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Dar es Salaam, 4 February 2013

Dar es Salaam, 4 February 2013. Assessment of health progress and performance, mainland Tanzania: Analytical report Introduction and outline. Objectives of the analytical report.

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Dar es Salaam, 4 February 2013

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  1. Dar es Salaam, 4 February 2013 Assessment of health progress and performance, mainland Tanzania: Analytical reportIntroduction and outline

  2. Objectives of the analytical report • To produce a comprehensive assessment of health progress and performance in mainland Tanzania in order to inform the MTR of HSSP III and other strategies/plans as relevant • Other strategies / plans may include: • National Roadmap strategic plan to accelerate reduction of maternal, newborn and child deaths 2008-2015 • Primary health services development programme 2007-2017 (MMAM) • MDG progress reviews, Global Fund and other development partner related monitoring • National strategies: Vision 2025, MKUKUTA • To strengthen capacity for health progress and performance assessment

  3. Indicators & analysis • Focus on the key indicators and targets of HSSP III (32) • Results framework: inputs-outputs-outcomes-impact • Consideration of "current" situation and 2015 targets • Also take into account additional indicators in the same programme areas if these can help assess progress or are included in related strategies/plans • E.g. life expectancy (Vision 2025), RMNCH indicators • Emphasis on disaggregation (equity) if possible, especially subnational (mostly region if possible district) • Take into account any contextual factors, such as economic and social indicators at subnational and national level

  4. 32 Indicators for HSSP III 2009-2015, MOHSW, Tanzania Inputs & processes Outputs Outcomes Impact • Financing • THE per capita • Enrollment in CHF • Human resources • Density by region: MO and AMO; nurse midwives; pharmacists; health officers; lab • Training institutions with accreditation • Service access • EMOC facilities • Medicines and medical products stockouts in health facilities • Quality • Malaria lab confirmation • TB treatment success • Leprosy treatment success • Immunization • Measles, DPT/penta3 • Vitamin A in children • Antenatal and delivery care • ANC At least 4 times • ANC started before 16 wks • TT2 • Skilled birth attendance Contraceptive prevalence • HIV • ART for PMTCT • ART coverage Malaria • IPT2 • ITN among children and pregnant women • Cholera CFR among treated • Hypertension prevalence 25-64 • Neonatal, infant and child mortality rates • Maternal mortality ratio • Total fertility rate • HIV prevalence • 15-24 years • Pregnant women 15-24 • Malaria parasitemia in children • TB notification rate • Leprosy notification rate • Cholera incidence Orphanhood prevalence Child growth: severe underweight, severe stunting

  5. Cross cutting issues in HSSP III • Equity: geographic, vulnerable groups • Gender sensitivity • Quality of services, management etc. • Community ownership, including healthy life styles, care in the family, health service interface • Coherence in health services planning and implementation • Complementarity in governance: management, PPP Equity analyses Improved service coverage Improved intervention quality, uptake and impact

  6. Implementation areas in HSSP III • District health services • Referral hospital services • Central level support • Human resources • Health care financing • Public private partnership • Maternal newborn and child health • Disease control: HIV/AIDS, TB & leprosy, NTD and epidemic prone diseases, NCD, environmental health • Emergency preparedness • Social welfare • M&E • Other important issues: capital investments, ICT 156 indicators, mostly for management purposes, limited use in this report Some could be included in the analytical progress report

  7. Main data sourcesInput indicators • Financial tracking; resources, expenditure • National Health Accounts: 2005, latest • Public Expenditure Reviews • Other sources • Health workforce • HR data bases: quality, other sources than MoH • Recent special studies • Policy changes • All relevant policies and policy changes since 2009 from qualitative review

  8. Main data sourcesOutput indicators • Availability and readiness of health services: tracer medicines and medical products • National data bases (by regional and district): facilities, specific type of services (ARV therapy, PMTCT, EMOC) • Health facility data (HMIS) • Facility surveys • 2008/09: 15 districts, NIMR & WHO • 2012: 27 districts, Ifakara • Quality of services • Health facility data (HMIS): • Lab confirmation rates for malaria • TB treatment outcome (success rate) • Research studies • Outpatient utilization rates • HMIS, economic survey

  9. Main data sourcesOutcome indicators • Coverage of interventions (with equity) • HMIS: ANC, PMTCT, postnatal care, delivery, CS rates, immunization, vitamin A, ART coverage, TB treatment and notification rates, FP • TDHS 2004/05 and 2010/11 • THMIS 2011 • National panel survey • Research studies • Risk factors • TDHS 2004/05 and 2010/11 • STEPS 2012 if available • Research studies

  10. Main data sourcesImpact indicators • Mortality and fertility • TDHS 2004/05 and 2010/11 • Census • HMIS (causes of death, case fatality rates) • Health and Demographic Surveillance Studies (Ifakara, NIMR) • Morbidity • HMIS • Surveillance system (HIV, cholera) • Surveys: THMIS • Financial protection

  11. Analytical approachesWhat can be done? • Data quality assessment: completeness accuracy • Target and trend analysis: rate of progress • Putting data from different sources together (to obtain best estimate and assess data quality) • Equity analysis: geographic, individual characteristics • Stepwise analysis using the results framework • Efficiency analysis: comparing results with inputs • Estimates: use of statistical modelling • Comparative analysis: internal and external • Lives saved computation (LiST)

  12. End

  13. Putting data from different sources together • Health facility and survey data available for the same indicators • Coverage of interventions: immunization, ANC, SBA/institutional delivery, etc. • Assess biases, make adjustments

  14. ComparisonDelivery rates: HMIS fairly consistent with DHS 2010 TDHS 2010 is higher Kigoma Rukwa HMIS is higher

  15. Disaggregation (equity) • Health facility reports • age • subnational data: district • Health surveys • sex, age • Education, wealth quintile • Place of residence: urban rural, province/region

  16. An example from a survey 2012 Countdown Report

  17. Stepwise analysis

  18. Efficiency – comparing inputs and results Underperformers – higher mortality than expected on the basis of money for health Good performers

  19. Regional performanceCoverage of deliveries by health worker density* Better than average performers Iringa Pwani Morogoro Tanga Mwanza Arusha Mbeya Shinyanga Poorer than average performers * Dar es Salaam and Kilimanjaro have more than one-third of health workers in Mainland and are excluded

  20. Use of estimates • An estimate is based on statistical modeling with transparent assumptions to obtain the best picture of the real situation • Done for many indicators • Mortality; child, maternal, adult, life expectancy, causes of death • Coverage: immunization, water and sanitation • Often done by global agencies to obtain comparable data • Same year, same method for all countries

  21. Child mortality – IGME estimateswww.childmortality.org

  22. Benchmarking • Comparison • Who to compare with: Regional average / peer countries • How: average, median or best performers, compared to international targets (e.g. MDG, Abuja 15%) • Statistical measures • Absolute or relative progress • Ranking (e.g. 14th out 42 countries) • Percentile (e.g. 67th percentile out of 42 countries) • Position compared to country or regional mean/median • Benchmarking • Comparison with top performers (e.g. best 10%)

  23. Performance assessmentPutting it all together • Identifying contextual changes • Demographic, economic, social and political factors • Progress assessment • Compared to targets • Compared to peers • Putting together data from different sources • Equity analysis • Trends in equity gaps by key stratifiers • Efficiency analysis • Results by inputs; use of summary measures • Performance = Summarizing and interpreting the results

  24. How well is the analysis in the annual review report done? • Data quality assessment included? • Target and trend analysis done? • Stepwise systematic analysis of progress and performance? • Data from different sources is put together? • Equity receiving attention? • Efficiency analysis done at subnational level? • Comparative analysis within country done? • Comparative analysis with peer countries done ?

  25. Benchmarking of progress (spreadsheet) • Spreadsheet - data from World Health Statistics 2010 • Selected set of indicators with data over time • Total health expenditure per capita • General government expenditure on health as percent of total expenditure • DPT3 coverage • Child stunting • Child mortality (under five) rate • Use different measures to examine the data and position over time • How well has your country done: Subjectively interpret your country's results and draw your conclusion for your country

  26. Components of the progress and performance review Context Context • Progress: the extent to which health system goals in terms of levels of health and financial risk protection have been attained • Equity: the progress in term of distribution of the health system goals • Efficiency: the extent to which the resources used by the health system have produced the maximum possible benefit to society Policies, strategies, resource allocation Performance

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