Self-reliant Capacity Development
for District Health Managers Harmonization of TAs and SWAp
A Case of Morogoro Health Project, Tanzania
Dr. G.J.B. MteyDr. G.J.B. Mtey & Ms. Erika FukushiMorogoro Health Project
LenCD Forum, Nairobi, Kenya3rd October, 2006
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Better ManagementBetter ManagementBetter HealthBetter HealthBetter FutureBetter Future
Mt. Ulugulu
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Contents
1. SWAp and Health Sector Reform in Tanzania
2. Morogoro Health Project (MHP)
3. Complementary Roles of SWAp & MHP
4. Effective Approaches for Self-reliant CD
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SWAp & Health Sector SWAp & Health Sector Reform in TanzaniaReform in Tanzania
Mkambarage Dispensary
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Fragmental budgeting
On budgeting
Sector Programming
Bipolar Sector Budgeting
Integrated Sector Budgeting
National budget
planning
Sector budget planningTransparent budgetingUnknown budgeting
MTEF Planning Management
Multiple budget complex
On project budget
Sector Basket Fund Project type budget (known)
Sector budget integration
TANZANIATANZANIA
Steps towards SWAp/GBS
Integrated National BudgetingIntegrated National BudgetingNational budget
integration (GBS)
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0
50
100
150
200
250
300
2000 2001 2002 2003 2005
Other foreignBasketGOT
million US $
24.2%
19.3%
13.9%
7.3%
Health Sector Public Expenditure Review 2003/ Annual Health Sector Review 2005
26.0%
Sector Basket Fund in Tanzania
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Health Sector Reform in Tanzania
PAST NOW
Central Government
International Society
Community
RHMT
CHMT
Central Government
International Society
Community
RHMT
CHMT
MHP
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Morogoro Health ProjectMorogoro Health Project
Morogoro Morogoro RHMTRHMTMunicipal Municipal CHMTCHMTMorogoro Morogoro CHMT CHMT Mvomero Mvomero CHMTCHMTKilosa CHMTKilosa CHMTKilombero Kilombero CHMTCHMTUlanga CHMTUlanga CHMT
&
Project Advisor TeamDr. Sugishita
Dr. FupiMs. Fukushi
Ms.TsudaMr. Goto
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Morogoro Health Project (MHP)(April 2001-March 2007)
OBJECTIVE
• Health management skills of the Regional/Council Health Management Teams (RHMT/CHMT) and other Frontline Health Workers (FLHWs) are improved in a self-reliant and sustainable manner.
OVERALL GOAL• Quality of health services in Morogoro region
is improved.
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Management Skills
MHP
Morogoro Health Project
• Leadership• Teamwork• Delegation • Resource Mgt.• M&E
• Community involvement• Active listening• Communication• Feedback & dissemination• Customer care
• PC skills• Data analysis• Financing• Documentation• Presentation
• FLHWs involvement • Data collection• Supervision• Motivation• Facilitation
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Development with MHP
Development without MHP
Daily Practice in workplace
Capacity Development
Team-work
TrainingWGs
MHP Development Package(Trainings + Working Groups + Support in Daily
Practices)
Leadership
FeedbackTraining
WGs
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Complementary Roles of SWAp & MHPComplementary Roles of SWAp & MHP
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Complementary Roles of SWAp and MHP in HSR
• Demand-driven prioritization and budgeting• Decentralized power of decision-making• Evidence-based planning • Sound M&E framework and managing system• Linkage between funding and outcomes• Sector-beyond coordination and collaboration• Effective use of rapidly increased budget for LG by SWAp• Smooth disbursement of the available funds• Scrutiny of different financial management practices• Timely reporting and visual presentation
MHP responds to various demands in Health Sector Reform at Local Government in collaboration with SWAp.
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Basis Political Basis Financial Basis Management Basis
ObjectiveSelf-reliant effort
for poverty reduction
Self-reliant budgeting at Local
Government
Sustainable management
capacity development at
Local Government
ImplicationAdministrative
reform and Power decentralization
Sector basket fund in health sector
Strengthening of office function and human resources
Response
National Policy
( PRSP, MTEF etc)
Available fund at Local Government
(26% x 48%)
JICA Morogoro Health Project
Enabling Health Sector Reform
Three Basis for sustainable CD
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Development Budget to Recurrent Budget
MHP integrated development budget for project operational costs into recurrent budget for the Local Government through Health Sector Basket Fund in the Health SWAp. This delegation is welcomed by Tanzanian side and Basket sponsors, because it promotes a self-reliant capacity development with a highly motivated way due to additional incentives.
Development budgetby JICA
Recurrent budget
by LG of TZ
Initial period
Development budgetby JICA
intermediate period
SWAp
HSBF
CCHP
Recurrent budget
by LG of TZ
Technical assistance (management training)
terminal period
Regular budgeting
IncentiveMotivation
CCHP SWAp
HSBF
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Effective Approaches Effective Approaches for Self-reliant CDfor Self-reliant CD
Kimamba Health Center
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A person or project that cause a change.“I see my role as being a catalyst for change.”
CatalystCatalyst
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Management trainingManagement training Working GroupsWorking Groups
Day-to-day ActivityDay-to-day Activity Communication forumCommunication forum
Self-reliant Self-reliant DevelopmentDevelopment
System System InnovationInnovation
Local to Local Local to Local NetworkNetwork
Potential CapacityLeadership, Teamwork, Communication
EncouragementEncouragementEnforcementEnforcement
ExposureExposure
EnhancementEnhancement ExcitementExcitement
Effective Approaches for Self-reliant CD
EmpowermentEmpowerment
ExerciseExercise
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7E Catalytic Approach for CD
3.Excitement
4.Exercise
2.Exposure
6.Empowerment
5.Enhancement
Think together, learn together! Think together, learn together! 1. Encouragement
7. Enforcement
To be exposed to new knowledge and experiences*Basic Management Trainings*Exchange/ Study visit *Involvement of stakeholders
To be exercised to consolidate applied skills in day to day routine activities. *Application of PCM method (project management tool) in Planning, implementation and M&E.
To be enhanced conventional skills to develop better management tools through local to local networking.*Working Group management*Utilization of local resources
To be empowered to innovate healthsystems in a self-reliant manner.*Continuous process of personal, organizational and system development.
To be excited to develop applied management skills. *Identification of district ignored problems through OPR, IT, communication and IRC tools.
To be enforced management tools in an institutionalization manner.*Dissemination, integration and sophistication in areas, organizations or sectors
CATALYSTS
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Innovation & Development
Central GovernmentCentral Government Development PartnersDevelopment Partners
RegionRegion RegionRegion
RegionRegion
RegionRegion
RegionRegion
RegionRegion
RegionRegion
RegionRegion
MorogoroMorogoro
Interactive Local Communication & Networks
System innovation at local levelSystem innovation at local level
Management Management EmpowermentEmpowerment
CommunicationCommunicationForumForum
Integration and Sophistication
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Lessons Learned Overview
• Basic and Applied Management skills
• Teamwork and Leadership
• Working Group Arrangement
• Visual Products
• Utilization of Local Resources
• District to District Networking in the Region
• Focus on Practices (Do it again and again and again!)
• Role of Catalysts
• Evidence-based District Health Management
• System innovation
• Cost-sharing in Collaboration with SWAp
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Innovation towards the health Innovation towards the health system, system, in which everybody feels happiness.in which everybody feels happiness.
I can do it !!I can do it !!
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The Way to Our FutureThe Way to Our Future
Tanzania – Japan Morogoro Health ProjectTanzania – Japan Morogoro Health ProjectP.O.Box 1193, Morogoro, TanzaniaP.O.Box 1193, Morogoro, TanzaniaTel: 023-2614002 Fax: 023-2614148Tel: 023-2614002 Fax: 023-2614148
Mobile: 0754-335599Mobile: 0754-335599E mail: E mail: [email protected]
[email protected]@yahoo.co.jpWebsite: Website: http://www.project.jica.go.jp/tanzania/5481081E0/
(Access to (Access to “Google”“Google” and search with “Morogoro Health Project”) and search with “Morogoro Health Project”)
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