THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH AND SOCIAL WELFARE

STRATEGIC HUMAN RESOURCES PLAN

(DRAFT 1)

DIRECTORATE OF HUMAN RESOURCE DEVELOPMENT MINISTRY OF HEALTH AND SOCIAL WELFARE P. O. BOX 9083 DAR ES SALAAM APRIL, 2006

HUMAN RESOURCE FOR HEALTH PLAN FORMAT

Table of Contents Abbreviations Foreword Acknowledgements Executive Summary 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Introduction Rationale of the plan Plan aim and objective Country and Health profile National Health policy and legal framework Situational analysis Human resource policy requirement Identification and assessment of key HRH priority areas HRH Strategic Plan and budget table Monitoring and evaluation Annexes

ABBREVIATIONS

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AIDS CHMT DED DMO HSR HRHSW HIV KRA MoHSW MDGE NHP NSGRP OPD OPRAS RAS RHMT RMO VA WHO

Acquired Immuno-deficiency Syndrome Council Health Management Team District Development Director District Medical Officer Health Sector reform Human Resource for Health and Social Welfare Key Result Area Ministry of Health and Social Welfare Millenium Development Goal National Health Policy National Strategy for Growth and Reduction of Poverty Out Patient Department Open Performance Appraisal System Regional Administrative Secretary Regional Health Management Team Regional Medical Officer Voluntary Agencies World Health Organization

1.0 INTRODUCTION

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1.1 HISTORICAL BACKGROUND OF THE HRH PLAN Human resource is the most important resource in the performance of all organization. In order for the HRH to achieve what is required by the organization needs to be handled with care. The purpose of this HRH Plan is to provide a general guide on the planning, management, training and development of human resources in the health sector. The plan intends to involve all HRH stakeholders to play their roles in HRH issues for quality health care provision in Tanzania. The plan is developed as a follow up of the HRH Plan of 1996 which were partially (68%) implemented due to inadequate funds. The plan is also derived from the HRH Policy guideline of the year 2005. The HRH Plan is based on the HRH database collected by the MoH survey countrywide 2002, HRH Audit conducted by CEDHA, WHO and CDC in 2005, 1999 staffing level guideline, MoH Report on the monitoring the applicability of the staffing level 2004/2005, Tanzania Health Report of 2004, MoH school database of 2005 and HRH situational analysis which were carried out in the year 2002. The HRH plan document is divided into the following key areas:• Background information • Rationale of the plan • Plan aims and objectives • Situational analysis • Future development in Health Services • Future HRH requirements • Future HRH supply • HRH Policy requirements • Identification and assessment of key HRH priority areas • Strategic planning table • Implementation of the plan • Monitoring and evaluation Development, monitoring and evaluation of the implementation of the plan is the responsibility of the Human Resources Development department on behalf of the Ministry of Health.

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1.1 MINISTRY OF HEALTH AND SOCIAL WELFARE VISION, MISSION, AND CORE VALUE Vision The vision of the Ministry of Health and Social Welfare is to provide health services of high quality that are effective, accessible and affordable to all, delivered by a well performing, intergrated and sustainable health system. Mission The mission of the Ministry of Health and Social Welfare is to facilitate the provision of equitable, quality and affordable health services, which are gender sensitive and sustainable, delivered by competent and well motivated health staff. Core Values The core values of the Ministry of Health are: quality care, professionalism, Moral and ethical practice, accountability and commitment.

1.2ORGANIZATION STRUCTURE OF THE MINISTRY OF HEALTH AND
SOCIAL WELFARE The Ministry of Health & Social Welfare (MoH&SW) is charged with the responsibility of ensuring the provision of quality health services in the country. To accomplish this responsibility, the Ministry’s functions are divided into six directorates which includes: Hospital Services, Preventive Services, Human Resource Development, Policy and Planning, Social welfare, Administration and Personnel. These departments are subsequently divided into sections for a more effective implementation as reflected in the organogram. Apart from the section there are semi – autonomous health agencies and institutes of the Ministry of Health and social Welfare which are Government Chemistry Laboratory, Food and Drugs Agency, Muhimbili National Hospital, Medical Stores Department, Muhimbili Orthopaedic Institute,The Ocean Road Cancer Institute, Tanzania Food and Nutrition Centre (TFNC), National Institute for Medical Research (NIMR), Mbeya Referral Hospital.These Agencies are semiautonomous publicly accountable government organizations managed by Chief Executives at arms length from Government. They are still part of government and are discrete business units with clear responsibilities and business boundaries. Agencies are to receive all the delegations or-power and authority over their resources necessary to enable them to meet their responsibilities. They will become more and more self sufficient in

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managerial and in some cases, financial terms. Some agencies will generate all their income from charging fees and/or trading. Others will remain dependent on Government subventions, and there will be a spectrum of combinations in between. (Refer to Annex 1) 2.0 RATIONALE OF THE PLAN There are 2 major rationale for HRH plan. (i) Situational analysis done in 2002 indicates the following HRH crisis which necessitated the need to develop HRH Plan. • Extreme shortage of staff in the health facilities and training institutions • Increase workload in the health facilities due to HIV/AIDS • HRH reluctancy to work in the hardship environment (Districts) • Mismatch between HRH demand and supply • HRH performance appraisal not linked to productivity • Inadequate HRH capacity in line with HSR requirements • Increasing HRH attrition (ii) Increasing customer demands and expectation which include Quality health care services, customer oriented services, financial management that ensures value for money and transparency, gender sensitive health services, equity in the distribution of services, accessible, affordable and available services of all types, health services without corruption, efficient referral system, community involvement, provision of health services by qualified and competent health workers, availability of primary health care services, sustainable health services, freedom of choice on where to get health services, well maintained health service infrustructures, reliable communication facilities, and health services without violation of human rights. In order to meet all this customer expectations as well as to achieve HSR requirement, development of HRHSW plan is very important. 3.0 HRH PLAN AIM AND OBJECTIVE Aim The aim of the strategic plan is to ensure availability of adequate, competent, motivated and equitably distributed staff for delivery of quality health and social welfare services at all levels

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Objective • To provide an insight and guidance in developing and retaining committed human resource for health and social welfare. • To ensure increased health budget on the personnel emoluments for increased deployment as per staffing level guideline by 2011 • Develop HRH capacity to deliver a minimum essential health care and quality training by 2011 • Ensure availability of a coordinated and intergrated efforts on HRH Planning, management, training and development by 2008 • To ensure equitable distribution of HRH at all levels by 2010 • Ensure increased productivity of health staff at all levels by 2011 • Improve human resource capacity to manage Health resources at all levels for quality care by 2011 • Ensure availability of the right number of the staff with the right skills, at the right place, cost and motivation by 2011 4.0 TANZANIA COUNTRY AND HEALTH PROFILE 4.1 COUNTRY PROFILE 4.2 HEALTH PROFILE Generally the health of the population of Tanzanian is characterized by a short life expectancy and a high burden of disease. The average life expectancy is 48.8 for males and 47.2 for females. Communicable diseases, maternal and prenatal conditions cause the majority of the disease burden. The infant mortality rate is about 93 per 1,000 live births. Vaccination coverage is 88% for BCG, 89% for Measles and 83% for DPT 3 Vitamin A Supplementation is 90%.(2002). The major causes of morbidity and mortality in Tanzania are infectious, and parasitic diseases. According to institutional based records, diseases of high endemicity include malaria, AIDS, Tuberculosis, respiratory infections and diarrhoea. According to hospital statistics, malaria appears to be the number one cause of morbidity in the country., diarrhoea and tuberculosis are also high on the list of leading killer diseases. The following table shows the most frequent causes of attendance at health facilities and the ten leading causes of deaths in hospitals.

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Table 1.0 Frequent Causes of Attendance at Health Facilities (All ages) SNo. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Disease % of all diagnosis Malaria 36.01 Upper Respiratory Tract Infection (URTI) 12.40 Diarrhoea 6.60 Pneumonia 4.70 Intestinal Worms 4.10 Eye Infections 3.90 Skin Infections 3.50 Minor Surgery 2.20 Anaemia 2.20 Pregnancy complications 2.00

Among important factors for a well performing health system is the human resource development (HRD). Human resource is a crucial factor in the sense that all initiatives within the health sector are strongly human centred. The need to determine human resource development in terms of infrastructure, institutional and human is important so as to address all problems related to it. 4.3 TANZANIA DEMOGRAPHY AND HEALTH SERVICES INFRASTRUCTURES

4.4

HEALTH SYSTEM

The health system in Tanzania comprises of various levels of health service delivery, These levels are there to ensure efficiency and demarcation of roles and responsibility for each level as follows:

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4.4.1 Level 1 (District level) This level provides primary health care services, which are basically clinical and public health services. The services are provided in the dispensary which is located at the ward level and planned to serve 3 - 5 villages with 10,000 population . Health centre is the referral level for the dispensary and it provides a slightly broader range of services than dispensaries, including inpatient care and covers an average population of 50,000. District hospitals are located at the district centre and each serves an average of 250,000 people. Tanzania comprises of 114 districts and there are district hospitals in all districts, except In 19 districts where there are no government hospitals, mission hospitals act as designated district hospitals (DDHs). Through agreements, the government provides essential supplies such as pharmaceuticals, and staff on secondment basis. Tanzania has the decentralized system where the districts are provided with full mandate in health planning implementation and evaluation of the services 4.4.2 Level II (Regional Hospitals), A level II which is a regional Hospital serves as a referral point for level I (District Hospital) with more specialized services and it caters for the population of about 1,000,000 people. 4.4.3 Level III (Referrals Hospitals) At this level, there are 4 referral hospitals and four others that are specialized in psychiatry, tuberculosis, orthopaedics/Trauma and cancer which provide highly specialised services. 4.5 HEALTH STATUS AND DISEASE BURDEN Despite increased availability of health care, the occurrence of some diseases is increasing. Such diseases include malaria, acute respiratory infections, waterborne diseases, skin conditions and chronic diseases such as hypertension and diabetes. The most threatening are AIDS related diseases including TB which have affected mostly the productive work force.

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The national statistics for diseases burden have singled out top ten diseases which are the most frequent cause of the mortality for all ages. Among the top ten are malaria, HIV/AIDS and Tuberculosis. Malaria Malaria is the leading disease in Tanzania for ill health and death. It accounts for 19% of all deaths and approximately 30% of all hospital visits. The groups most vulnerable to malaria are: • Children under five years of age (7.1 million) • Pregnant women (1.69 million) Malaria assessment at health facilities • The leading cause of outpatient attendance for children under 5 years (38%) • The leading cause of outpatient attendance for children 5 years and above (32%) • First ranked cause of deaths in hospitalised children less than 5 years (31%) • First ranked cause of deaths in hospitalised patients of all aged (19%) • The leading cause of admissions for children under five years of age (43%) Control Strategies To reduce malaria related mortality and morbidity by half by 2010 through: • Early diagnosis and treatment at household level: Target: 60% of febrile episodes correctly managed at home • Improve case management at health facility level: Target: 80% of malaria cases appropriately managed • Prevention of Malaria in Pregnancy: Target 60% of pregnant mothers use intermittent preventive treatment (IPT) • The use of insecticide treated nets: Target: 60% or pregnant mothers and 60% of children ,5 years sleep under ITNS • Epidemics detection and control: Target: Increase capacity of epidemic detection • Institutional strengthening. HIV/AIDS/STI The magnitude and trend of HIV/AIDS/STDI in Tanzania Mainland by January to December, 2001 was as follows: • A total of 14,112 AIDS cases were reported from 20 regions during the year 2001. HIV prevalence is 9.2% in females, being higher than in males. • The cumulative figure since 1983 when the first case was reported up to 2002 amount to 144,498 cases. Trend appears as follows:

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The estimate is that 1 in 5 AIDS cases is reported thus the estimate if all are reported could be 71,000 for the year 2001. Most cases fall within the age group 20-49. The highest numbers of cases reported are in the age group 25-34 and 30-39. Priority interventions a. Voluntary counselling and testing b. Distribution of condoms c. Information and education in schools d. Prevention of mother to child transmission e. Treatment of sexually transmitted infections (STI) other than HIV/AIDS. 5.0 NATIONAL HEALTH POLICY AND LEGAL FRAMEWORK 5.1 Human Resource for Health Policy Context HRHSW Vision To have in place well trained, highly qualified and competent staff who contribute efficiently and effectively in the delivery of quality health services to the Tanzanian society. Assumptions for achievement of HRH vision • Adequate skills mix against workload • Well motivated health workers with incentives • Opportunities in the labour market to be maximized • Conducive working environment • Prevalence of political will and commitment • Fair competition • Consideration of a global phenomenon in the care aspect, and • Attracting medical profession and best brains that will pursue to take lengthy training and difficult task • Strong commitment among HRH stakeholders HRHSW Mission To ensure proper HRH’SW planning, management, training and Development for quality health care delivered at all levels of the health sector. Assumption for achievement of HRH Mission  Strong political will and commitment  Remuneration commensurate with work  Appropriate utilization of the existing best brains

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 Minimal opportunity costs, and  Taking advantage of positive globalization affects. 6.0 SITUATIONAL ANALYSIS 6.1 HRH AND POLICY CONTEXT The National Strategy for Growth and Reduction of Poverty (NSGRP)1 finalized in 2005 has kept in focus the achievement of Millennium Development Goals, most of which are health related. Cluster 2 of the NSGRP aims in its second goal to improve survival, health and wellbeing of all children and women and of specially vulnerable groups, the segments of the population in which the largest burden of disease, disability and death occur. The NSGRP has provided clear strategies in its operational target on human resources and management in health including assessing the human resource development strategy, training in key areas, hiring and equity of deployment, incentives for “hardship posts” and improving human resource management practices. The National Health Policy (MoH, October 2003)2 has clearly outlined the policy objective to train and make available competent and adequate number of health staff to manage health services with due consideration to gender at all levels. Capacity building in health services management is part and parcel of this policy objective. Among the strategies for achieving the Health Policy, implementing a comprehensive human resource development plan that facilitates deployment and retention of well-trained and motivated staff is directed. While the Health Policy is clear on guiding the supply of HRH it remains quite limited in HRH planning and HRH deployment and retention.

DISPREPANCY BETWEEN POLICY STATEMENT(S) AND ACTUAL PRACTICE: The target population (women, children, vulnerable groups) of the NSGRP is well addressed in terms of specificity of health interventions and financial resource flows to deliver these interventions. However, actual practice is hampered by severe gaps of qualified human resources to deliver the health interventions. Health Centres and Dispensaries, where the largest load of morbidity affecting this target population is supposed to be serviced have the greatest shortage of qualified health staff (Gap of NMW = 562; PHNB = 1,074, and COs =
1 2

NSGRP MOH - NHP

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531 at Health Centre level and a Gap at Dispensary level of PHNB = 4,770, COs = 3,515)3. Hence policy goals such as reducing Maternal Mortality remain very elusive to reach given reliance on availability of a motivated qualified health workforce The National Health Policy’s (NHP) limited coverage of HRH planning and poor financing of the 5 year HRH Plan 1996 – 2001 may have influenced the sector’s slowness in taking comprehensive HRH planning more seriously. Insufficient articulation of HRH deployment and retention measures in the NHP may have given room to emergence of malpractices in deployment. The special circumstances surrounding the health workforce needed measures to brace it against forces operating in the free labour market. Where there were no deliberate retention measures severe strain on service delivery was inflicted as personnel gravitated to better served areas, sectors or sub sectors with better conditions and greater opportunities for personal advancement or simply succumbed to migration inducing factors. HRH planning requires up to date information; when cooperation of various stakeholders and all levels is not forthcoming updating of HRH data bases becomes incomplete. Cooperation of both public and private health care managers specifically in providing up to date and accurate data is critical for success in comprehensive HRH planning events. The policy to establish strategies to combat HIV/AIDs at workplace has taken quite long to be implemented in the health sector. As a result the sector is losing significant numbers of personnel to HIV/AIDS every year. Assurance of quality and professional competence is a prerogative of Training. Limitations in reaching this policy aim derive from inconsistency in linking training to comprehensive training needs assessment, lack of costs analysis of training that influences negatively institutional funding and teaching facilities provision. The National Strategy for Growth and Poverty Reduction (NSGRP) makes provision for special remuneration package for “hardship posts” but this has not been translated into HRH management practice. The special package has to be defined and agreed upon, followed by implementation measures.
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CEDHA, MOH,WHO 2005 HRH Audit

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At almost every policy forum debating health matters (e.g. several Health Sector Reviews) the critical state of Human Resources for Health has been referred to but this was not followed by measures to pool resources for a more comprehensive response. As a result HRH financing has been fragmented driven by uncoordinated agendas. A costed national HRH plan should be utilized as a rallying point for mobilising and pooling resources for actualising implementation. This is essential for minimizing the discrepancy between policy intent and actual practice.

6.3 HRH Planning Strengths, weaknesses, opportunities and threats With regard to the strengths in the HRH planning, the HRH Development Policy is already in place enriched with the achievements gained in the five-year plan of 1996. Furthermore, there is HRH section which deals with human resource planning, a comprehensive HRH database system, a monitoring guideline and a comprehensive guideline for staffing levels in the health facilities. On the other hand, there exist a Public Service Management and Employment Policy of 1999 together with Public Service Act. No. 8 of 2002, which are important tools for planning. Advocacy initiatives on HRH in the entire regions and districts have already been carried out and regional and some District Health Secretaries have been trained on HRH information system. However, weaknesses in HRH planning do also exist where most of the health facilities are not fully staffed as per staffing levels guideline with hardly HRH succession and career development plan. The HRH planning component lacks a comprehensive HRH database at the regional and district levels, has inadequate skills in health economics and health planning at lower levels. At the district level, for example, there is inadequate capacity and resources for the preparation of Human Resource Planning (HRP) as well as lack of Human Resource (HR) qualification audit. The HRH planning component, however boasts of a number of opportunities including expansion of medical colleges intakes both in the public and the private sectors, a National Health Policy having a clearly stated HRH policy statement, the Health Sector Medium Term Strategic Plan 2003/2008 and the current ongoing Health Sector Reform advocacy throughout the country. Despite these opportunities, threats also exist. These include deviation of health personnel from the health profession to other better paying jobs with conducive working conditions, the impact of HIV/AIDS on HRH production and brain drain.

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6.4 The HRH Management Strengths, weaknesses, opportunities and threats. The situation analysis reveals that several strengths exist in the HRH management component. There are already in place clear organizational and management structure at all levels of the health institutions, a decentralized HRH management and a Client Service Charter. Currently, there is increased gender awareness among the health workers as a result of HRH gender advocacy, increased efficiency due to public private partnership where non-core services are being contracted out and recruitment undertakings based on merit. The introduction of a new appraisal system namely the Open Performance Review Appraisal System (OPRAS) and an improved HRH scheme of services have proved to be an added advantage. The HRH management component is threatened by a shrinking health workforce as a result of high attrition rate probably due to HIV/AIDS impact, multiple HRH management nodes and a liberalized labour market. However, a national advocacy on good governance and a Public Service Reform process going on in the country where services are being contracted out to improve efficiency and the introduction of OPRAS constitute opportunities for the betterment of HRH management. 6.5 The HRH Training and Development Strengths, weaknesses, opportunities and threats. According to the situation analysis carried out, the HRH training and development component can make use of several strengths discovered. There exist a reviewed curricular and other learning materials which have already been distributed, there is availability of computers in the health learning institutions and a capacity building is going on which involves various skills at a multi-level. Included in the strengths list are also availability of a number of tutors who have already undergone postgraduate studies and training opportunities, improved students selection procedures and advocacy for upgrading and Continuing Education (CE) to staff at all levels. Furthermore, there is availability of health training institutions (108) and guidelines for CE/CPD for main actors. Accreditation of health training institutions is also going on and graduate induction courses that prepare graduates to challenges of taking up new job positions have been introduced. The HRH training and development is however faced with several weaknesses because there are lack of comprehensive training needs assessment and cost analysis of training. There are also problems of under-funding of training institutions, inadequate teaching facilities and staff and inadequate selfmotivation towards continuing education and continuous professional development among health workers.

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The HRH training and development component is also confronted by limited sponsorship of trainees and scope of practice for core primary health care staff. There is also a notable inadequate organizational learning culture and exchange programmes to promote HRH performance while on the other hand there is lack of follow-up evaluation of HRH performance on completion of training. Misallocation and underutilization of qualified/well trained teaching staff and unavailability of some key competencies and skills in the health workforce are also notable. As regards to threats, there are cases of changing development partners’ priorities, development of partners fatigue, the changing of knowledge gap due to fast Information and Communication Technology (ICT) and false commitment that does not match with disbursement. However, the HRH training and development component can effectively make use of the existing opportunities such as availability of qualified applicants for health schools and willing sponsors. There is also a global and regional integration and collaboration on HRH agenda, districts have budgets for training, the emergence of HRH as a global agenda and the existence of accredited health training institutions. 6.6 HRH financing Strengths, weaknesses, opportunities and threats As of the current situation, HRH financing has a number of strengths. Cost sharing guidelines for health services and training institutions are in place and supervision of cost-sharing implementation in the Health Training Institutions (HTIs) is carried out. Furthermore, there is improved transparency in financial management and also HRH skills in budgeting and budgetary control (MTEF) through training and practice. In the light of all these strengths, the HRH financing has to brave existing weaknesses. Still there are under-funding of health services, delays in disbursement of funds and bureaucratic procurement procedures. On the other hand, the prevailing cost-sharing exemption policy is difficult to implement and cost-sharing levels are too low. There are also problems of short landing materials and poor quality of supplies, poor financial management and inadequate involvement of staff in planning and budgeting process at the district level. Included in the weaknesses are also weak government stewardship and utilization of the HRH financing, inability of the in-service candidates to pay costsharing fees, cumbersome instructions from center regarding financial expenditure, diminished transparency that cannot match with disbursements and disbursement delays. The HRH financing component is also threatened by dependency of the sector budget on external funding, shift of the government focus from time to time and frequent shift of governance issues at global, national and sub-national levels.

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However, the prevailing national economic growth, establishment of independent funds including Community Health Fund (CHF), National Health Insurance Fund (NHIF), user fees and Drug Revolving Fund are clear opportunities that can be of much benefit to the HRH financing. Others are the existing cost-sharing policy in the training institutions, the fact that the HRH is at the center piece of the Millenium Development Goals (MDGs) accomplishment and a global agenda, increased sources of health care financing options and improved budget allocation for the health sector. 6.7 HRH Research Strengths, Weaknesses, opportunities and threats The already known major causes of attrition, the conducted study on HRH capacity assessment, the conducted HRH survey of 2001/2002, the already created HRH database system and the development monitoring guideline and the known expected annual input of HRH into the system, constitute strengths of the HRH research. But inadequate research methodology skills among the health workers and students tracer studies are among the weaknesses of the component. Other weaknesses include inexistence of priorities for HRH research, under-funding of HRH research activities, limited use of internal researchers and lack of understanding of HRH problem regarding its magnitude, complexity and sensitivity. HRH research is also faced with the problems of weak HRH information, weak application and use of research results in decision-making and inadequate emphasis and initiatives on HRH issues. The HRH research component can be strengthened by using opportunities such as the existing research section under the Policy and Planning Department, research methodology training provided by HRD department and the prevailing independent institute dealing with medical research, the National Institute for Medical Research (NIMR). Other opportunities include the capacity of all medical schools and colleges to address HRH issues, availability of institutions and universities in the country and in the region that can be outsourced and increased regional cooperation through bodies such as EAC and SADC. The only threat of HRH research is under-funding. 6.8 HRH performance and quality assurance Strengths, weaknesses, opportunities and threats In the prevailing HRH performance and quality assurance, several available strengths can enhance the activities of the component including the own HRH capacity regardless of the existing gaps. The component also boasts of the already established Open Performance Appraisal System (OPRAS), improved provision of basic resources inputs and management of the process through

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public health reforms, improved physical working conditions, continued rehabilitation of health facilities and training institutions and the availability of working tools such as computers and office space. Despite such strengths, substandard HRH performance, eroded professional ethics and deteriorating nursing and medical ethics tend to weaken the proper functioning of HRH performance and quality assurance. There are also discrepancies between service quality specification and the actual service delivery, lack of incentives/rewards for the provided quality health care at all levels, post-training evaluation on performance and team work leading to withholding of information which act as a draw back. Other weaknesses in the component are poor quality of HRH supervision and management of health services and absence of a system of ensuring continuous professional competence. The component is also threatened by low staff remuneration, expanding private sector that sometimes does not conform to national regulation and standards, periodic HR depletion due to economic and managerial factors and unfriendly labour market in the health sector. However, with opportunities such as partnership between the Government, Voluntary Agencies (VAs), Faith Based Organizations (FBOs), Private Sector and Development Partners dealing with health issues, the component can benefit a lot. It can also make use of other opportunities including the HRH which is now becoming an important global agenda through the MDGs; extensive rehabilitation and renovation of hospitals and training institutions and availability of agreed National Vision 2025, National Poverty Eradication Strategy 2010, National Strategy for Growth and Reduction of Poverty 2005 and other strategies. PERFORMANCE OF THE HEALTH SERVICE DELIVERY Tanzania has developed six indicators for measuring Health status outcome which are IMR, MMR, Proportion of children under one year with severe malnutrition, Proportion of under-five children with severe malnutrition, Prevalence of HIV infection among antenatal clinic attendees. It also developed Health service delivery indicators which includes Total OPD attendance per capita, Proportion of births attended by skilled attendants, Proportion of children under-one year fully immunized, Malaria cases as percent of all under five cases presenting at OPD, Total government public allocation to health per capita, Total government & donor (budget and off-budget) allocation to health per capita, Proportion of public health facilities in a good state of repair and Percentage of public health facilities without any stock out of 4 tracer drugs and 1 vaccine

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Data indicating the performance of health service delivery achieved using above indicators: Health Status Outcomes: a) Trends in the decline of infant (99/1000) and under-five (158/1000) mortality, which had been steady between the mid-1950s and mid-1980s stagnated and are being reversed. About one quarter of all under-five deaths occur within the first month and two-thirds within the first year after birth. Tanzania is not on track to meet the 2015 targets of reducing under-five mortality by two thirds unless urgent actions are taken. About 90% of all child deaths are attributable to common and preventable illnesses such as malaria, pneumonia, diarrhoea, malnutrition, HIV/AIDS and complications of low-birth-weight. Eight out of ten children die at home and six of them without any contact with formal health services. b) Low birth weight is also a proxy indicator of maternal deprivation, thus perpetuating the inter-generational cycle of deprivation and malnutrition. The onset of malnutrition starts soon after birth, and peaks by 12-18 months of age. 44% under-five children are stunted (implying significant chronic malnutrition) and 30% under weight.. Micronutrient malnutrition is rampant among women, about 14% in the high land and nearly 80% in coastal areas are anaemic during pregnancy, and nearly 70% are vitamin A deficient. About 25% of maternal deaths are associated with anaemia. c) Over 2.0 million Tanzanians are HIV infected, and an estimated cumulative total of 722, 490 suffer from AIDS. Only 1 in 5 AIDS cases is reported. Young people aged 15-24 accounts for 60% of new HIV infections and girls aged 1519 has a six-fold risk of infection compared with boys of the same age. About 72,000 babies become infected annually through mother-to-child transmission of HIV (MTCT). • Health Service Delivery The proportion of women receiving antenatal care and delivering with skilled personnel varies considerably across income levels and urban/rural residence. The declining number of deliveries in the health facilities (60%1984, 44%-1991/92, 38%-1996, and 36%-1999) may be a reflection of the government policy on this area to train professional midwives at the community level. Tanzania has achieved high rates of coverage of antenatal care (90%), immunization (DPT3 87%-in 2001) and vitamin A supplementation (over 90%in 2002). 68% of the households use iodised salt. The contraceptive prevalence rate has doubled since 1991-92, from 10 to 22% of all women. Measles, which used to be a common cause of child death, has been effectively contained. Despite these impressive gains, the general health and nutritional status of the population of Tanzania remains poor.

• •

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6.9 HRH AND HIV/AIDS Declining Health workforce due to deaths related to HIV/AIDS is a serious problem in the Human Resource for Health Planning. A total of 300 deaths due to HIV/AIDS among the health workers since 2003 were reported in the HRH Audit Report for HIV/AIDS care and treatment in the country. The ratio of deaths was higher for female employees than male, number of death to female are higher than the male and the most leading cadres were medical attendants followed by clinical officers. Either there is increase in number of absenteeism due to sick leave or man lost hours to HIV/AIDS. There must be a strong initiative to educate health workers on the prevention of HIV/AIDS as well as provision of protective measures while at work see annex seven 6.10HRH AND PARTNERSHIP Inadequate HRH stakeholders commitment and coordination HRH stakeholders involve POPSM, PORALG, MOF, WHO, Voluntary Agencies, RAS, DED, Private Health Sector, Health Students Community and Professional Associations. 6.11DISTRIBUTION OF STAFF PER DISTRICT According to the HRH situational Analysis conducted by the MoH 2004, there is a poor balance and distribution of health workers at all levels. There is an extreme shortage of staff especially in the remote districts as compared to the most preferred districts. There is a violation of HRH policies due to the fact that unqualified staff filled the managerial and technical posts. HRH skill mix is not given priority in some facilities because there is misallocation of qualified staff and especially in the specialist cadres like psychiatric nurses, nurse tutors, nursing officers, paediatric nurses and AMO specialists. The study recommended that there should be a reallocation of staff at all levels as well as establishing retention mechanism for the health workers to be willing to work in the remote districts. (See Annex 2 & 3.) 6.12 NUMBER AND TYPE OF STAFF AVAILABLE The situational analysis carried out in 2004 by the MoH indicated that, 66% of the health facilities are suffering from the extreme shortage of staff (See Annex. 4) The shortage is due to the following reasons:a) Increase in burden of diseases due to HIV/AIDS b) Bureaucratic recruitment procedures c) Poor balance and distribution of health workers at al levels d) Lack of incentive package

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e) Inadequate job rotation and low preference to work in the remote districts because there are no special incentives for people working in these areas. f) Lack of priority on human resources issues by local government authoritites g) Poor management of human resources h) Poor working environment i) Lack of enough protective measures against HIV/AIDS j) Lack of retention mechanisms k) Increasing customers demands l) Skill mix is not given a priority 6.13 Training Capacity and Output Ministry of Health and Social Welfare offers sponsorship for training of Health workers inside and outside the country in various training and development programmes aimed at equipping health workers with skills necessary for provision of quality health services. The capacity of training institutions in various programme are not reached, Subsidized cost of training a student and the number of graduates for the past five years are shown in the Annexes 5 & 6 6.14 Current and Projected Resources Including Finance and Human Retrenchment policy in the public health services declined the workforce size from 67,000 in 1994 to 49,000 health workers in 2001. Annual increase in population ratio of Tanzania is 3%. Currently Tanzania belongs to the countries with the lowest health workers per population ratio in Africa and the world. The performance of HRHSW is also affected by the following factors:  Number of Health professionals dying with HIV/AIDS  Increase in absenteeism (lost hours) due to sick leave accelerated by HIV/AIDS  Current employment system is limited by employment policies  Increase in demand for health services by 20% due to HIV/AIDS According to the 1999 staffing level approximately 16,000 positions for qualified staff remains vacant to date. At the same time a number of qualified health workers are unemployed or work in private sector or business other than health.

7.0 CURRENT HRH CHALLENGES IN THE HEALTH SECTOR 7.1 HRHSW PLANNING

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• • • • • • •

HSRs and demand for capacity Staff mobility and implications (HRH attrition) Involvement of private sector in the provision of health care services HRHSW planning in the prevailing HIV/AIDS pandemic High HRHSW attrition Too many organs dealing with HRH issues Limited funding for HRH

7.2 HRHSW MANAGEMENT • Poor linkage between recruitment and competence profile • Low salaries, lack of incentives package and retention mechanisms • HRH performance against objectives/targets centrally • Outdated rules, regulations, circular and legal issues • Top management and political commitment to HRH issues • Brain circulation, brain decay and brain drain • Employer employee interpersonal relationship 7.3 HRHSW TRAINING AND DEVELOPMENT • Limited resources • Involvement of HRHSW stakeholders 7.4 HRHSW RESEARCH • Competing priorities within HRHSW Researches • Meeting customers expectations • Ended professional ethics • Capacity to assure quality of health care • Understaffing at various level 7.5 HRHSW FINANCING • Understanding of HRSW • Low Economic power • Cross under funding of the health services as a whole affects HRH performance • Low budget for personnel involvement and other HRHSW activities • Low remuneration for the HRHSW which is below minimum living standards, has negative effects on staff performance and retention 8.0 INSTITUTIONAL FRAMEWORK 8.1 Public Private partnership 8.2 Relationship with various stakeholders 8.3 Decentralization

22

9.0 FUTURE DEVELOPMENT AND HEALTH SERVICES 9.1 Assumption on future health and health care needs 9.2 Service target 9.3 Institutional Development 9.4 Private sector growth 9.5 Public sector growth 10.0FUTURE HRH REQUIREMENTS 10.1Type and number of staff required 10.2Staffing norms 10.3Skills mix 10.4Distribution of staff/Redistribution 10.5Performance and productivity changes 11.0FUTURE HRH SUPPLY 11.1Expected attrition rates 11.2Public private sector movement 11.3Production capacity requirement targets 11.4Total supply requirements

HUMAN RESOURCE POLICY REQUIREMENT (New and amendments) HRH planning should ensure • Planning based on a comprehensive HRH management information system drawing from regularly updated databases at all levels • Consideration to HRH skills mix, workload and service delivery needs • Ministry of Health will coordinate all matters related to HRH Planning • Availability of staff retention mechanisms to minimize attrition • Availability of career development and succession plan which ensure equity to all cadres • HRH practices in line with policies to avoid mismatch between actual practices and policies • Regional and District Health secretaries are HRH focal persons at the regional and district level for effective HRH planning, management, research, finance, training and development

Training and development will ensure

23

Quality and professional competence assurance

HRH Management should ensure • HRH deployment and recruitment linked with competency profile • Equity and gender balance in deployment • Regular reviews of service conditions and schemes of service • Staff retention measures including improving work environment, tools, equipment and supplies, provision of housing especially in rural areas are stated. However, special remuneration package for “hardship posts” referred to in the NSGRP needs clear elaboration in the HRH policy and strategic plan. • Performance appraisal system and staff motivation linked to productivity and transparent to ensure equity and staff satisfaction • Free permit on the deployment of Health workers to fully manned health facilities as per staffing level • Reallocation of available Health workers for proper utilization • Socialization of new and old health workers HRH financing should ensure • Emphasize on resource mobilization from various sources, • Coordination and disbursement resources in line with current financial reforms. • Pooled funding for HRH is not explicitly specified • HRH support from various stakeholders will be coordinated by MoHSW in line with national priorities. HRH research should ensure • Strengthening of local capacity, • Resources mobilization and focus on critical HRH issues are emphasized • HRH research to comply with national requirements. HRH Performance and quality Assurance should ensure • HRH is seen to be benchmarked against set standards conduciveness of working environment, technical audit and inspectorate to HRH and strengthening professional bodies and associations • Compliance to set standards of performance and quality.

24

HRH and Partnership should ensure • Availability of the forum for HRH stakeholders • Coordination among all HRH stakeholders

HRH and HIV/AIDS prevention strategies should ensure • • • Availability of effective Health education to health workers for HIV/AIDS prevention Availability of effective protective and safety measures against HIV/AIDS to health workers Solicit more funds for fighting against HIV/AIDS

12.0IDENTIFICATION AND ASSESSMENT OF KEY PRIORITY ISSUES • Emergency Hiring for the hard to work environment (District) • • • • • • • • • • • • • Staff retention mechanism Challenge of Human Resource Planning in the era of HIV/AIDS Linking performance with productivity Capacity building to institutions and Health workers Improved staff pay package and motivation Implementation of the HRH policy and plan HRH Research Quality training in the health training institutions Improved psychological contract between employee and employer Effective HRH information system at all levels Implementable staffing levels in the health sector Partnership among HRH stakeholders Improved health resources

25

• • •

Improved HRH Working environments, equipment and supplies HRH competency profile HRH Advocacy

26

13. STRATEGIC PLANNING TABLES
HRH POLICY GUIDELINE Key Result Area: Harmonize and implement effectively HRH policy guideline Policy forums by 2010 Specific objective Ensure Incentive package for hardship posts issues addressed in the HR for Health and Social Welfare policy by 2007 Ensure a mechanism to manage recruitment and deployment of staffs is established by 2007 Improve implementation of HRHSW policy by 2011 HRHSW policy implementation improved by 2011 Coordinating mechanism established by 2007 Functional Mechanism for coordination in place Percentage of the implementation of policy Government gazette A legal instrument outlining powers and mandate of the mechanism in place HRHSW policy implementation report Top level management are committed Funds are available Stakeholders are committed STRATEGIC OBJECTIVE 2: Enhance understanding of health workers, policy makers and the general public on legal Po – PSM approve the coordinating mechanism Target/Output Incentive package for hardship posts addressed in the HRH’SW policy by 2007 Indicators Policy statement for hardship posts • Means of verification • Policy document for HRH’SW Government circulars Assumptions/Risks • Equity distribution of health resources remain the government priority Strategic Objective 1: Harmonize HR for Health and social Welfare policy guideline, implement effectively and review at

27

implications of unethical and iatrogenic practices by 2010. Specific objective Target Ensure adherence to ethics Practices of medical in medical and nursing and nursing practice by 2011 documented and analysed in ethical and Establish public debates on state of medical and nursing practices by 2011 legal viewpoint by 2010 Debates on state of medical and nursing practices established by 2010 Increase in number of informed debates in public media and policy forums Increase in number devising viable options for restoring ethics Media publications or broadcasts minutes Indicators Compiled case studies illustrating legal and ethical problems Means of verification Consultant report Assumptions/Risks Legal governing bodies will be willing to provide information to be compiled into a compendium Commitment of associations to address the issue of

Associations proceedings / eroded ethics

28

HRH POLICY GUIDELINE Key Result Area: Harmonize and implement effectively HRH policy guideline Strategic Goal 1: Improve HRHSW Policy guideline to facilitate effective implementation by harmonizing and reviewing at policy forums

29

Specific objective Ensure Incentive package for hardship posts are incorporated in the HR for HSW policy by 2007

Time frame strategies Review HR for HSW policy to incorporate incentive package for hardship posts Activities 1. Conduct a survey to identify criteria for hardship posts 2. Conduct workshop to seek consensus for hardship incentives package 3. Incorporate incentive package for hardship posts into HRHSW policy
Responsible 2006/ 07 2007/ 08 2008/ 09 2009/ 10 2010/ 11

Source of Funds
MOH Comm unity Others

Ensure a mechanism to manage recruitment and deployment of staffs is established by 2007

Establish a coordinating 1. Review recruitment mechanism for different procedures to reduce cadres to deal with issues beauracracy pertaining to 2. Study a current decentralization/centralization transitional central of HR for Health and social recruitment and Welfare deployment system and propose transformation programme 3. Appoint a multi-sectoral monitoring mechanism with decentralized recruitment and deployment with powers to intervene when necessary 4. Assign the mechanism to develop its work plan and budget

30

Specific objective Ensure Incentive package for hardship posts are incorporated in the HR for HSW policy by 2007

Time frame strategies Review HR for HSW policy to incorporate incentive package for hardship posts Activities 1. Conduct a survey to identify criteria for hardship posts 2. Conduct workshop to seek consensus for hardship incentives package 3. Incorporate incentive package for hardship posts into HRHSW policy Conduct follow-up monitoring and evaluation to ensure timely submission of implementation report
Responsible 2006/ 07 2007/ 08 2008/ 09 2009/ 10 2010/ 11

Source of Funds
MOH Comm unity Others

Improve implementation of HRHSW policy by 2011

Distribute resources on time for policy implementation

STRATEGIC GOAL 2: Increase awareness and understandings of health and social welfare workers, policy makers, and the general public on legal implications of unethical and iatrogenic practices

31

Time frame Specific objective strategies Ensure adherence to Advocate adherence ethics in medical and to ethics and legal nursing practice by standards Activities 1. Update the current legal and ethical viewpoint for quality health services 2. Conduct advocacy meetings to all health professionals on legal aspects of health 3. Document adverse medical and nursing practices and analyse from legal and ethical viewpoints 1. Introduce ethical issues’ debate in medicine practices to the media 2. Design posters to create community awareness on ethical issues and their legal rights Conduct workshop to develop options to restore ethics in health sectors
Responsible
2006/ 07 2007/ 08 2008/ 09 2009/ 10 2010/ 11

Source of Funds
MOH Comm unity Others

2011

Establish

public Raising awareness and sensitivity of debates on state of leaders, community medical and nursing and health care providers on ethical practices by 2011 issues

Increase the number of options to restore ethics in health sectors

32

33

BUDGET Specific objective Ensure Incentive package for hardship posts are incorporated in the HR for HSW policy by 2007 strategies Review HR for HSW policy to incorporate incentive package for hardship posts Activities 1. Conduct a survey to identify criteria for hardship posts 2. Conduct workshop to seek consensus for hardship incentives package 3. Incorporate incentive package for hardship posts into HRHSW policy 1. Review recruitment procedures to reduce beauracracy 2. Study a current transitional central recruitment and deployment system and propose transformation programme 3. Appoint a multi-sectoral monitoring mechanism with decentralized recruitment and deployment with powers to intervene when necessary 4. Assign the mechanism to develop its work plan and budget 1. Conduct follow-up monitoring and evaluation to ensure timely submission of implementation report Total Activity Cost

Ensure a mechanism to manage Establish a coordinating mechanism recruitment and deployment of staffs for different cadres to deal with is established by 2007 issues pertaining to decentralization/centralization of HR for Health and social Welfare

Improve implementation of HRHSW policy by 2011

Distribute resources on time for policy implementation

34

Specific objective strategies Ensure adherence to ethics in Advocate adherence to ethics medical and nursing practice by and legal standards 2011

Activities 1. Update the current legal and ethical viewpoint for quality health services 2. Conduct advocacy meetings to all health professionals on legal aspects of health 3. Document adverse medical and nursing practices and analyse from legal and ethical viewpoints Establish public debates on state Raising awareness and sensitivity 1. Introduce ethical issues’ debate in of leaders, community and health medicine practices to the media of medical and nursing practices care providers on ethical issues 2. Design posters to create community by 2011 awareness on ethical issues and their legal rights Increase the number of options to 1. Conduct workshop to develop options to restore ethics in health sectors restore ethics in health sectors

Total Activity Cost

HR FOR HEALTH AND SOCIAL WELFARE PLANNING

35

Key Result Area: Improved Planning Capacity for Health and Social Welfare Strategic Objective: Strengthen planning capacity for the HR at all levels by 2011 Specific objective Target Indicators Means of verification Enhance knowledge and skill Knowledge and Skills Number of trained • Training reports of health and social welfare enhanced to all HR for planners • staffs database planning team on Health and Social Welfare comprehensive HR planning planning team by 2010 by year 2010 Fill vacant posts from 46% to 30% of vacant post filled by vacant post filled Human resource data 76% by 2010 2010 base

Assumptions/Risks • Funds are available • All stakeholders involved and committed • • • Sufficient supply of qualified job seekers Funds are available Willingness to work in hardship area Funds are available All stakeholders are involved and willing to cooperate of qualified HRH

Improve HRH’SW database HRH’SW database improved Functional • HRH’SW database at the district and regional at district and regional level HRH’SW database • Reports level by 2008 by 2008 at district and regional levels Develop and finance a rapid Plan for rapid hiring and Costed list of needs Rapid hiring and hiring, redeployment plan for deployment developed and by needy districts redeployment plan critical cadres by 2010 financed by 2010 Vacant posts for critical cadres filled Establish criteria of hardship Criteria of hardship Criteria of hardship Study report on criteria environment for staff of environment for staff of areas for hardship areas for MoH’SW by 2008 MoH’SW established by MoH’SW staff 2008 Establish retention mechanism for HRHSW by 2011 Monitor applicability of staff levels Retention mechanism is established for HRHSW by 2011 Applicability of staffing level monitoring conducted Mechanism in place Number of districts visited Reports • HR Database updated

• •

Availability market • •

Funds are available Top management priority on HRH • All stakeholders are involved Funds are available Top management are committed • Availability of funds

Key Result Area: Improve Planning Capacity for Health and Social Welfare

36

Strategic Goal:

Develop and support gender sensitive planning capacity of MOHSW staff to produce comprehensive health training, employing, and improving database system

37

Specific Objectives Enhance knowledge and skill of HSW planning team on comprehensive HR planning by 2010

Strategies

Activity

Respon sible

Time Frame
2006 /07 2007 /08 2008/0 9 2009/1 0 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

Train MOHSW planning team to enhance knowledge and skill on planning

1. Identify sources of funds 2. Conduct stakeholders meeting to solicit funds on HR planning 3. Conduct training 1. Identify ands solicit exchange programme partners 2. Identify priority areas of exchange programme 3. Facilitate HR planning study tours and attachments 1. Identify sources of funds 2. Conduct stakeholders meeting to Solicit funds 3. Recruit new staffs 1. Review existing curricula inline with service needs 2. Increase training output by ensuring

Ensure regular HR planning exchange programme for cross fertilization of experience and ideas

Fill vacant posts in health facilities and training institutions from 46% to 76% by 2010

Mobilizing funds

Train existing staff

38

Specific Objectives Enhance knowledge and skill of HSW planning team on comprehensive HR planning by 2010

Strategies

Activity

Respon sible

Time Frame
2006 /07 2007 /08 2008/0 9 2009/1 0 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

Train MOHSW planning team to enhance knowledge and skill on planning

1. Identify sources of funds 2. Conduct stakeholders meeting to solicit funds on HR planning 3. Conduct training 1. Identify ands solicit exchange programme partners 2. Identify priority areas of exchange programme 3. Facilitate HR planning study tours and attachments 1. Train the staffs on the use of HRH database 2. Develop a system to ensure that knowledge of trainers is regularly updated inline with service needs 3. Establish and maintain accurate and up-to-date HRHSW database at

Ensure regular HR planning exchange programme for cross fertilization of experience and ideas

Improve HRH’SW database at the district and regional level by 2008

Strengthen HRHSW system at all levels for effective planning and decision making

39

Specific Objectives Enhance knowledge and skill of HSW planning team on comprehensive HR planning by 2010

Strategies

Activity

Respon sible

Time Frame
2006 /07 2007 /08 2008/0 9 2009/1 0 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

Train MOHSW planning team to enhance knowledge and skill on planning

1. Identify sources of funds 2. Conduct stakeholders meeting to solicit funds on HR planning 3. Conduct training 1. Identify ands solicit exchange programme partners 2. Identify priority areas of exchange programme 3. Facilitate HR planning study tours and attachments 1. Identify sources of funds 2. Conduct stakeholders meeting to Solicit funds 3. Recruit staff through emergency hiring programme

Ensure regular HR planning exchange programme for cross fertilization of experience and ideas

Develop and finance a rapid hiring, redeployment plan for critical cadres by 2008

Mobilizing funds for emergency hiring

40

Specific Objectives Enhance knowledge and skill of HSW planning team on comprehensive HR planning by 2010

Strategies

Activity

Respon sible

Time Frame
2006 /07 2007 /08 2008/0 9 2009/1 0 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

Train MOHSW planning team to enhance knowledge and skill on planning

1. Identify sources of funds 2. Conduct stakeholders meeting to solicit funds on HR planning 3. Conduct training 1. Identify ands solicit exchange programme partners 2. Identify priority areas of exchange programme 3. Facilitate HR planning study tours and attachments 1. Develop indicators for identification of hardship environment 2. Conduct a study to identify hardship areas 3. Identify priority cadres to retain 4. Develop affordable incentive package for hardship posts 5. Incorporate incentive DHR/D AP/DP P

Ensure regular HR planning exchange programme for cross fertilization of experience and ideas

Establish incentive package for hardship environment for staff of MoH’SW by 2008

1. Develop mechanism for selecting hardship environment

DAP/D HR

41

Specific Objectives Enhance knowledge and skill of HSW planning team on comprehensive HR planning by 2010

Strategies

Activity

Respon sible

Time Frame
2006 /07 2007 /08 2008/0 9 2009/1 0 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

Train MOHSW planning team to enhance knowledge and skill on planning

1. Identify sources of funds 2. Conduct stakeholders meeting to solicit funds on HR planning 3. Conduct training 1. Identify ands solicit exchange programme partners 2. Identify priority areas of exchange programme 3. Facilitate HR planning study tours and attachments 1. Initiate incentive package and other remunerations in hardship area 2. Solicit funds for retention mechanism 1. Conduct study to monitor applicability of staffing level DAP x x x x x x v

Ensure regular HR planning exchange programme for cross fertilization of experience and ideas

Establish retention mechanism for HRHSW by 2011 Monitor applicability of staff levels

Developing retention mechanism for HRHSW in hardship areas to assure availability of staff in the hardship areas Ensuring that all vacant post in MoH/SW are filled by the right cadres, right skill mix at the right

DHR

x

x

x

x

x

x

42

Specific Objectives Enhance knowledge and skill of HSW planning team on comprehensive HR planning by 2010

Strategies

Activity

Respon sible

Time Frame
2006 /07 2007 /08 2008/0 9 2009/1 0 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

Train MOHSW planning team to enhance knowledge and skill on planning

1. Identify sources of funds 2. Conduct stakeholders meeting to solicit funds on HR planning 3. Conduct training 1. Identify ands solicit exchange programme partners 2. Identify priority areas of exchange programme 3. Facilitate HR planning study tours and attachments

Ensure regular HR planning exchange programme for cross fertilization of experience and ideas

health facility to facilitate quality services BUDGET

43

Specific Objectives Enhance knowledge and skill of HSW planning team on comprehensive HR planning by 2010

Strategies Train MOHSW planning team to enhance knowledge and skill on planning Ensure regular HR planning exchange programme for cross fertilization of experience and ideas

Activity 1. Identify sources of funds 2. Conduct stakeholders meeting to solicit funds on HR planning 3. conduct training 1. Identify ands solicit exchange programme partners 2. Identify priority areas of exchange programme 3. Facilitate HR planning study tours and attachments 1. Identify sources of funds 2. Conduct stakeholders meeting to Solicit funds 3. Recruit new staffs 1. Review existing curricula inline with service needs 2. Increase training output by ensuring that the knowledge of trainers regularly updated inline with service needs 3. Improving the quality and cost effectiveness of in-service training

Total Activity Cost

Fill vacant posts in health facilities and training institutions from 46% to 76% by 2010

Mobilizing funds

Train existing staff

44

Specific Objectives Enhance knowledge and skill of HSW planning team on comprehensive HR planning by 2010

Strategies Train MOHSW planning team to enhance knowledge and skill on planning

Activity 1. Identify sources of funds 2. Conduct stakeholders meeting to solicit funds on HR planning 3. conduct training 1. Train the staffs on the use of HRH database 2. Develop a system to ensure that knowledge of trainers is regularly updated inline with service needs 3. Establish and maintain accurate and up-todate HRHSW database at the all levels 4. Establish/coordinate the HRH database which cover the entire sector 5. Carrying out regular analysis of the staffing data 6. procure necessary equipments for sustaining HRHSW database at all levels 1. Identify sources of funds 2. Conduct stakeholders meeting to Solicit funds 3. Recruit staff through emergency hiring programme

Total Activity Cost

Improve HRH’SW database at the Strengthen HRHSW system at all district and regional level by 2008 levels for effective planning and decision making

Develop and finance a rapid hiring, redeployment plan for critical cadres by 2008

Mobilizing funds for emergency hiring

45

Specific Objectives Enhance knowledge and skill of HSW planning team on comprehensive HR planning by 2010 Establish incentive package for hardship environment for staff of MoH’SW by 2008

Strategies Train MOHSW planning team to enhance knowledge and skill on planning Develop mechanism for selecting hardship environment

Activity 1. Identify sources of funds 2. Conduct stakeholders meeting to solicit funds on HR planning 3. conduct training 1. Develop indicators for identification of hardship environment 2. Conduct a study to identify hardship areas 3. Identify priority cadres to retain 4. Develop affordable incentive package for hardship posts 5. Incorporate incentive packages into HRH budget 6. Disseminate circular for incentive package for hardship posts 7. Monitor impact of attraction and retention package 1. Initiate incentive package and other remunerations in hardship area 2. Solicit funds for retention mechanism 1. Conduct study to monitor applicability of staffing level

Total Activity Cost

Establish retention mechanism for HRHSW by 2011

Developing retention mechanism for HRHSW in hardship areas to assure availability of staff in the hardship areas Ensuring that all vacant post in MoH/SW are filled by the right cadres, right skill mix at the right health facility to facilitate quality services

Monitor applicability of staff levels

46

Specific Objectives Enhance knowledge and skill of HSW planning team on comprehensive HR planning by 2010 Establish career and succession planning system in the health sector

Strategies Train MOHSW planning team to enhance knowledge and skill on planning Develop career and succession plans

Activity 1. Identify sources of funds 2. Conduct stakeholders meeting to solicit funds on HR planning 3. conduct training 1.Solicit finds 2.conduct situational analysis 3 Develop career development plan for all health cadres 4 Develop succession plan for all key management posts at all levels

Total Activity Cost

Key result Areas: Appropriate and adequate management of HR for Health and Social Welfare Strategic Objective: Improve working environment, incentives and fair distribution of health staff by 2011

47

Specific Objectives Review job list and job descriptions of all staff of the MoH’SW by 2007 Review scheme of service for health staff by 2007 Establish criteria of hardship environment for staff of MoH’SW by 2008

Target Job list and Job descriptions of all health staff reviewed by 2007 Scheme of service for staff of MoH’SW reviewed by 2007 Criteria of hardship environment for staff of MoH’SW established by 2008 Incentives for hardship areas introduced by 2011

Indicators Updated job list and job descriptions for health staff Updated scheme of service for health staff Criteria of hardship areas

Means of verification Report on review of job list and job descriptions for HR for Health and social welfare Report on review of scheme of service for health staff Study report on criteria for hardship areas for MoH’SW staff Government Circulars

Assumption/Risks • • Funds are available All staff are involved

• • • • • • • • • •

Funds are available All staff are involved Funds are available Top management priority on HRH All stakeholders are involved Funds are available Top management priority on HRH Political will Funds are available All stakeholders involved Funds are available All stakeholders involved

Introduce HRH’SW hardship incentives in difficult areas by 2011 Establish strategies to enhance productivity of HRHSW by 2011 Increase/Strengthen private sector participation in rendering health and social welfare services by 2010 Increase support to HRHSW staff by 30% of the current

Incentives packages for hardship areas implemented A number of strategies to enhance productivity for HRHSW Number of private sector effectively participating in rendering health and social welfare services % increase of support to HRHSW

Strategies to enhance productivity established

Report on established strategies Workshops and seminars reports

Private sector participation in rendering health and social welfare services by 2010 Support to HRHSW support increased by 2011

• •

Performance reports

• •

Funds are available Technical expert are

48

Specific Objectives support by 2011

Target staff

Indicators

Means of verification

Assumption/Risks Willing and capable to support Staff are ready to receive support from technical experts Funds are available Top level managers are interested and committed

• Improve working conditions for HRHSW by 50% of the current situation by 2011 Working condition for HRHSW improved by 50% by 2011 % improve of working condition for HRHSW • • • Strengthen management capacity of the MoH’SW institutions by 2010 Management capacity of MoH’SW institutions improved • Renovation reports Rehabilitation reports Procurement reports • •

49

Key Result Area: Strategic Goal: Specific Objectives Improve gender sensitive job list and job descriptions of all staff of the health and social welfare sector by 2007

Improve performance of health staff for quality care Increase MoHSW staff’s motivation and flexibility to work in all areas in the country by improving incentives and working environment Activity
Respon sible

Strategies

Time Frame
2006/ 07 2007 /08 2008/ 09 2009/ 10 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

Review job list and job description for all cadres in line with HSR requirements

1. Select task force for reviewing job list and job description 2. Conduct 4 meetings to review job list and job description 3. Seek approval from top level management 1. Select task force for reviewing scheme of service 2. Conduct 4 meetings to review scheme of service 3. Seek approval from top level management

DAP

Improve scheme of service for health staff by 2007

Review scheme of service for all cadres in line with the HSR requirements

DAP

50

Specific Objectives Improve gender sensitive job list and job descriptions of all staff of the health and social welfare sector by 2007

Strategies

Activity

Respon sible

Time Frame
2006/ 07 2007 /08 2008/ 09 2009/ 10 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

Review job list and job description for all cadres in line with HSR requirements

1. Select task force for reviewing job list and job description 2. Conduct 4 meetings to review job list and job description 3. Seek approval from top level management 8. Develop indicators for identification of hardship environment 9. Conduct a study to identify hardship areas 10. Identify priority cadres to retain 11. Develop affordable incentive package for hardship posts 12. Incorporate incentive packages into HRH budget 13. Disseminate circular for incentive

DAP

Establish incentive package for hardship environment for staff of MoH’SW by 2008

Develop mechanism for selecting hardship environment

DHR/D AP/DPP

DAP/D HR

51

Specific Objectives Improve gender sensitive job list and job descriptions of all staff of the health and social welfare sector by 2007

Strategies

Activity

Respon sible

Time Frame
2006/ 07 2007 /08 2008/ 09 2009/ 10 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

Review job list and job description for all cadres in line with HSR requirements

1. Select task force for reviewing job list and job description 2. Conduct 4 meetings to review job list and job description 3. Seek approval from top level management 1. Conduct a study to identify factors contributing to HRHSW attrition 2. Dissemination of the study report to all stakeholders

DAP

Identify factors contributing to HR for Health and Social Welfare attrition and measures for improvement by 2009

Identify factors contributing to HRHSW attrition

DHR

52

Specific Objectives Improve gender sensitive job list and job descriptions of all staff of the health and social welfare sector by 2007

Strategies

Activity

Respon sible

Time Frame
2006/ 07 2007 /08 2008/ 09 2009/ 10 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

Review job list and job description for all cadres in line with HSR requirements

1. Select task force for reviewing job list and job description 2. Conduct 4 meetings to review job list and job DAP description 3. Seek approval from top level management 1. Conduct stakeholders workshop to discuss study findings and propose measures for addressing factors contributing to attrition 2. Write strategies to DAP address factors contributing to attrition • Select and enhance DAP task force to review performance appraisal tools

Establish strategies to address factors contributing to HR for Health and Social Welfare attrition

Improve performance of the HRHSW staff by 2011

Review mechanism for performance appraisal for quality care

53

Specific Objectives Improve gender sensitive job list and job descriptions of all staff of the health and social welfare sector by 2007

Strategies

Activity

Respon sible

Time Frame
2006/ 07 2007 /08 2008/ 09 2009/ 10 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

Review job list and job description for all cadres in line with HSR requirements

1. Select task force for reviewing job list and job description 2. Conduct 4 meetings to review job list and job description 3. Seek approval from top level management 1. Conduct induction course to HRHSW graduates to orient them organisation objectives, job description, performance standards, and supportive supervision 2. Monitor and evaluate performance and take appropriate actions

DAP

Train new recruited staffs to orient them with the working environment

54

Specific Objectives Improve gender sensitive job list and job descriptions of all staff of the health and social welfare sector by 2007

Strategies

Activity

Respon sible

Time Frame
2006/ 07 2007 /08 2008/ 09 2009/ 10 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

Review job list and job description for all cadres in line with HSR requirements

1. Select task force for reviewing job list and job description 2. Conduct 4 meetings to review job list and job DAP description 3. Seek approval from top level management 1. Develop a proposal to solicit funds from the public and DAP stakeholders for training and recruitment 2. Conduct stakeholders workshop to discuss on funds mobilization for recruitment 1. Review recruitment policies and procedures to reduce bureaucracy on filling new vacant

Ensure 30% increase of MoH’SW qualified personnel by 2011

Mobilize funds for training, recruitment and advancement

Recruit new HSW staff for the existing vacant posts

55

Specific Objectives Improve gender sensitive job list and job descriptions of all staff of the health and social welfare sector by 2007

Strategies

Activity

Respon sible

Time Frame
2006/ 07 2007 /08 2008/ 09 2009/ 10 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

Review job list and job description for all cadres in line with HSR requirements

1. Select task force for reviewing job list and job description 2. Conduct 4 meetings to review job list and job description 3. Seek approval from top level management 1. Conduct training needs assessment 2. Solicit funds for training 3. Train with inappropriate qualifications to fit to their positions 1. Select and train TOT on advocacy and sensitization 2. Conduct advocacy and sensitization meetings

DAP

Train MOHSW staffs to have appropriate qualifications

Improve HRHSW advocacy & sensitization initiatives to Policy & Decision makers by 2009

Carry out HRHSW advocacy & sensitization to Policy & Decision makers

DHR

56

Specific Objectives Improve gender sensitive job list and job descriptions of all staff of the health and social welfare sector by 2007

Strategies

Activity

Respon sible

Time Frame
2006/ 07 2007 /08 2008/ 09 2009/ 10 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

Review job list and job description for all cadres in line with HSR requirements

1. Select task force for reviewing job list and job description 2. Conduct 4 meetings to review job list and job description 3. Seek approval from top level management 1. Review current system to identify weaknesses 2. Train Registry assistant on the modern records management 3. Conduct effective supervision to all registry assistant 4. Purchase enough and modern working tools for registry 5. Upgrade registry assistants to Form Four 6. Computerizing records management

DAP

Improve MoH records management by 2011

Review effective records management system in the MoHSW for improvement

DAP

57

Specific Objectives Improve gender sensitive job list and job descriptions of all staff of the health and social welfare sector by 2007

Strategies

Activity

Respon sible

Time Frame
2006/ 07 2007 /08 2008/ 09 2009/ 10 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

Review job list and job description for all cadres in line with HSR requirements

1. Select task force for reviewing job list and job description 2. Conduct 4 meetings to review job list and job description 3. Seek approval from top level management 1. Conduct a study to identify motivating factors 2. Introduce affordable motivation and incentive scheme 3. Orient management on motivation and incentive packages

DAP

Enhance productivity of HRHSW by 2011

Develop motivation and incentive package

DAP/D HR

58

Specific Objectives Improve gender sensitive job list and job descriptions of all staff of the health and social welfare sector by 2007

Strategies

Activity

Respon sible

Time Frame
2006/ 07 2007 /08 2008/ 09 2009/ 10 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

Review job list and job description for all cadres in line with HSR requirements

1. Select task force for reviewing job list and job description 2. Conduct 4 meetings to review job list and job description 3. Seek approval from top level management 1. Identify areas for privatization 2. Select mechanism for contracting out 3. Set standards for services to be contracted out 4. Develop contracts 5. Contract out the agreed services Monitor and evaluate the implementation

DAP

Increase/Strengthe n private sector participation in rendering health and social welfare services by 2010

Design mechanism for Health and Social Welfare services privatization

DAP

59

Specific Objectives Improve gender sensitive job list and job descriptions of all staff of the health and social welfare sector by 2007

Strategies

Activity

Respon sible

Time Frame
2006/ 07 2007 /08 2008/ 09 2009/ 10 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

Review job list and job description for all cadres in line with HSR requirements

1. Select task force for reviewing job list and job description 2. Conduct 4 meetings to review job list and job description 3. Seek approval from top level management 1. Monitor applicability of staffing levels annually 2. Reallocate excessive staff at all levels

DAP

Improve distribution of HRHSW at all levels by 2011

Ensure equitable distribution of HRHSW at all levels

DHR/D AP

60

Specific Objectives Improve gender sensitive job list and job descriptions of all staff of the health and social welfare sector by 2007

Strategies

Activity

Respon sible

Time Frame
2006/ 07 2007 /08 2008/ 09 2009/ 10 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

Review job list and job description for all cadres in line with HSR requirements

1. Select task force for reviewing job list and job description 2. Conduct 4 meetings to review job list and job description 3. Seek approval from top level management 1. Solicit funds for improving working conditions 2. Install Information Technology at all levels of health care 3. Conduct a survey to establish needs for improving working environment 4. Procure materials and equipments according to needs 5. Rehabilitate, renovate, and construct buildings 6. Provide refreshments for HRHSW staff 7. Provide transport

DAP

Improve working conditions for HRHSW by 50% of the current situation by 2011

Design mechanism for improving working conditions

DAP/D HR

61

Specific Objectives Improve gender sensitive job list and job descriptions of all staff of the health and social welfare sector by 2007

Strategies

Activity

Respon sible

Time Frame
2006/ 07 2007 /08 2008/ 09 2009/ 10 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

Review job list and job description for all cadres in line with HSR requirements

1. Select task force for reviewing job list and job description 2. Conduct 4 meetings to review job list and job description 3. Seek approval from top level management 1. Conduct management training to middle and top level managers

DAP

Strengthen management capacity of the MoHSW institutions by 2010

Train MOHSW staff on management skills

DHR

62

BUDGET Specific Objectives Improve job list and job descriptions of all staff of the MoH’SW by 2007 Strategies Activity Total Activity Cost

Reviewing job list and job description for all cadres in line with HSR requirements

Improve scheme of service for health staff by 2007

Reviewing scheme of service to all cadres in line with the HSR requirements

Establish criteria of hardship environment for staff of MoH’SW by 2008

• • • •

Develop mechanism for selecting hardship environment Improving ways of attracting and retaining staff particular in the hard to work environment Review recruitment procedures Reviewing registration procedures

Select task force for reviewing job list and job description • Conduct 4 meetings to review job list and job description • Seek approval for top level management from all stakeholders • Select task force for reviewing scheme of service • Conduct 4 meetings to review scheme of service • Seek approval for top level management from all stakeholders Conduct simple study to identify hard to work environment Identify priority cadre to retain Develop affordable incentive package for hard

• •

63

Specific Objectives

Strategies

Activity to work environment • • • • Improve HRH budget Monitor impact of attraction and retention package Review recruitment procedure Review registration procedure • Budget for hardship incentive • Pay hardship incentive to responsible staff • Develop proposal for the study • Data collection • Data analysis and interpretation • Report writing • Dissemination of the study report Write invitation letters to stakeholders Conduct meeting with stakeholders Write strategies to address

Total Activity Cost

• • Establish factors contributing to HR for Health and Social Welfare attrition by 2009 •

Distributing hardship incentive circular Incorporating hardship incentives into budget

Conduct studies on the factors contributing to HRHSW attrition

Develop strategies to address factors contributing to HR for Health and Social Welfare attrition by 2008

Getting proposals from stakeholders

• • •

64

Specific Objectives

Strategies

Activity factors contributing to attrition Present draft to MoH SW management team Write strategies to address factors contributing to attrition & submitting to PS MoHSW Conduct induction course to HRHSW graduates Develop clear objectives and ensure availability of up to date job description Develop performance standards Ensure effective supportive supervision to all cadres Monitor and evaluate performance and take appropriate actions Identify OPRAS facilitators Conduct training to all staff Visit work places to follow up use of OPRAS Solicit funds Long course training Short course training Review recruitment procedures

Total Activity Cost

• •

Improve performance of the HRHSW staff by 2011

• •

Design mechanism for performance appraisal Improving staff performance by providing them enough skills and working tools

• • • • •

Ensure OPRAS is used effectively to all staff of MoHSW by 2009 Ensure 30% increase of MoH’SW qualified personnel by 2011

Creating awareness on OPRAS to all staff

• • • • • • •

• •

Increasing MoHSW qualified staff by 30% of the current situation Increase personnel emolument budget

65

Specific Objectives

Strategies

Activity • • • • Replacement Conduct sensitization meetings Carry out advocacy Conduct various training related to HRHSW issues • • Obtain list of all Health Secretaries Conduct induction course to all Health Secretaries

Total Activity Cost

Advocacy and sensitization on issues pertaining to HRHSW, policy and decision makers by 2009

Carrying out advocacy & sensitization on HRHSW Policy & Decision makers

Introduce induction courses to all health secretaries by 2011

Organize Induction course to all Health secretaries

Improve MoH records management by 2011

• • • • •

Design effective records management system in the MoHSW Computerizing records management Changing Index system Reviewing employees data Increase budget for MoHSW registry

• • • • •

Review current system to identify weaknesses Train Registry assistant on the modern records management Conduct effective supervision to all registry assistant Purchase enough and modern working tools for registry Upgrade registry assistants to Form Four Identify types of motivation

Enhance productivity of HRHSW

Develop motivation and incentive package

66

Specific Objectives by 2011

Strategies

Activity • • Train management on motivation and incentive packages Introduce affordable motivation and incentive scheme • • • • • • Identify areas for privatization Select mechanism for contracting out Set standards for services to be contracted out Develop contracts Contract out the agreed services Monitor and evaluate the implementation Monitor applicability of staffing levels annually Reallocate/retrench excessive staff at all levels Develop mechanism for improving working conditions Repair of offices

Total Activity Cost

Increase/Strengthen private sector participation in rendering health and social welfare services by 2010

Design mechanism for Health and Social Welfare services privatization

Improve distribution of HRHSW at all levels

Ensure equitable distribution of HRHSW at all levels

• • • •

Improve working conditions for HRHSW by 50% of the current situation by 2011

• •

Design mechanism for improving working conditions Improve budget for working conditions

67

Specific Objectives

Strategies

Activity • Purchase of office equipment i.e. computers, printers, photocopier machine tables, chairs, file cabinets. • Provide refreshments for HRHSW staff • Provide transport • Provide House especially those in hard working environment Capacity building to HRHSW staff Conduct management training to HRHSW Strengthen pre-service training

Total Activity Cost

Strengthen management capacity of the MoHSW institutions by 2010

Enhancing management capability of health and social welfare institutions

• • •

Total Cost

68

EDUCATION/TRAINING AND SKILLS DEVELOPMENT Key Result Area: Develop and improve Human Resource capacity in the MOH and Social Welfare Strategic Objective: Strengthen HR for Health and Social Welfare at all level by 2011 Specific Objectives Harmonize and rationalize capacity building with policy intentions by 2011 Increase capacity building funding by 30 % of the current budget by 2011 Target Capacity building harmonized and rationalized with policy intentions by 2011 Capacity building funding increased by 30% of the current budget by 2011 Indicators Number of capacity building activities Means of verification Report on harmonization and rationalization of capacity buildings and policy intention • • Budget document Funding agreements documents in place Assumption/Risks • • • • • • Funds are available Support from the top level managers All stakeholders involved Funds are available Support from the top level managers All stakeholders are interested Gender balance remain a government priority Support of the top levels managers Funds are available Stakeholders are willing to support Funds are available

• •

% increase of capacity building funding Number of agreement signed for sponsoring capacity building

Promote gender balance for HRHSW staff at all levels by 20% of the current situation by 2011 Increase training opportunities by 20% for HRHSW staff by 2011 Improve capacity of

20% decreased of gender gaps by 2011

Number of gander gaps decreased at different levels Number of training opportunities Numbers training

• • • •

Training reports Sensitization reports Employment data Training reports

• • • • •

20% increase of training for HRHSW staff opportunities by 2011 Capacity of training

Improvement reports

69

Specific Objectives MoHSW training institutions by 2011 Improve capacity alternative medicines providers by 2011

Target institutions improved by 2011

Indicators institutions improved

Means of verification • Institutions database

Assumption/Risks • • • • • Support from stakeholders Political will Funds are available alternative medicine providers are willing Support from top level management Funds are available All stakeholders are involved Political will Funds are available Capacity building initiatives are available Target groups are available Funds are available Capacity building initiatives are available Target groups are available

Capacity of alternative medicine providers improved by 2011

Number of alternative medicine providers reached

Capacity building reports

Promote community participation on preventable health problems by 2011 Ensure Monitoring HRHSW performance capacity building initiatives at all cadres to 90% by 2010 Ensure evaluation of HRHSW performance capacity building initiatives at cadres to 90% by 2010

Increased community participation on preventable health problems by 2011

Reduced number of reported cases from preventable health problems Number of monitored capacity building initiatives

Outpatient cases reports

• • •

90% of capacity building initiates at all cadres monitored by 2010

Monitoring reports

• • •

90% of capacity building initiates at all cadres evaluated by 2010

Number of evaluated capacity building initiatives

Evaluation reports

• • •

70

Key Result Area: Develop and improve Human Resource capacity in the MOH and Social Welfare Strategic Goal: Strengthen HR for Health and Social Welfare to commensurate with demands through increasing training opportunities, supporting alternative medicine providers in capacity building, and ensure monitoring and evaluation of capacity building initiatives for all cadres. Specific Objectives 1. Harmonize and Rationalize Capacity Building with policy intentions by 2010 Strategies Activity Responsi ble MOH, H Time Frame
2006/ 07 2007/ 08 2008/ 09 2009/ 10 20010/ 11 20011/ 12 MoH LG

Sources of Funds
Commu nity Others

Monitoring and evaluate policy from time to time to ensure HR capacity objectives have been implemented

2.Increase the current capacity building funding for HRH and SW Budget by 30% by 2010

Mobilize resources for HRH and SW Capacity Building Strengthen skills in budgeting and budgetary control

Create a team for monitoring and evaluation Provide monitoring and evaluation team with the necessary resource to facilitate the process Conduct stakeholders consultations meeting to harmonize policy measures on capacity building Identify and solicit funds from various stakeholders Conduct consultative meeting to discuss and agree on funding mechanisms Train health Secretaries and Administrators on effective budgeting and funds accounting

v

v

v

v

v

v

71

Specific Objectives 3. Promote gender balance for HRHSW staff at all levels by 20% of the current situation

Strategies

Activity

Respons ible

Time Frame
2006/ 07 2007/ 08 2008/ 09 2009/ 10 20010/ 11 20011/ 12 MoH LG

Sources of Funds
Commu nity Others

Mainstreamin g gender in HRHSW capacity building initiatives

4. Increase training opportunitie s for HRHSW staff by 20% by 2011.

1.Establish prioritized and comprehensiv e training and skills development needs 2.Mobilize funds for training

1. Conduct gender awareness seminars for policy and decision makers at all levels 2. Review guidelines and other working documents of HRHW to incorporate gender concerns 3. Review curricula to Incorporate gender perspectives in at all levels 1. Conduct training needs assessment 2. Develop training program 3. Solicit training opportunities from both external and internal 4. Develop proposal to solicit funds for training

x

x

x

x

X

x

x

x

x

x

72

Specific Objectives 3. Promote gender balance for HRHSW staff at all levels by 20% of the current situation

Strategies

Activity

Respons ible

Time Frame
2006/ 07 2007/ 08 2008/ 09 2009/ 10 20010/ 11 20011/ 12 MoH LG

Sources of Funds
Commu nity Others

Mainstreamin g gender in HRHSW capacity building initiatives

5. Enhance rapid upgrading of phased out cadres through Distance Education by 2010

Design a programme to carter for out phased cadres in MOHSW

1. Conduct gender awareness seminars for policy and decision makers at all levels 2. Review guidelines and other working documents of HRHW to incorporate gender concerns 3. Review curricula to Incorporate gender perspectives in at all levels 1. Conduct advocacy regarding self development to phased out cadres 2. Design modality for supporting phased out cadres 3. Redesign health and training institutions to accommodate phased out cadres 4. Enrolment of CA, MCHA and “Enrolled Nurses foe Distance

x

x

x

x

X

DHR

x

x

x

x

x

v

73

Specific Objectives 3. Promote gender balance for HRHSW staff at all levels by 20% of the current situation

Strategies

Activity

Respons ible

Time Frame
2006/ 07 2007/ 08 2008/ 09 2009/ 10 20010/ 11 20011/ 12 MoH LG

Sources of Funds
Commu nity Others

Mainstreamin g gender in HRHSW capacity building initiatives

6. Improve capacity of HSW training institutions by 2011

1. Strengthen Health training institutions for quality training

1. Conduct gender awareness seminars for policy and decision makers at all levels 2. Review guidelines and other working documents of HRHW to incorporate gender concerns 3. Review curricula to Incorporate gender perspectives in at all levels 1. Conduct cost analysis of rehabilitating and renovating existing institutions 2. Build new or rehabilitate infrastructurure 3. Coordinate training offered at different levels 4. Create awareness of Administrative Officers on cost effective analysis in capacity building

x

x

x

x

X

MOHS W

x

x

x

x

x

74

Specific Objectives 3. Promote gender balance for HRHSW staff at all levels by 20% of the current situation

Strategies

Activity

Respons ible

Time Frame
2006/ 07 2007/ 08 2008/ 09 2009/ 10 20010/ 11 20011/ 12 MoH LG

Sources of Funds
Commu nity Others

Mainstreamin g gender in HRHSW capacity building initiatives

7. Improve capacity of alternative medicines providers b y 2011

Mobilize and supervise alternative medicine providers to practice safely and appropriately

1. Conduct gender awareness seminars for policy and decision makers at all levels 2. Review guidelines and other working documents of HRHW to incorporate gender concerns 3. Review curricula to Incorporate gender perspectives in at all levels 1. Identify alternative medicine providers for registration and supervision 2. Orient alternative medicine providers on safety measures 3. Conduct quarterly follow up inspection

x

x

x

x

X

DMO

x

x

x

x

x

75

Specific Objectives 3. Promote gender balance for HRHSW staff at all levels by 20% of the current situation

Strategies

Activity

Respons ible

Time Frame
2006/ 07 2007/ 08 2008/ 09 2009/ 10 20010/ 11 20011/ 12 MoH LG

Sources of Funds
Commu nity Others

Mainstreamin g gender in HRHSW capacity building initiatives

8. Ensure monitoring of HRHSW performanc e capacity building initiatives at all levels by 2010

Develop mechanisms to monitor capacity building initiatives and incorporate in operational plan

1. Conduct gender awareness seminars for policy and decision makers at all levels 2. Review guidelines and other working documents of HRHW to incorporate gender concerns 3. Review curricula to Incorporate gender perspectives in at all levels 1. Develop tools for monitoring performance capacity building initiatives 2. Monitor performance after training to establish the impact of capacity building initiatives 3. Conduct tracer studies for curricula review

x

x

x

x

X

76

Specific Objectives 3. Promote gender balance for HRHSW staff at all levels by 20% of the current situation

Strategies

Activity

Respons ible

Time Frame
2006/ 07 2007/ 08 2008/ 09 2009/ 10 20010/ 11 20011/ 12 MoH LG

Sources of Funds
Commu nity Others

Mainstreamin g gender in HRHSW capacity building initiatives

9. Ensure evaluation of HRHSW performanc e capacity building initiatives for all cadres to 90% by 2001

1. Develop mechanisms to monitor capacity building initiatives and incorporate in operational plan

1. Conduct gender awareness seminars for policy and decision makers at all levels 2. Review guidelines and other working documents of HRHW to incorporate gender concerns 3. Review curricula to Incorporate gender perspectives in at all levels 1. Develop tools for monitoring performance capacity building initiatives 2. Monitor performance after training to establish the impact of capacity building initiatives 3. Conduct tracer studies for curricula review

x

x

x

x

X

77

BUDGET SPECIFIC OBJECTIVES 1. Harmonize and Rationalize Capacity Building with policy intentions by 2010 STRATEGIES Monitoring and evaluate policy from time to time to ensure HR capacity objectives have been implemented ACTIVITY Create a team for monitoring and evaluation Provide monitoring and evaluation team with the necessary resource to facilitate the process Conduct stakeholders consultations meeting to harmonize policy measures on capacity building Identify and solicit funds from various stakeholders Conduct consultative meeting to discuss and agree on funding mechanisms Train health Secretaries and Administrators on effective budgeting and funds accounting Conduct gender awareness seminars for policy and decision makers at all levels Review guidelines and other working documents of HRHW to incorporate gender concerns Review curricula to Incorporate gender perspectives in at all levels TOTAL ACTIVITY COST

2.Increase the current capacity building funding for HRH and SW Budget by 30% by 2010

Mobilize resources for HRH and SW Capacity Building

Strengthen skills in budgeting and budgetary control 3. Promote gender balance for HRHSW staff at all levels by 20% of the current situation Mainstreaming gender in HRHSW capacity building initiatives

78

SPECIFIC OBJECTIVES 1. Harmonize and Rationalize Capacity Building with policy intentions by 2010

STRATEGIES Monitoring and evaluate policy from time to time to ensure HR capacity objectives have been implemented

ACTIVITY Create a team for monitoring and evaluation Provide monitoring and evaluation team with the necessary resource to facilitate the process Conduct stakeholders consultations meeting to harmonize policy measures on capacity building Conduct training needs assessment Develop training program Solicit training opportunities from both external and internal

TOTAL ACTIVITY COST

4. Increase training opportunities for HRHSW staff by 20% by 2011.

Establish prioritized and comprehensive training and skills development needs

Mobilize funds for training 5. Enhance rapid upgrading of phased out cadres through Distance Education by 2010 Design a programme to carter for out phased cadres in MOHSW

Develop proposal to solicit funds for training 4. Conduct advocacy regarding self development to phased out cadres 5. Design modality for supporting phased out cadres 6. Redesign health and training institutions to accommodate phased out cadres 7. Enrolment of CA, MCHA and “Enrolled Nurses foe Distance Education upgrading

79

SPECIFIC OBJECTIVES 1. Harmonize and Rationalize Capacity Building with policy intentions by 2010

STRATEGIES Monitoring and evaluate policy from time to time to ensure HR capacity objectives have been implemented

ACTIVITY Create a team for monitoring and evaluation Provide monitoring and evaluation team with the necessary resource to facilitate the process Conduct stakeholders consultations meeting to harmonize policy measures on capacity building programme”

TOTAL ACTIVITY COST

80

SPECIFIC OBJECTIVES 1. Harmonize and Rationalize Capacity Building with policy intentions by 2010

STRATEGIES Monitoring and evaluate policy from time to time to ensure HR capacity objectives have been implemented

ACTIVITY Create a team for monitoring and evaluation Provide monitoring and evaluation team with the necessary resource to facilitate the process Conduct stakeholders consultations meeting to harmonize policy measures on capacity building Conduct cost analysis of rehabilitating and renovating existing institutions Build new or rehabilitate infrastructurure Coordinate training offered at different levels Create awareness of Administrative Officers on cost effective analysis in capacity building Outsource service basing to outcomes of cost effectiveness analysis Create a Governing Boards for monitoring quality control in infrastructure and process of capacity building Identify services to be outsourced and establish outsourcing

TOTAL ACTIVITY COST

6. Improve capacity of HSW training institutions by 2011

1. Strengthen Health training institutions for quality training

81

SPECIFIC OBJECTIVES 1. Harmonize and Rationalize Capacity Building with policy intentions by 2010

STRATEGIES Monitoring and evaluate policy from time to time to ensure HR capacity objectives have been implemented

ACTIVITY Create a team for monitoring and evaluation Provide monitoring and evaluation team with the necessary resource to facilitate the process Conduct stakeholders consultations meeting to harmonize policy measures on capacity building Identify alternative medicine providers for registration and supervision Orient alternative medicine providers on safety measures Conduct quarterly follow up inspection Develop tools for monitoring performance capacity building initiatives Monitor performance after training to establish the impact of capacity building initiatives Conduct tracer studies for curricula review

TOTAL ACTIVITY COST

7. Improve capacity of alternative medicines providers b y 2011

Mobilize and supervise alternative medicine providers to practice safely and appropriately

8. Ensure monitoring of HRHSW performance capacity building initiatives at all levels by 2010

Develop mechanisms to monitor capacity building initiatives and incorporate in operational plan

82

SPECIFIC OBJECTIVES 1. Harmonize and Rationalize Capacity Building with policy intentions by 2010

STRATEGIES Monitoring and evaluate policy from time to time to ensure HR capacity objectives have been implemented

ACTIVITY Create a team for monitoring and evaluation Provide monitoring and evaluation team with the necessary resource to facilitate the process Conduct stakeholders consultations meeting to harmonize policy measures on capacity building Develop tools for monitoring performance capacity building initiatives Monitor performance after training to establish the impact of capacity building initiatives Conduct tracer studies for curricula review

TOTAL ACTIVITY COST

9. Ensure evaluation of HRHSW performance capacity building initiatives for all cadres to 90% by 2001

1. Develop mechanisms to monitor capacity building initiatives and incorporate in operational plan

83

Key Result Area: Enhanced Resource mobilization, financial management and accountability Strategic Objective: To reduce financial gap in the health sector and ensure equity in allocation of resources Specific Objectives 1. To establish and enhance mechanism for mobilization of funds from Government, donors and community by 2011 2. Pooled financing of HRH comprehensive plan established 3. To develop a comprehensive HR planning and budgeting for the health sector by 2011 Target Mobilization of alternative financing mechanism established and enhanced Indicators Number of alternative financing options identified Amount of funds raised from alternative financing options Number of district/regions institutions established alternative financing mechanisms Means of verification Progress report from facilities Financial reports Progress report from facilities Progress report from facilities Assumption/Risks Cooperation between MOH, PORALG and MOF Cooperation between MOH, PORALG and MOF Cooperation between MOH, PORALG and MOF

Resource envelope for HRH clearly MTEF and Annual budget outlined in updated HSSP and sector PER budget Number of employers of district, regions and facilities with a developed HR plan and budget P. E budget allocation to employers in line with agreed resource allocation formula or criteria Audit reports Progress report Cooperation between MOH, PORALG and MOF Cooperation between MOH, PORALG and MOF

HR planning and budgeting process strengthened Fairness in HR budget allocation in terms of equity ensured 4. To strengthen HR Management

HR budget allocation to MOH, regions and districts

Public expenditure report

Cooperation between

84

Specific Objectives Target financial management, accountability, procurement and disbursement procedures by 2011 5. Enhance public private HR partnership in provision of health services by 2011 6. Increase recruitment fund by 25% of the current allocation by 2010 and accountability of Government, donors and community funds strengthened Cooperation between Public and Private providers enhanced current allocation of recruitment fund increased by 25% at the end 2010 Indicators

Means of verification

Assumption/Risks MOH, PORALG and MOF

Number of regions, districts and training institutions with public private cooperation in service delivery Decreased shortage of health staff in the health sector

Region/district report

Sound policy between Government and Private partnership

Approved budget on personnel emolument

85

Key Result Area: Strategic Goal:

Improve performance of health staff for quality care Increase MoHSW staff’s motivation and flexibility to work in all areas in the country by improving incentives and working environment

86

Sn

Specific Objectives

Strategies

Activity

Respon sible
MOH/MO F

Time Frame
2006/ 07 2007/ 08 2008/ 09 2009/ 10 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

1.

Streamline and harmonize the existing financing mechanism

Comprehensive HR funding Strengthen implementation of cost sharing scheme

2.

To strengthen HR Planning and budgeting process

Guidelines for comprehensive health planning, budgeting and reporting

Hold consultative meeting between Government and Development partners Develop/review cost sharing guideline including exemption scheme Conduct a study on cost analysis to determine cost sharing scheme Prepare budget for comprehensive HR plans and budgets Facilitate development of HR district health plans Establish an equitable HR allocation formula

X

MOH (DHS/ DHR) MOH (DHR)

X X

MOH (DHR) MOH (DHR)

X X X X X

MOH (DHR)

X

87

Sn

Specific Objectives

Strategies

Activity

Respon sible
MOH/MO F

Time Frame
2006/ 07 2007/ 08 2008/ 09 2009/ 10 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

1.

Streamline and harmonize the existing financing mechanism

Comprehensive HR funding Strengthen implementation of cost sharing scheme

Hold consultative meeting between Government and Development partners Develop/review cost sharing guideline including exemption scheme Conduct a study on cost analysis to determine cost sharing scheme

X

MOH (DHS/ DHR) MOH (DHR)

X X

3.

To strengthen financial management and accountability

4.

Enhance public private partnership in provision of health services

Management of Govt funds, cost sharing, user fees, CHF and Health insurance scheme etc strengthened Participation of the private sector in provision of health services

Conduct situational analysis to identify and hold consultations with potential strategic investors

88

HRH RESEARCH Key Results Area: Improve research capacity of Human Resource for Health and Social Welfare

Strategic Objective: Enhance research capacity of HRHSW, dissemination and utilization of research results by 2011 Specific Objective Develop research capacity for HRHSW by 2011 Target Research capacity for HRHSW developed by 2011 Indicator Increase number of HRHSW staff with research skills • • • Means of Verification Training reports Certificates Research reports • • Assumption/Risks Funds are available Staff are willing to participate Funds are available All stakeholders are willing to participate

Strengthen effective Effective coordination of Increase number coordination of HRHSW Research coordinating mechanism HRHSW Research strengthened by 2010 in the MoHSW by 2011

of Report on developed • coordination mechanism •

89

Increase by 50% researches conducted by HRHSW experts by 2009

50 % of research conducted by HRHSW experts by 2009

Increase number of research conducted by HRHSW experts

Research report

• • •

Funds are available Support from the top level managers HRHSW experts are willing and capable

Strategic Goal:

Improve research capacity of MoHSW staff to undertake local researches related to health and social welfare issues for evidence based decisions and planning

90

Specific Objectives

Strategies

Activity

Respon sible DHR

Time Frame
2006/ 07 2007/ 08 2008/ 09 2009/ 10 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

1.Improve research capacity for HRHSW by 2011

Improve the quality of HRHSW research training

Mobilize funds for developing HRHSW research capacity Conduct meeting to develop optimum HRHSW Research staffing structures Conduct workshop to revise the existing HRHSW Research curricula in line with research needs Recruit new staff for HRHSW researches Conduct training to Update skills and knowledge of HRHSW researchers annually Improve research tools

DHR & DPP

DHR & DPP

DHR DHR

√ √

√ √

DHR & DPP

91

Specific Objectives

Strategies

Activity

Respon sible DHR

Time Frame
2006/ 07 2007/ 08 2008/ 09 2009/ 10 2010/ 11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

1.Improve research capacity for HRHSW by 2011

Improve the quality of HRHSW research training

Mobilize funds for developing HRHSW research capacity Conduct meeting to develop optimum HRHSW Research staffing structures Conduct workshop to revise the existing HRHSW Research curricula in line with research needs Recruit new staff for HRHSW researches Conduct training to Update skills and knowledge of HRHSW researchers annually Improve research tools

DHR & DPP

DHR & DPP

DHR DHR

√ √

√ √

DHR & DPP

92

BUDGET Specific Objective 1.Develop research capacity for HRHSW by 2011 Strategies Improve the quality of HRHSW research training Activity Mobilize funds for developing HRHSW research capacity Conduct meeting to develop optimum HRHSW Research staffing structures Conduct workshop to revise the existing HRHSW Research curricula in line with research needs Recruit new staff for HRHSW researches Conduct training to Update skills and knowledge of HRHSW researchers annually Improve research tools Develop evaluation and monitoring of HRHSW Research system Total Activity Cost 12,000,000 5,000,000 50,000,000 32,000,000 15,000,000 5,000,000 50,000,000

93

Specific Objective 2.Strengthen effective coordination of HRHSW Research in the MoHSW by 2011

Strategies

Activity

Total Activity Cost 15,000,000 35,000,000 15,000,000 50,000,000 12,000,000 15,000,000 10,000,000 35,000,000 375,000,000

Ensuring HRHSW Conduct meeting to Identify key HRHSW Research is Research Stakeholders coordinated Conduct workshop with HRHSW stakeholders to Set legal framework for HRHSW researches Conduct meeting with HRHSW stakeholders to provide directives and guidelines on HRHSW researches Monitoring and evaluation of researches adherence to directives, rules and guidelines provided Improve HRHSW Recruit a HRHSW database Administrator researches Procure and install equipments for HRHSW Research Database Create HRHSW Research database Provide training on HRHSW database application Up date HRHSW Research database monthly

94

Specific Objective 3.Increase by 50% researches conducted by HRHSW experts by 2009

Strategies Improve HRHSW researches

Activity Identify key HRHSW areas requiring research Identify personnel with appropriate skill mix for HRHSW research Mobilize funds for conducting researches Develop research tools Conduct research on HRHSW critical issues Prepare research reports Conduct meeting to identify the key stakeholders of the research reports Circulate research results Conduct meetings to promote uses of HRHSW research results Monitor the applicability of HRHSW Research results

Total Activity Cost 8,000,000 5,000,000 15,000,000 5,000,000 25,000,000 5,000,000 10,000,000 5,000,000 15,000,000 20,000,000 844,000,000

Promote Decision making using Research results (Evidence based decision making)

Total Cost HRH PERFORMANCE AND QUALITY ASSURANCE Key Result Area: Improved performance for quality services Strategic Objectives: Improve staff performance and quality assurance for health services and social welfare by 2011 Specific Objectives 1. Improve MOHSW staff knowledge and skills at all levels by 2009 2. Improve performance assessment by 2009 Target MOHSW staff knowledge and skills improved by 2009 Performance assessment tools Indicators Number of staff trained Means of verification Training reports Assumption • • • •

Funds available All staff are involved Funds available All staff involved

Number of updated performance tools

Reports of updated performance

95

Specific Objectives 3. Strengthen quality assurance system in all health facilities and training institutions by 2010 4. Establish schools boards in all health and social welfare training institutions by 2011

Target improved by 2008 Quality assurance systems in all health facilities and training institutions strengthened by 2010 School boards in all health training institutions established by 2011

Indicators Number of effectively operating quality assurance systems

Means of verification assessment tools Survey reports

Assumption • •

Funds are available All stakeholders involved Funds are available All stakeholders involved Support from top level managers Legal agreement Funds are available All stakeholders involved Support form top level managers Funds are available All stakeholders involved Political will Support from the top managers

Number of boards in health and social welfare training institutions

School boards establishment reports

• • • •

5. Strengthen health professional bodies and associations to enhance ethics and code of conduct by 2007

Health professional bodies and associations strengthened by 2007

Number of effectively operating professional bodies and associations

• • •

Review reports Training reports Workshop reports

• • •

6. Improve and operationalize all Public Health Ordinances by 2010

All Public Health Ordinances updated and operationalised by 2010

Number of public Health Ordinances updated and operationalized

• •

Review reports Advocacy and sensitization reports

• • • •

96

Specific Objectives

Target

Indicators

Means of verification

Assumption • • • • Funds are available All stakeholders involved Political will Support from the top managers CHMTs are willing to receive support RHMTs are willing and capable to provide support Funds availability Political will

7. Strengthen relationships between RHMTs and CHMTs for quality services by 2008

Relationships between RHMTs and CHMTs strengthened by 2008

Number effective supervision and meetings

• • •

Supervision reports Minutes HMIS book 2

• •

8. Provide conducive environment to enhance quality services

Improve working environment for staff at all levels

• •

Strengthen resource centres by providing them with equipment, supplies by 2005 9. Establish quality assurance in selection, involvement and training of pre-service

Resources centres strengthened Quality assurance ensured in pre-service training

Number of facilities rehabilitated Number of staff house constructed Number of resources centres strengthened

Reports

• •

Availability of equipment supplies Certificate enrolled trainees Performance Records of graduates at different level

Funds will be available Fund availability

Certificates of enrolled trainees result of matriculation examination conducted

• •

97

Specific Objectives

Target

Indicators

Means of verification • Question bank Inspection and supervision reports

Assumption

10. Conduct Technical Audit to health welfare institutions as part of inspection at supervision by 2008

Health welfare institution supervised and inspected by technical audit boards

Improved performance in Health and SW institution

98

Key Result Area: Improve performance for quality services
Strategic Goal: Improve staff performance and quality assurance for provision of quality health and social services by developing strategies to address factors contributing to poor staff performance.

99

Specific Objectives

Strategies

Activites

Responsi ble DHR/CMO

Time Frame
2006 /07 x 2007 /08 x 2008/ 09 x 2009 /10 x 2010 /11 x 20011/ 12

Sources of Funds
MoH Comm unity v Others

1. Improve Quality Assurance knowledge and skills for MOHSW staff at all levels by 2009

Increase inservice training developmen t and improve knowledge and skills of HRH&SW

1. Conduct training needs assessment to identify performance gaps in all Health & Social welfare staff 2. Develop training programme to address factors contributing to poor performance 3. Train health facilities management teams and training institutions on quality assurance, Infection prevention, control and Injection Safety, 4. Orient tutors,

100

Specific Objectives

Strategies

Activites

Responsi ble DHR/CMO

Time Frame
2006 /07 x 2007 /08 x 2008/ 09 x 2009 /10 x 2010 /11 x 20011/ 12

Sources of Funds
MoH Comm unity v Others

1. Improve Quality Assurance knowledge and skills for MOHSW staff at all levels by 2009

Increase inservice training developmen t and improve knowledge and skills of HRH&SW

1. Conduct training needs assessment to identify performance gaps in all Health & Social welfare staff 2. Develop training programme to address factors contributing to poor performance 3. Train health facilities management teams and training institutions on quality assurance, Infection prevention, control and Injection Safety, 4. Orient tutors,

101

102

103

Specific Objectives

Strategies

Activity

Respons ible

Time Frame
20 06/ 07 2007 /08 2008 /09 2009/ 10 2010 /11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

3. Strengthen Quality Assurance System in Health facilities and training institutions by 2011

Improve quality assurance system to facilitate performance improvement

1. Conduct Quality DHR/CM Assurance O Survey in health facilities training institutions and social welfare centres to establish baseline data and identify gaps 2. Conduct stakeholders workshop to contribute to the improvement and adjustment of quality assurance system 3. Establish Quality improvement committees in facilities and institutions to implement quality assurance 4. Train health facilities and

x

x

x

x

x

v

v

104

Specific Objectives

Strategies

Activity

Respons ible

Time Frame
20 06/ 07 2007 /08 2008 /09 2009/ 10 2010 /11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

3. Strengthen Quality Assurance System in Health facilities and training institutions by 2011

Improve quality assurance system to facilitate performance improvement

1. Conduct Quality DHR/CM Assurance O Survey in health facilities training institutions and social welfare centres to establish baseline data and identify gaps 2. Conduct stakeholders workshop to contribute to the improvement and adjustment of quality assurance system 3. Establish Quality improvement committees in facilities and institutions to implement quality assurance 4. Train health facilities and

x

x

x

x

x

v

v

105

Specific Objectives

Strategies

Activity

Respons ible

Time Frame
20 06/ 07 2007 /08 2008 /09 2009/ 10 2010 /11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

3. Strengthen Quality Assurance System in Health facilities and training institutions by 2011

Improve quality assurance system to facilitate performance improvement

1. Conduct Quality DHR/CM Assurance O Survey in health facilities training institutions and social welfare centres to establish baseline data and identify gaps 2. Conduct stakeholders workshop to contribute to the improvement and adjustment of quality assurance system 3. Establish Quality improvement committees in facilities and institutions to implement quality assurance 4. Train health facilities and

x

x

x

x

x

v

v

106

Specific Objectives

Strategies

Activity

Respons ible

Time Frame
20 06/ 07 2007 /08 2008 /09 2009/ 10 2010 /11 2011/ 12 MoH

Sources of Funds
LG Comm unity Others

3. Strengthen Quality Assurance System in Health facilities and training institutions by 2011

Improve quality assurance system to facilitate performance improvement

1. Conduct Quality DHR/CM Assurance O Survey in health facilities training institutions and social welfare centres to establish baseline data and identify gaps 2. Conduct stakeholders workshop to contribute to the improvement and adjustment of quality assurance system 3. Establish Quality improvement committees in facilities and institutions to implement quality assurance 4. Train health facilities and

x

x

x

x

x

v

v

107

108

8. Strengthen Resources centre by providing them with equipment supplies by 2011

Enhance availability of quality learning materials and equipments to the resource centres

9. Establish quality assurance in selection, enrolment and training of preservice and inservice by 2011

Establish quality assurance mechanism in pre-service and in-service training to ensure competent products to render quality services

1. Train a target group on the management of resource centre 2. Update essential health learning materials 3. Procure quality and updated equipment - Books - Posters - Modules (Training) - Computers - Printers - Heavy duty photocopie rs - LCD projectors (power point projectors) 1. Review selection criteria and adhere 2. Conduct and record continuing assessment on the performance 3. Develop question bank and data base. 4. Review Institutional quality assurance indicators and supervision guide 1. Review

DHR

x

x

x

x

x

v

v

DHR

x

x

x

x

x

v

109
CMO x x x x x v

10. Conduct

Strengthen

110

BUDGET

111

Specific Objectives 1.Improve Quality Assurance knowledge and skills for MOHSW staff at all levels by 2009

Strategies Increase in-service training development and improve knowledge and skills of HRH&SW

Activites 1. Conduct training needs assessment to identify performance gaps in all Health & Social welfare staff 2. Develop training programme to address factors contributing to poor performance 3. Train health facilities management teams and training institutions on quality assurance, Infection prevention, control and Injection Safety, 4. Orient tutors, CHMTs and RHMTs teams on supportive supervision 5. Develop teaching and learning materials for in-service training 1. Conduct writers workshop to develop HIV module, Leadership and management module, Quality improvement, Research in Health, HMIS/IDSR 2. Produce and distribute learning materials 6. Review curricula of Allied Health Training Institutions to incorporate concepts of quality assurance 1. Identify ands solicit exchange

Total Activity Cost

Ensure regular quality assurance

112

Specific Objectives 1.Improve Quality Assurance knowledge and skills for MOHSW staff at all levels by 2009

Strategies Increase in-service training development and improve knowledge and skills of HRH&SW

Activites 1. Conduct training needs assessment to identify performance gaps in all Health & Social welfare staff 2. Develop training programme to address factors contributing to poor performance 3. Train health facilities management teams and training institutions on quality assurance, Infection prevention, control and Injection Safety, 4. Orient tutors, CHMTs and RHMTs teams on supportive supervision 5. Develop teaching and learning materials for in-service training 1. Conduct writers workshop to develop HIV module, Leadership and management module, Quality improvement, Research in Health, HMIS/IDSR 2. Produce and distribute learning materials 6. Review curricula of Allied Health Training Institutions to incorporate concepts of quality assurance

Total Activity Cost

113

Specific Objectives 1.Improve Quality Assurance knowledge and skills for MOHSW staff at all levels by 2009

Strategies Increase in-service training development and improve knowledge and skills of HRH&SW

Activites 1. Conduct training needs assessment to identify performance gaps in all Health & Social welfare staff 2. Develop training programme to address factors contributing to poor performance 3. Train health facilities management teams and training institutions on quality assurance, Infection prevention, control and Injection Safety, 4. Orient tutors, CHMTs and RHMTs teams on supportive supervision 5. Develop teaching and learning materials for in-service training 1. Conduct writers workshop to develop HIV module, Leadership and management module, Quality improvement, Research in Health, HMIS/IDSR 2. Produce and distribute learning materials 6. Review curricula of Allied Health Training Institutions to incorporate concepts of quality assurance

Total Activity Cost

114

Specific Objectives 1.Improve Quality Assurance knowledge and skills for MOHSW staff at all levels by 2009

Strategies Increase in-service training development and improve knowledge and skills of HRH&SW

Activites 1. Conduct training needs assessment to identify performance gaps in all Health & Social welfare staff 2. Develop training programme to address factors contributing to poor performance 3. Train health facilities management teams and training institutions on quality assurance, Infection prevention, control and Injection Safety, 4. Orient tutors, CHMTs and RHMTs teams on supportive supervision 5. Develop teaching and learning materials for in-service training 1. Conduct writers workshop to develop HIV module, Leadership and management module, Quality improvement, Research in Health, HMIS/IDSR 2. Produce and distribute learning materials 6. Review curricula of Allied Health Training Institutions to incorporate concepts of quality assurance

Total Activity Cost

115

Specific Objectives 1.Improve Quality Assurance knowledge and skills for MOHSW staff at all levels by 2009

Strategies Increase in-service training development and improve knowledge and skills of HRH&SW

Activites 1. Conduct training needs assessment to identify performance gaps in all Health & Social welfare staff 2. Develop training programme to address factors contributing to poor performance 3. Train health facilities management teams and training institutions on quality assurance, Infection prevention, control and Injection Safety, 4. Orient tutors, CHMTs and RHMTs teams on supportive supervision 5. Develop teaching and learning materials for in-service training 1. Conduct writers workshop to develop HIV module, Leadership and management module, Quality improvement, Research in Health, HMIS/IDSR 2. Produce and distribute learning materials 6. Review curricula of Allied Health Training Institutions to incorporate concepts of quality assurance

Total Activity Cost

116

Specific Objectives 1.Improve Quality Assurance knowledge and skills for MOHSW staff at all levels by 2009

Strategies Increase in-service training development and improve knowledge and skills of HRH&SW

Activites 1. Conduct training needs assessment to identify performance gaps in all Health & Social welfare staff 2. Develop training programme to address factors contributing to poor performance 3. Train health facilities management teams and training institutions on quality assurance, Infection prevention, control and Injection Safety, 4. Orient tutors, CHMTs and RHMTs teams on supportive supervision 5. Develop teaching and learning materials for in-service training 1. Conduct writers workshop to develop HIV module, Leadership and management module, Quality improvement, Research in Health, HMIS/IDSR 2. Produce and distribute learning materials 6. Review curricula of Allied Health Training Institutions to incorporate concepts of quality assurance

Total Activity Cost

117

Specific Objectives 1.Improve Quality Assurance knowledge and skills for MOHSW staff at all levels by 2009

Strategies Increase in-service training development and improve knowledge and skills of HRH&SW

Activites 1. Conduct training needs assessment to identify performance gaps in all Health & Social welfare staff 2. Develop training programme to address factors contributing to poor performance 3. Train health facilities management teams and training institutions on quality assurance, Infection prevention, control and Injection Safety, 4. Orient tutors, CHMTs and RHMTs teams on supportive supervision 5. Develop teaching and learning materials for in-service training 1. Conduct writers workshop to develop HIV module, Leadership and management module, Quality improvement, Research in Health, HMIS/IDSR 2. Produce and distribute learning materials 6. Review curricula of Allied Health Training Institutions to incorporate concepts of quality assurance

Total Activity Cost

118

Specific Objectives 1.Improve Quality Assurance knowledge and skills for MOHSW staff at all levels by 2009

Strategies Increase in-service training development and improve knowledge and skills of HRH&SW

Activites 1. Conduct training needs assessment to identify performance gaps in all Health & Social welfare staff 2. Develop training programme to address factors contributing to poor performance 3. Train health facilities management teams and training institutions on quality assurance, Infection prevention, control and Injection Safety, 4. Orient tutors, CHMTs and RHMTs teams on supportive supervision 5. Develop teaching and learning materials for in-service training 1. Conduct writers workshop to develop HIV module, Leadership and management module, Quality improvement, Research in Health, HMIS/IDSR 2. Produce and distribute learning materials 6. Review curricula of Allied Health Training Institutions to incorporate concepts of quality assurance

Total Activity Cost

119

Specific Objectives 1.Improve Quality Assurance knowledge and skills for MOHSW staff at all levels by 2009

Strategies Increase in-service training development and improve knowledge and skills of HRH&SW

Activites 1. Conduct training needs assessment to identify performance gaps in all Health & Social welfare staff 2. Develop training programme to address factors contributing to poor performance 3. Train health facilities management teams and training institutions on quality assurance, Infection prevention, control and Injection Safety, 4. Orient tutors, CHMTs and RHMTs teams on supportive supervision 5. Develop teaching and learning materials for in-service training 1. Conduct writers workshop to develop HIV module, Leadership and management module, Quality improvement, Research in Health, HMIS/IDSR 2. Produce and distribute learning materials 6. Review curricula of Allied Health Training Institutions to incorporate concepts of quality assurance

Total Activity Cost

120

Specific Objectives 1.Improve Quality Assurance knowledge and skills for MOHSW staff at all levels by 2009

Strategies Increase in-service training development and improve knowledge and skills of HRH&SW

Activites 1. Conduct training needs assessment to identify performance gaps in all Health & Social welfare staff 2. Develop training programme to address factors contributing to poor performance 3. Train health facilities management teams and training institutions on quality assurance, Infection prevention, control and Injection Safety, 4. Orient tutors, CHMTs and RHMTs teams on supportive supervision 5. Develop teaching and learning materials for in-service training 1. Conduct writers workshop to develop HIV module, Leadership and management module, Quality improvement, Research in Health, HMIS/IDSR 2. Produce and distribute learning materials 6. Review curricula of Allied Health Training Institutions to incorporate concepts of quality assurance

Total Activity Cost

121

122

13.0IMPLEMENTATION OF THE PLAN • Institutional arrangements • Timeframe/phasing of the implementation • Follow-up of implementation e.g. forming of steering committee • Relationships with operational plans 14.0MONITORING AND EVALUATION • Indicators Development • Review of performance • Midterm review and final evaluation

123

ANNEX I. CURRENT MOH ORGANIZATIONAL STRUCTURE
MINISTRY POLICY AND PLANNING DIVISION DIRECTOR DIRECTOR INTERNAL AUDIT UNIT INTERNAL AUDITOR CHIEF MEDICAL OFFICER GOVERNMENT CHEMIST LAB PHARMACY BOARD NATIONAL FOOD CONTROL COMMISSION PROPOSED AGENCY ACCOUNTS UNIT CHIEF ACCOUNTANT PERMANENT SECRETARY HEALTH SERVICES ADMINISTRATION AND INSPECTORATE UNIT PERSONNEL DIVISION

COUNCILS COMMISSIONS AND BOARDS NURSING SERVICES UNIT CHIEF NURSING OFFICER

PREVENTIVE HEALTH SERVICE DIVISION DIRECTOR EPIDEMIOLOGY AND DISEASES CONTROL REPRODUCTIVE & CHILD HEALTH SERVICES ENVIRONMENTAL HEALTH AND SANITATION HEALTH EDUCATION

CURATIVE HEALTH SERVICES DIVISION DIRECTOR NATIONAL HOSPITALS REGIONAL AND DISTRICT HOSPITALS PRIVATE AND VOLUNTARY HEALTH SERVICES PHARMACEUTICAL SERVICES DIAGNOSTIC SERVICES TRADITIONAL MEDICINE Proposed Agency

HUMAN RESOURCE DEVELOPMENT DIVISION DIRECTOR HEALTH HUMAN RESOURCES PLANNING ALLIED HEALTH SCIENCES TRAINING NURSES TRAINING CONTINUING EDUCATION

124

ANNEX 2: DISTRIBUTION OF STAFF PER DISTRICT
HEALTH EMPLOYEES 993 913 493 352 338 400 287 267 522 312 630 1,579 1,667 313 811 551 530 254 440 489 309 950 277 385 732 371 529 330 893 660 352 923 466 371 455 624 1,220 531 421 702 737 544 459 266 229 POPULATION 516,814 282,712 178,434 185,237 129,776 230,164 132,045 95,614 40,801 187,428 203,102 637,573 1,088,867 771,500 440,565 324,347 429,824 249,760 254,500 245,623 106,668 128,520 106,061 283,032 420,348 410,794 395,130 81,221 425,476 386,328 334,939 628,677 414,764 490,816 144,852 259,958 402,431 144,336 115,620 246,479 212,325 171,850 215,764 41,549 75,546 EMPLOYEES/ 100,000 POPULATION 192 323 276 190 260 174 217 279 1,279 166 310 248 153 41 184 170 123 102 173 199 290 739 261 136 174 90 134 406 210 171 105 147 112 76 314 240 303 368 364 285 347 317 213 640 303

REGION Arusha Arusha Arusha Arusha Arusha Coast Coast Coast Coast Coast Coast Dar es Salaam Dar es Salaam Dar es Salaam Dodoma Dodoma Dodoma Dodoma Dodoma Iringa Iringa Iringa Iringa Iringa Iringa Kagera Kagera Kagera Kagera Kagera Kagera Kigoma Kigoma Kigoma Kigoma Kilimanjaro Kilimanjaro Kilimanjaro Kilimanjaro Kilimanjaro Kilimanjaro Lindi Lindi Lindi Lindi

DISTRICT Arumeru Arusha Karatu Monduli Ngorongoro Bagamoyo Kibaha Kisarawe Mafia Mkuranga Rufiji Ilala Kinondoni Temeke Dodoma Rural Dodoma Urban Kondoa Kongwa Mpwapwa Iringa Rural Iringa Urban Ludewa Makete Mufindi Njombe Biharamulo Bukoba Rural Bukoba Urban Karagwe Muleba Ngara Kasulu Kibondo Kigoma Rural Kigoma Urban Hai Moshi Rural Moshi Urban Mwanga Rombo Same Kilwa Lindi Rural Lindi Urban Liwale

125

REGION Lindi Lindi Manyara Manyara Manyara Manyara Manyara Mara Mara Mara Mara Mara Mbeya Mbeya Mbeya Mbeya Mbeya Mbeya Mbeya Mbeya Morogoro Morogoro Morogoro Morogoro Morogoro Mtwara Mtwara Mtwara Mtwara Mtwara Mwanza Mwanza Mwanza Mwanza Mwanza Mwanza Mwanza Rukwa Rukwa Rukwa Rukwa Ruvuma Ruvuma Ruvuma Ruvuma Shinyanga Shinyanga Shinyanga

DISTRICT Nachingwea Ruangwa Babati Hanang Kiteto Mbulu Simanjiro Bunda Musoma Rural Musoma Urban Serengeti Tarime Chunya Ileje Kyela Mbarali Mbeya Rural Mbeya Urban Mbozi Rungwe Kilombero Kilosa Morogoro Rural Morogoro Urban Ulanga Masasi Mtwara Rural Mtwara Urban Newala Tandahimba Geita Kwimba Magu Misungwi Mwanza Sengerema Ukerewe Mpanda Nkasi Sumbawanga Rural Sumbawanga Urban Mbinga Songea Rural Songea Urban Tunduru Bariadi Bukombe Kahama

HEALTH EMPLOYEES 721 277 511 654 194 539 163 530 392 335 381 1,006 400 317 491 396 281 603 546 909 481 702 647 798 544 537 266 335 322 182 474 427 663 516 463 672 371 465 341 1,787 389 1,088 552 349 411 484 248 483

POPULATION 162,081 124,516 303,013 205,133 152,757 237,882 141,676 260,000 330,953 108,242 176,609 492,798 206,615 110,194 174,470 234,908 254,897 266,422 515,270 307,270 322,779 489,513 263,920 228,863 194,209 442,573 204,770 92,602 183,930 204,648 712,195 316,180 416,113 257,155 501,915 261,944 412,683 208,497 373,080 147,483 404,799 147,924 131,336 247,976 605,509 396,423 596,456

EMPLOYEES/ 100,000 POPULATION 445 222 169 319 127 227 115 204 118 309 216 204 194 288 281 169 110 226 106 296 149 143 245 349 280 121 130 362 175 89 67 135 159 201 134 142 113 164 479 264 269 373 266 166 80 63 81

126

REGION Shinyanga Shinyanga Shinyanga Shinyanga Singida Singida Singida Singida Tabora Tabora Tabora Tabora Tabora Tabora Tanga Tanga Tanga Tanga Tanga Tanga

DISTRICT Maswa Meatu Shinyanga Rural Shinyanga Urban Iramba Manyoni Singida Rural Singida Urban Igunga Nzega Sikonge Tabora Rural Tabora Urban Urambo Handeni Korogwe Lushoto Muheza Pangani Tanga Total

HEALTH EMPLOYEES 381 342 730 510 572 674 508 484 578 608 393 298 410 386 431 868 372 475 238 542 60,320

POPULATION 305,473 248,949 277,518 135,166 368,131 205,423 401,850 115,354 325,547 417,097 133,388 188,808 370,796 249,572 261,004 419,970 279,423 44,107 243,580 31,790,507

EMPLOYEES/ 100,000 POPULATION 125 137 263 377 155 328 126 420 178 146 295 217 104 173 333 89 170 540 223 190

ANNEX 2: STAFFING CHARACTERISTICS BY DISTRICT
District Population Total number of health workers Staff per 100,000 population ratio for skilled health professionals Shortage according to manning levels for skilled health professionals Cumulative shortage

Bukombe Nkasi Meatu Bariadi Kasulu Simanjiro Kinondoni Geita Singida Rural Karatu Kahama Kiteto

396,423 208,497 248,949 605,509 628.677 141,676 1,088,867 712,195 401,850 178,434 596,456 152,757

95 103 117 272 219 50 220 408 166 72 272 77

11 12 13 14 16 16 16 16 18 19 20 20

84 168 168 159 162 35 0 165 108 72 71 74

84 252 420 579 741 776 776 941 1,049 1,121 1,192 1,266

127

District

Population

Total number of health workers

Staff per 100,000 population ratio for skilled health professionals

Shortage according to manning levels for skilled health professionals

Cumulative shortage

Ngorongoro Ngara Mkuranga Kigoma Rural Urambo Musoma Rural Biharamulo Mbeya Urban Hanang Mpwapwa Kondoa Iramba Arumeru Lushoto Lindi Rural Njombe Magu Tarime Masasi Bukoba Rural Tandahimba Nzega Mbulu Misungwi Sengerema Mufindi Mbeya Rural Mbozi Karagwe Dodoma Rural Kibondo Kilosa Temeke Kongwa Mbarali Ukerewe Mtwara Rural Sumbawanga Rural

129,776 334,939 187,428 490,816 370,796 330,953 410,794 266.422 205,133 254,500 429,824 368,131 516,814 419,970 215,764 420,348 416,113 492,798 442,573 395,130 204,648 417,097 237,882 257,155 501,915 283,032 254,897 515,270 425,476 440,565 414,764 489,513 771,500 249,760 234,908 261,944 204,770 373,080

65 143 95 238 207 184 237 106 106 159 261 192 247 281 123 215 336 266 231 182 114 260 142 171 343 172 137 368 338 297 316 334 366 137 132 269 131 334

20 20 21 22 22 22 23 23 23 24 24 24 24 25 25 27 27 27 28 28 28 28 29 30 30 30 30 31 31 32 32 32 32 32 32 32 34 35

62 72 116 139 129 135 108 8 226 184 181 213 185 122 121 166 173 115 104 61 61 106 82 144 213 105 83 106 150 267 139 214 99 72 60 117 93 841

1,328 1,400 1,516 1,655 1,784 1,919 2,027 2,035 2,261 2,445 2,626 2,839 3,024 3,146 3,267 3,433 3,606 3,721 3,825 3,887 3,948 4,04 4,136 4,280 4,493 4,598 4,681 4,787 4,937 5,204 5,343 5,557 5,458 5,530 5.590 5,707 5,800 6,641

128

District

Population

Total number of health workers

Staff per 100,000 population ratio for skilled health professionals

Shortage according to manning levels for skilled health professionals

Cumulative shortage

Shinyanga Rural Muleba Mpanda Rufiji Igunga Newala Rungwe Kilwa Chunya Iringa Rural Ulanga Sikonge Mbinga Ruangwa Maswa Kwimba Kibaha Morogoro Rural Makete Bagamoyo Monduli Manyoni Bunda Korogwe Tunduru Moshi Rural Handeni Serengeti Kilombero Same Kisarawe Ilala Kyela Babati Liwale Ludewa Nachingwea Hai Ileje

277,518 386,328 412,683 203,102 325,457 183,930 307,270 171,850 206,615 245,623 194,209 133,388 404,799 124,516 305,473 316,180 132,045 263,920 106,061 230,164 185,237 205,423 260,000 261,004 247,976 402,431 249,572 176,609 322,779 212,325 95,614 637,573 174,470 303,013 75,546 128,520 162,081 259,958 110,194

258 349 349 195 258 212 264 159 165 133 226 126 314 108 339 313 98 294 107 225 173 234 303 335 271 520 257 239 346 316 158 551 247 354 110 190 204 263 189

35 36 36 37 37 37 37 37 37 37 41 41 42 43 44 44 44 44 45 46 46 47 48 49 49 50 50 51 53 56 58 58 60 61 61 64 65 65 65

216 42 119 208 88 112 180 148 155 146 113 69 129 86 81 92 277 277 104 114 110 118 92 247 125 115 107 96 26 111 208 133 38 86 152 116 157 104

6,857 6,899 7,018 7,226 7,314 7,426 7,606 7,754 7,909 8,055 8,168 8,237 8,366 8,452 8,533 8,625 8,920 8,920 9,024 9,138 9,248 9,366 9,458 9,705 9,830 9,945 10,052 10,148 10,122 10,233 10,114 10,247 10,285 10,371 10,523 10,639 10,696 10,800

129

District

Population

Total number of health workers

Staff per 100,000 population ratio for skilled health professionals

Shortage according to manning levels for skilled health professionals

Cumulative shortage

Tanga Dodoma Urban Arusha Muheza Tabora Morogoro Urban Songea Rural Kigoma Urban Rombo Songea Urban Sumbawanga Urban Shinyanga Urban Musoma Urban Mafia Pangani Mwanga Mtwara Urban Singida Urban Iringa Urban Moshi Urban Bukoba Urban Lindi Urban

243,580 324,347 282,712 279,423 188,808 228,863 147,924 144,852 246,479 131,336 147,483 135,166 108,242 40,801 44,107 115,620 92,602 115,354 106,668 144,336 81,221 41,549.

361 357 450 456 348 332 263 305 408 263 251 311 336 102 119 267 248 288 300 451 266 184

67 70 71 73 75 76 77 80 82 91 91 92 106 108 109 113 114 117 124 147 188 250

36 21 15 41 26 133 118 75 63 19 20 2 31 220 82 107 36 79 9 -63 -3 19

10,836 10,857 10,842 10,883 10,909 11,042 11,160 11,235 11,317 11,317 11,337 11,339 11,370 11,590 11,672 11,779 11,815 11,894 11,903 11,840 11,837 11,856

130

ANNEX 4: REQUIREMENT OF STAFF BY CADRE BY EMPLOYERS

ANNEX 4.1:Requirement of Staff by Cadre in Regional Hospitals
Total Required 7 10 13 18 33 5 1 1 1 2 1 92 147 210 273 378 693 105 21 21 21 42 21 1932 MANYARA MTWARA MWANZA RUVUMA KAGERA ARUSHA TABORA 7 10 13 18 33 5 1 1 1 2 1 92 7 10 13 18 33 5 1 1 1 2 1 92 SINGIDA KIGOMA RUKWA MBEYA IRINGA TANGA

MORO

MARA

COST

LINDI

DOM

DSM

CADRE PHYSICIAN AMO CO NO NM PHNB PHARMACIST PHARM. ASST. LAB.TECHNICIAN LAB. ASST HEALTH SECRETARY TOTAL

7 10 13 18 33 5 1 1 1 2 1 92

7 10 13 18 33 5 1 1 1 2 1 92

7 10 13 18 33 5 1 1 1 2 1 92

7 10 13 18 33 5 1 1 1 2 1 92

7 10 13 18 33 5 1 1 1 2 1 92

7 10 13 18 33 5 1 1 1 2 1 92

7 10 13 18 33 5 1 1 1 2 1 92

7 10 13 18 33 5 1 1 1 2 1 92

7 10 13 18 33 5 1 1 1 2 1 92

7 10 13 18 33 5 1 1 1 2 1 92

7 10 13 18 33 5 1 1 1 2 1 92

7 10 13 18 33 5 1 1 1 2 1 92

7 10 13 18 33 5 1 1 1 2 1 92

7 10 13 18 33 5 1 1 1 2 1 92

7 10 13 18 33 5 1 1 1 2 1 92

SHY 7 10 13 18 33 5 1 1 1 2 1 92

KILI

131

ANNEX 4.2:Availability of Staff by Cadre in Regional Hospitals
Total Available 90 201 221 590 1038 168 26 28 53 47 19 2481

MANYARA

MWANZA

MTWARA

RUVUMA

KAGERA

ARUSHA

TABORA 4 7 9 36 44 2 1 2 3 2 1 111

SINGIDA

KIGOMA

RUKWA

MBEYA

CADRE PHYSICIAN AMO CO NO NM PHNB PHARM. PHARM. ASST. LAB.TECH. LAB. ASST H. SECRETARY TOTAL

12 17 8 56 85 4 2 0 4 6 2 196

7 8 17 42 80 14 1 3 7 3 1 183

7 18 11 45 56 41 6 5 1 4 2 196

4 9 6 35 77 5 1 1 5 0 1 144

8 12 10 31 64 3 1 2 2 3 2 138

2 8 9 16 26 1 1 2 2 1 1 69

9 8 22 53 79 6 2 1 2 3 1 186

5 14 4 16 51 5 1 1 1 1 1 100

5 10 11 20 42 3 1 0 6

2 6 20 4 23 2 1 2 2 2

1 9 21 4 21 4 1

9 6 8 31 52 4 1 2

2 17 20 49 38 7 1 1 2 1 2 140

1 10 7 36 36 56 1 2 3 5 0 157

1 15 6 41 92 0 1 0 4 0 1 161

5 8 11 26 72 5 1 3 0 3 1 13 5

4 8 5 1 9 4 2 3 1 0 0 5 1 8 8

3 3 1 68

3 5 0 121

1 99

0 64

125

132

TANGA 2 11 16 30 58 3 1 1 3 0 0

IRINGA

MORO

MARA

COST

LINDI

DOM

DSM

SHY

KILI

ANNEX 4.3:Requirement of Staff by Cadre in District Hospitals
RUKWA MBEYA KILIMANJARO SINGIDA DAR-ES-SALAASM MANYARA SHINYANGA MOROMA RUVUMA MWANZA ARUSHA KIGOMA DODOM MTWARA TANGA IRINGA KAGERA TOTAL 8 20 52 40 13 2 20 4 4 4 8 4 296 COAST 8 20 52 40 13 2 20 4 4 4 8 4 29 6 6 15 39 30 99 15 3 3 3 6 3 222 10 25 65 50 16 5 25 5 5 5 10 5 370 136 340 875 749 2160 328 68 68 71 133 66 4994 MARA TABORA 6 15 39 30 99 15 3 3 3 6 3 222 6 15 39 30 99 15 3 3 3 6 4 223 6 15 39 30 99 15 3 3 3 6 3 222 6 15 39 30 99 15 3 3 3 6 3 222 6 15 39 30 99 15 3 3 3 6 3 222 4 10 26 20 66 10 2 2 2 4 2 148 4 10 26 20 66 10 2 2 2 4 2 14 8 8 20 52 40 13 2 20 4 4 4 8 4 29 6 LINDI 8 20 52 40 13 2 20 4 4 4 8 4 29 6

CADRE Physician AMO General Clinical Officer Nursing Officer Nurse Midwife PHNB Pharmacist Pharm Asst Lab Technician Lab Asst H/Secretar y TOTAL 4 10 26 20 66 10 2 2 2 4 2 14 8 8 20 52 40 13 2 20 4 4 4 8 4 29 6 4 10 26 20 66 10 2 2 2 4 2 148 8 20 52 40 13 2 20 4 4 4 8 4 29 6 6 15 39 30 99 15 3 3 3 6 3 22 2 6 15 30 99 15 3 3 3 6 3 3 186 6 15 39 30 99 15 3 3 3 6 3 22 2 8 20 52 40 13 2 20 4 4 4 8 4 296

133

ANNEX 4.4:Availability of Staff by Cadre in Government District
SHYINYAN GA SINGIDA IRINGA KILIMANJA RO RUKWA ARUSHA MANYARA MBEYA MORO TANGA DSM DOM RUVUMA CADRE

Hospitals
MWANZA 3 17 13 47 103 20 5 1 5 8 3 22 5 MARA TABORA MTWARA KAGERA KIGOMA TOTAL 98 354 375 794 1243 302 27 38 72 116 45 3464

Physician AMO General Clinical Officer Nursing Officer Nurse Midwife PHNB Pharmacist Pharm Asst Lab Technician Lab Asst H/Secretary TOTAL

2 8 26 20 27 8 2 1 1 6 3 10 4

1 20 32 30 98 20 2 0 2 1 3 209

2 7 16 19 42 6 0 0 1 4 1 98

3 20 33 28 79 30 0 0 4 3 3 203

2 9 21 29 57 12 0 2 3 5 3 143

3 20 31 105 8 1 0 4 3 2

2 15 15 46 68 14 2 1 2 5 2 172

177

4 16 30 25 62 6 1 0 6 15 2 16 7

23 69 33 102 56 31 3 7 12 14 2 352

2 10 0 18 17 37 1 2 1 2 3 93

2 15 0 31 81 10 1 1 2 6 3 15 2

4 11 10 18 68 9 1 2 6 4 2 13 5

3 14 18 35 82 20 0 1 5 9 0 18 7

1 3 0 10 25 2 0 1 0 4 1 47

2 13 0 21 42 7 0 1 3 6 3 98

4 17 25 42 53 13 0 0 3 5 3 16 5

LINDI 4 17 21 36 65 13 1 2 2 4 2 167

3 10 12 15 29 5 1 1 3 2 1 82

2 15 5 28 58 18 2 0 1 2 0 13 1

134

ANNEX 4.5: Requirement of Staff by Cadre in the Health Centres
DAR-ES-SALAAM KILIMANJARO

MOROGORO

SHINYANGA

MANYARA

MWANZA

MTWARA

DODOMA

TAB ORA

ARUSHA

TANGA

RUVUMA 24 48

KAGERA

KIGOMA

SINGIDA

RUKWA

IRINGA

MBEYA

CADRE

COAST

AMO Clinical Officer Nurse Officer Assistant C/O Lab . Assistant Pharm Assistant Nurse Midwife

32 64

12 24

16 32 0 0 8 8 32 40 16 16
168

32 64 32 0 16 0 64 80 32 32
352

31 65 31 0 14 0 65 82 31 31
350

40 80 0 0 20 20 80 100 40 40
420

8 24 12 0 6 6 24 30 12 12
134

18 36 0 0 9 9 36 45 18 18
189

22 60 30 0 15 15 60 75 30 30
337

30 60 30 0 15 0 60 75 30 30
330

24 48 0 0 10 10 48 60 24 24
248

4 32 4 0 3 12 31 14 9 114
223

62 12 0 62 0 31 8 10 8 14 7 66 66
670

26 52 26 0 13 13 52 65 26 30
303

24 48 0 0 12 12 48 60 24 24
252

26 28 26 0 13 0 28 33 18 18
190

28 43 28 0 14 0 43 49 31 31
267

30 56 0 0 15 0 56 75 24 24
280

32 64 0 0 16 16 64 80 32 32
336

36 84

TOTAL 527 1132 368 0 283 129 1119 1385 573 682
6198

MARA

32 0 16 0 64

LINDI

0 0 0 0 24

21 0 21 0 84

34 0 16 0 48

80 PHNB MCHA Medical Attendant
TOTAL

30 32 32
352

12 12
114

10 5 42 42
435

60 24 24
278

135

ANNEX 4.6: Availability of Staff by Cadre in Government Health Centers
DAR-ES-SALAAM KILIMANJARO MOROGORO SHINYANGA

MANYARA

MWANZA

MTWARA

DODOMA

RUVUMA

TAB ORA

KAGERA

KIGOMA

SINGIDA

ARUSHA

RUKWA

IRINGA

MBEYA

CADRE

TANGA

COAST

AMO Clinical Officer Nurse Officer Assistant C/O Lab . Assistant Pharm Assistant Nurse Midwife PHNB MCHA Medical Attendant
TOTAL

4 48 15 0 2 0 30 17 16 113
245

1 10 0 0 5 0 14 7 9 43
89

0 15 0 16 6 3 21 12 10 41
124

5 29 9 0 10 44 0 23 23 149
292

9 43 12 0 6 0 40 20 31 15 6
317

9 56 3 11 9 1 30 21 16 10 4
260

13 56 57 3 13 6 64 12 43 53
320

6 5 3 4 6 0 14 12 4 34
88

2 25 0 6 3 2 20 14 13 93
178

0 25 4 0 14 0 16 4 16 74
153

0 14 0 4 10 2 17 7 13 65
132

4 32 4 0 3 0 31 14 9 114
211

3 51 7 0 15 6 59 23 13 10 4
281

4 16 3 0 6 0 16 4 11 59
119

4 22 1 8 6 0 33 10 12 54
150

2 19 4 0 5 0 10 14 4 49
107

2 19 1 0 7 0 5 18 18 57
127

7 29 0 2 6 0 33 23 9 57
166

4 34 1 7 9 1 38 20 10 61
185

10 31 10 0 0 10 39 18 7 89
214

2 22 5 0 6 0 27 18 7 63
150

TOTAL 91 601 139 61 147 75 557 311 294 1632
3908

MARA

136

LINDI

ANNEX 4.7: Requirement of Staff by Cadre in Government Dispensaries

KILIMANJARO

MOROGORO

SHINYANGA

MANYARA

DODOMA

MTWARA

MWANZA

RUVUMA

KAGERA

ARUSHA

DAR ES SALAAM

TABORA

SINGIDA

KIGOMA

RUKWA

CADRE

MBEYA

IRINGA

TANGA

AMO NO CO ACO Lab. Asst Phar Asst NM PHNB MCHA M. Att. TOTAL 84 236 84 197 921 0 214 0 107 535 236 84 214 0 0

0 0 214 0 0 0 0 214 107 535 0 260 0 130 650 0 120 0 60 300 0 164 0 82 410 0 240 0 432 260 0 0 120 0 0 164 0 0 0 192 0

0 384 0 0 0 0 384 0 192 960 352 0 176 880 0 360 0 180 900 0 262 0 131 655 0 368 0 184 920 0 256 0 128 640 0 266 0 133 665 0 262 0 131 655 0 550 0 255 1 315 352 0 360 0 0 262 0 368 0 0 256 0 266 262 510 0

0 0 294 302 0 180 0 190 0 0 0 294 0 147 735 0 302 0 151 755 0 180 0 90 450 0 190 0 95 475 0 354 0 0 0 0 354 0 177 885

TOTAL 0 384 5164 276 0 0 84 5588 324 2853 14673

137

MARA

COST

LINDI

ANNEX 4.8:

Availability of Staff by Cadre in Government Dispensaries

KILIMANJARO

MOROGORO

SHINYANGA

MANYARA

DODOMA

MTWARA

MWANZA

RUVUMA

ARUSHA

KAGERA

SINGIDA

TABORA

DAR ES SALAAM

KIGOMA

RUKWA

CADRE

MBEYA

IRINGA

TANGA

AMO NO CC.O. ACO Lab. Asst Parm. Asst N.M PHNB MCHA MM. Att TOTAL 19 15 49 88 258 6 22 11 80 181 56 31 24 36 2

0 0 24 0 0 6 22 11 80 143 5 88 115 365 735 49 37 111 115 495 4 16 21 96 199 78 84 18 135 26 4 47 15

1 1 65 22 1 114 17 7 1 23 24 80 217 45 30 39 228 481 4 65 18 274 535 129 45 89 63 1 24 49 100 211 537 2 111 48 168 471 30 31 61 214 494 14 46 45 152 352 47 18 48 227 415 1 31 46 127 256 12 48 66 390 736 125 17 92 66 1 71 23 75 51 113 107

1 0 76 62 54 51 35 44 22 0 29 34 29 173 342 0 34 28 243 421 12 28 40 97 263 1 18 36 91 212 4 128 54 4 1 21 52 83 294 641

1649 717 18 1 332 818 1029 3793 8384

138

TOTAL 2 25

MARA

COST

LINDI

ANNEX 4.9: Requirement of Staff by Cadre in FBO Hospitals
KILIMANJARO MOROGORO SHINYANGA MANYARA

MWANZA

DODOMA

MTWARA

RUVUMA 6 15 39 30 99 15 3 3 3 6 3

KAGERA

KIGOMA

SINGIDA

ARUSHA

TABORA

RUKWA

IRINGA

MBEYA

TANGA

COAST

CADRE Physician AMO General Clinical Officer Nursing Officer Nurse Midwife PHNB Pharmacist Pharm Asst Lab Technician Lab Asst Health Secretary

14 35 91 70 231 35 7 7 7 14 7

2 5 13 10 33 5 1 1 1 2 1

6 15 39 30 99 15 3 3 3 6 3

16 31 71 56 171 31 11 11 11 16 12

10 25 65 50 165 25 5 5 5 10 5

8 20 52 40 132 20 4 4 4 8 4

4 10 26 20 66 10 2 2 2 4 2

4 10 26 20 66 10 2 2 2 4 2

4 10 26 20 66 10 2 2 2 4 2

2 5 13 10 33 5 1 1 1 2 1

16 40 104 80 264 40 8 8 8 16 8

2 5 13 10 33 5 1 1 1 2 1

2 5 13 10 33 5 1 1 1 2 1

36 26 68 54 175 28 5 5 5 10 2

10 25 65 50 165 25 5 5 5 10 5

TOTAL 142 282 724 560 1831 284 61 61 61 116 59

MARA

TOTAL

51 8

7 4

22 2

43 7

37 0

29 6

148

14 8

14 8

7 4

59 2

LINDI

DAR

74

7 4

41 4

37 0

22 2

41 81

139

ANNEX 4.10: Availability of Staff by Cadre in FBO Hospitals
KILIMANJARO MOROGORO SHINYANGA

MANYARA

MWANZA

MTWARA

DODOMA

RUVUMA

KIGOMA

KAGERA

SINGIDA

ARUSHA

TABORA

RUKWA

CADRE

IRINGA

MBEYA

TANGA

COAST

MARA

Physician AMO General Clinical Officer Nursing Officer Nurse Midwife PHNB Pharmacist Pharm Asst Lab Technician Lab Asst H/Secretary TOTAL

23 10 35 58 122 6 4 2 11 19 4 294

3 5 20 89 0 0 1 3 3 6 1 131

0 7 7 12 20 0 0 1 1 2 1 51

10 19 16 100 136 5 4 3 3 12 5 313

8 5 15 11 23 5 0 0 4 2 2 75

4 7 6 27 56 0 9 1 4 3 0 117

4 2 0 42 15 2 0 1 4 2 0 72

2 4 0 27 47 0 2 3 6 2 2 95

2 10 0 27 49 3 0 0 1 8 2 102

1 2 0 4 13 0 0 0 2 0 1 23

12 24 21 86 131 62 0 6 5 13 4 364

1 1 0 4 0 0 0 0 0 2 1 9

2 2 0 3 11 1 0 0 0 3 1 23

6 33 169 73 818 26 1 3 4 10 3 1146

7 12 2 32 135 4 0 2 7 13 3 217

8 11 8 33 129 7 0 4 3 13 3 219

TOTAL 93 154 299 628 1705 121 21 29 58 110 33 3251 TOTAL

ANNEX: 4.11

Requirements of Staff by Cadre in FBO Health Centers
KILIMANJARO MOROGORO SHINYANGA

MANYARA

MWANZA

MTWARA

DODOMA

LINDI

DAR

CADRE AMO Clinical Officer Nurse Midwife PHNB MCHA Medical Attendant TOTAL

36 72 72 90 36 36 342

10 20 20 25 10 10 95

10 20 20 25 10 10 95

18 36 36 45 18 18 171

16 32 32 40 16 20 156

6 12 12 15 6 10 61

0 0 0 0 0 0 0

0 0 0 0 0 0 0

0 0 0 0 0 0 0

6 12 12 15 6 6 57

2 4 4 5 2 2 19

0 0 0 0 0 0 0

6 12 12 15 6 6 57

10 20 20 25 10 5 90

2 4 4 5 2 2 19

4 8 8 10 4 4 38

0 0 0 0 0 0 0

14 28 28 35 14 14 133

2 4 4 5 2 2 19

10 20 20 25 10 10 95

RUVUMA

KAGERA

KIGOMA

SINGIDA

ARUSHA

TABORA

RUKWA

IRINGA

MBEYA

TANGA

COAST

MARA

LINDI

DAR

0 0 0 0 0 0 0

152 304 304 380 152 155 1447

140

ANNEX 4.12: Availability of Staff by Cadre in FBO Health Centres
KILIMANJARO MOROGORO SHINYANGA

MANYARA

MTWARA

MWANZA

DODOMA

RUVUMA

KAGERA

KIGOMA

SINGIDA

ARUSHA

TABORA

RUKWA

IRINGA

MBEYA

TANGA

COAST

CADRE AMO Clinical Officer Nurse Midwife PHNB MCHA Medical Attendant TOTAL

12 28 32 5 6 69 152

0 4 5 0 2 13 24

1 5 11 4 2 22 45

2 17 22 2 7 36 86

6 17 20 7 7 42 99

4 5 4 2 3 15 33

2 3 3 1 3 14 26

1 11 13 4 6 30 65

0 0 0 0 0 0 0

0 6 6 0 5 18 35

0 1 2 17 1 2 23

1 2 3 1 0 4 11

0 0 0 1 2 19 22

3 4 7 2 0 28 44

0 3 2 0 3 1 9

2 8 5 0 3 66 84

0 0 0 0 0 0 0

TOTAL

MARA

LINDI

DAR

34 114 135 46 50 379 758

141

ANNEX 4.13: Staff Requirement in FBO Dispensaries in Tanzania
KILIMANJARO

MOROGORO

SHINYANGA

MANYARA

MWANZA

MTWARA

DODOMA

RUVUMA 46 0 46 0 31 123

KAGERA

KIGOMA

SINGIDA

ARUSHA

TABORA

RUKWA

IRINGA

MBEYA

TANGA

COAST

Clinical Officer Nurse Midwife PHNB MCHA Medical Attendant TOTAL

106 0 106 0 53 265

56 0 56 0 28 140

46 0 46 0 23 115

168 0 168 0 84 420

78 0 78 0 39 195

90 0 90 0 45 225

12 0 12 0 6 30

2 0 2 0 1 5

44 0 48 0 22 114

6 0 6 0 3 15

33 0 48 0 19 100

26 0 28 0 13 67

18 0 9 0 27 54

42 0 42 0 15 99

12 0 10 0 6 28

16 0 16 0 8 40

48 0 48 0 5 101

0 0 0 0 0 0

18 0 16 0 8 42

TOTAL 867 0 875 0 436 2178 TOTAL 395 148 219 143 937

MARA

ANNEX 4.14: Staff Availability in FBO Dispensaries in Tanzania

KILIMANJARO

MOROGORO

SHINYANGA

MANYARA

MWANZA

LINDI

DAR

MTWARA

DODOMA

Clinical Officer Nurse Midwife PHNB MCHA Medical Attendant TOTAL

72 44 27 13 171

18 4 22 5 56

11 11 3 2 44

79 11 65 26 167

26 20 9 8 67

63 7 25 52 125

5 0 9 1 5

2 0 1 2 0

23 0 11 2 63

2 0 2 0 4

8 6 9 3 32

10 12 12 4 19

12 0 4 3 24

0 0 0 0 0

15 23 2 4 43

15 2 2 2 16

8 6 2 1 26

13 2 6 11 55

0 0 0 0 0

4 0 3 0 13

327

105

71

348

130

272

20

5

99

8

58

57

43

0

87

37

43

87

0

20

RUVUMA 9 0 5 4 7

KAGERA

KIGOMA

SINGIDA

ARUSHA

TABORA

RUKWA

IRINGA

MBEYA

TANGA

COAST

MARA

LINDI

DAR

25

1842

142

ANNEX 5.0: UNIT COST OF TRAINING A HEALTH STUDENT PER YEAR (Source: MoH Study 2004) Table 1 : Costs of Training for a Diploma courses Unit Costs per Students per Course year 1. Assistant Medical Officers– Mbeya 2,139,994 2. 3. 4. Public Health Nurses A – Morogoro Theatre Management – Mbeya Advance Dip health education – Iringa 1,884,933 3,160,334 7,472,297

20% Unit Costs 427,991 376,986 632,067 1,494,459

143

Table 2: Costs of Training for Diploma Courses

Diploma Courses Clinical Officers Training CentreKilosa Clinical Officers Training CentreKilosa Diploma Nursing - Muhimbili Diploma Nursing – Mirembe Health Officers –Mpwapwa Dental Therapy School - Mbeya
Table 3: Costs of Training for Certificate Courses

Unit Costs per Students per year 1,909,571 1,479,181 1,347,394 1,812,274 1,686,498 2,982,768

20% Unit Costs 381,914 295,836 269,439 463,503 337,299 596,553

Certificate Courses 1. 2. 3. 4. Mbozi Nursing NTC Bagamoyo NTC Kondoa Njombe NTC

Unit Costs per Students per year 1,197,650 1,021,621 1,605,863 1,901,891

20% Unit Costs 239,530 204,529 321,172 380,378

Table 4. PROPOSED FEE STRUCTURE – FULL COSTS

Item Accommodation Meals Examination Caution Money Tuition Fee Book allowance Field work/research Certificate Medical Treatment Registration Total

% 12 30 4.33 2 40 3.33 5 0.67 2 0.67 100

Certificate 180,000 450,000 65,000 30,000 600,000 50,000 75,000 10,000 30,000 10,000 1,500,000

Diploma 240,000 600,000 86,000 40,000 800,000 66,000 100,000 13,000 40,000 15,000 2,000,000

Advance Diploma 288,000 720,000 103,000 48,000 960,000 79,000 120,000 16,000 48,000 18,000 2,400,000.0 00

144

Table 5. PROPOSED COST SHARING STRUCTURE (20%)

ITEM
Food Examination Registration Tuition Certificate Boarding & Lodging Medical Treatment Caution Money Total

CERT

Existing DIP

ADV

CERT

Recommended DIP ADV
250,000 25,000 12,500 75,000 12,500 12,500 5,000 75,000 400,000 240,000 72,000 12,000 120,000 12,000 12,000 4,800 7,200 480,000

100,000 100,000 100,000 10,000 10,000 30,000 5,000 5,000 5,000 10,000 30,000 50,000 5,000 5,000 5,000 UNIT COST OF TRAINING A STUDENT IN 5,000 5,000 5,000 2,000 3,000 140,000 2,000 3,000 160,000 2,000 3,000 200,000

214,000 21,400 10,700 21,400 10,700 BAR11,600 CHART 4,280 6,420 300,000

COST

1,000,000 900,000 800,000 700,000 600,000 500,000 400,000 300,000

200,000 Accomodation Caution Money 100,000 ITEM

Examination

Field work/research

Book allowance

Medical Treatment

Meals

Tuition Fee

Certificate

Advance Diplom a Registration Certificate

Certif icate Diploma

Advance Diploma

145

ANNEX 6.0 NUMBER OF TRAINING GRADUATES FOR SELECTED CADRES DURING PUBLIC SECTOR EMPLOYMENT FREEZE (1993 TO 1998, THEN PARTIALLY LIFTED)
CADRE
Clinical Officers General Practitioners/Medical Officers Medical Specialists Dentists Pharmacists Registered Nurses + Specialized Nurses Midwives Public health nurses

1993
318 17 9 4 11 552 368

1994 1995
148 26 11 2 16 699 423 72 156 46 10 5 13 471 287

1996 1997
268 28 9 4 19 647 336 36 423 31 7 7 18 787 347

1998 1999
478 30 6 4 14 732 366 34 464 42 9 8 17 480 409 24

2000 2001
536 50 7 16 19 753 398 618 61 8 11 14 936 408

2002 TOTAL
639 67 8 8 21 801 497 11 4,048 398 84 69 162 6,604 3,839 197

ANNEX 7.0 Table 3. 4: Reported HRH Deaths due to AIDS related complications Number of deaths in Cadre Total 2003 2004 2005 F M F M F M Mos 3 6 2 6 AMOs 4 2 7 6 7 Pharmacists 2 3 2 3 Lab Technicians 3 5 5 Nurses 21 2 5 2 5 Clinical Officers 1 10 0 11 3 11 Administrators 2 3 1 3

17 26 10 13 35 36 9

146

Medical attendants Health Assistant Total Level III II I I I

51 73

2 4 30

48 4 54

6 6 52

37 2 55

6 6 52 Private Total 8 17 183 402 4380 4990

150 22 316

Table 1.1 Number of Health Facilities by Levels Facility Government Voluntary Parastatal Hospitals 25 Referrals 6 2 Regional 17 Districts 62 79 13 Health 292 69 5 Centres Dispensaries 2683 598 187 Total 3060 748 205 ASSESSMENT OF THE CURRENT SITUATION

29 36 912 977

Tanzania has placed importance on decentralised management of basic services for many years. When local governments were reinstated in mid 1980s responsibility of basic services, including health had been transferred to each local government. However, local authorities have so far not been able to sufficiently exercise their authority in management of these services due to lack of critical decision making power including on allocation of the central government subvention, hiring and firing of staff as well as inadequate resources available beyond staff salaries. Although most of health workers at primary care facilities are already local government employees, key members such as doctors, nurses, and district health management teams (DHMTs) are still employed by central government and have a dual answerability to both the district authorities the Ministry of Health (MOH). The quality and availability of services are seriously compromised by financial constraints and poor management. The hospitals they often lack essential medical equipment, drugs and supplies and suffer from deteriorating infrastructure. Inadequate working conditions have contributed to loss of specialists and skilled staffs. The description of the health status suggests that there is a need to come up with programmes that will lead health sector towards attainment of the millennium development goals which aim at reducing child mortality, improve maternal health and combat HIV/AIDS, Malaria and other diseases by 2015.

Tanzania Health Profile
The major causes of morbidity and mortality in Tanzania are infectious diseases and parasitic diseases. According to institutional based records, diseases of high endemicity include malaria, AIDS, Tuberculosis, respiratory infections and diarrhoea.

147

According to hospital statistics, malaria appears to be the number one cause of morbidity in the country. AIDS, Diarrhoea Diseases and Tuberculosis are also high on the list of leading killer diseases. The following two tablets shows the most frequent causes of attendance at health facilities and the ten leading causes of deaths in hospitals. FREQUENT CAUSES OF ATTENDANCE AND DEATH AT HEALTH FACILITIES (All ages) SNo. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12 Disease Malaria Upper Respiratory Tract Infection (URTI) Diarrhoea Pneumonia Intestinal Worms Eye Infections Skin Infections Minor Surgery Anaemia Pregnancy Normal Ill defined, no diagnoses All other diagnoses Table 1.3 AIDS CASES TREND 1983 – 2001 % of all diagnosises 36.01 12.40 6.60 4.70 4.10 3.90 3.50 2.20 2.20 2.00 4.30 19.00

The table 1.4 below indicates the Training capacity and output for the past 5 years
number of health training schools per zone, ownershipand Level of certification Zone
Eastern zone Southern Highland zone No. of Institutions 20 9 No. of Govt. Institution 14 14 No. of NGO/Priv ate/TPDF 8 5 No. of Adv. 6 1 No. of Dipl. 13 5 No. of Certificat e 2 3

148

Lake zone Northern zone Southern zone Western zone Central zone Mbeya? Total

22 31 7 3 10 7 109

12 22 6 1 5 6 68

9 10 1 2 5 1 41

1 5 0 0 1 2 16

10 21 5 3 4 3 64

10 6 2 0 2 5 40

NB:

Training Capacity:
Table 1.5 Training Capacity
Number of institutio ns CAN ADNT ADO AMO AMOO AO AON APHN APN CO DIDT DT HO HOV HRT IEDH LA DMLT ADML DN OM DOT PHA PHCI PHT PT RDTC RG 1 1 1 4 1 1 1 1 1 1 16 1 2 5 1 1 1 2 3 1 26 1 1 1 1 2 1 1 1

CADRES 1ADVANCED DIPLOMA PAEDIATRIC NURSING 2ADVANCED DIPLOMA NURSE TEACHERS 3ASSISTANT DENTAL OFFICERS 4ASSISTANT MEDICAL OFFICERS 5ASSISTANT MEDICAL OFFICERS, OPTHALMOLOGY 6ANAESTHETIC OFFICERS 7ADVANCED DIPLOMA OPHTHALMIC NURSING 8ADVANCED DIPLOMA PUBLIC HEALTH NURSING 9ADVANCED DIPLOMA MENTAL HEALTH NURSING 11CLINICAL OFFICERS 13DENTAL TECHNICIANS 14DENTAL THERAPY 16HEALTH OFFICERS 17HEALTH OFFICERS VECTOR CONTROL 18TRAINING CENTRE FOR HEALTH RECORDS 19CEDHA, CENTRE FOR EDUCATIONAL DEVELOPMENT20LABORATORY ASSISTANTS 21DIPLOMA IN MEDICAL LABORATORY 23ADVANCED DIPLOMA MEDICAL LABORATORY 24DIPLOMA IN NURSING 25DIPLOMA IN OPTOMETRY 26TATCOT DIP. 28PHARMACEUTICAL ASSISTANTS 29PRIMARY HEALTH CARE INSTITUTE 30PHARMACEUTICAL TECHNICIANS 31DIPLOMA IN PHYSIOTHERAPY 33DERMATOLOGY 34DIPLOMA IN RADIOGRAPHER

Intake 14 24 11 160 5 11 14 25 23 14 720 4 22 150 21 30 20 60 90 15 780 12 9 15 20 30 30 9 30

Capacity 14 24 22 360 5 11 14 25 23 14 2160 12 66 600 42 60 40 120 270 15 3120 36 27 30 40 90 90 9 90

10ADVANCED DIPLOMA THEATRE MANAGEMENT SCHOOL ATM

149

35RADIOLOGY OFFICERS (AMO) 36CERTIFICATE IN GENERAL NURSING 37ADVANCED DIPLOMA IN MIDWIFERY

RO GN ADM

1 23 1 106

9 690 40 3,107

9 2070 40 9,548

Training Outputs The following table 1.6 indicates the number of students who graduated from each cadre from health training institutions (2000/ 2004)
CADRES 1ADVANCED DIPLOMA PAEDIATRIC NURSING 2ADVANCED DIPLOMA NURSE TEACHERS 3ASSISTANT DENTAL OFFICERS 4ASSISTANT MEDICAL OFFICERS 5ASSISTANT MEDICAL OFFICERS, OPTHALMOLOGY 6ANAESTHETIC OFFICERS 7ADVANCED DIPLOMA OPHTHALMIC NURSING 8ADVANCED DIPLOMA PUBLIC HEALTH NURSING 9ADVANCED DIPLOMA MENTAL HEALTH NURSING 10ADVANCED DIPLOMA THEATRE MANAGEMENT SCHOOL 11CLINICAL OFFICERS 13DENTAL TECHNICIANS 14DENTAL THERAPY 16HEALTH OFFICERS 17HEALTH OFFICERS VECTOR CONTROL 18TRAINING CENTRE FOR HEALTH RECORDS 19CEDHA, CENTRE FOR EDUCATIONAL DEVELOPMENT20LABORATORY ASSISTANTS 21DIPLOMA IN MEDICAL LABORATORY 22ADVANCED DIPLOMA MEDICAL LABORATORY 24DIPLOMA IN NURSING 25DIPLOMA IN OPTOMETRY 26TATCOT DIP. 27TATCOT CERT. 28HEALTH TECHNICIAN 29PHARMACEUTICAL ASSISTANTS 30PRIMARY HEALTH CARE INSTITUTE *31PUBLIC HEALTH NURSE "B" 31PHARMACEUTICAL TECHNICIANS 32DIPLOMA IN PHYSIOTHERAPY 33RADIOGRAPHIC ASSISTANTS 34DERMATOLOGY CAN ADNT ADO AMO AMOO AO AON APHN APN ATM CO DIDT DT HO HOV HRT IEDH LA DMLT ADML DN OM DOT COT HT PHA PHCI PHN PHT PT RA RDTC 88 26 9 190 11 11 25 7 219 14 13 18 11 78 33 6 403 11 8 3 28 18 19 197 12 10 10 5 81 25 10 60 12 22 10 42 12 9 222 14 13 13 5 87 30 8 454 10 13 3 44 19 9 184 14 12 15 5 156 8 13 15 4 60 19 85 49 9 391 9 2000 12 12 12 130 5 11 14 10 616 4 23 68 10 16 2001 7 165 2 20 4 599 4 15 86 9 15 2002 8 17 9 133 5 9 -9 645 4 16 95 10 12 2003 11 147 4 21 31 670 4 22 76 8 18 12 578 4 22 72 9 15 2004 15 24 7 116 4 5 14 -

150

35DIPLOMA IN RADIOGRAPHER 36RADIOLOGY OFFICERS (AMO) 37CERTIFICATE IN GENERAL NURSING 38CERTIFICATE IN NURSE MIDWIFERY 39ADVANCED DIPLOMA IN MIDWIFERY

RG RO GN NM ADM

9 5 534 415

12 522 408

11 5 468 515 40

12 560 429

9 5 508 498

2,548

2,701

2,561

2,920

2,735

Table 1.7 List of Courses, Awards, Duration and Entry Qualification
No Course Type 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 A.M.O General A.M.O. Ophthalmology A.M.O. Radiology A.M.O. Anesthesia A.M.O. Dermatology Clinical Officers Clinical Officers Health Technicians Health Officers Health Vector Control Health Education Education Development Health Personnel Education / Medical Education Dipl.Medical Laboratory Tech. Advanced Dip. Medical Laboratory Laboratory Assistants Asst. Dental Officers Dental Therapy Radiographer Pharmaceutical Technician Pharmaceutical Assistant Dipl. In Orthopaedic Tech. 3 1 2 2 2 1 1 Pre / In-service Certificate 2 years In-service Pre-service Pre/In-service Adv. Dipl. Diploma Diploma 2 years 3 years 3 years 3 years 2 years 3 years In-service L./Attendant In-service DT Form four/six Form four/Radiogr. Asst. Form four/four/Phar. Assistant Form four/four/Phar. Att. Form four No of Institute 6 1 1 1 1 6 9 2 3 1 1 1 3 1 Nature of the course In-service In-service In-service In- service In-service Pre-service In-service Pre-service Pre/In-service In-service In-service In-service Pre-service In-service Award Adv. Dipl. Diploma Diploma Diploma Diploma Diploma Diploma Duration 2 years 1 year 1 year 1 year 1 year 3 years 2 years Level of Entrance * In-service CO In-service AMO In-service AMO In-service AMO In-service AMO Form four and Form six In-service CA Form four Form four/ Form six /HA with form four In-service HO In-service H/Worker In-service H/Worker Form four In-service Dipl.Lab.Tech.

Certificate 2 years Diploma Adv.Dipl Adv. Dipl. Diploma Diploma Adv. Dipl. 3 years 2 years 2 years 1 year 3 years 2 years

Pre/ In-service Diploma Pre/ In-service Cert. Pre-service Diploma

151

22 23 24 25 26 27 28 29 30 31 32 33

Certificate Orthopaedic Tech Physiotherapy Optometry Health Record Technology Adv Dipl. In Nursing Education Adv. Dipl. in Pediatric Nursing Adv. Diploma Ophthalmic Nursing Adv. Diploma in theatre Management Adv. Dipl. in Public Health Nurse Certificate in General Nursing “B” Diploma in Nursing Diploma in Nursing Certificate in Nursing and midwives Adv. Dipl. Mental Health Nursing Adv. In Midwifery Occupational Therapy

1 1 1 1 1 1 1 1 1 10 9 17 13 1 1 1

Pre-service Pre-service Pre-service Pre-service In-service In-service In-service In-service In-service In-service In-service Pre-service Pre-service In-service In-service Pre/In-service

Certificate 1 year Diploma Diploma 3 years 3 years

Form four Form four Form four IForm four In-service Dipl. In Nursing In-service Dipl.Nursing In-service Dipl. In Nursing In-service Dipl.In Nursing In-service Dipl. In nursing MCHA and Nurse Assistant In-service Cert.Nursing Form four /six Form four In-service nursing Dipl. In-service nursing Dipl. H/Workers, Form six

Certificate 2 years Adv. Dpl Adv. .Dipl Adv..Dipl Adv. .Dipl Adv. Dipl. 2 years 2 years 2 years 2 years 2 years

Certificate 3 years Diploma Diploma 2 years 4 years

Certificate 4 years Adv. Dipl. Adv. Dipl Diploma 2years 2 years 3 years

34 35 36 37

152