Operational Mapping of Health Service Provision in the Southern Zone of Tanzania
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OPERATIONAL MAPPING OF HEALTH SERVICE PROVISION IN THE SOUTHERN
ZONE OF TANZANIA
Management Team Meeting
Richard NkweraDr. Oberlin Kisanga
15th November 2011
Findings and Recommendations
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Outline2
Background and Objective
Methodology
Findings
Issues and recommendations
Way forward
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Background and Objective3
Gain insight of the Public and Private health services: in Lindi, Mtwara and Ruvuma
through assessment of location service availability in view of rationalization
potentials. output and potential of health facilities
Transparency improvement among regional /zonal stakeholders for improved PPP
Service Rationalization: support informed Partnership decision making among: location, capacity and potential of health services (following key health problems), physical infrastructure and catchment area human resources and staff perspectives at governmental and private facilities
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Background: Study Area
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Methodology5
17 facilities physically visited others through regional/district respondents
Data assessment on district and hospital facility level Quantitative
Questionnaires
Qualitative Open ended questions Focus group discussions
Desk review5
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Findings
Reference is made in respect to: Lindi Mtwara Ruvuma
At the level of: Regional District /Council Hospital
Facility level
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Health Facilities7
Strong role and presence of faith based sector
MMAM requirement is almost three times of the available facilities (e.g. 181 to 496 Mtwara)
High number of health facilities - low number of skilled health workers
Over reliance of medical attendant – quality of services
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Equipment and Infrastructure Availability of beds
Rural hospitals have higher number of patients because of large catchment area and geographical location leaves patients with limited choice of hospital
The study recorded 2651 public and FBO inpatient hospital beds (public: 1,602; FBO: 1049)
In Lindi Region, for example, the faith-based sector operates 45% beds and Mtwara region in fact 63% of the beds are in faith-based hospital
Water and power supply: Water – most facilities use piped Electricity – mostly use of generator
General purpose Equipment – average - available and working X-ray Oxygen Theater Ambulance Refrigerator etc.
Communications – limited internet access
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Support Services
Laboratory Services Basics (malaria) tests available Advanced lab services – not available (sending
samples for days) Blood transfusing
Services available, though interruption reported to some districts in a period of three months (eg. Ruangwa and Liwale)
In all districts except for Tandahimba D.C relatives/friends or donors from the district are the main sources of blood donations, while Tandahimba the main type of donors are volunteers.
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Patient disease specific interventions Maternal and Child health interventions
Available at all facilities
Malaria services – available Presumptive IPT for Malaria during pregnancy
HIV and AIDS, SRH and STI Services Average: No SRH services targeting adolescents
needs Roman catholic facilities lack contraceptives HIV counseling and testing – available ART services – satisfactory (availability) Overall SRH commodities - satisfactory
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Human Resources
Density of medical doctors is very low Ranging from 0.03 to 0.6 per 10,000 population
Backbone of services: midlevel cadres (AMO/CO - ENs)
Non professional: high number of Medical attendants
Specialists: nine (9) in the mapped area
Staff movement: from FBO to public
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Human Resources
Back bone of Health Services
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Training
Per facility: All health workers in each hospital received at least
one training
At least one laboratory staff member trained in the diagnosis and treatment of malaria is less than 20% of facilities across the districts surveyed in Lindi and Mtwara Region.
At least one health worker in each hospital received the following trainings:
HIV and AIDS Mother and Child Health Reproductive Health Malaria Infection control Tuberculosis Drug Management Health Information Management System
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Training
Training Potentials: High potential of the present institutions to cater for HRH
development but No strategy for local demands. shortage of tutors on top of the attrition due to retirement
and disease burden is a challenge facing all the institutes e.g. in COTC Lindi, there are four tutors and two will be retired by year 2009/2010.
Recruitment of new tutors has not moved in proportion to student enrolment in most institutions.
Capacity to handle increased numbers of students and manage the condensed curriculum aimed at meeting MMAM targets is questionable as workload increase with no additional tutors
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Partners Support
Presence - variety of
stakeholders
Low coordination
Overlap esp. in HIV/A support
No support management plan
Mismatch between resource
input with available
Management capabilities.
Lindi Clinton Foundation (CHAI)
(HIVAIDS) EGPAF – Care and Treatment AGOTA USAID BIOSHAPE – HIV/AIDS Care and
Treatment BMAF – Staff support
Mtwara JICA BMAF UNICEF CHAI EGPAF Action Aid
Ruvuma JICA DANIDA ITIAPOCUNICEF
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for normal delivery from wards to assessed health facility
Patients Movement (GIS)
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Lindi Region
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Mtwara region
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Tunduru District
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Recommendations
Service provision Where patients go to receive services? (avoid resource consuming duplication
extensively explore the opportunities to invest in private service providers) Recruit more national specialists to assure sustainability (as the majority of
medical specialists identified in the study area were expatriates working on a short-contract basis)
Improve coordination of the few specialists available in the zone Resources availability / facilities management
Human resources: Retention measures should apply to both – public and private Increase the availability of Assistant Medical Officers and maintain the
relatively sound densities of enrolled nurses and clinical officers The need for a more comparable system. (Districts use different staffing
norms when calculating deficits for their Comprehensive Council Health Plans) Health Training Institutions should have strategy to cater HRH local demands
Public and Private collaboration: Enforcement of PPP
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Way forward21
Have TGPSH feedback
Linking stakeholders to these results
Building capacity of: Regional referral HRH
Government – informed decision making What is available
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ASANTENI