
key to both clinical and financial management at all levels of the system including facility level use
of direct facility financing to procure inputs and improve management and service delivery. GOT,
other DP projects and PS3 solidified both system and PORALG Muungano Gateway and Ministry
of Health, Community Development, Gender, Elderly and Children (MOHCDGEC) Health
Information Mediator (HIM) interoperability. By the end of Year 4, the four systems successfully
sent data to each other via Muungano Gateway and HIM.
In Year 4, PORALG, Global Health Supply Chain (GHSC), Maternal, Child, Survival Project
(MCSP), Management Science for Health (MSH) and PS3 technical experts programmed and
configured GOTHOMIS/Muungano Gateway and eLMIS/HIM interoperability allowing the
systems to exchange data. Both systems were equipped to send drug request and requisition
(R&R) data to each other. In addition to system testing and user acceptance, PS3 work continued
to complete interoperability development and testing for GOTHOMIS and HMIS, and
GOTHOMIS and NHIF. GOTHOMIS and NHIF claims management interoperability is currently
being tested at Galapo Health Center in Manyara Region.
Towards the end of Year 4, PORALG, MOHCDGEC, DPs including PS3, and other stakeholders
participated in GOT-organized dialogue and consultative meetings to develop a roadmap for
collaboration in extending only one health information system to the facility level.
To achieve the GOT goal, a steering committee was formed comprised of members from
PORALG, MOHCDGEC, and DPs. PORALG/DHS and MOHCDGEC/Director of Curative
Services were appointed as co-chairs of the steering committee. A Secretariat to the steering
Committee was also formed with the primary function of supporting GOTHOMIS roadmap
technical tasks. The Secretariat conducted a large and participatory process of requirements
gathering from business owners (subject matter experts) from all levels of health facilities, LGAs,
RS, PORALG, MOHCDGEC, DPs and other stakeholders in Morogoro from May 23 to June 8,
2019. As portrayed in Figure 4, 191 participants (123 from health facilities and 68 from national level) worked to validate health services business processes. Following the requirements
gathering process, PS3 supported the Secretariat to compile and merge system requirements
23
from stakeholders and draft a system requirement specification, infrastructure requirements and
system architecture documents.
Figure 4: GOTHOMIS Requirement gathering illustrations and participants
At the end of Year 4, MOHCDGEC and PORALG were considering GOTHOMIS roadmap next
steps. One way or another, it’s still a cautionary tale with many qualifications, including
complexity of health information systems in general, global experience in integrating vertical
programs, difficulty adapting to primary health care (PHC) where services must be integrated and
costs of administratively overburdening facilities already suffering significant human resource (HR)
shortages, and how to put in place a culture valuing continuous refinement, flexibility and avoiding
the system becoming obsolete.
1.2.2. Support Strengthening other Sector Information Systems
To increase efficiency and help improve and sustain service delivery to citizens, GOT has
embraced e-Government, including introducing e-Office for use by public institutions to facilitate
service processes for employees and citizens. Teacher’s Service Commission (TSC) was
established in 2015, it is expected to be custodian of a fundamental transformation in teacher
service management, including maintaining personnel records for all teachers employed in the
public service. As a new institution it serves as a good test case to obtain experiences and lessons
learned for extension of automated correspondence and personnel records to other GOT
institutions. In Year 3, PORALG, eGA, TSC and PS3 introduced e-Office system at TSC national
office in Dodoma. The e-Office system aims to obtain substantial efficiency gains by automating
the process of storing personnel records and receiving and dispatching files and letters within and
outside government institutions, thus replacing the current practice of handling official
correspondence, documents and files manually or by using unsecure e-mails.
In Year 4, TSC and PS3 solidified use of e-Office at TSC headquarters in Dodoma and began to
develop plans to connect district TSC offices (139 district offices serving 185 LGAs). TSC and
PS3 implemented e-Office for storage and maintenance of teacher confidential files,
including personnel records, and TSC began to
enter these confidential files into e-Office. As
described in Box 3, e-Office saves time and
increases efficiency in records management.
Also in Year 4, TSC and PS3 worked to identify
data entry issues address them with system and
process changes, and clean data to ensure
system is consistent and complete going
forward. PS3 also revised e-Office hierarchy to
match TSC organizational structure. Finally,
PS3 mentored TSC staff on proper usage of e-
Box 3: e-Office enables TSC functions and saves
time
“As a new institution we requested support from
PS3 to establish e-Office to improve performance
of our functions because we had a big burden to
deal with all teachers nationwide. Normally it took
us more than two hours for file transfer within TSC,
with assistance from PS3 and capacity building, we
now transfer files in only five minutes. We reduced
costs, improved record keeping, safety of
information and easy monitoring.
Devota Gabriel, TSC Head of ICT
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Office as new features were introduced for better performance and oriented new TSC staff on
proper operation of e-Office.
1.3 Management of Strengthened Information Systems
1.3.1. Central Help Desk Supports Management, Use, Refinement and
Maintenance of Strengthened National Systems
GOT and PS3 have implemented strengthened LGA systems with an eye towards management,
use, and institutionalization for sustainability. System expert groups consisting of Tanzanian
national, regional, and LGA public workers and PS3 have been the main mechanism for developing
and implementing strengthened national systems. In Year 4, PORALG and PS3 improved
operation of the Help Desk (established in Year 3) that uses a customized web-based system that
creates tickets allowing technicians to enter, support, track, document and respond to RS and
LGA user questions, issues, and requests. Management structure, roles, and relationships were
developed and there are currently 20 GOT staff assigned to the Help Desk to support resolution
of system issues. Systems supported by the Help Desk include PlanRep, Epicor, LGRCIS, FFARS,
Government Mailing System (GMS), networks, and general ICT questions or problems. PORALG
plans to add other systems over time including: GOTHOMIS, Workload Indicators Staffing Need
and Priority Optimization Analysis (WISN plus POA), developed Government Internal Audit
Management Information System (GIAMIS), Integrated Monitoring and Evaluation System (iMES),
Multisectoral Nutrition Information System (MNIS), Basic Education Management Information
System (BEMIS)/School Information System (SIS), and Agriculture Routine Data System (ARDS).
The Help Desk sends a response to users after actions requested by user have been taken or the
problem has been resolved. The Help Desk also generates daily reports on the status and number
of tickets that have been resolved or pending. These reports are shared to users through TWGs,
WhatsApp groups and other mechanisms to update on the status of tickets (planning is in process
to extend the Help Desk to regional level). Table 2 reports and analyzes the number of PORALG
Help Desk tickets received in the system in a ten month period from July 2018 to April 2019.
Table 2: PORALG Help Desk Tickets Received per System from July 1, 2018 to April 12, 2019
System Application Technical Other Special
request Total Percent
Epicor 228 114 342 40.0%
LGRCIS 69 103 172 20.0%
FFARS 65 15 80 9.3%
PlanRep 45 25 70 8.1%
General IT 49 92 141 16.4%
Network 36 36 4.1%
GMS 18 18 2.1%
TOTAL 407 311 49 92 859 100%
Percent 47.4% 36.2% 5.7% 10.7% 100%
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1.3.2. Establish and Maintain LGA Local Area Networks (LANs)
Local area networks (LANs) are a precondition for successful operation of strengthened GOT
and PS3 systems. As shown in the indicator result table below, in Years 1-3, GOT and PS3
strengthened LANs in all 13 PS3 regions and 93 LGAs.
# Indicator Name BL Y1 RSLT Y2 TGT Y2 RSLT Y3 TGT Y3 RSLT Y4 TGT Y4 RSLT
4.4.2 % targeted reg/LGAs strengthened LANs 0.0% 0.0% 0.0% 100.0% Complete 100.0% Done
Year 4 activities solidified LANs in PS3 regions, collaborated to extend
LANs to non-PS3 regions, and began
to extend LANs to facility level to
support key national systems. In
Year 4, PS3 solidified operation and
maintenance of LANs in PS3 13
regions and 93 LGAs prioritizing
ownership and management by LGA
ICT officers, and LGA funding of
maintenance costs. Box 4
quantitatively describes the
efficiency gains that LGA HR officers
attribute to LANs.
A PS3 strategic tenet is that institutionalization requires national implementation of the systems
(not piloting or fragmented geographic/programmatic deployment that may undermine ownership
and use after PS3 ends). Thus establishment or extension of LANs in non-PS3 regions is critical
for sustainability of strengthened systems in Tanzania. In Year 4, PS3 provided technical assistance
to Global Fund Resilient Systems Strengthened for Health (RSSH) grant to facilitate justification,
approval and specification of LANs in 13 non-PS3 regions/92 LGAs (Global Fund has approved
and MOHCDGEC is in the process of procurement).
In Year 4, GOT and PS3 began to
extend LANs to facility level in a
cost-share between facilities, LGAs,
and PS3 with facilities paying for the
small equipment required, LGAs
paying labor costs for the LGA ICT
officer, and PS3 providing training
for facility staff who will be using the
system. As facility level demand for
strengthened national systems (e.g. PlanRep, FFARS, GOTHOMIS)
increases, LAN extension and
system installation are accelerating.
Box 4: LAN increases HCMIS efficiency and productivity
“Downloading staff salary slips from HCMIS took 45 minutes
before LAN installation in Magu DC. While doing this I was
unable to do any other activities, leading to poor performance on
other official duties. Thanks to Government and PS3 for LAN to
strengthen our system performance, now the exercise takes less
than 10 minutes.” Sililo Posiano Butoke, HR Officer in Magu DC,
Mwanza.
“We had to travel out of our Council to find reliable network to
access HCMIS. Sometimes we had to work in the middle of the
night when the network was not busy,” explains Benedict Sailes,
Makete DC HR Officer. “With LAN everything is now done at
our offices. It used to take 30 minutes to feed new staff information
into the system, now the process takes only three minutes.”
Box 5: LAN boosts Ilemela MC
“Not having a LAN at health facilities in Ilemela MC was very
challenging and resulted in low morale among health workers. We
were also the lowest performing council in the country! No matter
how hard we tried there was no improvement, so we decided to
invest to install LAN to support us in managing our activities and
installing systems like GOTHOMIS. I can proudly say we are
delighted because hope has been restored to our staff. We will never
again be the lowest performing council, as installing LAN to all our
health facilities also prompted us to set a monitoring tool, and we
believe it is one of our greatest successes.”
John Paul Wanga, Council Director – Ilemela MC
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1.4 Strengthen System Interoperability, Data Access and Use
1.4.1. Strengthen System Interoperability
Improving efficiency, transparency, and management of public services at all levels of government
and in all sectors requires shifting from fragmented standalone information systems to
interoperable systems that link or integrate management and service delivery information. GOT
and PS3 are working together to make national, LGA and facility level cross-sectoral and sector-
specific systems interoperable to improve both basic business management functions in all public
sectors and sector service delivery.
In Year 3, PORALG and PS3 developed and implemented an information mediator called
Muungano Gateway as the mechanism for the exchange of data between systems. For example,
interoperable systems (e.g. PlanRep, LGRCIS, Epicor, and FFARS) enabled 24,229 health facilities
and schools to auto-populate budgets from PlanRep to FFARS. In Year 4, the PS3 focus was
technical strengthening of Muungano Gateway., for example, GOT and PS3 refined the
information mediator to enable data to be transformed from one protocol to another. Indicator
table shows PS3 system interoperability M&E indicator results, and Table 3 shows the detailed
status of interoperability of the seven sets of systems.
# Indicator Name BL Y1 RSLT Y2 TGT Y2 RSLT Y3 TGT Y3 RSLT Y4 TGT Y4 RSLT
4.4.1
% of 7 sets of national priority systems
made interoperable and deployed to the
LGAs and /or facility level
0.0% 0.0% 0.0% 0.0% 0.0% 57.1% 71.0% 57.1%
Table 3: GOT and PS3 progress toward system interoperability
Indicator Seven Systems Status
PlanRep and Epicor Complete
PlanRep and LGRCIS Complete
Epicor and LGRCIS Complete
Epicor and FFARS Complete
PlanRep and HMIS Final user testing
GOTHOMIS, HMIS (on DHIS2 platform),
eLMIS, and NHIF
Final user testing
PlanRep and HCMIS POPSM and PORALG engaging in dialogue but
unlikely to be interoperable by the end of PS3.
Other systems being made interoperable
include WISN plus POA, HMIS, and
PlanRep: iMES: HCMIS and e-OPRAS
Interoperability in various stages of development
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Other Year 4 activities improved the management console to enable users to view transaction
logs; configured application programming interface (API); configured alerts and notifications; set-
up authentication and authorization to improve system security; and added more web APIs,
triggers and services to enable it to pull public financial management date (PFM) data from
PlanRep, FFARS, Epicor and LGRCIS and send it to iMES. In addition, GOT, other
DP projects, and PS3 engaged in dialogue
and addressed technical issues related to
interoperability between PORALG
Muungano Gateway and MOHCDGEC
HIM as well as links between MOFP
information mediator, and eGA plans for an
umbrella information mediator to ensure
interoperability across all GOT information
mediators. As described in Box 6, the
awareness of interoperability benefits
among LGA officers is growing.
1.4.2. Improve Data Access and Use Through iMES
Muungano Gateway and its inter-system communication or interoperability is the start, not the
end, of strengthening access and use of both cross-sectoral and sector-specific information to
improve efficiency, equity, transparency, management and service delivery. In Year 4, PORALG,
eGA, sector ministries and PS3 developed the iMES, a cross-sectoral web-based system or
database being built on DHIS2 platform. It will be key to maximizing access, use, and analysis of
information, and also to production of timely and relevant reports contributing to improved
management and service delivery.
Selected information from cross-sectoral and sector-specific interoperable systems flowing
through Muungano Gateway will be exported and stored in iMES, together with information from
other systems hosted outside of PORALG including systems flowing through MOHCDGEC HIM.
Development of a public portal/dashboard began as shown in Figure 5. Cross-sectoral data in
this dashboard will be populated from iMES. Through the portal/dashboard, the general public
will be able to access and use data which has been authorized by PORALG for public
consumption. Users without official credentials will be able to visualize and query data by sector
or program and time period.
Box 6: System interoperability improves budget and
expenditure management in Songea MC
“There are several advantages of system interoperability
and one is the ability to track expenditure activity in
PlanRep. Linking PlanRep, FFARS, and Epicor has
enabled those of us who supervise budget implementation
in our LGAs to identify what is happening in other
systems. For instance, we are able to view the amount of
money received in facilities through FFARS dashboard
thus getting a good link between money budgeted and
used, and producing a final report.”
Christopher Ngonyani, Economist in Songea MC Ruvuma
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Figure 5: screen shot of the public portal/dashboard currently under development.
In Year 4, PORALG, eGA, sector ministries and PS3 performed the following activities:
▪ Dialogue and decision to place iMES on DHIS2 platform (parallel to HMIS and WISN plus POA)
▪ Designed and developed detailed structure of iMES database, configured iMES in DHIS2
platform and database server, developed and reviewed iMES API, and imported
organizational units to iMES
▪ Engaged in participatory dialogue on selection of indicators for iMES dashboard
▪ Created/imported data elements and indicators and datasets for different sectors and
types of information including PFM, health, socio-economic profile, nutrition, social
welfare
▪ Designed data quality tools and indicators
▪ Added functionality to Muungano Gateway and iMES to obtain data for compact nutrition data sets used for the quarterly nutrition scorecard
▪ Created user groups to control access to datasets depending on the sector and role of
the user
▪ Designed and developed iMES public dashboard
▪ Tested iMES functionality in Mwanza region
2. FINANCE
Changing the way money is allocated and paid to facilities is a PS3 implementation strategy, and
is one of three system strengthening dynamics critical to improving delivery, quality, and use of
public services, particularly for underserved populations. Direct facility financing (DFF) is a
primary trigger for transformation of service providers (health facilities and schools) into entities
performing standard or cross-sectoral basic management functions required to produce any
product or deliver any service in any sector (outputs). These management functions including
planning, budgeting, procurement, accounting, HR management and reporting are extended to
facility level and catalyzed by strengthened interoperable systems.
In Year 4, an element of the PS3 reform and system strengthening foundation drove
implementation sequencing, GOT relationships, DP collaborations, and integration of program
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interventions. Figure 6 illustrates creation of a new PFM and sector service payment intersection
intended to enable both good financial controls and “buying the right thing” to better match
payment to priority services, increase efficiency, and reduce waste. Creation of a new
intersection also enables the health sector to establish sequencing for movement towards NHI
and universal health coverage (UHC).
Figure 6: New Intersection of PFM and Sector Service Purchasing/Provider Payment
2.1 Support Development of National Health Insurance Architecture
GOT is implementing major health financing reform to help ensure that every citizen has equal
access to needed health care services through the introduction of single NHI with a standard
Minimum Benefit Package (MBP) entitlement for every citizen. GOT approval of Health Financing
Strategy (HFS) and single NHI Law/Act has been a long process with many consultation processes
and reviews by stakeholders. As part of this process, health purchasing reforms, including DHFF,
have mitigated the multiple delays and shifting deadlines through establishing the foundation of
output-based payment better matching general revenue funds to priority services for the poor,
harmonization of information and claims management systems, and improved health facility
management that will be at the core of single NHI implementation.
In Year 4, GOT reaffirmed its intent to establish one insurance pool to provide equal access to a
standard MBP for all citizens including the poor and underserved. In addition, high level GOT
dialogue on NHI accelerated and shifted to a new policy of merging Worker’s Compensation
Fund (WCF) with NHIF and Community Health Fund (CHF) consistent with GOT intent to
reduce overlapping or fragmented social protection programs. Given practicalities of this merger
including elements of direct health and non-health related compensation, technical teams from
MOHCDGEC and Ministry of Labor suggested sequencing of first establishing single NHI and
then incorporating WCF over time. Subsequent high level GOT policy dialogue resulted in an
Inter-Ministerial Technical Commission (IMTC) proposal to conduct an actuarial study of the
merger of NHIF, CHF, and WCF with findings used to inform the policy decision. In Year 4, PS3
supported MOHCDGEC in policy dialogue and response to IMTC and Cabinet Secretariat
comments, and supported the multi-sectoral technical team to develop Terms of Reference (TOR) for the actuarial study. The actuarial study is expected to be completed early in 2020.
At MOHCDGEC request, PS3 provided technical assistance to review National Health Policy
(NHP) to make sure it is consistent with the goal of achieving UHC through NHI. A draft revised
policy together with its implementation strategy has been developed and is currently under
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review by MOHCDGEC management. Also in Year 4, PS3 provided technical facilitation for a
Dodoma workshop of directors of MOHCDGEC agencies that aimed to increase awareness of
the proposed single NHI. Organized by MOHCDGEC, the workshop was chaired by the
Permanent Secretary and Chief Medical Officer, and the participants included NHIF, Medical
Stores Department (MSD), Kilimanjaro Christian Medical Centre (KCMC), Muhimbili Orthopedic Institute (MOI), Muhimbili University of Health and Allied Sciences (MUHAS), Tanzania Food and
Drug Authority (TFDA), National Institute of Medical Research (NIMR), and vertical programs.
Dialogue was productive as participants had the opportunity to comment on single NHI design.
2.2 Strategic Purchasing and Shift to Output-Based Payment
DFF and implementation of output-based provider payment systems better matches payment to
priority services, increases facility transparency, autonomy, and accountability, and enables facility
management to better plan, budget, procure, perform internal controls, account, and report
expenditures for services delivered to citizens. DFF will not yield its expected results if there is
not solid financial management at the service provider level or if health facilities and schools are
not ready to capitalize on the financing reforms. Figure 7 shows the health sector financing and
management (or purchasing and provision) sides of the shift to output-based payment inherent in direct health facility financing (DHFF) including strengthened systems, increased efficiency from
reductions in fragmentation and conflicting financial incentives, and realigned roles and
relationships around greater facility transparency, autonomy and accountability.
Figure 7: Two sides of DHFF
Results for PS3 purchasing services from facilities, core output-based provider payment, and RBF additional stimulation M&E indicators are shown in the table below:
# Indicator Name BL Y1
RSLT
Y2 TGT Y2 RSLT Y3 TGT Y3 RSLT Y4 TGT Y4 RSLT
2.3.1 % expected RBF funds received by each facility 32.0% 47.4% 50.0% 66.3% 70.0% 81.5% 83.0% 89.0%
2.3.3 % OC funds disbursed from central or LGAs to
facilities 0.0% 0.0% 0.0% 0.0% 80% 78.6% 81.0% 63.1%
4.3.1 % providers paid using output-based payment 0.0% 0.0% 0.0% 0.0% 20.0% 21.5% 21.5% 21.7%
P-7 % of health facilities paid using new or improved
output based provider payment systems. 80.0% 98.5%
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As shown in Figure 7 implementation sequencing for DHFF and shift to output-based payment
consists of three phases: 1) introduction of mixed payment model consisting of core PHC per
capita payment system for public health basket funds (HBF) and private improved community
health fund (iCHF) premiums together with RBF fee-for-service leveraging all funding through
very direct incentives for service delivery improvement (green); 2) NHIF begin to refine payment systems, harmonize information/claims management systems and prepare to be single NHI
purchaser together with dialogue on shifting domestic general revenue funding for other charges
(OC) or recurrent costs of direct patient care to output-based payment (yellow); and 3) realize
the full impact of DHFF and improved health facility management by establishing single NHI
architecture on top including policy, legal and institutional framework to increase general revenue
for the poor, transfer and pool funds in NHIF, and define MBP.
In Year 3, GOT, numerous DPs (both health basket funders and projects), and PS3 implemented
Phase 1 of DHFF strategic purchasing by shifting general revenue HBF to output-based payment
for 5,459 health centers and dispensaries in all 185 LGAs in Tanzania. The PHC per capita
payment formula includes base rate (facility fee) and three adjusters for need (catchment
population), performance (utilization), and equity (distance). In Year 4, PS3 supported
MOHCDGEC and PORALG to continuously improve data quality for PHC capitated rate
payment adjusters and calculate facility level payments that MOFP transfers directly to facility
bank accounts. In addition, dialogue and technical coordination continued on the agreement to
harmonize DHFF HBF and iCHF payment systems to avoid the unintended consequences of
conflicting incentives in payment to PHC providers.
RBF is a key block in the unified DHFF purchasing framework as it provides direct and powerful
fee-for-service incentives on top of the core output-based payment systems to stimulate service
delivery improvements in the large public sector health delivery system. RBF serves as a trigger
for a variety of systems strengthening interventions, including shift to DHFF and output-based
payment, and making providers more visible by extending systems to service provider level. In
Year 4, PS3 supported PORALG, MOHCDGEC, and DPs in RBF implementation through LGA
mentoring and capacity building in Kagera, Kigoma, Mwanza and Shinyanga regions, improving
data quality linked to strengthening and interoperability of information systems extended to
facility level, and monitoring and analyzing RBF data including invoicing and payment processes.
In addition, MOHCDGEC, Medical Stores Department (MSD) (headquarters and zonal office),
NHIF, GHSC, and PS3 developed and implemented an automated system to calculate MSD RBF
indicators and payments.
In Year 4, PS3 also continued to follow the process of RBF disbursement to health facilities as
some facilities continued to face delays in fund disbursements (some for up to five cycles). This delay is largely due to MOFP requirements, including the need to provide financial reports on
how RBF funds have been used to date. In Year 4, MOFP disbursed funds for April-June 2018
quarter while disbursement for remaining quarters awaits release of funds to the MOFP. In
summary, shifting public HBF funds to core output-based payment system, harmonizing with
payment systems for private iCHF premiums, and adding direct incentives of RBF on top has
begun to unify payment systems and reduce funds flow fragmentation. Achievements in Phase I
DHFF and shift to output-based payment are serving as a first step in single NHI implementation.
Year 4 saw the beginning of Phase II of DHFF and shift to output-based payment on the road to
single NHI and UHC. NHIF and PS3 engaged in dialogue and held an intensive technical workshop
to start the process of refining NHIF payment systems, harmonizing information/claims
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management systems, and preparing NHIF to become SNHI purchaser. Specific activities included
development of detailed plans to further improve and automate the PHC capitated rate payment
system and integrate it into NHIF; agreement to shift hospital and outpatient specialty payment
from fee-for-service to a formula-based budget neutral payment system; agreement on
establishment of a new hierarchy to classify hospital cases for payment and preliminary specification of new hospital payment groups; development of plans to conduct hospital cost
accounting, calculate relative payment weights, and improve claims management; and specifying
NHIF institutional and staff roles and relationships in the context of both DHFF and SNHI.
2.2.1. Strengthen Other Public Sector Output-Based Payment Systems
The education sector was the first to implement DFF and corresponding shift to output-based
payment by introducing capitation payment in primary and secondary schools whereby MOFP disburses funds directly to school bank accounts using a flat fee adjusted by number of enrolled
students. Following implementation of a budget neutral formula-based system in the health
sector, in Year 3 the Ministry of Education, Science, and Technology (MOEST), PORALG, DP
education Programme for Results (P4R), and PS3 developed a comparable payment formula for
the education sector, adjusting for need and characteristics of individual schools, and increasing
equity and fairness in payment. In Year 4, MOEST and PORALG reviewed the proposed formula
and submitted to the MOFP for approval. PS3 continued to engage in dialogue and follow-up on
the status of approval of the revised formula. MOEST requested increases in budget because
education is underfunded and also to hold all schools harmless, meaning no school would have
its total payments reduced solely due to any changes in the payment formula. MOFP has not yet
approved the budget increase although there does not appear to be any issues with payment
formula specification.
2.3 Strengthen Service Provider Financial Management
2.3.1. Support Use of Facility Financing Accounting and Reporting System
DFF and its shift to output-based payment require strengthened financial management at facility
level. An element of financial management is accounting and financial reporting. Facility Financial Accounting and Reporting System (FFARS) meets the growing demand for financial management
systems and capacity at the service provider level and empowers facilities and schools to be more
autonomous and accountable. FFARS is a simple accounting system used by service providers to
acknowledge receipt of revenue, process procurements, enter expenditures, and produce
financial reports for all funds flowing directly to facility bank accounts. FFARS comes in both
manual (paper) and automated (electronic) versions. This enabled nationwide implementation as
any facility without a computer and good internet connection could use the manual version and
enter their transactions in the electronic FFARS when visiting LGA headquarters.
In previous project years, PORALG, MOFP, MOHCDGEC, MOEST, DPs (basket funders and
projects) and PS3 collaborated to design, develop, deploy and launch FFARS in July 2017 in 24,229
LGA health facilities and schools in all 26 regions and 185 LGAs in Mainland Tanzania. Variation
in documentation of the number of health facilities and schools using FFARS and PlanRep is an
example of the wide range of operational issues that can arise in nationwide implementation:
▪ When FFARs was deployed at the start of FY2017/18 (July 1, 2017), GOT provided a list of 28,000 facilities for entry into FFARS. However, the education sector did not have a
33
single source of facility codes comparable to Health Facility Registry (HFR) for health
facilities.
▪ Following development of interoperability of FFARS and PlanRep through Muungano Gateway, a data cleaning exercise addressed discrepancies on facility lists (e.g. duplicates)
and determined the number of health facilities and schools to be 24,229.
▪ It is a continuous management improvement process as new facilities are built or go out of service. For FY2019/20, 25,604 facilities registered in PlanRep and FFARS of which
25,479 have plans and budgets for execution in the current financial year (and 125 have
no plans and budgets for receipt of public money).
Results for PS3 FFARS M&E indicators are shown in the table below.
# Indicator Name BL Y1 RSLT Y2 TGT Y2 RSLT Y3 TGT Y3 RSLT Y4 TGT Y4 RSLT
4.3.2.a % LGA service providers oriented on use of FFARS 0.0% 0.0% 90.0% 99.4% Complete 99.4% Done
4.3.2.b % LGA service providers upload data to FFARS 0.0% 0.0% 0.0% 0.0% 50.0% 97.7% 97.7% 99.7%
In Year 4, PORALG and PS3 refined FFARS based on user experience. Improvements are listed
below with changes documented and user guidance shared across regions, LGAs, and facilities:
▪ Improve journal voucher post, cash receipt post, and FFARS dashboard
▪ Enhance bank reconciliation window to show open balance and address other challenges
▪ Add reports (e.g. outstanding transactions), and increase access to itemized reports
▪ Map activities with specific budget types, and GFS code mapped with budgeted fund source and activities to minimize errors during fund receipt and expenditures
▪ Review performance in automatic transfer of plans and budgets from PlanRep to FFARS
▪ Enhance adjustment window to give users the right to remove negative balances that were appearing in the system due to wrongly budgeted ‘fund sources’ for carry over funds
▪ Pagination of the reconciled transactions to fit into the reconciliation window
▪ Add facility fund source status report for easy tracking of each fund source
▪ Add feature to track all the outstanding transactions especially old cheques
▪ Add approval control when facility wants to reverse paid payment voucher. The rights
to approve are set by Council Treasurer.
In Year 4, ICT, and business process experts from PORALG, MOHCDGEC, MSD, GHSC and
PS3 developed and implemented integrated FFARS, MSD Epicor-9 accounting system, and eLMIS.
Integration makes budget funds allocated by MOFP to MSD visible in FFARS thus improving the
ability of facilities to plan procurement of medicine and other supplies. In addition, integration
will improve MSD procurement planning, as they will be able to monitor stock-outs across all
facilities, and hence be prepared for procurement requests coming from the facilities. Successful
exchange of data occurred between FFARS and MSD Epicor-9 and between FFARS and eLMIS
through Muungano Gateway. The integrated systems were deployed on July 1, 2019 at the start
of FY2019/20. PORALG Help Desk, MOHCDGEC, MSD, GHSC, and PS3 provide user support,
fix bugs or technical issues, and identifying system refinements as part of a continuous
improvement process.
34
In Year 4, PORALG and PS3 completed development of
FFARS mobile application and conducted system and
user testing. Both system and program or accounting
functions performed as expected during testing and
small technical issues were addressed. FFARS mobile app has been deployed and service providers are slowly
adopting it. The mobile app is accessible through
android mobile phones and tablets. It contains all the
features in the web-based system and facilities that have
electricity, computer, or internet challenges are free to
use the FFARS mobile app. All future improvements
done for web-based FFARS will also be incorporated
into the mobile app. The FFARS mobile app dashboard
is shown for Nyakato Dispensary, Ilemela Municipal Council in the figure to the right. Also in
Year 4, PORALG and PS3 continued to support LGA and facility FFARS users to address a variety
of different implementation challenges. PORALG, LGAs, and PS3 staff prioritized providing
technical support to service providers to undertake bank reconciliations in order to prepare
financial reports for the end of the fiscal year.
As shown in Box 7 and 8, FFARS has resulted in efficiency and productivity gains, saving time and
administrative costs including reduced time and travel costs for requesting funds, and reduced
time to produce better quality reports. The cost savings allow the education sector and schools
to use resources for other priorities.
2.3.2. Strengthen Direct Health Facility Financing Management
GOT is clear in its ambition to increase facility autonomy and accountability by adopting DFF in
health and education sectors together with extending systems to facility level including PlanRep
to plan and budget based on service delivery needs and community priorities, and FFARS to
account and report on revenues and expenditures. In addition, DHFF is a microcosm that can
help meet pre-conditions for implementation of single NHI. Whether or not health facilities
realize their potential depends on the nature of DHFF management which includes governing
Figure 8: FFARS mobile app dashboard at
PORALG level
Box 8: Gairo Primary School benefits from
FFARS
“Previously when the LGA demanded a report,
both the Accounts Teacher and the Head
Teacher would cancel all their classes and
other duties so as to dedicate their whole day
to prepare the report. Despite the time it would
take, the report still came out full of errors.
Since the introduction of FFARS, now it takes
just a click to produce a perfect report.
Angelus Mlahagwa, Head Teacher at Gairo
Primary School in Gairo DC
Box 7: FFARS saves time and money for Bukililo
Primary School by reducing trips to LGA HQ
Bukililo Primary School is among 59 in Kakonko DC in
Kigoma region, situated 40 km from LGA HQ with
limited public transport. The Head Teacher is very happy
with FFARS as it relieves him of many tedious trips to
HQ to request funds for school activities. “I have more
time to teach, attend to other school matters and it saves
transport costs. Previously I traveled to LGA HQ 4-5
times per month to request funds for various activities,
and most times would return only with promises and
should come back next week.”
Jonathan Buzobona (Bukililo Primary School Head
Teacher)
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how facilities spend funds to procure the best mix of inputs to deliver service outputs; increasing
efficiency; reducing funds flow fragmentation, harmonizing spending guidelines and reducing PFM
barriers; enabling environment including timely disbursement of sufficient funds; good monitoring
processes; increased facility management capacity; and realigned roles and relationships.
In Year 4, PORALG, MOHCDGEC, NHIF, UNICEF, GHSC, Boresha Afya, and PS3 conducted a workshop to begin development of DHFF Management Framework. The purpose of the DHFF
Management Framework is to: 1) realign roles and relationships across national, regional, LGA
and facility levels of government and other key stakeholders in the context of DHFF; and 2) design
and develop systems and processes to enhance health facility autonomy and monitor DHFF
implementation. The framework also encompasses RBF and its alignment with broader health
financing and purchasing priorities including reducing fragmentation and increasing efficiency and
sustainability. The draft DHFF Management Framework was shared with PORALG and
MOHCDGEC senior management, and the technical team is currently incorporating their
comments before its approval and implementation.
Also in Year 4, MOHCDGEC, PORALG, DPs, and PS3 reviewed facility level expenditure or
spending guidelines in order to begin to harmonize the guidelines across revenue sources and
funds flows which is key to DHFF management. Different rules for how to spend money in
different funds flows creates confusion and inefficiencies for facilities trying to manage their
consolidated funds procure inputs and deliver services. A technical review of the Comprehensive
Council Health Plan (CCHP) guide was completed by MOHCDGEC, UNICEF, other DPs, and
PS3. While its core focus is planning and budgeting, it is closely related to DHFF management
largely due to the still prevalent input-based central planning mentality in which planning/budgeting
and procurement/spending funds are largely the same function. Upon completion of CCHP
review, PS3 will support PORALG and MOHCDGEC to program all improvements into PlanRep
to be ready for FY2020/21 planning and budget cycle.
2.4. Strengthen Resource Allocation and Tracking
2.4.1. Better Define Public Sector Service Outputs
Better definition of public sector service outputs
is a pre-condition for shifting from input-based to
output-based planning, budgeting, and payment
to better match resource allocation to priority
sector services. In Year 4, PS3 supported all
levels of government and multiple sectors,
programs and objectives to better define their
public sector service outputs as core to
strengthening planning, budgeting, management,
and delivery of public services. A focus of GOT
and PS3 strategy to solidify PlanRep
implementation is defining service outputs to
improve horizontal or multi-sectoral planning and
purchasing of services (e.g. nutrition, social
welfare) that also span public and private sectors.
In Year 4, PORALG Nutrition Coordination Unit (NTC) and PS3 strengthened nutrition planning
and budgeting by building capacity of selected RS and LGA staff to use PlanRep and its service
PORALG Minister Selemani Jafo, addressing a
workshop (sector ministries, DPs) to refine social
welfare service outputs and enter into PlanRep
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outputs to improve development and implementation of multi-sectoral nutrition plans and
budgets. In addition, PS3 provided technical assistance at the nutrition budget scrutinization
workshop that brought together finance staff and national and regional nutrition officers to
scrutinize the nutrition budget for FY2019/2020 including improving alignment with national
nutrition priorities. The workshop was useful and provided experiences, lessons learned conclusions and recommendations on a variety of topics:
▪ Ability to differentiate between nutrition and non-nutrition activities planned and
budgeted: Improved differentiation is made possible by FY2019/20 inclusion of a nutrition
objective with its corresponding 12 service outputs in PlanRep. Detailed budget analysis
using the nutrition objective, 12 nutrition service outputs, priority areas, and activities
demonstrated inclusion of many activities that had little or no relationship or impact on
nutrition service outputs. The budget scrutiny exercise that focused on aligning activities to
service outputs revealed the budget to be TZS 16.7 billion which is substantially different
from the TZS 50 billion based on nutrition public expenditure estimates. PORALG NTC,
USAID, and PS3 agreed to use the FY2019/20 nutrition budget as a comprehensive and
realistic baseline for future tracking of GOT nutrition budget and spending performance.
▪ LGA competency in ensuring better match between activities and service outputs: The FY2019/20 budget scrutinization exercise demonstrated that LGAs are capable of
aligning activities with service outputs. Only 8% of activities did not match service outputs.
▪ Planning and budgeting using service outputs makes it easier to determine if budgets prioritize service delivery: The budget analysis shows a large part of the budget (68%) is
allocated to service delivery, 6% to nutrition commodities, 12% to meetings, and 7% to
trainings. On the surface, it is a reasonable expenditure type distribution enabling nutrition
budget to deliver expected results.
In Year 4, the main PS3 gender activity was to deepen integration of gender objectives and
activities in PlanRep and support LGA community development departments (CDDs), community
development officers (CDOs), social welfare officers (SWOs), nutrition officers, and gender focal
persons to define service outputs, and better plan, budget and implement activities to increase
gender sensitivity and integration in public sector service delivery. To ensure gender
mainstreaming in all sectors, four cross-cutting gender related service outputs have been defined:
enhanced gender mainstreaming across sectors; improved women’s access to labor saving
technologies; improved women participation in decision making; and improved gender based
violence services. PlanRep now enables analysis of LGA alignment to national priority gender
policies; for example, an analysis of LGA budget allocations to gender based violence service
outputs shows a substantial increase in the budget from 340 million TZS in FY2018/19 to 3.3
billion TZS in FY2019/20. This type of analysis produces evidence for dialogue between GOT,
non-governmental organizations (NGO) and other stakeholders.
Results for PS3 public-private contracting and dialogue M&E indicators are in the table below:
# Indicator Name BL Y1 RSLT Y2 TGT Y2 RSLT Y3 TGT Y3 RSLT Y4 TGT Y4 RSLT
3.2.1 % total public payments contracts private providers 22.8% 2.8% 3.0% 2.1% 3.0% 1.8% 2.5% 4.1%
3.2.2 # agriculture public-private dialogue events 0 0 4 5 9 12 Done
2.4.2. Strengthen Intergovernmental Fiscal Transfers and Resource Tracking
GOT general revenue funding plays a crucial role in ensuring that public services are equitably, efficiently, and effectively delivered to citizens especially the underserved. There are many factors
37
determining the level and flow of intergovernmental fiscal transfers (IGFT) to LGAs, with most
of them beyond the reach of PS3 (or even GOT in some cases), including fiscal situation, political
will, and aspects of MOFP national budget formation process. One factor within the control of
PORALG, RS, LGAs, and PS3 is strengthening production of LGA CFRs and CDRs, efficiently
aggregating the reports to national level, and improving quality and analysis of data to demonstrate good financial management. The old Excel system and manual process of compiling or aggregating
individual LGA CFRs into national CFR data and reports frequently resulted in data issues or
errors. Better CFRs builds confidence or the business case to promote increasing resource
allocation to service delivery at the lowest level of government or periphery of the system,
including LGAs and facilities.
In Year 4, PORALG and PS3 completed a PlanRep, LGRCIS, Epicor and FFARS system and
interoperability refinement that allows LGA CFRs and CDRs to be automatically generated from
PlanRep for all 185 LGAs. The next step was CFR “business owner” PORALG Directorate of
Local Government Finance Department (DLG/FD), PORALG/DICT, and PS3 worked to develop
national and regional CFR consolidated report template. CFRs were produced and then further
refined including fixing reporting structure challenges communicated by DLG/FD, RS and LGAs
especially related to information on own source revenue, transfers and borrowing, expenditure
summary, and expenditure details. The results of strengthened systems are expected to include
automatic and on-time production of LGA CFRs; more timely and effective aggregation of LGA
financial data to national level; increasing efficiency and reducing administrative costs; better data
quality; data more suited for analysis, enabling better use of information for both managing LGA
financing and advocating to MOFP for additional IGFT; and establishing an environment to build
data analysis capacity in PORALG.
Results for PS3 IGFT M&E indicator are shown in the table below:
# Indicator Name BL Y1 RSLT Y2 TGT Y2 RSLT Y3 TGT Y3 RSLT Y4 TGT Y4 RSLT
2.3.2 % approved budget transferred central to LGAs 70.7% 81.5% 85.0% 74.1% 76.0% 73.5% 75.0% 72.2%
Resource tracking can supplement accounting systems and reports to feed information back into
ongoing analysis, policy dialogue and system refinement. In Year 4, PS3 provided technical
assistance to the MOHCDGEC to finalize National Health Accounts (NHA) analyses for financial
years 2013/14, 2014/15, 2015/16, and to write reports. The reports have been completed and
are currently with MOHCDGEC for dissemination. In addition, MOHCDGEC and PS3 cleaned
data and initiated analysis for preparation of FY2016/17 National Health Accounts (NHA) report.
In Year 4, PS3 supported the incorporation of a resource tracking course including NHA
methodology and FFARS into the curricula at Kilimanjaro Christian Medical University College
(KCMC) and Mzumbe University. Resource tracking including PlanRep and FFARS is also being
integrated into the curriculum at Muhimbili University of Health and Allied Sciences (MUHAS)
and Mzumbe University. PS3 oriented ten lecturers from MUHAS and Mzumbe University on
PlanRep and FFARS to equip them with knowledge and skills on how to use these two systems
as they will be teaching the PlanRep and FFARS modules at their Universities starting the coming
academic year. NHA, FFARS and other resource tracking courses are contained in different
departments or programs in different universities: in UDSM, it is in the Economics program; in
MUHAS it is currently in the M&E program and will also be introduced in Health Economics
program; in Mzumbe University it is the Health Economics program; and in KCMC it is in the
Masters of Public Health program, specifically health financing and health economics module.
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3. HUMAN RESOURCES
The strength of any institution lies within its human
resources, particularly in the public sector where human
resources are required to deliver essential services. To
act upon their mission, organizations must be able to attract, develop, and retain staff with the right skills in the
right positions at the right time. Human resource
management (HRM) is therefore a key strategic function,
extending far beyond payroll administration into
systematically managing human talent to meet the
organization’s objectives. The linkages shown in Figure 9
between allocation and distribution, staff orientation and
retention, and performance management and efficiency
are particularly important in the context of fiscal
constraints or workforce shortfalls, as management for
performance and productivity can help offset shortages.
3.1 HR Planning and Distribution
In Year 4, GOT and PS3 continued to support strengthening HR planning and distribution,
dovetailed with DFF and the shift to output-based payment, specifically ensuring that human
resources are distributed to the service provider level according to need. Together with a third
key intervention of strengthened PlanRep, Epicor, and FFARS systems extending LGA planning,
budgeting, accounting, and reporting to the service provider level, these key interventions are
envisioned to drive GOT management and service delivery improvement, especially in
underserved areas. The two main HR planning and distribution interventions are Workload
Indicators of Staffing Need (WISN) plus Prioritization and Optimization Analysis (POA) in the
health sector, and strengthening staff allocation and distribution in other sectors.
3.1.1. Implement WISN Plus POA in the Health Sector
In Years 1-3, MOHCDGEC, PORALG, POPSM, Touch Foundation and PS3 partnered to further
develop, implement and scale-up WISN plus POA to determine health worker need, and
prioritize staff allocation and distribution by cadre to the health facility level resulting in LGA
distribute of 2,038 and 6,180 new health workers. Based on this experience, a GOT policy
decision was made to simplify WISN to reduce data collection costs and enabled routine use of
WISN plus POA.
In Year 4, GOT and PS3 activities focused on institutionalizing WISN plus POA through: 1) system
design and development to integrate into GOT systems by upgrading system, placing on DHIS2
platform, and making interoperable with other GOT systems including HMIS and PlanRep; and 2)
mentoring LGAs on using WISN plus POA to request, distribute and redistribute staff and link
with other HRM interventions at both national and LGA levels. In January 2019, PORALG and
MOHCDGEC decided their roles and relationships in integration of WISN plus POA into GOT
systems with PORALG responsible to operate WISN plus POA for HR planning and distribution
at LGA and facility level, and MOHCDGEC responsible to determine health worker need. Table
Figure 9: Integrated Approach to HRM
39
4 summarizes MOHCDGEC, PORALG, POPSM, Touch Foundation and PS3 activities. In Year 5,
PORALG, POPSM, MOHCDGEC, Touch Foundation, and PS3 will complete WISN plus POA
integration into PORALG and deployment of the system to LGA level.
Table 4: Year 4 Activities to Integrate WISN plus POA into GOT Systems
# Activities Responsible Timeline Status
1 Initial design and program WISN plus POA on DHIS2
platform
Touch contracting
with UDSM
Oct 2018-
Apr 2019 Done
2 Form national multi-disciplinary WISN plus POA team
of experts, update POPSM
PORALG, POPSM,
MOH Feb 2019 Done
3 WISN plus POA system testing, feedback, and
refinement UDSM, Touch, PS3
May-July
2019 Done
4
User testing by developing WISN plus POA standard
packages, identify challenges and refine (e.g. missing
facilities, cadres, workload data)
PORALG, MOH,
PS3, UDSM, Touch
July-Oct
2019 Ongoing
6 Develop automated WISN plus POA technical and user
manuals
PORALG, MOH,
PS3, UDSM, Touch
July-Oct
2019 Ongoing
5 Build capacity of the national expert team (both IT and
business owners)
PORALG, MOH,
UDSM, Touch, PS3
June-Dec
2019 Ongoing
7
Establish operating requirements including
interoperability with other systems through PORALG
Muungano Gateway and MOHCDGEC HIM
PORALG, MOH,
PS3, UDSM, Touch
Sept-Dec
2019 Ongoing
By the end of Year 4, GOT was completing the
final steps to integrate an automated WISN plus
POA system that can be used in real time to
inform staff allocation, distribution, and
redistribution decisions in a cost-effective
manner. Box 9 describes PORALG encouraging
LGAs to use WISN plus POA to better distribute and redistribute staff. This achievement makes
Tanzania the first country in the world to have an
automated WISN plus POA system integrated
into government systems. It will improve GOT’s
ability to make key HRM distribution decisions
alongside planning and finance decisions.
Results on three PS3 staff allocation and distribution indicators are shown in the following table.
# Indicator Name BL Y1 RSLT Y2 TGT Y2 RSLT Y3 TGT Y3 RSLT Y4 TGT Y4 RSLT
3.3.3.a % of targeted LGAs who submitted a permit allocation request based on POA
0.0% 0.0% 0.0% 0.0% 10.0% 0.0% 30.0% 0%
3.3.3.b POPSM introduces a prioritization methodology as the basis for allocation of staff permits to LGA level
0 0 0 0 0 0 1 1
3.3.3.c % of targeted LGAs who have distributed or redistributed staff based on POA
0.0% 0.0% 0.0% 0.0% 10.0% 60.2%
65.0% 100.0%
Box 9: PORALG emphasis on staff
redistribution
In July 2019, the PORALG Deputy PS, Dr Dorothy
Gwajima held a teleconference with RMOs to
highlight the importance of redistributing health
workers using WISN plus POA. During the Annual
RMO and DMOs meeting, Dr. Ntuli Kipologwe,
PORALG Director of Health Department said, “An
advantage of WISN plus POA is that it uses service
delivery data from facilities and LGAs. DMOs
should work to ensure that requests are realistic
based on services provided, also redistribute in
places where there are less services provided to the
public.”
40
3.1.2. Strengthen Staff Allocation and Distribution in Other Sectors
POPSM has repeatedly voiced a strong opinion that improving staff allocation and distribution
should not only be done in the health sector. Using its comparative advantage to work across
sectors, PS3 engaged in preliminary dialogue with POPSM, PORALG, TSC, MOEST, and World
Bank P4R resulting in agreement to collaborate to improve teacher allocation and distribution to
the school level. No concrete achievements or results have been obtained to date, but the
dialogue has been productive. Also in Year 4, in the context of integration of WISN plus POA
into GOT systems, PORALG/DICT and PS3 engaged in dialogue on development and integration
of systems to improve HR allocation, distribution, and redistribution in other sectors.
3.2. HR Retention
Good HRM must go beyond allocating and distributing staff to help ensure that new staff are
supported to perform well in their positions thus contributing to increased staff motivation and
retention, particularly in an environment of limited financial and human resources. In addition to
the activities described in the two sections below, PS3 also engaged in policy dialogue to
incorporate both new staff orientation and customized retention strategies into GOT HRH
Strategic Plan (2020-2025). Strengthening HR, information systems, finance and governance
systems functions all contribute to the service provider staff retention indicator results shown
below. The indicator is placed in the HR retention section, as the most direct relationships are
between new LGA staff orientation and customized LGA retention strategy interventions.
# Indicator Name BL Y1 RSLT Y2 TGT Y2 RSLT Y3 TGT Y3 RSLT Y4 TGT Y4 RSLT
2.2.1 Retention rates of recruited service provider
staff (started reporting in Y3, targets not set) 65.0% 64.6% 66.0% 99.3%
P-3 # of LGAs with customized retention packages 26 26
3.2.1. Implement New LGA Staff Orientation Process
During PS3 regional launches, all regions reported challenges with orientation and induction in
terms of timing, resources, guidelines, and lack of training skills and materials. Over the past 3
years, GOT and PS3 supported a response to this bottom-up request through an extensive and
participatory process to develop a new LGA staff orientation manual. The new staff orientation
manual and process was launched by Minister of PORALG in July 2017 and rolled out nationwide
for both sectoral and administrative staff. By the end of Year 3, new staff orientation was being
implemented nationwide or in all 26 regions and 185 LGAs of Mainland Tanzania.
In Year 4, PS3 shifted from direct mentoring of LGAs on performing new staff orientation to a
focus on institutionalizing the process for sustainability. GOT and PS3 activities included: 1)
mentoring LGAs to take responsibility for organizing, conducting, and financing new staff
orientation themselves; 2) extending new staff orientation from the LGA level to the staff’s posted
position (e.g. health facility, school) to deepen the staff orientation; 3) involving regional level to
support and institutionalize the process; 4) aligning orientation processes with other HR
management improvements including WISN plus POA and personnel records management; 5)
engaging in dialogue and supporting inclusion of new staff orientation in redesigned HCMIS to
document and publicize it; and 6) developing a cost-efficient distance learning course (see Institutionalization section).
41
Results on PS3 M&E indicator for new staff orientation are shown in the following table. In Year
4, the percentage of newly reported staff receiving a job orientation declined slightly, possibly
related to reducing PS3 direct LGA mentoring. On the other hand, the result remains greater
than 50% which could reflect LGA awareness, acceptance, and commitment to perform the new
staff orientation process themselves.
# Indicator Name BL Y1 RSLT Y2 TGT Y2 RSLT Y3 TGT Y3 RSLT Y4 TGT Y4 RSLT
4.2.2 Percentage of newly reported staff receiving a job orientation using new orientation manual
0.0% 0.0% 10.0% 0.0% 30.0% 58.8% 65.0% 54.4%
3.2.2. Develop and Implement LGA Customized Retention Strategies
For rural and hard-to-reach areas, developing a package of incentives can be a powerful method
of proactively retaining staff. In Years 2-3, GOT and PS3 agreed to use a bottom-up approach to
retention and implemented LGA customized retention strategies. All 26 PS3 Phase I LGAs (as
well as six additional LGAs identified by GOT for 32 LGAs) developed their own incentive
strategies, customized to each LGA’s staff retention challenges, operating environment and
resources.
Year 4 GOT and PS3 activities included: 1) mentoring 32 LGAs on implementation of their
customized retention strategies including executing the FY2018/19 plans and budgets contained
in PlanRep (see Box 10 for examples of LGA spending for staff incentives); 2) provide technical
assistance to incorporate retention incentives into LGA FY2019/20 plans and budgets to the
greatest extent possible; and 3) engage in dialogue with PORALG resulting in approval of the
LGA customized retention strategies approach document as a best practice for use across LGAs.
3.3. Improve HR Performance Management and Efficiency
In Year 4, GOT and PS3 continued to develop linkages between the three HR performance
management interventions of improving content of the Open Performance Review and Appraisal
System (OPRAS), e-OPRAS and interoperability with redesigned HCMIS, and improving
personnel records management. These linkages and synergies within HR performance
management and efficiency interventions, together with HR planning and distribution linkages (e.g.
WISN plus POA), contribute to realizing the strategy of taking a comprehensive approach to
HRM.
3.3.1. Strengthen Performance Management and Open Performance Review
and Appraisal System (OPRAS)
GOT manages civil servant performance through OPRAS, a formal HR appraisal system for all
public workers. It is well recognized that OPRAS challenges exist, however, reaching consensus
Box 10: Snapshot of LGA commitment to customized retention strategies. In 2018/19, Kwimba DC constructed two staff houses
Masasi DC expanded its “best employee of the year” reward program, providing Tshs 300,000 to 23
employees instead of only one.
Masasi DC provided 17 health workers houses, and one motorcycle for livestock staff
Iringa DC included in its 2019/20 budget TZS 28 million from its own source to renovate and equip three
staff houses, and procure for motorcycles for remote staff
42
on solutions has proved more elusive than expected particularly related to setting OPRAS goals
based on LGA strategic plans. In Year 3, POPSM, PORALG, TSC, and PS3 worked to develop a
methodology and process to set OPRAS goals based on the performance tasks assigned to
teachers. In Year 4, POPSM, PORALG, TSC, and PS3 worked together to: 1) change the basis of
teacher OPRAS goals from LGA strategic plans (confusing and unrealistic) to job descriptions and competencies in a new approved OPRAS goals form/template with standard objectives and
targets; and 2) conducted regional workshops for RS and LGA education officials to disseminate
the simpler and more relevant standard teachers OPRAS template to all 185 LGAs, who then
cascaded the training to all heads of schools and teachers in each school (see specific activities in
Table 5). During mentoring visits by GOT and PS3, an average of 92% of teachers in schools
completed OPRAS forms using the new template.
Table 5: Nationwide implementation of new teacher OPRAS goals/template
# Activities Responsible Timeline Status
1 Finalize new teacher OPRAS goals, template and
materials for national implementation
POPSM, PORALG, TSC, PS3 Sept-Oct
2018
Done
2 Establish and train 52 national facilitation team
(NFT) members on teacher OPRAS goals
POPSM, PORALG, TSC, PS3 Oct 2018 Done
3 Conduct regional workshops for LGA Edu Dept and
TSC LGA representatives
PORALG, TSC, NFT, RS,
LGAs, PS3
Oct-Dec
2018
Done
4 Conduct cascaded training for all Heads of Schools
on teachers OPRAS goals/template
LGA Edu Dept., TSC, NFT,
RS, PORALG, PS3
Dec 2018-
Jan 2019
Done
5 Conduct cascaded training for all teachers on
OPRAS goals/template
School Heads, LGA, TSC,
NFT, RS, PORALG, PS3
Jan-Feb
2019
Done
6 Conduct mentoring and monitoring in Phase I LGAs
for teacher OPRAS goals/template
LGA, TSC, RS, PORALG, PS3 Mar-June
2019
Done
7 Complete mentoring, documenting and linking with
other GOT systems (e-OPRAS, HCMIS)
POPSM, PORALG, TSC, NFT,
RS, LGA, PS3
July-Dec
2019
Ongoing
3.3.2. Develop e-OPRAS and Strengthen Human Capital Management
Information System (HCMIS)
HCMIS (often called the Lawson system) is the centralized POPSM HRM system currently used
largely as the payroll system for all public servants. In Year 4, POPSM and PS3 agreed to work
together to automate OPRAS (e-OPRAS) and make it interoperable with the redesign of HCMIS.
PS3 focused on development of e-OPRAS but contributed to broader framing of HRM functions
and interoperability of HCMIS. A focus of the linkage between e-OPRAS and HCMIS is a
performance management module which will facilitate keeping electronic records of annual
appraisals and evidence-based HR decisions related to promotions, rewards, staff development,
and discipline. POPSM and PS3 completed a review of more than 4,500 replies to questionnaires
sent out by POPSM to OPRAS stakeholders on challenges and obstacles that have rendered the
existing OPRAS ineffective. In addition, the POPSM and PS3 team developed new OPRAS forms
to address the challenges, and the refined forms were used to program the e-OPRAS system.
Specifics of the technical activities performed by POPSM and PS3 team to develop e-OPRAS are
detailed in Table 6.
43
Table 6: Development of e-OPRAS
# Main Activity Timeline Status
1 Analyze questionnaires and refine OPRAS form to automate in e-OPRAS Feb-Mar 2019 Done
2 Prepare and conduct e-OPRAS user requirements gathering exercise Apr 2019 Done
4 Design system architecture, user interface and database Apr-Aug 2019 Done
5 Develop system including programming and coding May-Sept 2019 Done
6 Prepare e-OPRAS documentation including guidelines, training manual, system
and user manuals Aug-Nov 2019
Ongoin
g
7 Conduct system and user acceptance testing Sept-Nov 2019 Ongoin
g
8 Design and develop interoperability between e-OPRAS and redesigned HCMIS June-Nov 2019 Ongoin
g
3.3.3. Improve HR Personnel Records Management
Personnel records management is a significant problem in Tanzania, negatively impacting service
delivery and performance on a number of other objectives, including efficiency. In Years 1-4,
GOT and PS3 developed and implemented a bottom up approach for strengthening personnel
records to improve LGA management and obtain efficiency gains. This strategy was based on the
premise of cleaning up manual systems as a pre-condition to automation to avoid the “garbage-
in, garbage out” effect, increasing LGA level ownership, and pride in management improvements,
and starting to develop linkages between a number of interventions to improve LGA HR
management (e.g., Lawson system, OPRAS, records management). In Year 4, GOT and PS3
completed the last steps of the Phase I LGA intervention, including on-the-job training, records
decongestion, and linkage to TSC automation of teacher personnel records.
Results on PS3 personnel records management M&E indicator are shown in the following table:
# Indicator Name BL Y1 RSLT Y2 TGT Y2 RSLT Y3 TGT Y3 RSLT Y4 TGT Y4 RSLT
4.2.1 % of targeted LGAs that strengthened the records
management system 0.0% 0.0% 0.0% 23.3% 50.0% 80.0% 90.0 100.0%
LGA ownership of the process was immediate. It improved HR and Archive Officers motivation
and generated substantial efficiency gains. For example, the time and administrative cost of
searching for lost but essential staff personnel records was greatly reduced. In four LGAs studied,
the time spent searching for a file was reduced by an average of 47% after the intervention (with
a range from 33% to 68%). In addition, for the new health workers distributed based on WISN
plus POA, PS3 mentored LGAs to open personnel records or master files for all new staff—
something that had never been done before.
44
4. GOVERNANCE AND CITIZEN ENGAGEMENT
Results for PS3 incorporating feedback from citizens M&E indicator are shown in the table below
(reflects contributions from all governance interventions).
# Indicator Name BL Y1 RSLT Y2 TGT Y2 RSLT Y3 TGT Y3 RSLT Y4 TGT Y4 RSLT
2.1.1 % LGAs that incorporate feedback from citizens 74.7% 75.3% 77.0% 94.6% 80.0% 98.9% 98.9% 94.6%
4.1. Improve Sharing of Information with Citizens
Transparency is an indispensable ingredient in stronger governance and more responsive LGAs
and service facilities. In Year 3, PORALG, eGA and PS3 refined the RS/LGA websites (deployed
in all 26 regions and 185 LGAs in Year 2), and mentored RS/LGA ICT officers to maintain and
use their websites. PORALG, eGA, and PS3 also developed Government Web Framework
(GWF) Content Guidelines and an Orientation Manual to assist information officers and ICT
officers in all RS and LGAs across the country to abide by formal and consistent standards for
website management.
In Year 4, PORALG Help Desk and PS3 governance mentors advised LGA council management
team, information officers and ICT officers on uploading to websites and posting information in
public places to increase transparency and share information with citizens. GWF Guidelines and
related reference materials, training and mentoring are having a positive impact as described in
Box 11. Also, the websites are making access to information easier, particularly for those in
remote locations as described in Box 12. PORALG, RS, LGAs, and PS3 initiated dialogue on
institutionalization, including solidifying LGA willingness to share information with citizens, and
their information officer’s capacity to obtain or develop information, upload it, and monitor the
type of information found to be relevant to citizens.
PS3 monitored website use focusing on the frequency of updating information on the website. In
Year 4, approximately 75% of RS/LGAs updated their website within 40 days. The number of
website visitors in the 26 PS3 Phase1 LGAs increased from 72,709 (2018) to 105,435 (2019), an
increase of 45%. LGAs which have linked their social media networks with their websites
contributed to an increase in the number of website visitors. Results for PS3 sharing information
with citizens M&E indicator are shown in the table below.
Box 11: GWF boosts website viewership
“With the reference materials for managing our
websites that were given to us by PORALG and
PS3 by November 2018 we have been able to
reach 3,200 viewers up from the 700 we had in
April 2018. The materials have been very useful
and helpful to us because they provide various
techniques in terms of content that help us
promote our website, hence increase
viewership.”
Maria Sanga, Information Officer – Mbeya DC
Box 12: Easy access to information through LGA
website
“As citizen’s representatives we work in very remote
areas where the people are. Therefore it may not be
easy to travel daily or weekly to our LGA
Headquarters to get information on development
activities and follow-up on our council meetings.
Nanyumbu DC website gives us access to
information on implementation of development
projects in our council”
Benjamin Masime, Councilor of Masuguru Ward and
Assistant Council Chairperson in Nanyumbu DC
45
# Indicator Name BL Y1 RSLT Y2 TGT Y2 RSLT Y3 TGT Y3 RSLT Y4 TGT Y4 RSLT
4.1.1 % LGAs using website to share info with citizens 0.0% 0.0% 10.0% 23.7% 75.0% 79.6% 80.0% 83.9%
Dialogue with LGA councilors, committee members, and staff revealed that most stakeholders,
including citizens, would be more likely to use the LGA website if it is accessible through their
mobile (smart) phones. Ease of access (one click) and mobile penetration in Tanzania solidify the
rationale for RS/LGA mobile application (app). In Year 4, PORALG/DICT, Open University of
Tanzania (OUT), and PS3 developed a RS/LGA website mobile app. It was approved by PORALG
management, and will be deployed early in 2020 after completing development of the user manual.
A technical workshop in Mwanza refined the mobile app for Android platform based on feedback
from user testing and developed platform for iPhones operating system. Specifically, GOT and
PS3 governance and information systems teams:
▪ Improved mobile app design and functionality based on input from GWF team and
feedback from user testing
▪ Developed web API containing a list of all region and LGA websites
▪ Refined RS/LGA website Android mobile app and developed IOS or iPhone mobile app
▪ Initiated development of RS/LGA website mobile app user manual
4.2. Strengthen Citizen Feedback and Complaint Management
Strengthening complaints management (CM) is a high POPSM and PORALG priority, reflected in
repeated requests for PS3 support. A PS3 governance premise is that GOT receiving and acting
on citizen feedback, including complaints, is key to engaging citizens, promoting more responsive
systems and improving service delivery. In Years 2-4, POPSM, PORALG, and PS3 implemented
mechanisms to strengthen and extend citizen feedback and CM to service delivery level in four
LGAs (Kishapu DC, Shinyanga; Kigoma-Ujiji MC, Kigoma; Mtwara-Mikindani MC, Mtwara; and
Bahi DC, Dodoma). In Year 4, POPSM stated they are impressed with the results in the four
LGAs and dialogue on how to disseminate and expand the experience resulted in a request for
PS3 support to develop and air a national TV program to inform citizens about the CM system.
Following USAID approval, development of the TV program (and associated TV clips) was largely
completed in Year 4.
Assessed Criteria
FY 2017/18
Score FY2018/19
Score
LGAs % LGAs %
CHM guideline 20 76.9% 26 100%
CH officers 20 76.9% 26 100%
CH desk/office 9 34.6% 19 73.1%
CHM register 9 34.6% 20 76.9%
Report submission 5 19.2% 10 38.5%
In parallel, PORALG, LGAs, and PS3 advised 26 Phase I LGAs on strengthening CM in the context
of benchmarking to improve LGA performance, including strengthening committee functioning.
Table 7 compares Phase I LGA CM benchmarking for FY 2017/18 and FY2018/19. Contributing
factors to LGA CM improvement include substantial increases in availability of CM guidelines,
mentoring, and the demonstrated commitment of LGAs to strengthen CM system by appointing
Table 7: Phase 1 LGA using CM system: FY2017/18 vs
FY2018/19
46
complaints handling officers, establishing CM offices/desks, opening complaints registers,
recording complaints, submitting reports, and informing citizens about the existence of the
service. A few LGAs that have established special free phone numbers at hospital and health
centers that service users can use to lodge complaints. Others like Kilosa and Gairo DCs
established a complaint handling committee instead of relying on one complaint handling officer.
4.3. Strengthen Committee Functioning and Gender Sensitivity
4.3.1. Strengthen Committee Functioning
Higher local government (HLG) and LLG committee functioning is critical to citizen engagement,
community involvement, and service delivery improvement. LLG committees form the backbone
of LLG, and are often comprised of volunteers, thus building capacity and increasing motivation
and commitment of committee members is important to performance of committee functions.
Better committee functioning contributes to use of strengthened systems, involving communities
and citizens, and better aligning roles and relationships within LGAs to improve oversight,
management, and service delivery. In Year 4, PS3 supported the 26 Phase I LGAs to strengthen
the basic processes and functioning of HLG and LLG committees to ensure that committees are
properly constituted, meet according to approved schedules, prepare and act on meeting
minutes, and execute their mandated functions according to guidelines, standing orders, and
bylaws.
The primary PS3 intervention to
strengthen committee functioning is
mentoring LGAs to address gaps identified through application of the benchmarking
tool developed and implemented in Years
2-3. In Year 4, LGAs and PS3 conducted
benchmarking, developed reports, and
used the findings to mentor LGA
committees and committee clerks (who
have a major role in supporting
committees) on how to improve
performance. Results of committee
benchmarking exercises were also used to
advise LGA council management teams to improve both the process and content aspects of
committee functioning including links to operation of strengthened national cross-sectoral
PlanRep, LGRCIS, Epicor and FFARS systems. Energy, ownership, and pride are beginning to
emerge in committees and facilities from the increased civic space and visible change that
extending systems to facilities, direct facility financing, increased facility autonomy, improving
management and service delivery injects into LLG.
Results for PS3 benchmarking committee functioning M&E indicator are in the table below:
# Indicator Name BL Y1 RSLT Y2 TGT Y2 RSLT Y3 TGT Y3 RSLT Y4 TGT Y4 RSLT
4.1.2 % increase LGA committee benchmarking scores 0.0% 0.0% 0.0% 0.0% 10.0% 78.6% 10.0% 3.2%
Benchmarking, mentoring, and ongoing dialogue led to the observation that committee minutes
are inadequate at both LLG and facility level, and the conclusion that a simple standardized
automated template should be developed to record meeting minutes which will be linked to the
Village executive Officer addressing citizens in one of the
village in Mtwara
47
LGAs’ websites, and to establish a process to identify constraints and barriers to LLGs holding
statutory meetings. In Year 4, PORALG and PS3 met in Dodoma to discuss developing a simple
automated standard committee minutes template and broader constraints to LLG committees
holding statutory meetings. The results of the meeting was PORALG assigning Departments of
Local Government (DLG), Regional Administration, Legal Service, and DICT and PS3 to identify constraints and propose strategies to overcome them. PORALG and PS3 held a workshop where
experiences on functioning of LLG committees were shared and problems, constraints, and
barriers identified as follows:
▪ Procedures for conducting LLG meetings were available at HLG, however, they were not
available in the majority of villages
▪ Procedures for conducting meetings at ward and mtaa levels are not available at either HLG or LLG levels
▪ Most LLG committees do not have meeting schedules and convene fewer times than
required in Local Government Acts
▪ Income and expenditure reports are usually not included in LLG meeting agenda
▪ Attendance at meetings at all levels is inadequate, particularly village assembly meetings
▪ Minutes are poorly written, have no standard format, and the majority of LLG committees
do not submit copies to HLGs
▪ RS and HLG systems of backstopping and coordination are inadequate
▪ Only a few LGAs had reliable methods of storing copies of minutes received
▪ No evidence that HLGs acknowledge, read or act upon LLG minutes
▪ Few RSs perform their role of supporting and supervising LGAs effectively
Following this feedback, PORALG and PS3 began development of a web-based standard
committee minute writing template with the expectation that one of its uses will be to deepen
PlanRep implementation by incorporating citizen input to plans and budgets. In the process,
PORALG also stressed addressing the bigger problem of the majority of LLG committees not
holding statutory meetings.
4.3.2. Gender Sensitivity and Integration
Gender sensitivity, integration, and equity in service access and quality is crucial to building human
capital of men and women in Tanzania and increasing their economic productivity. PS3 takes an
integrated or horizontal approach to gender sensitivity and integration and tries to incorporate
it into all interventions to realize delivery of gender sensitive services and benefits. The majority
of gender activities in Year 4 relate to better definition of public service outputs (see finance
component) although PS3 also completed several governance gender activities.
A gender checklist was developed and used to assist Phase I LGA Community Development
Departments (CDDs) to improve multi-sectoral gender planning and coordinate gender
mainstreaming across all LGA public sectors. In addition, PS3 sensitized LGAs on using the gender
checklist in planning and budgeting in the context of the Gender Responsive Planning and
Budgeting Initiative supported by UN Women. The gender team worked with the gender focal
person in Iringa DC CDD to identify how to enhance the use of the gender checklist to support
integration of gender service outputs across priority sectors at the LGA level including
agriculture/forestry, livestock, and water.
48
PS3 also participated in a public consultation on the Public Expenditure and Financial
Accountability (PEFA) Gender Module, and provided input on the proposed approach to
collecting information on gender responsive PFM practices including suggesting additional
questions likely to inspire country progress in collecting and producing sex and gender
disaggregated data. The PS3 Gender Assessment revealed minimal LGA progress on gender disaggregation of data. PORALG and PS3 followed up on issues related to institutionalization of
generation, collection, and use of sex-disaggregated data in LGAs, and agreed to incorporate this
topic into discussion of reports produced in PlanRep.
Results for PS3 facility committee representation M&E indicator are shown in the table below:
# Indicator Name BL Y1 RSLT Y2 TGT Y2 RSLT Y3 TGT Y3 RSLT Y4 TGT Y4 RSLT
3.1.1 % women serving on facility governing committees 31.6% 32.0% 36.0% 32.0% 34.0% 34.1% 36.0% 36.0%
4.4. Strengthen Public Finance Management
As described in the Finance Component, in Year 4, PS3 continued to support GOT to create a new PFM and sector purchasing intersection to both improve financial control and enable a shift
to output-based payment to buy the right product or service, increase efficiency, extend
coverage, and improve management and service delivery. PS3 interventions to strengthen PFM
are categorized into strengthening LGA financial management systems and strengthening internal
control and audit systems.
Results for PS3 clean audit report and internal audit M&E indicators are in the table below:
# Indicator Name BL Y1 RSLT Y2 TGT Y2 RSLT Y3 TGT Y3 RSLT Y4 TGT Y4 RSLT
3.3.4 % of LGAs with clean audit reports 25.0% 82.0% 79.6% 83.0% 93.6% 83.9% 93.6%
4.1.3 % of LGAs strengthened internal audit system 0.0% 0.0% 0.0% 0.0% 9.7% 9.7% 9.7% 9.7%
PS3 interventions to strengthen PFM are categorized into strengthening LGA accounting and
financial management systems and strengthening internal control and audit systems. In Years 1-
4, PORALG, MOFP, and PS3 built capacity of RS and LGA accountants and internal auditors in
International Public Sector Accounting Standards (IPSAS) in order to strengthen procedures for
yearly closure of books and final account preparation, and other LGA PFM statutory frameworks,
systems and processes. Capacity building also identified inconsistencies and changes required
within LGA finance templates. Subsequent dialogue with MOFP/Accountant General (ACCGEN)
and PORALG resulted in issuance of a circular to revise LGA financial templates to be consistent
with IPSAS and reduce potential for LGAs to receive qualified opinions from Controller Auditor
General (CAG) reports. In Year 4, PORALG, GIZ Good Financial Governance (GFG) project
and PS3 supported revision of Local Authority Accounting Manual (LAAM) including shift from
manual to automated and interoperable systems (e.g. Epicor, FFARS).
Based on a request from MOFP/Internal Auditor General Department (IAGD), in Year 3, PS3
assisted in LGA internal audit automation by adapting the Teammate internal audit package and
supporting the first phase of implementation in Morogoro region. However, the experience
identified issues with the high cost of Teammate licenses and it’s configuration as a “standalone
system” meaning it is hard to manage and aggregate data and analysis for all LGAs. These lessons
led MOFP/IAG and PORALG to conclude that a web-based system through a centralized server
made interoperable with other financial management systems would be more efficient and
effective.
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In Year 4, MOFP/IAGD, PORALG Directorate of Inspectorate and Financial Tracking (DIFT) and
DICT, Public Finance Management Reform Program V (PFMRP V) and PS3 developed
Government Internal Audit Management Information System (GIAMIS). The system will perform
internal audit business processes, to be used by internal auditors at MDAs, RSs and LGAs, and
equip internal auditors with the necessary knowledge and skills on audit processes and procedures. In addition, MOFP/IAGD and PORALG agreed on roles and relationships, including
increased involvement of PORALG/DIFT as the business process owner of internal LGA audits
(in the past MOFP/IAGD assumed the primary role and collaboration between MOFP/IAGD and
PORALG/DIFT was less than optimal). Specific Year 4 activities are described in the table below.
Table 8: GIAMIS Development Plan
# Activity Responsible Deliverable/Remarks
1 Perform requirements
gathering analysis April 2019
Requirement gathering team
(40 members)
GIAMIS Requirement and Project Charter Documents
2 Validate and prioritize
requirements April 2019
Technical team and
stakeholders (users)
Validated GIAMIS
Requirement and Project
Charter documents
3 Orient design team May 2019 Design team (15 members) System Design Document
4 Develop and program system Aug-Sept
2019
Programming team (15
members)
System programming
almost complete
5
Test and fix bugs, develop
system documentation,
training materials and overall
TOT program for nationwide
deployment
Oct 2019-Feb
2020
Technical team (40
members) and users, i.e.
high-level, RS and LGAs
Deploy GIAMIS system
nationwide with MOFP,
PORALG, and PFMRP V
follow-up user support
5. OPERATIONS RESEARCH
The role of the PS3 operations research (OR) component has evolved every year in parallel with
the sequencing and dynamics of project implementation. The constant in the evolution is PS3’s
commitment to closely and practically link OR to implementation of strengthened systems and
related increases in efficiency and transparency and improvements in management and service
delivery. The Year 4 focus was facility OR study, completing other studies, and evolving to
contribute to targeted results analyses using data from strengthened systems that will be the
priority in Year 5.
Facility OR Study
The facility OR study is the largest PS3 OR study. It strikes at the heart of the transformation
envisioned by PS3, which is to extend systems and shift money and public workers to facility level
(especially in underserved areas) to increase transparency, autonomy, accountability, efficiency
and equity, and improve management and service delivery. The study is a deep qualitative study
digging into the dynamics of change in health facility and school management and governance related to DFF and extension of PlanRep and FFARS to facility level.
In Year 4, the facility OR study was conducted in nine LGAs at 72 public health facilities
(dispensaries, health centers) and public education facilities (primary and secondary schools).
Data was collected through key informant interviews and focus group discussions. A total of 708
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respondents participated in the study including facility in-charges, staff, and facility governing
committee (FGC) members, and LGA councilors, directors, and heads of departments. The data
collection exercise was guided by interview instruments for each category of respondents. A
total of 6,372 responses generated through interviews and focus group discussions were coded,
classified, and analyzed. Initial analysis indicated that the overall perception of health and school in-charges, staff, and FGCs is that DFF and the extension of strengthened systems to the facility
level have improved their ability to manage and deliver services. A draft facility study report was
completed in August 2019, is currently under USAID review, and will be finalized in Year 5.
Other OR Studies and Analyses
In Year 4, PS3 OR component contributed to a number of small assessments or analyses directly
linked to program implementation including automation of LGA CFRs and resource tracking, and
PlanRep service output and budget analyses for nutrition and gender. PS3 largely completed
Intergovernmental Fiscal Transfers (IGFT), LGA revenue enhancement, and RS/LGA website use
studies which will be edited and finalized in Year 5. The OR component also supported initial
design of results analysis to be developed in Year 5 including budgets in PlanRep, revenue in
LGRCIS and GOTHOMIS, LGA expenditures in Epicor, facility expenditures in FFARS, and small
analyses documenting efficiency gains.
6. INSTITUTIONALIZATION FOR SUSTAINABILITY
PS3 prioritizes institutionalization of systems strengthening for sustainability in every aspect of
the project including building relationships with GOT at all levels, and focusing on integration,
linkages, collaboration, and leveraging resources. Institutionalization is complex, but GOT and
PS3 have a clear goal in mind: by the end of the project, all responsible LGA and facility staff will
take ownership and pride in their work as they use the strengthened systems and management
processes on a daily basis to perform their routine work. It is expected that these investments
will produce efficiency gains vital to sustaining improved management and extending coverage of
services for the population. Governance realigning roles and relationships and incorporation of
distance learning into GOT continuing education to increase responsiveness and reduce cost of
training are two avenues that GOT and PS3 are using to try to institutionalize strengthened
systems and improved management for sustainability.
Realigning Roles and Relationships
PS3’s implementation strategy of establishing dynamics to extend or shift systems, money and
public workers to service providers requires realignment of roles and relationships to be
successful. At the national level, examples of pressure points for realigning and/or ensuring
productive roles and relationships include the multi-sectoral ministries of PORALG, POPSM, and
MOFP; PORALG and sector ministries particularly MOHCDGEC; and MOFP and sector
ministries. One LGA level pressure point is roles and relationships between LGA headquarters
apparatus and service providers (e.g. health facilities and schools) in an environment of increased
facility autonomy. A second LGA focal point is structure, roles and relationships between LGA
executive arm (district executive director, departments and facilities), political arm (district
commissioner, Council, standing committees, ward development committees, and village/mtaa
committees), and their convergence in health facility/school governing committees/boards.
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In Year 4, all GOT and PS3 interventions encompassed productive realignment of LGA and facility
roles and relationships to implement and institutionalize systems strengthening, increase
ownership, drive public sector transformation, and enable management and service delivery
improvement. For example, PORALG and PS3 made progress in aligning roles and relationships
in management of strengthened systems between PORALG DLG/Finance Department, PORALG/DICT, and other PORALG departments. Dialogue resulted in understanding and
agreement that PORALG DLG/Finance Department should gradually increase their role as
business owner or manager of the functional and programmatic aspects of most PFM systems,
including LGRCIS, Epicor and FFARS.
Use of Distance e-Learning to Institutionalize Strengthened System Support and Capacity Building
The role of formal training institutions is central to the institutionalization of strengthened
systems and improved management, as ensuring human resources have the required knowledge
and skills is a basic function of these institutions. PS3 subcontractor Local Government Training
Institute (LGTI), under PORALG, is one of the right institutions in which to build capacity as they
are the official GOT institution with the mandate to conduct continuing education, training and
mentoring for LGA institutions and public workers. In Year 3, PORALG, LGTI, Open University
of Tanzania (OUT), and PS3 developed the strategy to incorporate practical training on use of
strengthened national systems into LGTI curriculum and using distance e-learning (DeL) hosted
on PORALG servers as a sustainability mechanism. LGA councilor training was selected as the
first DeL course in recognition of the importance LGTI’s function of informing new councilors of
their roles to improve governance, and also to lower the high cost of councilor training.
In Year 4, PS3 developed the LGA Councilor DeL
course, performed user testing, and then refined
the course to improve the learning experience
based on issues or opportunities identified during
user testing. Then LGTI and three LGAs (Bahi DC,
Gairo DC, and Iringa DC) provided training to
LGA councilors to build LGTI course facilitation
capacity and provide practical experience to LGTI
in preparation for country-wide training after the
next elections. Based on LGA councilor DeL
course experience, PORALG, LGTI, OUT, and PS3
began development of a second DeL course on
new staff induction and orientation. POPSM,
PORALG, OUT, and PS3 developed the DeL
course as shown in Figure 10 with a focus on
ensuring an appropriate conversion of the staff
orientation manual to DeL style.
Figure 10: Phases in DeL course development
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7. COLLABORATIONS
In Year 4, PS3 continued to collaborate to its comparative advantages with USAID activities and
other DP projects. In addition, regional/LGA operations intensified the focus on leveraging
USAID funds as systems strengthening for improving service delivery moved into full
implementation and institutionalization at the LGA level. The status at the end of Year 4 and
expectations for Year 5 are described in Table 9 below.
Table 9: PS3 Collaborations with USAID and Development Partner Projects
PS3 Collaborations with USAID Activities and Other Development Partner (DP) Projects
Collaboration End of Year 4 Status Planned Year 5 Activities
USAID Activities
Iringa Hub Implement PS3 activities in the context of Iringa
Hub plans, and participate in Iringa Hub meetings
Implement PS3 activities in the context of Iringa
Hub plans, and participate in Iringa Hub meetings
Touch
Foundation
Largely complete development of WISN+POA
IT platform for integration into GOT systems
Deploy WISN+POA IT platform integrated into
GOT systems for routine LGA use to request,
distribute and redistribute staff
GHSC (and also
Gates Foundation
and other HIS DP
projects)
Developed and testing interoperability between
Muungano/GOTHOMIS and HIM/eLMIS, and
MSD Epicor and FFARS, DHFF including RBF,
and GOTHOMIS development
Implement interoperable Muungano/GOTHOMIS
and HIM/eLMIS, and MSD Epicor and FFARS,
DHFF including RBF enabling facilities to better
spend DHFF to procure drugs, SNHI dialogue, and
further develop GOTHOMIS
Boresha Afya,
other USAID and
CDC health
service projects
Per collaboration plan with emphasis on linking
to PlanRep, DHFF (including HBF, RBF, iCHF)
and FFARS, and WISN+POA as management
opens service delivery improvement
Per collaboration plan with emphasis on linking to
PlanRep, DHFF (including HBF, RBF, iCHF) and
FFARS, and WISN+POA as management opens
service delivery improvement
CHSSP and
Kizazi Kipya
Link with MOHCDGEC and PORALG on social
welfare service outputs and PlanRep, and also
coordination of community workers
Continue to link with MOHCDGEC and PORALG
on social welfare service outputs and PlanRep, and
also coordination of community workers
HP+ Dialogue on IMTC response to HFS/SNHI Ongoing SNHI dialogue
Boresha Habari,
Governance
Activities
Participating in governance “Integration Baraza”
meetings
Participate in governance “Integration Baraza”
meetings, dialogue about opening “civic space”
with facility autonomy, governing committees and
links to community and other program topics
Lishe Endelevu
Activity No collaboration to date
Develop collaboration including nutrition service
outputs, and improving planning, budgeting,
implementation and monitoring
Education
Activity Minimal collaboration in Year 4
Link on Facility OR study, PlanRep and FFARS,
e-OPRAS for teachers and other relevant topics
Agriculture
Activities
Link to PlanRep and better define public sector
service outputs in agriculture, nutrition activities
Link to PlanRep and better define public sector
service outputs in agriculture, nutrition activities
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Other Activities Meetings upon request, and continue to identify
potential collaborations
Meetings upon request, and continue to identify
potential collaborations
Development Partner Projects
UNICEF Strong links on PlanRep implementation, revising
CCHP guideline, HIS, PFM, and nutrition
Strong links on PlanRep implementation, revising
CCHP guideline, HIS, PFM, and nutrition
activities
World Bank,
SDC, Danida,
other HFB, GIZ
DHFF HBF and its PHC capitated rate payment
system, facility manage funds & procure inputs
Institutionalize DHFF HBF PHC per capita
payment in NHIF, develop DHFF management
framework (e.g. how to spend DHFF to improve
service delivery), harmonize spending guidelines
DFID, Norway,
World Bank, EU
Ongoing meetings and PFMRP V collaboration
on PlanRep, LGRCIS, Epicor, FFARS, GIAMIS,
and other PFM systems
PFMRP V collaboration on PlanRep, LGRCIS,
FFARS, Epicor including asset management,
GIAMIS (internal audit), and link PORALG
systems to MOFP Government Electronic Payment
Gateway (GePG) to ensure continued functioning
World Bank Support RBF and productive dialogue with Public
Service Management project.
Support RBF, and link Public Service Management
(few projects support cross-sectoral HR).
P4H, WHO, all
HF DPs
Provide TA and coordinate SNHI policy dialogue
with WB, P4H, and WHO.
Coordinate all steps on ongoing policy dialogue,
SNHI Act, and SNHI architecture.
SDC/HPSS, GIZ,
KfW, P4H
Support iCHF and solidify agreement on
harmonizing iCHF payment and information
systems with other DHFF funds flow (HBF).
Harmonize DHFF purchasing and information
systems, implement iCHF, link to NHIF
development as purchaser and SNHI
GF RSSH Dialogue/TA on non-PS3 region LAN
procurement documents and cost estimates
Finalize procurement, install non-PS3 region
LANs, and HIS/GOTHOMIS development
OGAC/PEPFAR,
Global Fund,
Gates Foundation
Initial meeting on costing HIV/AIDS services and
integration into PHC
Analysis of costs of integrating HIV/AIDS services
into PHC with focus on public expenditures in
public systems (e.g. FFARS, Epicor, and HCMIS).
GIZ, OGP
Collaboration on sharing information with
citizens, complaints management, and other
governance activities
Continue collaboration on sharing information
with citizens, complaints management, and other
governance activities
Education
projects
Link P4R on education capitation grant payment
formula and teacher allocation and distribution,
link region/LGA level with LANES, EQUIP-T
Link P4R on education capitation grant payment
formula and teacher allocation and distribution,
link region/LGA level with LANES, EQUIP-T
8. COMMUNICATIONS AND KNOWLEDGE
MANAGEMENT
Communications and knowledge management plays a vital role in ensuring all project information
is communicated effectively to its stakeholders. It also plays a major role in ensuring that
communication within PS3 is quick and effective, so that all staff are able to share experiences,
address challenges and build on lessons learned. In Year 4, PS3 submitted all contractual
deliverables, including workplan, annual report, quarterly reports, monthly events calendars and
documentation of achievements in mini-success stories. Four “Road-to-Results” success stories
54
submitted were entitled: Change That Matters: the Solution to a Persistent Health Workforce
Challenge; PlanRep and FFARS as the Bookends of Facility Autonomy for Improved Malaria
Service Delivery; Direct Facility Financing to Improve Malaria Service Delivery; Workforce
Allocation and Distribution to Meet Malaria Service Delivery Requirements. Deliverables were
uploaded to the Development Exchange Clearinghouse (DEC) as outlined in the contract.
In Year 4, PORALG and PS3 developed PlanRep and FFARS tutorials that users can reference
when they encounter an on-the-job challenge using the system. The tutorials enhance user
support materials with a step-by-step process on how regional, LGA and facility officers should
access and work in the system. PS3 communications team supported POPSM and governance
team to develop TV programs and clips that POPSM plans to air to increase population awareness
and promote the new complaints management system. The team also continued to support GOT
and PS3 interventions requiring communication expertise including photographing activities.
Examples include Orientation Program for Nutrition Service Output in PlanRep for Mtwara
Region LGAs (finance and gender); extension of GWF and websites to regional referral hospitals
(governance and information systems); and workshop for development of Retention and
Incentives Guidelines for LGAs in Mwanza (HR component).
At the end of Year 4, PS3 began to collaborate with USAID Tanzania and USAID Washington to
develop the key communication messages that PS3 will use to disseminate information about the
outcomes achieved through PS3, as well as larger lessons on how to implement systems level
changes effectively. The communication messages will be targeted towards Tanzanian citizens,
the Tanzanian government, the global development community, USAID, and American taxpayers.
In Year 4, the communications team supported senior management and technical teams in
preparing and documenting correspondence with the GOT, including communication between
PS3 and ministries, departments and agencies. PS3 also continued to manage Jamvi, the project’s
internal website for communication, management, and storage of contractual deliverables,
products and internal documents. The team improved the design and interface of the internal
communication platform Jamvi through additional features which make the platform more user
friendly, including a more detailed activity schedule and mapping of staff and events, and began to
create links which will be used to archive technical materials in Year 5.
Joint Quarterly Newsletter
In Year 4, PORALG and PS3 produced the 7th, 8th and 9th editions of the quarterly joint newsletter
known as Mifumo Yetu (Our Systems). Mifumo Yetu reflects the collaboration of GOT and
USAID/PS3 in implementing systems strengthening in Tanzania, and has been well received
nationwide. The 7th edition highlights GOTHOMIS which supports health facilities in enhancing
health information at all levels of health service delivery. The 8th edition focuses on how the
redesigned PlanRep system has been further refined with additional features, and has been used
for the FY2019/20 planning and budgeting cycle. The 9th edition highlights the development of
iMES, including how extracting interoperable system data from Muungano Gateway will help
stakeholders to more conveniently access and use higher quality data to manage, monitor and conduct analysis or research. The 10th edition highlights the overall implementation status of the
different systems that are being used in RS/LGAs and at the facility level. PORALG disseminated
the newsletter to their stakeholders, including all PORALG departments, other GOT ministries,
systems strengthening partners, and all Regional Secretariats and LGAs, who posted the
newsletter on their websites.
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9. MONITORING AND EVALUATION
Consistent with PS3 implementation strategy, this results framework is intended to portray a
direct link between systems strengthening and service delivery improvements. It prioritizes the
policy objectives of efficiency or better use of existing resources, and responsiveness of public
services to the needs of citizens.
Figure 11: PS3 Results Framework
Year 3 and Year 4 M&E Plan Activities
In Year 4, PS3 priorities were to complete Year 3 indicator analysis and submit results in the first
quarter of Year 4, follow-up on results, and prepare and conduct Year 4 M&E data collection.
Specific activities included:
▪ Completed Year 3 indicator data entry, quality assurance, and analysis, and submitted
results to USAID including uploading to Implementing Partner Reporting System (IPRS)
▪ Supported regional program managers to follow-up on indicator data availability challenges and data quality issues identified during Year 3 M&E data collection exercise
Editions of the joint ‘Mifumo Yetu’ newsletter produced in Year 4
56
▪ Compiled Performance Indicator Reference Sheet. (PIRS) revisions and submitted to
USAID. Examples of revisions made include adjusting the data collection methodology
for data that can now be accessed directly from national systems, and updating
terminology consistent with program implementation
▪ Established nutrition indicators and targets ▪ Prepared for Year 4 M&E indicator data collection including logistics planning and refining
data collection tools to reflect changes in indicators or process of data collection
▪ Conducted Year 4 M&E plan data collection including LGA level and national system data
collection, and data entry, cleaning, quality assurance, and initial analysis
In Year 4, PS3 supported an internal review of indicators and results with a view to inform and
refine programmatic system strengthening interventions. For example, by identifying additional
ways to improve data quality for the indicator 3.1.1 “percentage of women serving on local facility
and school committees for targeted LGAs”. While the indicator results show good progress in
Year 3, sex disaggregation of members of facility governing committees was problematic. The
analysis revealed that PORALG monitors the facility governing committees’ compliance with
guidelines on inclusion of women in the composition of facility committees, but the monitoring
process was not systematic enough to ensure that information on sex disaggregation of members
of facility committee is readily available at LGA level. PORALG’s suggestion was to develop an
automated system for monitoring inclusion of women in the membership of facility governing
committees. This suggestion goes hand-in-hand with exploring the idea of coordinators who will
be responsible for following-up issues related to facility governing committee functioning. Other
examples of indicators where challenges were addressed or systems and processes improved
include committee benchmarking and district HR officers maintaining records of new staff
orientation.
In Year 4, PS3 worked with LGA focal persons to build LGA M&E capacity through dissemination
of Year 3 indicator results to LGA council management teams and selected LGA officers. Data
visualization figures and corresponding narratives were developed for all 93 LGAs. Indicator
results dissemination events were held in 27 LGAs (four in Dodoma, five in Lindi, two in Mbeya,
seven in Mtwara, three in Rukwa, and six in Shinyanga). The process empowered LGA reflection
and action to enhance implementation and use of strengthened systems to improve management
and service delivery. Overall, LGAs appreciated getting feedback on their progress in the use of
strengthened systems. They developed plans to follow-up in areas where they performed below
set targets.
Results for PS3 M&E outcome or impact indicators requiring contributions from all components
are shown in the table below.
# Indicator Name BL Y1 RSLT Y2 TGT Y2 RSLT Y3 TGT Y3 RSLT Y4 TGT Y4 RSLT
1.1 % of citizens report being satisfied by services in LGAs
(USAID)
1.2.a % change in PE per capita expenditure in LGAs 7.4% 41.6% 12.1% 7.4% 7.0% -1.0% 3.0% -7.4%
1.2.b % change in equity in distribution of PE across LGAs 80.0% -65.2% 125.7% 2.6% 3.0% 7.6%
1.3.a % change in OC per capita expenditures in LGAs -27.7% 3.5% 6.0% -22.5% 3.0% 31.0% 3.0% -15.7%
1.3.b % change in equity in distribution of OC across LGAs -10.4% 16.7% -29.1% 3.9% 3.0% NA
1.3.c % change in the ratio of OC to PE in LGAs -32.7% -26.9% -27.9% 32.4% 3.0% -9.0%
57
2.2.2 % LGAs with nurse ratios ≥ 3/10,000 - PAF
(USAID)
71.9% 71.9% 72.0% 69.6% 72.0% 66.3% 68.0% 73.1%
2.2.3 % LGAs pupil-teacher ratio ≤ 45 in primary
schools (USAID)
53.3% 47.5% 75.0% 22.8% 28.0% 18.0% 19.0% 17.2%
2.1.2 % citizens believe citizen participation is effective in
making govt more responsive to citizen needs (USAID)
P-6 # of key HIV policies where PO-RALG was actively
engaged and contributed to the operational roll out.
6 4
Technical Assistance to Gender, Nutrition and iMES Program Activities
PS3 also provided M&E technical assistance. In Year 4, the PS3 engaged with MOHCDGEC,
PORALG, and LGAs to assess progress related to LGA performance in collecting and reporting
on gender disaggregated data. The discussion created an opportunity to better define information
needs and use PlanRep for tracking progress on gender equality across levels of government.
Results of dialogue were MOHCDGEC commitment to finalize the Gender Profile containing
national level gender indicators for monitoring LGA progress in addressing barriers to gender
equality through improved service delivery, and PORALG commitment to explore generating a
National Annual Gender Report. This report will aggregate all LGA expenditures on service
outputs that directly impact gender indicators as outlined in the MOHCDGEC Gender Profile.
This initiative is also supported by UN Women and the Gender Macro Working Group through
the Gender Budget Initiative coordinated by MOFP.
In Year 4, PS3 provided technical assistance to PORALG NCU to orient regional and district
nutrition officers on compact indicators and improve indicator data collection. PS3 assisted NCU
to refine indicator numerators and denominators, identify data sources, and automate compact
indicator data collection to improve efficiency in extraction and collation of LGA data. Previously,
nutrition coordinators had to manually extract compact indicator data for all 185 LGAs, a tedious
and time consuming process. As shown in Figure 12, PORALG NCU, DPs, and PS3 began to automate data collection for compact indicators by integration into multi-sectoral nutrition
information system (MNIS) linked to iMES.
Figure 12: Nutrition compact indicator scorecard on iMES
58
Results for PS3 nutrition indicators are shown in the table below. USAID and PS3 agreed on four
nutrition indicators in March 2019, and also agreed to explore how best to measure the increase/
decrease in nutrition budget. FY2019/20 must be the baseline year for tracking the national
nutrition budget using PlanRep as it is the first year the new nutrition objective and service
outputs were included in the system. The FY2019/2020 budget information extracted from PlanRep is more comprehensive than FY2018/19 public expenditure review as it discerns
information on nutrition activities and corresponding inputs to deliver the 12 service outputs.
Reporting on indicators related to the increase/decrease in the nutrition budget requires two
years of data and PORALG NCU agreed to start reporting on it in FY2020/21.
# Indicator Name BL Y4 TGT Y4 RSLT
N-1 EG.3.1-d Milestones in improved institutional architecture for food security policy achieved with USG support [Multi-
level] 0 10 69
N-2 CBLD-9 Percent of USG-assisted organizations with improved performance [IM-level] 0 30.3%
100%
N-3 HL.9-4 Number of individuals receiving nutrition-related professional training through USG-supported programs 0 155 368
N-4a NMNAP Proportion of councils using bottleneck analysis and scorecard findings to undertake planning, budgeting and
reporting that is evidence-based. 0 30.3% 0.0%
N-4b # of LGAs using automated scorecard findings to undertake planning, budgeting and reporting that is evidence-based 0 NA NA
N-5 % increase in LGA PlanRep budget under nutrition objective NA NA NA
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10. CHALLENGES
As of the end of Year 4, PS3 faces no major challenges to program implementation—no significant
problems or barriers are currently undermining PS3 progress towards achieving results and
improving LGA management and service delivery, especially in underserved areas. However,
program implementation challenges are constantly being identified, managed, and resolved by PS3,
and they are expected to continue to arise until the end of the project due to its size, complexity, collaborations, and multi-sectoral work across all levels of government.
In Y4Q3, USAID obligated additional funding to PS3 in response to issues arising from changes in
the implementation and rigidity of PEPFAR applied pipeline rules that created a PS3 PEPFAR
funding timing problem. This obligation is very important as knowledge and certainty on funding
levels is critical to PS3 program management and success.
RBF challenges arose due to MOFP program delays, and issues have been partially addressed
although full resolution is still in process. While not good news, there are also opportunities to
further integrate and harmonize DHFF and RBF in payment, information, and quality assurance
systems. These opportunities also extend to enabling facilities to procure the best mix of inputs
to produce service outputs and improving facility financial management. RBF has been a trigger
for many system and management improvements, but it can benefit from integration into the
broader health financing, purchasing, and PFM systems to increase efficiency and sustainability and
support the development of single NHI moving towards universal health coverage.
In Year 3, technical challenges emerged related to interoperability between PORALG information
mediator, Muungano Gateway, and MOHCDGEC HIM, and related interoperability between
GOTHOMIS, eLMIS, HMIS, and NHIF claims management. In addition, remaining inconsistencies
between LGA planning and budgeting guidelines (PlanRep) and the Council Comprehensive
Health Plan (CCHP) guideline, became starkly visible at the start of the FY2019/20 planning and
budgeting cycle due to duplication and manual entry requirements. In Year 4, PORALG,
MOHCDGEC, other DPs, other USAID projects, and PS3 made progress in resolving technical
challenges related to: 1) interoperability between PORALG Muungano Gateway and
MOHCDGEC HIM; 2) interoperability between GOTHOMIS, PlanRep, HMIS, eLMIS, and NHIF
claims management; and 3) harmonization of remaining inconsistencies between LGA general
planning and budgeting guidelines (PlanRep) and the CCHP guideline.
In Year 4, many, if not most, of PS3’s challenges have been related to integration and
institutionalization of strengthened systems into GOT functional and sectoral/program
operations (“business process owners” in Tanzanian terminology). Most of the issues are related
to the inherent nature of organization or human behavior change as the way public sector services
are managed and delivered is transformed. Very few of the challenges are related to the systems
themselves as they are desired by stakeholders and efficiency gains and management
improvements have been broadly recognized. GOT and PS3’s productive relationship has been
enhanced by identification, communication and resolution of behavior change management issues,
specifically those related to realignment of roles and relationships.
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11. PROGRAM MANAGEMENT
In Year 3, PS3 reached its peak program
implementation intensity level. In Year 4,
program management plateaued as
implementation intensity decreased and
greater focus was placed on the management of complex operational issues and
development of project close-out plans. As
PS3 transitioned from peak level of
implementation intensity into
institutionalization, the strong foundation
built for program management and
regional/LGA operations was crucial to the
transition. Notably, the especially strong
communication and collaborations across
national and regional/LGA teams was
complemented by the strong relationship
between technical and management teams,
national and regional/LGA teams, across components, and across partners to ensure the project
is responsive not only to USAID but also to the GOT stakeholders, ultimately maximizing PS3
impact and sustainability. PS3 internal communication was a priority using many mechanisms
including meetings (e.g. regional cluster meetings, technical team meetings), reports, Jamvi, and a
variety of information technology applications. PS3 continued to invest in management
improvements and obtaining efficiency gains to maximize the impact of USAID funding.
Regional/LGA operations embody the hub where all four components or system functions
integrate, synergize, and result in strengthening systems and improving public service delivery.
Regional clusters are the PS3 unit of operations and consist of two to three regions, regional
program managers (RPMs) and at least one information system, finance, HR and governance
mentor to integrate systems strengthening across components or systems functions. The six
regional clusters are shown in the map in Figure 11: East Southern Highlands area (Iringa and
Njombe), West Southern Highlands area (Mbeya and Rukwa), Central area (Dodoma and
Morogoro), Southern area (Mtwara and Lindi), Western area (Kigoma and Kagera), and Eastern
Lake area (Mwanza, Shinyanga and Mara).
Regional/LGA operations matured rapidly in Year 3 and drove explosive growth and acceleration
in Year 4 of all GOT and PS3 activities in 13 regions covering 93 LGAs. A November 2018
meeting of RPMs, national technical staff, and project management produced strategies to begin to shift program management from intense system development and deployment to deepening
system use and institutionalization. Specifically, PS3 began movement towards institutionalizing
system user support across levels of government and addressing any remaining management
barriers. Also in Year 4, PS3 continuously improved scheduling and management of activities;
conducted monthly regional cluster meetings (where regions belonging to the same cluster meet
to develop plans and operations schedule); maintained good communication and relationships
with RS and LGAs through focal persons; and solidified matrix management roles and
relationships including optimization of synergies, and strong team spirit between national and
regional/LGA staff.
Figure 13: PS3 Regional Clusters
PUBLIC SECTOR SYSTEMS STRENGTHENING
(PS3) IN TANZANIA
