Day 3 Summary

1. Day 3 Summary By Dr. M. Ongara and Dr. B. Kajuna

2. Day 3 Activities Rapporteurs� Report (Day 2 Summary) followed by the following presentations: District Health Service Website (www.districthealthservice.com) by Dr. Hingora (MoH) Pre-entry Career Motives and the Ultimate Quality of the Medical Workforce in Tanzania by Dr. K. Leon Experiences and Findings from the Pre-tested Implementation of CCHP Guideline of March 2004 by A. Nswilla and Maganga (MoH) Role and Responsibilities of LGA in the Implementation of the CCHP by M.W. F. Maganga (PORALG) Progress in Implementation of LG Programme in Relation to HSR by Mr. J. Mallya (PORALG)

3. Day 3 Activities Main Public Sector Reforms by S. Gatunga (PO-PSM) Establishment of National Blood Transfusion Services by Dr. F. Ndugulile (MoH) Bird Flu or Avian Influenza by M. Mmari and E. Nangawe (WHO Country Office) Demographic Health Survey 2004 � 2005 by Dr. Mpemba Development of a Modular Course on District Health Management in Tanzania by Dr. A. O. Mwakilasa (MoH) Policy Guidelines for Human Resource Development Fellowships Guidelines by Dr. L. R, Mashauri (MoH) Human Resource for Health Crisis: Steps to address the Crisis by E. Mwakalukwa (MoH) Priority Setting: Closing the Gap between Theory and Practice by Dr. S. Mshana (PHCI � Iringa) Plenary discussions of all the presentations

4. Emerging Issues from Day 2 Summary TEHIP is in the process of reviewing the DHA tool to make it more user-friendly. Inputs are needed from districts which are already using the tool in order to achieve this. There is need to focus on preventive interventions in malaria control in addition to the curative interventions. MoH is not opposed to decentralisation of selection and training of health workers to the councils. However, more discussions are needed on this with the LGAs to ensure that councils have adequate capacity to handle this responsibility.

5. Issues Emerging from Day 3 Presentations MoH has established a national website on the district health service to facilitate sharing of information on implementation of different health interventions at all levels. The website has district specific data, policy documents from the national level and links to other important sources of health information. Councils were requested to provide the necessary information towards enrichment and regular updating of the site. The website can be accessed on www.districthealthservice.com. Pre-caution should be taken not to forget to send important docs to the districts, as there is no guarantee that all the councils will be online by next year. It was suggested that CCHPs should be posted onto the website with effect from next financial year. A resolution is needed from the conference on this matter. The CCHPs should be submitted in electronic form.

6. Issues Emerging from Day 3 Presentations Continue� Information from Zanzibar will also be posted to website upon consultation with the relevant authorities. Date of the last update of information on the website should be indicated to ensure that outdated information is not in use. There is need to create links to other important websites such the Ministry of Health website as well as the PORALG�s.

7. Issues Emerging from Day 3 Presentations Continue.. The presentation on �Pre-entry Career Motives and the Ultimate Quality of the Medical Workforce in Tanzania� indicated that: More than two thirds of Tanzanian final year medical students are less motivated at exit from the medical school than they were at entry. De-motivation among medical doctors can be traced back to medical school experiences, where two thirds of finalists are already de-motivated even before starting their internship. Commonest de-motivators are low income and poor working environment, heavy workload, occupational risks and unfavourable medical school experiences, among others.

8. Issues Emerging from Day 3 Presentations Continue� Aptitude tests should be conducted to prospective candidates for medical training in order to ensure that the candidates have the right attitude, commitment, vision and expectations from the career. Pre-testing of policy documents and guidelines is crucial in ensuring their relevance, technical appropriateness and acceptability by the intended users. This was vividly demonstrated by the presentation on experiences from pre-testing of the CCHP guideline of March 2004.

9. Issues Emerging from Day 3 Presentations Continue� The DHA tool and the CCHP-Sure developed by GTZ complement each other. The DHA tool focuses more on resource allocation while the GTZ tool comes in handy in costing. However, both tools should be harmonised for more effective use in development of the CCHP. In order to improve transparency, accountability and good relations between the DDHs/VAs and the councils, it was suggested that contracts should be signed between them, not between the DDH/VA and the central level Ministry. DDHs and Regional hospitals are not fully accountable to the councils on the disbursed basket funds. They should be made more accountable to the councils. It was reported that some councils have already started publicising their plans and financial information to encourage transparency and accountability in management of public resources.

10. Issues Emerging from Day 3 Presentations Continue� Changes made in CCHP planning guidelines on resource utilisation should be made available to auditors in order to avoid audit queries to the councils. The councils should also keep copies of official communication from the central level on various changes in the guidelines. Delays in preparation of financial reports by the councils delay auditing activities. Councils should promptly prepare their financial and technical reports. Regarding public sector reforms, it was suggested that the Client Service Charter should be reviewed in line with the available resource at the service delivery points in order to make it implementable and relevant to both parties. It was also explained that promotion of health works will be on the basis of performance but not automatic promotion. Vacancies within the civil service will also be filled on a competitive basis.

11. Issues Emerging from Day 3 Presentations Continue� MoH has established a national blood transfusion service to help strengthen and sustain a nationally coordinated blood transfusion system and to ensure availability of adequate supplies of safe blood from voluntary, non remunerated repeat blood donors from low risk population throughout the country, by 2008. Subsequently, zonal blood centres have been established to help increase access to safe blood by health facilities within the zones. Plans are under-way to establish similar centres in hard-to-reach regions

12. Issues Emerging from Day 3 Presentations Continue� Regarding the threat of the avian flu, it was explained that Tanzania is still in the pre-pandemic phase. However, draft guidelines have been developed by WHO to enable health workers handle the disease. Orientation will be given to health workers on the guidelines at an opportune time. As a matter of pre-caution, TFDA has also withdrawn permits for importation of poultry products from 27 countries including South Africa and Egypt. Council authorities at points of entry into the country were also urged to be vigilant about this, while awaiting guidance from the national and regional task forces on the avian flu.

13. Issues Emerging from Day 3 Presentations Continue� Going by the DHS of 2004/2005, Tanzania is the only country in the East African Region likely to meet the MDG No.4 by the year 2015. However, the increasing maternal mortality is a major challenge given that several interventions have implemented in the country towards improvement of maternal care. Modalities should be created to share the DHS information with the lower levels to enable them compare the information with what is available particularly at the village level, in order to take appropriate action.

14. Issues Emerging from Day 3 Presentations Continue� MoH is in the process of developing a course on District Health Management, tailored to the Tanzania experience on the district health service strategy. To ensure that staff do not leave their workplaces for long periods and that learning can be spread over time and tailored to individual needs/interests, a Modular Structure has been proposed. The course is for CHMTs and health workers in the districts. Accreditation of the course is underway and the course is expected to be launched by July 2006. The study time frame is 18 � 30 months, depending on the learning ability of the student. Considerations are being made for on-line delivery of some of the modules of the course.

15. Issues Emerging from Day 3 Presentations Continue� In order to make it easier for health staff to improve their professional skills without having to leave their work stations, consideration should be made for part-time MPH courses as is the case in other countries. It was suggested that MoH should discuss with the relevant institutions about the suggestion for MPH as part-time. Policy guidelines for human resource development fellowships have been developed by MoH to enable those responsible for training and selection of health workers to achieve their selection goal and maintain consistent standards. It was mentioned that MoH will announce each year the number of fellowships available. Apart from that, post-graduate scholarships outside the country are no longer a secret, since 2004.

16. Issues Emerging from Day 3 Presentations Continue� The conference was also informed about the Belgium Government scholarships, which are available through MoF and the Belgium embassy. DMOs were urged to apply. Regarding the human resource crisis in the sector, a multisectoral task force has been formed to look into this matter. The task force include MoH, MoF, PORALG, PO-PSM, and Development Partners. In terms of human resource management, there is need to review salary scales of health workers on the basis of their training and day-to-day responsibilities (e.g. same scale for NM and CO). A national strategy for human resource development should also be developed to address such issues.

17. Thank Very Much for Listening