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HUMAN RESOURCE FOR HEALTH PLAN FORMAT
THE UNITED REPUBLIC OF TANZANIAMINISTRY OF HEALTH AND SOCIAL WELFARE
STRATEGIC HUMAN RESOURCES PLAN
(DRAFT 1)
DIRECTORATE OF HUMAN RESOURCE DEVELOPMENTMINISTRY OF HEALTH AND SOCIAL WELFAREP. O. BOX 9083DAR ES SALAAM
APRIL, 2006
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Table of Contents
Abbreviations
Foreword
Acknowledgements
Executive Summary
1. Introduction
2. Rationale of the plan
3. Plan aim and objective
4. Country and Health profile
5. National Health policy and legal framework
6. Situational analysis
7. Human resource policy requirement
8. Identification and assessment of key HRH priority areas
9. HRH Strategic Plan and budget table
10. Monitoring and evaluation
11. Annexes
ABBREVIATIONS
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AIDS Acquired Immuno-deficiency SyndromeCHMT Council Health Management TeamDED District Development Director DMO District Medical Officer
HSR Health Sector reformHRHSW Human Resource for Health and Social WelfareHIVKRA Key Result AreaMoHSW Ministry of Health and Social WelfareMDGE Millenium Development GoalNHP National Health PolicyNSGRP National Strategy for Growth and Reduction of PovertyOPD Out Patient DepartmentOPRAS Open Performance Appraisal SystemRAS Regional Administrative Secretary
RHMT Regional Health Management TeamRMO Regional Medical Officer VA Voluntary AgenciesWHO World Health Organization
1.0 INTRODUCTION
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1.1MINISTRY OF HEALTH AND SOCIAL WELFARE VISION, MISSION,AND CORE VALUE
VisionThe vision of the Ministry of Health and Social Welfare is to provide healthservices of high quality that are effective, accessible and affordable to all,delivered by a well performing, intergrated and sustainable health system.
MissionThe mission of the Ministry of Health and Social Welfare is to facilitate theprovision of equitable, quality and affordable health services, which aregender sensitive and sustainable, delivered by competent and wellmotivated health staff.
Core ValuesThe core values of the Ministry of Health are: quality care,professionalism, Moral and ethical practice, accountability andcommitment.
1.2ORGANIZATION STRUCTURE OF THE MINISTRY OF HEALTH ANDSOCIAL WELFARE
The Ministry of Health & Social Welfare (MoH&SW) is charged with theresponsibility of ensuring the provision of quality health services in the
country. To accomplish this responsibility, the Ministrys functions aredivided into six directorates which includes: Hospital Services, PreventiveServices, Human Resource Development, Policy and Planning, Socialwelfare, Administration and Personnel. These departments aresubsequently divided into sections for a more effective implementation asreflected in the organogram. Apart from the section there are semi autonomous health agencies and institutes of the Ministry of Health andsocial Welfare which are Government Chemistry Laboratory, Food andDrugs 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 semi-autonomous publicly accountable government organizations managed byChief Executives at arms length from Government. They are still part ofgovernment and are discrete business units with clear responsibilities andbusiness boundaries. Agencies are to receive all the delegations or-powerand authority over their resources necessary to enable them to meet theirresponsibilities. They will become more and more self sufficient in
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managerial and in some cases, financial terms. Some agencies willgenerate all their income from charging fees and/or trading. Others willremain dependent on Government subventions, and there will be aspectrum of combinations in between. (Refer to Annex 1)
2.0 RATIONALE OF THE PLANThere 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 Qualityhealth care services, customer oriented services, financial managementthat ensures value for money and transparency, gender sensitive healthservices, equity in the distribution of services, accessible, affordable andavailable services of all types, health services without corruption, efficientreferral system, community involvement, provision of health services byqualified and competent health workers, availability of primary health careservices, sustainable health services, freedom of choice on where to gethealth services, well maintained health service infrustructures, reliablecommunication facilities, and health services without violation of humanrights.
In order to meet all this customer expectations as well as to achieve HSRrequirement, development of HRHSW plan is very important.
3.0 HRH PLAN AIM AND OBJECTIVEAimThe aim of the strategic plan is to ensure availability of adequate,competent, motivated and equitably distributed staff for delivery of qualityhealth 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 andquality 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 PROFILE4.1 COUNTRY PROFILE
4.2 HEALTH PROFILEGenerally the health of the population of Tanzanian is characterized by ashort life expectancy and a high burden of disease. The average lifeexpectancy is 48.8 for males and 47.2 for females. Communicablediseases, maternal and prenatal conditions cause the majority of the
disease burden.
The infant mortality rate is about 93 per 1,000 live births. Vaccinationcoverage is 88% for BCG, 89% for Measles and 83% for DPT 3 Vitamin ASupplementation is 90%.(2002).
The major causes of morbidity and mortality in Tanzania are infectious,and parasitic diseases. According to institutional based records, diseasesof high endemicity include malaria, AIDS, Tuberculosis, respiratoryinfections and diarrhoea.
According to hospital statistics, malaria appears to be the number onecause of morbidity in the country., diarrhoea and tuberculosis are also highon the list of leading killer diseases. The following table shows the mostfrequent causes of attendance at health facilities and the ten leadingcauses of deaths in hospitals.
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Table 1.0
Frequent Causes of Attendance at Health Facilities (All ages)
SNo. Disease % of all diagnosis
1. Malaria 36.01
2. Upper Respiratory Tract Infection (URTI) 12.40
3. Diarrhoea 6.60
4. Pneumonia 4.70
5. Intestinal Worms 4.10
6. Eye Infections 3.90
7. Skin Infections 3.50
8. Minor Surgery 2.20
9. Anaemia 2.2010. Pregnancy complications 2.00
Among important factors for a well performing health system is the humanresource development (HRD). Human resource is a crucial factor in the sensethat all initiatives within the health sector are strongly human centred. The needto determine human resource development in terms of infrastructure, institutionaland human is important so as to address all problems related to it.
4.3 TANZANIA DEMOGRAPHY AND HEALTH SERVICESINFRASTRUCTURES
4.4 HEALTH SYSTEM
The health system in Tanzania comprises of various levels of health servicedelivery, These levels are there to ensure efficiency and demarcation of roles andresponsibility 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 andpublic health services. The services are provided in the dispensary which islocated 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 slightlybroader range of services than dispensaries, including inpatient care and coversan average population of 50,000.
District hospitals are located at the district centre and each serves an average of250,000 people. Tanzania comprises of 114 districts and there are districthospitals in all districts, except In 19 districts where there are no governmenthospitals, mission hospitals act as designated district hospitals (DDHs). Throughagreements, the government provides essential supplies such as
pharmaceuticals, and staff on secondment basis.
Tanzania has the decentralized system where the districts are provided with fullmandate 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 (DistrictHospital) with more specialized services and it caters for the population of about1,000,000 people.
4.4.3 Level III (Referrals Hospitals)
At this level, there are 4 referral hospitals and four others that are specialized inpsychiatry, tuberculosis, orthopaedics/Trauma and cancer which provide highlyspecialised services.
4.5 HEALTH STATUS AND DISEASE BURDEN
Despite increased availability of health care, the occurrence of some diseases isincreasing. Such diseases include malaria, acute respiratory infections,waterborne diseases, skin conditions and chronic diseases such as hypertensionand diabetes. The most threatening are AIDS related diseases including TBwhich have affected mostly the productive work force.
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The national statistics for diseases burden have singled out top ten diseaseswhich are the most frequent cause of the mortality for all ages. Among the topten are malaria, HIV/AIDS and Tuberculosis.
Malaria
Malaria is the leading disease in Tanzania for ill health and death. It accounts for19% of all deaths and approximately 30% of all hospital visits. The groups mostvulnerable 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 StrategiesTo 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 useintermittent 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/STIThe 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 inmales.
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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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 MillenniumDevelopment Goals, most of which are health related. Cluster 2 of theNSGRP aims in its second goal to improve survival, health and well-being of all children and women and of specially vulnerable groups, thesegments of the population in which the largest burden of disease,disability and death occur. The NSGRP has provided clear strategies inits operational target on human resources and management in healthincluding assessing the human resource development strategy,training in key areas, hiring and equity of deployment, incentives forhardship posts and improving human resource management
practices.
The National Health Policy (MoH, October 2003)2 has clearly outlinedthe policy objective to train and make available competent andadequate number of health staff to manage health services with dueconsideration to gender at all levels. Capacity building in healthservices management is part and parcel of this policy objective.Among the strategies for achieving the Health Policy, implementing acomprehensive human resource development plan that facilitatesdeployment and retention of well-trained and motivated staff isdirected. While the Health Policy is clear on guiding the supply of HRH
it remains quite limited in HRH planning and HRH deployment andretention.
DISPREPANCY BETWEEN POLICY STATEMENT(S) AND ACTUALPRACTICE: The target population (women, children, vulnerable groups) of theNSGRP is well addressed in terms of specificity of health interventionsand 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 andDispensaries, where the largest load of morbidity affecting this targetpopulation is supposed to be serviced have the greatest shortage ofqualified health staff (Gap of NMW = 562; PHNB = 1,074, and COs =
1 NSGRP2 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 MaternalMortality remain very elusive to reach given reliance on availability of amotivated qualified health workforce
The National Health Policys (NHP) limited coverage of HRH planningand poor financing of the 5 year HRH Plan 1996 2001 may haveinfluenced the sectors slowness in taking comprehensive HRHplanning more seriously.
Insufficient articulation of HRH deployment and retention measures inthe NHP may have given room to emergence of malpractices indeployment. The special circumstances surrounding the healthworkforce needed measures to brace it against forces operating in thefree labour market. Where there were no deliberate retentionmeasures severe strain on service delivery was inflicted as personnel
gravitated to better served areas, sectors or sub sectors with betterconditions and greater opportunities for personal advancement orsimply succumbed to migration inducing factors.
HRH planning requires up to date information; when cooperation ofvarious stakeholders and all levels is not forthcoming updating of HRHdata bases becomes incomplete. Cooperation of both public andprivate health care managers specifically in providing up to date andaccurate data is critical for success in comprehensive HRH planningevents.
The policy to establish strategies to combat HIV/AIDs at workplace hastaken quite long to be implemented in the health sector. As a resultthe sector is losing significant numbers of personnel to HIV/AIDS everyyear.
Assurance of quality and professional competence is a prerogative of Training. Limitations in reaching this policy aim derive frominconsistency in linking training to comprehensive training needsassessment, lack of costs analysis of training that influences negativelyinstitutional funding and teaching facilities provision.
The National Strategy for Growth and Poverty Reduction (NSGRP)makes provision for special remuneration package for hardship postsbut this has not been translated into HRH management practice. Thespecial package has to be defined and agreed upon, followed byimplementation measures.
3 CEDHA, MOH,WHO 2005 HRH Audit
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6.4 The HRH ManagementStrengths, weaknesses, opportunities and threats.The situation analysis reveals that several strengths exist in the HRHmanagement component. There are already in place clear organizational and
management structure at all levels of the health institutions, a decentralized HRHmanagement and a Client Service Charter. Currently, there is increased genderawareness among the health workers as a result of HRH gender advocacy,increased efficiency due to public private partnership where non-core servicesare being contracted out and recruitment undertakings based on merit.The introduction of a new appraisal system namely the Open PerformanceReview Appraisal System (OPRAS) and an improved HRH scheme of serviceshave proved to be an added advantage.
The HRH management component is threatened by a shrinking health workforceas a result of high attrition rate probably due to HIV/AIDS impact, multiple HRH
management nodes and a liberalized labour market. However, a nationaladvocacy on good governance and a Public Service Reform process going on inthe country where services are being contracted out to improve efficiency and theintroduction of OPRAS constitute opportunities for the betterment of HRHmanagement.
6.5 The HRH Training and DevelopmentStrengths, weaknesses, opportunities and threats.According to the situation analysis carried out, the HRH training anddevelopment component can make use of several strengths discovered. Thereexist a reviewed curricular and other learning materials which have already been
distributed, there is availability of computers in the health learning institutions anda 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 havealready undergone postgraduate studies and training opportunities, improvedstudents selection procedures and advocacy for upgrading and ContinuingEducation (CE) to staff at all levels. Furthermore, there is availability of healthtraining institutions (108) and guidelines for CE/CPD for main actors.Accreditation of health training institutions is also going on and graduateinduction courses that prepare graduates to challenges of taking up new jobpositions have been introduced.
The HRH training and development is however faced with several weaknessesbecause there are lack of comprehensive training needs assessment and costanalysis of training. There are also problems of under-funding of traininginstitutions, inadequate teaching facilities and staff and inadequate self-motivation towards continuing education and continuous professionaldevelopment among health workers.
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The HRH training and development component is also confronted by limitedsponsorship of trainees and scope of practice for core primary health care staff.There is also a notable inadequate organizational learning culture and exchangeprogrammes 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 andunavailability of some key competencies and skills in the health workforce arealso notable.
As regards to threats, there are cases of changing development partnerspriorities, development of partners fatigue, the changing of knowledge gap due tofast Information and Communication Technology (ICT) and false commitment thatdoes not match with disbursement. However, the HRH training and developmentcomponent can effectively make use of the existing opportunities such asavailability 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 agendaand the existence of accredited health training institutions.
6.6 HRH financingStrengths, weaknesses, opportunities and threatsAs of the current situation, HRH financing has a number of strengths. Costsharing guidelines for health services and training institutions are in place andsupervision of cost-sharing implementation in the Health Training Institutions(HTIs) is carried out. Furthermore, there is improved transparency in financialmanagement 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 existingweaknesses. Still there are under-funding of health services, delays indisbursement of funds and bureaucratic procurement procedures. On the otherhand, the prevailing cost-sharing exemption policy is difficult to implement andcost-sharing levels are too low. There are also problems of short landingmaterials and poor quality of supplies, poor financial management andinadequate involvement of staff in planning and budgeting process at the districtlevel. Included in the weaknesses are also weak government stewardship andutilization of the HRH financing, inability of the in-service candidates to pay cost-sharing fees, cumbersome instructions from center regarding financialexpenditure, diminished transparency that cannot match with disbursements anddisbursement delays. The HRH financing component is also threatened bydependency of the sector budget on external funding, shift of the governmentfocus from time to time and frequent shift of governance issues at global, nationaland sub-national levels.
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Data indicating the performance of health service delivery achieved usingabove 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 andare being reversed. About one quarter of all under-five deaths occur within thefirst month and two-thirds within the first year after birth. Tanzania is not ontrack to meet the 2015 targets of reducing under-five mortality by two thirdsunless urgent actions are taken. About 90% of all child deaths are attributableto common and preventable illnesses such as malaria, pneumonia, diarrhoea,malnutrition, HIV/AIDS and complications of low-birth-weight. Eight out of tenchildren die at home and six of them without any contact with formal healthservices.
b) Low birth weight is also a proxy indicator of maternal deprivation, thusperpetuating the inter-generational cycle of deprivation and malnutrition. The
onset of malnutrition starts soon after birth, and peaks by 12-18 months ofage. 44% under-five children are stunted (implying significant chronicmalnutrition) and 30% under weight.. Micronutrient malnutrition is rampantamong women, about 14% in the high land and nearly 80% in coastal areasare anaemic during pregnancy, and nearly 70% are vitamin A deficient. About25% of maternal deaths are associated with anaemia.
c) Over 2.0 million Tanzanians are HIV infected, and an estimated cumulativetotal of 722, 490 suffer from AIDS. Only 1 in 5 AIDS cases is reported. Youngpeople aged 15-24 accounts for 60% of new HIV infections and girls aged 15-19 has a six-fold risk of infection compared with boys of the same age. About72,000 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/ruralresidence. The declining number of deliveries in the health facilities (60%-1984, 44%-1991/92, 38%-1996, and 36%-1999) may be a reflection of thegovernment policy on this area to train professional midwives at thecommunity 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 childdeath, has been effectively contained. Despite these impressive gains, thegeneral health and nutritional status of the population of Tanzania remainspoor.
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6.9HRH AND HIV/AIDS
Declining Health workforce due to deaths related to HIV/AIDS is a seriousproblem in the Human Resource for Health Planning. A total of 300 deathsdue to HIV/AIDS among the health workers since 2003 were reported in theHRH 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 tofemale are higher than the male and the most leading cadres were medicalattendants followed by clinical officers.
Either there is increase in number of absenteeism due to sick leave or manlost hours to HIV/AIDS. There must be a strong initiative to educate healthworkers on the prevention of HIV/AIDS as well as provision of protectivemeasures while at work see annex seven
6.10HRH AND PARTNERSHIP
Inadequate HRH stakeholders commitment and coordination HRHstakeholders involve POPSM, PORALG, MOF, WHO, Voluntary Agencies,RAS, DED, Private Health Sector, Health Students Community andProfessional Associations.
6.11DISTRIBUTION OF STAFF PER DISTRICT
According to the HRH situational Analysis conducted by the MoH 2004, thereis a poor balance and distribution of health workers at all levels. There is anextreme 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 factthat unqualified staff filled the managerial and technical posts. HRH skill mixis not given priority in some facilities because there is misallocation ofqualified staff and especially in the specialist cadres like psychiatric nurses,nurse tutors, nursing officers, paediatric nurses and AMO specialists. Thestudy recommended that there should be a reallocation of staff at all levels aswell as establishing retention mechanism for the health workers to be willingto 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% ofthe health facilities are suffering from the extreme shortage of staff (SeeAnnex. 4) The shortage is due to the following reasons:-
a) Increase in burden of diseases due to HIV/AIDSb) Bureaucratic recruitment proceduresc) Poor balance and distribution of health workers at al levelsd) Lack of incentive package
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e) Inadequate job rotation and low preference to work in the remotedistricts because there are no special incentives for people working inthese areas.
f) Lack of priority on human resources issues by local governmentauthoritites
g) Poor management of human resourcesh) Poor working environmenti) Lack of enough protective measures against HIV/AIDS
j) Lack of retention mechanismsk) Increasing customers demandsl) Skill mix is not given a priority
6.13 Training Capacity and OutputMinistry of Health and Social Welfare offers sponsorship for training of Healthworkers inside and outside the country in various training and development
programmes aimed at equipping health workers with skills necessary forprovision of quality health services. The capacity of training institutions in variousprogramme are not reached, Subsidized cost of training a student and thenumber of graduates for the past five years are shown in the Annexes 5 & 6
6.14 Current and Projected Resources Including Finance and HumanRetrenchment policy in the public health services declined the workforce size
from 67,000 in 1994 to 49,000 health workers in 2001. Annual increase inpopulation ratio of Tanzania is 3%. Currently Tanzania belongs to the countrieswith 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 byHIV/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 qualifiedstaff remains vacant to date. At the same time a number of qualified healthworkers are unemployed or work in private sector or business other than health.
7.0 CURRENT HRH CHALLENGES IN THE HEALTH SECTOR7.1 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
8.0INSTITUTIONAL FRAMEWORK8.1Public Private partnership8.2Relationship with various stakeholders8.3Decentralization
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9.0FUTURE DEVELOPMENT AND HEALTH SERVICES9.1Assumption on future health and health care needs9.2Service target9.3Institutional Development9.4Private sector growth
9.5Public sector growth
10.0FUTURE HRH REQUIREMENTS10.1Type and number of staff required10.2Staffing norms10.3Skills mix10.4Distribution of staff/Redistribution10.5Performance and productivity changes
11.0FUTURE HRH SUPPLY11.1Expected attrition rates
11.2Public private sector movement11.3Production capacity requirement targets11.4Total 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
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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 workenvironment, tools, equipment and supplies, provision ofhousing especially in rural areas are stated. However, specialremuneration package for hardship posts referred to in theNSGRP needs clear elaboration in the HRH policy and strategicplan.
Performance appraisal system and staff motivation linked to
productivity and transparent to ensure equity and staffsatisfaction
Free permit on the deployment of Health workers to fullymanned 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 andinspectorate to HRH and strengthening professional bodiesand associations
Compliance to set standards of performance and quality.
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implications of unethical and iatrogenic practices by 2010.
Specific objective Target Indicators Means of verification Assumptions/Risks
Ensure adherence to ethicsin medical and nursingpractice by 2011
Practices of medical
and nursing
documented and
analysed in ethical and
legal viewpoint by 2010
Compiled case studies
illustrating legal and
ethical problems
Consultant report Legal governing bodies w
be willing to provide
information to be compile
into a compendium
Establish public debates on
state of medical and nursing
practices by 2011
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
Associations proceedings /
minutes
Commitment of associatio
to address the issue of
eroded ethics
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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
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Specificobjective strategies Activities Responsible
Time frame Source of Fu2006/07
2007/08
2008/09
2009/10
2010/11 MOH
Community
EnsureIncentivepackage forhardship postsare
incorporated inthe HR for HSW policy by2007
Review HR for HSW policy toincorporate incentivepackage for hardship posts
1. Conduct a survey toidentify criteria forhardship posts
2. Conduct workshop toseek consensus for
hardship incentivespackage
3. Incorporate incentivepackage for hardshipposts into HRHSWpolicy
Ensure amechanism tomanagerecruitment anddeployment ofstaffs isestablished by2007
Establish a coordinatingmechanism for differentcadres to deal with issuespertaining todecentralization/centralizationof HR for Health and socialWelfare
1. Review recruitmentprocedures to reducebeauracracy
2. Study a currenttransitional centralrecruitment anddeployment system andpropose transformationprogramme
3. Appoint a multi-sectoralmonitoring mechanismwith decentralizedrecruitment anddeployment with powersto intervene whennecessary
4. Assign the mechanismto develop its work planand budget
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Specific objective strategies Activities Responsible
Time frame Source of Fu2006/07
2007/08
2008/09
2009/10
2010/11 MOH
Community
Ensure adherence to
ethics in medical andnursing practice by
2011
Advocate adherenceto ethics and legalstandards
1. Update the current legaland ethical viewpoint forquality health services
2. Conduct advocacymeetings to all health
professionals on legalaspects of health
3. Document adversemedical and nursingpractices and analysefrom legal and ethicalviewpoints
Establish public
debates on state of
medical and nursing
practices by 2011
Raising awarenessand sensitivity ofleaders, communityand health careproviders on ethicalissues
1. Introduce ethicalissues debate inmedicinepractices to themedia
2. Design posters tocreatecommunityawareness on
ethical issuesand their legalrights
Increase the numberof options to restoreethics in healthsectors
Conduct workshop todevelop options to restoreethics in health sectors
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BUDGET
Specific objective strategies ActivitiesTotal ActivityCost
Ensure Incentive package forhardship posts are incorporated inthe HR for HSW policy by 2007
Review HR for HSW policy toincorporate incentive package forhardship posts
1. Conduct a survey to identify criteria forhardship posts
2. Conduct workshop to seek consensusfor hardship incentives package
3. Incorporate incentive package forhardship posts into HRHSW policy
Ensure a mechanism to managerecruitment and deployment of staffsis established by 2007
Establish a coordinating mechanismfor different cadres to deal withissues pertaining todecentralization/centralization of HRfor Health and social Welfare
1. Review recruitment procedures toreduce beauracracy
2. Study a current transitional centralrecruitment and deployment systemand propose transformationprogramme
3. Appoint a multi-sectoral monitoringmechanism with decentralizedrecruitment and deployment withpowers to intervene when necessary
4. Assign the mechanism to develop itswork plan and budget
Improve implementation of HRHSWpolicy by 2011 Distribute resources on time forpolicy implementation 1. Conduct follow-up monitoring andevaluation to ensure timely submissionof implementation report
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Specific objective strategies Activities Total Activity CosEnsure adherence to ethics inmedical and nursing practice by2011
Advocate adherence to ethicsand legal standards
1. Update the current legal andethical viewpoint for qualityhealth services
2. Conduct advocacy meetings toall health professionals on legalaspects of health
3. Document adverse medical andnursing practices and analysefrom legal and ethical viewpoints
Establish public debates on state
of medical and nursing practices
by 2011
Raising awareness and sensitivityof leaders, community and healthcare providers on ethical issues
1. Introduce ethical issues debate inmedicine practices to the media
2. Design posters to create communityawareness on ethical issues and theirlegal rights
Increase the number of options torestore ethics in health sectors
1. Conduct workshop to develop options torestore ethics in health sectors
HR FOR HEALTH AND SOCIAL WELFARE PLANNING
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Key Result Area: Improved Planning Capacity for Health and Social WelfareStrategic Objective: Strengthen planning capacity for the HR at all levels by 2011
Specific objective Target Indicators Means of verification Assumptions/RisksEnhance knowledge and skillof health and social welfareplanning team oncomprehensive HR planningby year 2010
Knowledge and Skillsenhanced to all HR forHealth and Social Welfareplanning team by 2010
Number of trainedplanners
Training reports
staffs database
Funds are available
All stakeholders involved
committed
Fill vacant posts from 46% to76% by 2010
30% of vacant post filled by2010
vacant post filled Human resource database
Sufficient supply of qual
job seekers
Funds are available
Willingness to work in hard
area
Improve HRHSW databaseat the district and regionallevel by 2008
HRHSW database improvedat district and regional levelby 2008
FunctionalHRHSW databaseat district andregional levels
HRHSW database
Reports
Funds are available
All stakeholders are invo
and willing to cooperate
Develop and finance a rapidhiring, redeployment plan forcritical cadres by 2010
Plan for rapid hiring anddeployment developed andfinanced by 2010
Costed list of needsby needy districtsVacant posts forcritical cadres filled
Rapid hiring andredeployment plan
Availability of qualified Hmarket
Establish criteria of hardshipenvironment for staff ofMoHSW by 2008
Criteria of hardshipenvironment for staff ofMoHSW established by2008
Criteria of hardshipareas
Study report on criteriafor hardship areas forMoHSW staff
Funds are available
Top management priority oHRH
All stakeholders are involve
Establish retentionmechanism for HRHSW by2011
Retention mechanism isestablished for HRHSW by2011
Mechanism inplace
Reports Funds are availableTop management are committe
Monitor applicability of stafflevels
Applicability of staffing levelmonitoring conducted
Number of districtsvisited
HR Database
updated
Availability of funds
Key Result Area: Improve Planning Capacity for Health and Social Welfare
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Strategic Goal: Develop and support gender sensitive planning capacity of MOHSW staff to produce comprehensive health
training, employing, and improving database system
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SpecificObjectives
Strategies Activity Responsible Time Frame Sources of Fu
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
MoH LG Community
O
Enhanceknowledge andskill of HSWplanning team
oncomprehensiveHR planningby 2010
Train MOHSWplanning team toenhance knowledgeand skill on planning
1. Identify sources offunds
2. Conductstakeholders
meeting to solicitfunds on HRplanning
3. Conduct training
Ensure regular HRplanning exchangeprogramme for crossfertilization ofexperience and ideas
1. Identify ands solicitexchangeprogramme partners
2. Identify priority areasof exchangeprogramme
3. Facilitate HRplanning study toursand attachments
Fill vacantposts in health
facilities andtraininginstitutionsfrom 46% to76% by 2010
Mobilizing funds 1. Identify sources of funds
2. Conductstakeholdersmeeting to Solicitfunds
3. Recruit new staffs
Train existing staff 1. Review existingcurricula inline withservice needs
2. Increase trainingoutput by ensuring
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SpecificObjectives
Strategies Activity Responsible Time Frame Sources of Fu
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
MoH LG Community
O
Enhanceknowledge andskill of HSWplanning team
oncomprehensiveHR planningby 2010
Train MOHSWplanning team toenhance knowledgeand skill on planning
1. Identify sources offunds
2. Conductstakeholders
meeting to solicitfunds on HRplanning
3. Conduct training
Ensure regular HRplanning exchangeprogramme for crossfertilization ofexperience and ideas
1. Identify ands solicitexchangeprogramme partners
2. Identify priority areasof exchangeprogramme
3. Facilitate HRplanning study toursand attachments
ImproveHRHSW
database atthe district andregional levelby 2008
Strengthen HRHSWsystem at all levels for
effective planning anddecision making
1. Train the staffs onthe use of HRH
database2. Develop a system to
ensure thatknowledge of trainers is regularlyupdated inline withservice needs
3. Establish andmaintain accurateand up-to-dateHRHSW database at
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SpecificObjectives
Strategies Activity Responsible Time Frame Sources of Fu
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
MoH LG Community
O
Enhanceknowledge andskill of HSWplanning team
oncomprehensiveHR planningby 2010
Train MOHSWplanning team toenhance knowledgeand skill on planning
1. Identify sources offunds
2. Conductstakeholders
meeting to solicitfunds on HRplanning
3. Conduct training
Ensure regular HRplanning exchangeprogramme for crossfertilization ofexperience and ideas
1. Identify ands solicitexchangeprogramme partners
2. Identify priority areasof exchangeprogramme
3. Facilitate HRplanning study toursand attachments
Establishincentive
package forhardshipenvironmentfor staff ofMoHSW by2008
1. Developmechanism for
selecting hardshipenvironment
1. Develop indicatorsfor identification of
hardshipenvironment
DHR/D
AP/DPP
2. Conduct a study toidentify hardshipareas
3. Identify prioritycadres to retain
4. Develop affordableincentive packagefor hardship posts
DAP/DHR
5. Incorporate incentive
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SpecificObjectives
Strategies Activity Responsible Time Frame Sources of Fu
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
MoH LG Community
O
Enhanceknowledge andskill of HSWplanning team
oncomprehensiveHR planningby 2010
Train MOHSWplanning team toenhance knowledgeand skill on planning
1. Identify sources offunds
2. Conductstakeholders
meeting to solicitfunds on HRplanning
3. Conduct training
Ensure regular HRplanning exchangeprogramme for crossfertilization ofexperience and ideas
1. Identify ands solicitexchangeprogramme partners
2. Identify priority areasof exchangeprogramme
3. Facilitate HRplanning study toursand attachments
health facility tofacilitate quality
servicesBUDGET
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Specific Objectives Strategies Activity Total ActiviCost
Enhance knowledge and skill ofHSW planning team oncomprehensive HR planning by2010
Train MOHSW planning team toenhance knowledge and skill onplanning
1. Identify sources of funds
2. Conduct stakeholders meeting to solicitfunds on HR planning
3. conduct training
Ensure regular HR planningexchange programme for crossfertilization of experience and ideas
1. Identify ands solicit exchange programmepartners
2. Identify priority areas of exchangeprogramme
3. Facilitate HR planning study tours andattachments
Fill vacant posts in health facilitiesand training institutions from 46% to76% by 2010
Mobilizing funds 1. Identify sources of funds
2. Conduct stakeholders meeting to Solicitfunds
3. Recruit new staffs
Train existing staff 1. Review existing curricula inline with serviceneeds
2. Increase training output by ensuring thatthe knowledge of trainers regularlyupdated inline with service needs
3. Improving the quality and cost
effectiveness of in-service training
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Specific Objectives Strategies Activity Total ActiviCost
Enhance knowledge and skill ofHSW planning team oncomprehensive HR planning by2010
Train MOHSW planning team toenhance knowledge and skill onplanning
1. Identify sources of funds
2. Conduct stakeholders meeting to solicitfunds on HR planning
3. conduct training
Improve HRHSW database at thedistrict and regional level by 2008
Strengthen HRHSW system at alllevels for effective planning anddecision making
1. Train the staffs on the use of HRHdatabase
2. Develop a system to ensure thatknowledge of trainers is regularly updatedinline with service needs
3. Establish and maintain accurate and up-to-date HRHSW database at the all levels
4. Establish/coordinate the HRH databasewhich cover the entire sector
5. Carrying out regular analysis of the staffingdata
6. procure necessary equipments forsustaining HRHSW database at all levels
Develop and finance a rapid hiring,redeployment plan for critical cadresby 2008
Mobilizing funds for emergencyhiring
1. Identify sources of funds
2. Conduct stakeholders meeting to Solicit
funds
3. Recruit staff through emergency hiringprogramme
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Specific Objectives Strategies Activity Total ActiviCost
Enhance knowledge and skill ofHSW planning team oncomprehensive HR planning by2010
Train MOHSW planning team toenhance knowledge and skill onplanning
1. Identify sources of funds
2. Conduct stakeholders meeting to solicitfunds on HR planning
3. conduct training
Establish incentive package forhardship environment for staff ofMoHSW by 2008
Develop mechanism for selectinghardship environment
1. Develop indicators for identification ofhardship environment
2. Conduct a study to identify hardship areas
3. Identify priority cadres to retain
4. Develop affordable incentive package forhardship posts
5. Incorporate incentive packages into HRHbudget
6. Disseminate circular for incentive packagefor hardship posts
7. Monitor impact of attraction and retentionpackage
Establish retention mechanism for
HRHSW by 2011
Developing retention mechanism for
HRHSW in hardship areas to assureavailability of staff in the hardshipareas
1. Initiate incentive package and other
remunerations in hardship area
2. Solicit funds for retention mechanism
Monitor applicability of staff levels Ensuring that all vacant post inMoH/SW are filled by the rightcadres, right skill mix at the righthealth facility to facilitate qualityservices
1. Conduct study to monitor applicability ofstaffing level
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Specific Objectives Strategies Activity Total ActiviCost
Enhance knowledge and skill ofHSW planning team oncomprehensive HR planning by2010
Train MOHSW planning team toenhance knowledge and skill onplanning
1. Identify sources of funds
2. Conduct stakeholders meeting to solicitfunds on HR planning
3. conduct training
Establish career and successionplanning system in the health sector
Develop career and successionplans
1.Solicit finds
2.conduct situational analysis
3 Develop career development plan for allhealth cadres
4 Develop succession plan for all keymanagement posts at all levels
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
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Specific Objectives Target Indicators Means of verification
Assumption/Risks
Review job list and jobdescriptions of all staff of theMoHSW by 2007
Job list and Jobdescriptions of all healthstaff reviewed by 2007
Updated job listand jobdescriptions forhealth staff
Report on review of job list and jobdescriptions for HRfor Health andsocial welfare
Funds are available
All staff are involved
Review scheme of service for
health staff by 2007
Scheme of service for staff
of MoHSW reviewed by2007
Updated scheme of
service for healthstaff
Report on review of
scheme of servicefor health staff
Funds are available
All staff are involved
Establish criteria of hardshipenvironment for staff ofMoHSW by 2008
Criteria of hardshipenvironment for staff ofMoHSW established by2008
Criteria of hardshipareas
Study report oncriteria for hardshipareas for MoHSWstaff
Funds are available
Top management
priority on HRH
All stakeholders are
involved
Introduce HRHSW hardshipincentives in difficult areas by2011
Incentives for hardshipareas introduced by 2011
Incentivespackages forhardship areasimplemented
GovernmentCirculars
Funds are available
Top management
priority on HRH
Political will
Establish strategies toenhance productivity ofHRHSW by 2011
Strategies to enhanceproductivity established
A number ofstrategies toenhanceproductivity forHRHSW
Report onestablishedstrategies
Funds are available
All stakeholders
involved
Increase/Strengthen privatesector participation inrendering health and socialwelfare services by 2010
Private sector participationin rendering health andsocial welfare services by2010
Number of privatesector effectivelyparticipating inrendering healthand social welfareservices
Workshops andseminars reports
Funds are available
All stakeholders
involved
Increase support to HRHSWstaff by 30% of the current
Support to HRHSWsupport increased by 2011
% increase ofsupport to HRHSW
Performancereports
Funds are available
Technical expert are
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Specific Objectives Target Indicators Means of verification
Assumption/Risks
support by 2011 staff Willing and capable tosupport
Staff are ready to
receive support fromtechnical experts
Improve working conditions for
HRHSW by 50% of the currentsituation by 2011
Working condition for
HRHSW improved by 50%by 2011
% improve of
working conditionfor HRHSW
Renovation
reports
Rehabilitation
reports
Procurement
reports
Funds are available
Top level managers are
interested andcommitted
Strengthen managementcapacity of the MoHSWinstitutions by 2010
Management capacity ofMoHSW institutionsimproved
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Key Result Area: Improve performance of health staff for quality care
Strategic Goal: Increase MoHSW staffs motivation and flexibility to work in all areas in the country by improving incentivesand working environment
SpecificObjectives
Strategies Activity Responsible Time Frame Sources of F
2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 MoH LG CommunityOt
Improve gendersensitive job listand jobdescriptions of allstaff of the healthand social welfaresector by 2007
Review job listand jobdescription forall cadres in linewith HSRrequirements
1. Select task force forreviewing job listand job description
2. Conduct 4meetings to reviewjob list and jobdescription
DAP
3. Seek approval fromtop levelmanagement
Improve scheme ofservice for healthstaff by 2007
Review schemeof service for allcadres in line
with the HSRrequirements
1. Select task force forreviewing schemeof service
2. Conduct 4meetings to reviewscheme of service
DAP
3. Seek approval fromtop levelmanagement
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SpecificObjectives
Strategies Activity Responsible Time Frame Sources of F
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
MoH LG Community
Ot
Improve gendersensitive job listand jobdescriptions of all
staff of the healthand social welfaresector by 2007
Review job listand jobdescription forall cadres in line
with HSRrequirements
1. Select task force forreviewing job listand job description
2. Conduct 4meetings to reviewjob list and jobdescription
DAP
3. Seek approval fromtop levelmanagement
Establish incentivepackage forhardshipenvironment forstaff of MoHSW by2008
Developmechanism forselectinghardshipenvironment
8. Develop indicatorsfor identification ofhardshipenvironment
DHR/DAP/DPP
9. Conduct a study toidentify hardshipareas
10. Identify prioritycadres to retain
DAP/DHR
11. Develop affordableincentive packagefor hardship posts
12. Incorporateincentive packagesinto HRH budget
13. Disseminate circularfor incentive
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SpecificObjectives
Strategies Activity Responsible Time Frame Sources of F
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
MoH LG Community
Ot
Improve gendersensitive job listand jobdescriptions of all
staff of the healthand social welfaresector by 2007
Review job listand jobdescription forall cadres in line
with HSRrequirements
1. Select task force forreviewing job listand job description
2. Conduct 4meetings to reviewjob list and jobdescription
DAP
3. Seek approval fromtop levelmanagement
Identify factorscontributing to HRfor Health andSocial Welfareattrition andmeasures forimprovement by2009
Identify factorscontributing toHRHSW attrition
1. Conduct a study toidentify factorscontributing toHRHSW attrition
DHR
2. Dissemination ofthe study report toall stakeholders
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SpecificObjectives
Strategies Activity Responsible Time Frame Sources of F
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
MoH LG Community
Ot
Improve gendersensitive job listand jobdescriptions of all
staff of the healthand social welfaresector by 2007
Review job listand jobdescription forall cadres in line
with HSRrequirements
1. Select task force forreviewing job listand job description
2. Conduct 4meetings to reviewjob list and jobdescription
DAP
3. Seek approval fromtop levelmanagement
Train newrecruited staffsto orient themwith the workingenvironment
1. Conduct inductioncourse to HRHSWgraduates to orientthem organisationobjectives, jobdescription,performancestandards, andsupportivesupervision
2. Monitor andevaluateperformance andtake appropriateactions
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SpecificObjectives
Strategies Activity Responsible Time Frame Sources of F
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
MoH LG Community
Ot
Improve gendersensitive job listand jobdescriptions of all
staff of the healthand social welfaresector by 2007
Review job listand jobdescription forall cadres in line
with HSRrequirements
1. Select task force forreviewing job listand job description
2. Conduct 4meetings to reviewjob list and jobdescription
DAP
3. Seek approval fromtop levelmanagement
Train MOHSWstaffs to haveappropriatequalifications
1. Conduct trainingneeds
assessment
2. Solicit funds fortraining
3. Train withinappropriatequalifications to fitto their positions
Improve HRHSWadvocacy &sensitizationinitiatives to Policy& Decision makersby 2009
Carry outHRHSWadvocacy &sensitization toPolicy &Decision makers
1. Select and trainTOT on advocacyand sensitization
DHR
2. Conduct advocacyand sensitizationmeetings
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SpecificObjectives
Strategies Activity Responsible Time Frame Sources of F
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
MoH LG Community
Ot
Improve gendersensitive job listand jobdescriptions of all
staff of the healthand social welfaresector by 2007
Review job listand jobdescription forall cadres in line
with HSRrequirements
1. Select task force forreviewing job listand job description
2. Conduct 4meetings to reviewjob list and jobdescription
DAP
3. Seek approval fromtop levelmanagement
Improve MoHrecordsmanagement by2011
Review effectiverecordsmanagementsystem in theMoHSW forimprovement
1. Review currentsystem to identifyweaknesses
DAP
2. Train Registryassistant on themodern recordsmanagement
3. Conduct effectivesupervision to allregistry assistant
4. Purchase enoughand modernworking tools forregistry
5. Upgrade registryassistants to FormFour
6. Computerizingrecords
management
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SpecificObjectives
Strategies Activity Responsible Time Frame Sources of F
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
MoH LG Community
Ot
Improve gendersensitive job listand jobdescriptions of all
staff of the healthand social welfaresector by 2007
Review job listand jobdescription forall cadres in line
with HSRrequirements
1. Select task force forreviewing job listand job description
2. Conduct 4meetings to reviewjob list and jobdescription
DAP
3. Seek approval fromtop levelmanagement
Enhanceproductivity ofHRHSW by 2011
Developmotivation andincentivepackage
1. Conduct a study toidentify motivatingfactors
DAP/D
HR2. Introduce affordable
motivation andincentive scheme
3. Orient managementon motivation andincentive packages
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SpecificObjectives
Strategies Activity Responsible Time Frame Sources of F
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
MoH LG Community
Ot
Improve gendersensitive job listand jobdescriptions of all
staff of the healthand social welfaresector by 2007
Review job listand jobdescription forall cadres in line
with HSRrequirements
1. Select task force forreviewing job listand job description
2. Conduct 4meetings to reviewjob list and jobdescription
DAP
3. Seek approval fromtop levelmanagement
Increase/Strengthen private sectorparticipation inrendering healthand social welfareservices by 2010
Designmechanism forHealth andSocial Welfareservicesprivatization
1. Identify areas forprivatization
DAP
2. Select mechanismfor contracting out
3. Set standards forservices to becontracted out
4. Develop contracts
5. Contract out theagreed services
Monitor andevaluate theimplementation
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SpecificObjectives
Strategies Activity Responsible Time Frame Sources of F
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
MoH LG Community
Ot
Improve gendersensitive job listand jobdescriptions of all
staff of the healthand social welfaresector by 2007
Review job listand jobdescription forall cadres in line
with HSRrequirements
1. Select task force forreviewing job listand job description
2. Conduct 4meetings to reviewjob list and jobdescription
DAP
3. Seek approval fromtop levelmanagement
Improve workingconditions forHRHSW by 50% ofthe current situationby 2011
Designmechanism forimprovingworkingconditions
1. Solicit funds forimproving workingconditions
DAP/DHR
2. Install InformationTechnology at alllevels of health care
3. Conduct a survey toestablish needs forimproving workingenvironment
4. Procure materialsand equipmentsaccording to needs
5. Rehabilitate,renovate, andconstruct buildings
6. Providerefreshments forHRHSW staff
7. Provide transport
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SpecificObjectives
Strategies Activity Responsible Time Frame Sources of F
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
MoH LG Community
Ot
Improve gendersensitive job listand jobdescriptions of all
staff of the healthand social welfaresector by 2007
Review job listand jobdescription forall cadres in line
with HSRrequirements
1. Select task force forreviewing job listand job description
2. Conduct 4meetings to reviewjob list and jobdescription
DAP
3. Seek approval fromtop levelmanagement
Strengthenmanagementcapacity of theMoHSW institutionsby 2010
Train MOHSWstaff onmanagementskills
1. Conductmanagementtraining to middleand top levelmanagers
DHR
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BUDGET
Specific Objectives Strategies Activity Total ActivityCost
Improve job list and jobdescriptions of all staff of theMoHSW by 2007
Reviewing job list and job description for all
cadres in line with HSR requirements
Select task force for
reviewing job list and
job description Conduct 4 meetings to
review job list and jobdescription
Seek approval for top
level management fromall stakeholders
Improve scheme of service forhealth staff by 2007
Reviewing scheme of service to all cadres in
line with the HSR requirements
Select task force for
reviewing scheme ofservice
Conduct 4 meetings to
review scheme ofservice
Seek approval for top
level management from
all stakeholdersEstablish criteria of hardshipenvironment for staff ofMoHSW 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
Conduct simple study to
identify hard to workenvironment
Identify priority cadre to
retain
Develop affordable
incentive package for hard
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Specific Objectives Strategies Activity Total ActivityCost
to work environment
Improve HRH budget
Monitor impact of attraction
and retention package
Review recruitment
procedure
Review registration
procedure
Distributing hardship incentive circular
Incorporating hardship incentives into budget
Budget for hardship
incentive
Pay hardship incentive
to responsible staff
Establish factors contributing toHR for Health and SocialWelfare attrition by 2009
Conduct studies on the factors contributing to
HRHSW attrition
Develop proposal for
the study
Data collection
Data analysis and
interpretation
Report writing
Dissemination of the
study report
Develop strategies to addressfactors contributing to HR forHealth and Social Welfareattrition by 2008
Getting proposals from stakeholders Write invitation letters to
stakeholders
Conduct meeting with
stakeholders
Write strategies to address
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Specific Objectives Strategies Activity Total ActivityCost
factors contributing toattrition
Present draft to MoH SW
management team
Write strategies to address
factors contributing toattrition & submitting to PSMoHSW
Improve performance of theHRHSW staff by 2011
Design mechanism for performance appraisal
Improving staff performance by providing them
enough skills and working tools
Conduct induction course to
HRHSW graduates
Develop clear objectives
and ensure availability of upto date job description
Develop performance
standards
Ensure effective supportive
supervision to all cadres
Monitor and evaluate
performance and takeappropriate actions
Ensure OPRAS is usedeffectively to all staff of MoHSWby 2009
Creating awareness on OPRAS to all staff Identify OPRAS facilitators
Conduct training to all staff
Visit work places to follow
up use of OPRAS
Ensure 30% increase ofMoHSW qualified personnel by2011
Increasing MoHSW qualified staff by 30% of the
current situation
Increase personnel emolument budget
Solicit funds
Long course training
Short course training
Review recruitment
procedures
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Specific Objectives Strategies Activity Total ActivityCost
Replacement
Advocacy and sensitization onissues pertaining to HRHSW,policy and decision makers by2009
Carrying out advocacy & sensitization on
HRHSW Policy & Decision makers
Conduct sensitization
meetings
Carry out advocacy
Conduct various training
related to HRHSW issues
Introduce induction courses toall health secretaries by 2011
Organize Induction course to all Health
secretaries
Obtain list of all Health
Secretaries
Conduct induction
course to all HealthSecretaries
Improve MoH recordsmanagement 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 recordsmanagement
Conduct effective
supervision to all registryassistant
Purchase enough and
modern working tools forregistry
Upgrade registry assistants
to Form Four
Enhance productivity of HRHSW Develop motivation and incentive package Identify types of motivation
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Specific Objectives Strategies Activity Total ActivityCost
by 2011 Train management on
motivation and incentivepackages
Introduce affordable
motivation and incentive
scheme
Increase/Strengthen privatesector participation in renderinghealth and social welfareservices by 2010
Design mechanism for Health and Social
Welfare services privatization
Identify areas for
privatization
Select mechanism for
contracting out
Set standards for
services to becontracted out
Develop contracts
Contract out the agreed
services
Monitor and evaluate
the implementation
Improve distribution of HRHSWat all levels
Ensure equitable distribution of HRHSW at
all levels
Monitor applicability of
staffing levels annually
Reallocate/retrench
excessive staff at alllevels
Improve working conditions forHRHSW by 50% of the currentsituation by 2011
Design mechanism for improving working
conditions
Improve budget for working conditions
Develop mechanism for
improving workingconditions
Repair of offices
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Specific Objectives Strategies Activity Total ActivityCost
Purchase of office
equipment i.e.computers, printers,photocopier machinetables, chairs, file
cabinets. Provide refreshments
for HRHSW staff
Provide transport
Provide House
especially those in hardworking environment
Strengthen managementcapacity of the MoHSWinstitutions by 2010
Enhancing management capability of health and
social welfare institutions
Capacity building to
HRHSW staff
Conduct management
training to HRHSW
Strengthen pre-service
training
Total Cost
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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 Target Indicators Means of verification Assumption/Risks
Harmonize andrationalize capacitybuilding with policyintentions by 2011
Capacity building harmonizedand rationalized with policyintentions by 2011
Number of capacitybuilding activities
Report on harmonizationand rationalization ofcapacity buildings andpolicy intention
Funds are available
Support from the top
level managers
All stakeholders involv
Increase capacitybuilding funding by 30 %of the current budget by2011
Capacity building fundingincreased by 30% of thecurrent budget by 2011
% increase of
capacity buildingfunding
Number of agreement
signed for sponsoringcapacity building
Budget document
Funding agreements
documents in place
Funds are available
Support from the top
level managers
All stakeholders are
interested
Promote gender balancefor HRHSW staff at alllevels by 20% of thecurrent situation by 2011
20% decreased of gendergaps by 2011
Number of gander gapsdecreased at differentlevels
Training reports
Sensitization reports
Employment data
Gender balance rema
a government priority
Support of the top lev
managers
Increase trainingopportunities by 20% forHRHSW staff by 2011
20% increase of training forHRHSW staff opportunitiesby 2011
Number of trainingopportunities
Training reports Funds are available
Stakeholders are willi
to support
Improve capacity of Capacity of training Numbers training Improvement reports Funds are available
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Specific Objectives Target Indicators Means of verification Assumption/Risks
MoHSW traininginstitutions by 2011
institutions improved by 2011 institutions improved Institutions database Support from
stakeholders
Political will
Improve capacityalternative medicinesproviders by 2011
Capacity of alternativemedicine providers improvedby 2011
Number of alternativemedicine providersreached
Capacity building
reports
Funds are available
alternative medicine
providers are willing Support from top leve
management
Promote communityparticipation onpreventable healthproblems by 2011
Increased communityparticipation on preventablehealth problems by 2011
Reduced number ofreported cases frompreventable healthproblems
Outpatient cases
reports
Funds are available
All stakeholders are
involved
Political will
Ensure MonitoringHRHSW performancecapacity buildinginitiatives at all cadresto 90% by 2010
90% of capacity buildinginitiates at all cadresmonitored by 2010
Number of monitoredcapacity buildinginitiatives
Monitoring reports Funds are available
Capacity building
initiatives are availabl
Target groups are
available
Ensure evaluation ofHRHSW performance
capacity buildinginitiatives at cadres to90% by 2010
90% of capacity buildinginitiates at all cadres
evaluated by 2010
Number of evaluatedcapacity building
initiatives
Evaluation reports Funds are available
Capacity building
initiatives are availabl
Target groups are
available
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Key Result Area: Develop and improve Human Resource capacity in the MOH and Social WelfareStrategic Goal: Strengthen HR for Health and Social Welfare to commensurate with demands through increasing
training opportunities, supporting alternative medicine providers in capacity building, and ensuremonitoring and evaluation of capacity building initiatives for all cadres.
SpecificObjectives
Strategies Activity Responsible Time Frame Sources of Fu
2006/
07
2007/
08
2008/
09
2009/
10
20010/
11
20011/
12
MoH LG Commu
nity
Othe
1.HarmonizeandRationalizeCapacityBuildingwith policyintentionsby 2010
Monitoringand evaluatepolicy fromtime to time toensure HRcapacityobjectiveshave beenimplemented
Create a team formonitoring andevaluation
MOH, H v v
Provide monitoringand evaluation teamwith the necessaryresource tofacilitate the process
Conduct stakeholdersconsultations meetingto harmonize policymeasures on capacitybuilding
2.Increasethe currentcapacitybuildingfunding forHRH andSW Budgetby 30% by2010
Mobilizeresources forHRH and SWCapacityBuilding
Identify and solicitfunds from variousstakeholders
v v v v
Conduct consultativemeeting to discussand agree on fundingmechanisms
Strengthenskills inbudgeting andbudgetarycontrol
Train healthSecretaries andAdministrators oneffective budgetingand funds accounting
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SpecificObjectives
Strategies Activity Responsible Time Frame Sources of F
2006/07
2007/08
2008/09
2009/10
20010/11
20011/12
MoH LG Community
O
3. Promotegenderbalance for
HRHSWstaff at alllevels by20% of thecurrentsituation
Mainstreaming gender inHRHSW
capacitybuildinginitiatives
1. Conduct genderawarenessseminars for policy
and decisionmakers at all levels
x x x x X
2. Review guidelinesand other workingdocuments ofHRHW toincorporate genderconcerns
3. Review curricula toIncorporate genderperspectives in atall levels
4. Increasetrainingopportunities for
HRHSWstaff by 20%by 2011.
1.Establishprioritized andcomprehensive training and
skillsdevelopmentneeds
1. Conduct trainingneeds assessment
x x x x x
2. Develop trainingprogram
3. Solicit trainingopportunities fromboth external andinternal
2.Mobilizefunds fortraining
4. Develop proposalto solicit funds fortraining
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SpecificObjectives
Strategies Activity Responsible Time Frame Sources of F
2006/07
2007/08
2008/09
2009/10
20010/11
20011/12
MoH LG Community
O
3. Promotegenderbalance forHRHSW
staff at alllevels by20% of thecurrentsituation
Mainstreaming gender inHRHSWcapacity
buildinginitiatives
1. Conduct genderawarenessseminars for policyand decision
makers at all levels
x x x x X
2. Review guidelinesand other workingdocuments ofHRHW toincorporate genderconcerns
3. Review curricula toIncorporate genderperspectives in atall levels
5. Enhancerapidupgrading ofphased outcadresthroughDistanceEducationby 2010
Design aprogramme tocarter for outphasedcadres inMOHSW
1. Conduct advocacyregarding selfdevelopment tophased out cadres
2. Design modality forsupporting phasedout cadres
DHR x x x x x v
3. Redesign healthand traininginstitutions toaccommodatephased out cadres
4. Enrolment of CA,MCHA andEnrolled Nursesfoe Distance
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SpecificObjectives
Strategies Activity Responsible Time Frame Sources of F
2006/07
2007/08
2008/09
2009/10
20010/11
20011/12
MoH LG Community
O
3. Promotegenderbalance forHRHSW
staff at alllevels by20% of thecurrentsituation
Mainstreaming gender inHRHSWcapacity
buildinginitiatives
1. Conduct genderawarenessseminars for policyand decision
makers at all levels
x x x x X
2. Review guidelinesand other workingdocuments ofHRHW toincorporate genderconcerns
3. Review curricula toIncorporate genderperspectives in atall levels
6. Improvecapacity ofHSWtraininginstitutionsby 2011
1. StrengthenHealthtraininginstitutions forqualitytraining
1. Conduct costanalysis ofrehabilitating andrenovating existinginstitutions
MOHSW
x x x x x
2. Build new orrehabilitateinfrastructurure
3. Coordinate trainingoffered at differentlevels
4. Create awarenessof AdministrativeOfficers on costeffective analysis incapacity building
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SpecificObjectives
Strategies Activity Responsible Time Frame Sources of F
2006/07
2007/08
2008/09
2009/10
20010/11
20011/12
MoH LG Community
O
3. Promotegenderbalance forHRHSW
staff at alllevels by20% of thecurrentsituation
Mainstreaming gender inHRHSWcapacity
buildinginitiatives
1. Conduct genderawarenessseminars for policyand decision
makers at all levels
x x x x X
2. Review guidelinesand other workingdocuments ofHRHW toincorporate genderconcerns
3. Review curricula toIncorporate genderperspectives in atall levels
7. Improvecapacity ofalternativemedicinesproviders by 2011
Mobilize andsupervisealternativemedicineproviders topracticesafely andappropriately
1. Identify alternativemedicine providersfor registration andsupervision
DMO x x x x x
2. Orient alternativemedicine providerson safety measures
3. Conduct quarterlyfollow up inspection
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SpecificObjectives
Strategies Activity Responsible Time Frame Sources of F
2006/07
2007/08
2008/09
2009/10
20010/11
20011/12
MoH LG Community
O
3. Promotegenderbalance forHRHSW
staff at alllevels by20% of thecurrentsituation
Mainstreaming gender inHRHSWcapacity
buildinginitiatives
1. Conduct genderawarenessseminars for policyand decision
makers at all levels
x x x x X
2. Review guidelinesand other workingdocuments ofHRHW toincorporate genderconcerns
3. Review curricula toIncorporate genderperspectives in atall levels
9. Ensureevaluationof HRHSWperformance capacitybuildinginitiatives forall cadres to90% by2001
1. Developmechanismsto monitorcapacitybuildinginitiatives andincorporate inoperationalplan
1. Develop tools formonitoringperformancecapacity buildinginitiatives
2. Monitorperformance aftertraining to establishthe impact ofcapacity buildinginitiatives
3. Conduct tracerstudies for curriculareview
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BUDGET
SPECIFIC OBJECTIVES STRATEGIES ACTIVITY TOTAL ACTIVITY COS
1. Harmonize and RationalizeCapacity Building with policyintentions by 2010
Monitoring and evaluate policy from time totime to ensure HR capacity objectives havebeen implemented
Create a team for monitoring andevaluation
Provide monitoring and evaluation
team with the necessary resourcetofacilitate the process
Conduct stakeholdersconsultations meeting toharmonize policy measures oncapacity building
2.Increase the current capacitybuilding funding for HRH andSW Budget by 30% by 2010
Mobilize resources for HRH and SWCapacity Building
Identify and solicit funds fromvarious stakeholders
Conduct consultative meeting todiscuss and agree on fundingmechanisms
Strengthen skills in budgeting andbudgetary control
Train health Secretaries andAdministrators on effectivebudgeting and funds accounting
3. Promote gender balancefor HRHSW staff at all levelsby 20% of the current situati