Health Sector Strategic Plan
2015-2020
(HSSP IV)
Reaching All Households with Quality Health Care
JAHSR –TECH NOV 27,2015
Dr. Oberlin M. E. Kisanga-Head/HSRS
The HSSP IV
is about
 Increasing efficiency through more
integration and capitalizing synergies
 Deepening D-by-D (fiscal decentralization +)
 Improving quality of services through
Better performance
Enhancing partnerships
Priorities and where to gain more value for
money
2
HSSP IV Overall objective:
 To reach all households with essential
health and social welfare services,
meeting as much as possible expectations
of the population and objective quality
standards applying evidence-based,
efficient channels of service delivery.
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Strategic Objectives
1.
Attain objectively measurable quality improvement of
primary health care services
2. Improve equity of access to services by focusing on
geographic areas with higher disease burden and vulnerable
groups .
3.
Achieve active community partnership through
intensified population interactions for better health and social well
being
4. Applying modern management methods and
innovative partnerships
5. Improve on social determinants of health through
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inclusion of health protection and
promotion
Strategic Decision: Emphasis on
Community Health and Primary
Prevention
 Health Promotion, Prevention and Basic Care
in Community Health is key element of
strategy to reach all people and to reduce
costs of health and social welfare services
5
Strategic Decision : Enhanced
Social Welfare at LGAs
Create a full-fledged department at LGAs addressing:1. Operationalization of MVC action plan
2. Establishing social protection for persons with
disabilities, MVCs and elderly persons
3. Establishing multi-disciplinary prevention and
response services for victims of violence, abuse,
neglect, exploitation and trafficking
4. Building capacity for Juvenile Justice and
Correctional Services
5. Setting up accountability mechanisms for child
protection
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Strategic Decision: Emphasis on
Quality Primary Care services
 Pursuing Star Rating and Improvement
programme countrywide (achieve 80% of the
PHC facilities 3 star at least)
 Essential National Package of Health
Interventions to be agreed and provided
 BEmONC and CEmONC capabilities at all
primary facilities
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Critical support systems
1. Human resource for Health production, redistribution, fast
track deployment, retention, P4P, accreditation and CPD
recognition
* Social Welfare workforce production plan
implementation
2. Medicines and supplies availability
2. Maintenance and ppm (infrastructure, transport and
equipment); new infrastructure in underserved areas,
avoid duplication
3. Financing – Universal and equitable access (single public
insurance servicing MBP); efficient and effective use
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Strategic Decision: Equity for
populations and vulnerable groups
 More resources to Regions with higher
burden of diseases
 More resources to Regions with lower levels
of service delivery
 RMNCH has priority because of vulnerability
pregnant mothers and children
 Adolescents (girls and boys) services
 Integration of health and social welfare
services at district ,ward &community level
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Strategic Decision: Social
Accountability
 Empowerment of communities to co-manage
health facilities
 Decision making Powers of Governing
Committees and Boards
 Transparency: community reporting on health
facilities’ performance
 Client satisfaction as element in performance
management
10
Strategic Decision: Performance
as Basis for Operations
 Performance Management Systems
 Individual level
 Institution level
 Results Based Financing
 Level playing field Public and Private Facilities
 Monitoring of Performance
 Data for decision-making approach
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Strategic Decision: Accommodate
upcoming NCD needs
 Emphasis on prevention of NCDs
 Improve capacities of health staff in handling
NCDs
 Integrate NCDs in diagnostic and treatment
centres
 Strengthen treatment of advanced NCDs with
innovative financing strategies
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Professional Councils and
Associations
 Professional Councils – Shall Update Existing Policy
guidelines on Medical and Professional ethics and
monitor Compliance and
 Professional Associations –Shall Promote Professional
Standards, Commitment, Attitudes and ethics.
 Pr.Associations shall organise and Conduct Regular
CPD activities in line with national CPD guidelines
 The Federation of Tanz. Health Professional
Associations shall be the Voice of all the professionals.
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Strategic Direction: Operational
Research and Surveys
 NIMR,IHI, the Eight Medical Universities have
demonstrated joint efforts in Health and Social
Welfare research.
 National Health and SW Research Priorities identified
and Documented. Take note of the 5 Strat Objectives.
 Joint efforts are encouraged to address total
National research priorities
 Utilisation of Research findings for policy decision
making –a crucial element
 Open Access Policy for available information
advocated
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Strategic Direction:
Accommodate Research and
production
 MOHSW ,COSTECH, ACCADEMIC INSTITUTIONS to
create condusive environment to maximise research
and capacity dev. for local pharmaceutical industries.
 Facilitate PPP in local production of Right Priced
quality pharmaceutical products
 Single
 Maximise Tanzanian Medicinal plants research and
protect Intellectual property.
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Strategic Decision: Health Financing
 Health Financing strategy
 aim for equitable access
 Universal health coverage
 Single National Health Insurer
 Implement Minimum Benefit Package (MBP)
 Advocate for more Government Resources
 Raising resources for health
 revenue, sin and other taxes
 Trauma fund, from road taxes insurances
 Revolving Funds; OOP payments
 Regulatory body: Price control medicines
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Strategic Decision: Governance
 Decentralisation by Devolution (to LGAs)
 Fiscal decentralisation to institutions
 Partnership
 PPP, private sector participation
 Public-Public Partnerships, networking
 Social accountability
 Increased inter-ministerial collaboration
 SWAp mechanisms
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BRN is top priority in
implementation
Scale up BRN
Countrywide after
2018
Health services
or systems area
HSSP IV
costs
BRN costs included
(constant across scenarios)
(TSH
billions)
RCHS
Maternal and child health support activities (e.g. trainings,
mass media, etc.) specified as priorities under BRN and
expanded under OnePlan II
323.1
Infrastructure
Costs of facility upgrades and equipment for BeMONC
and CeMONC
59.3
Performance
Improvement
Facility star rating assessment, fiscal decentralization,
social accountability, and performance target activities as
specified under BRN
25.0
Commodities
Costs related to commodities and quality improvement,
including costs to address pilferages
21.9
HRH
Staff redistribution costs and other priority BRN HRH
activities
14.6
Fiscal Space for HSSP IV
 Resources for the HSSP IV – Costs
 In five years TZS 11,300 billion (11.3 Trillion)
 In 2015-16 TZS 2,087 billion (2 trillion) available Vs 4,031b (4tr)
needed per year.
 Increase to 2,503 billion (2.5 trillion) in 2019-20
Commodities represent 78%; HIV about 30 to 33%
 Financing gap from fiscal space analysis
o Ambitious scenario (SNHI and Innovative fin) the financing
gap will be TZS 515 billion (0.5 Trillion) in 2016/2017 growing to
TZS 1,525 billion (1.5 Trillion) in 2019/2020
o Without SNHI and Innovative financing the gap is TZS 1,410
billion (1.4 Tr)in 2016/2017 and grow to TZS 2,453 billion (2.4
Tr) by 2019/2020
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Scenario 2: Funding gap
6000
Close the
funding gap!
TZS Billions
5000
Scenario 2 costs
4000
Base, no SNHI, no
innovative sources
3000
Base, no SNHI, with
innovative sources
2000
SNHI scenario 1
1000
SNHI scenario 2
0
2015/16
2016/17
2017/18
2018/19
2019/20
Summary
 With innovative financing and continued growth in existing
health insurance schemes, the Country can access 3─3.5
trillion TZS per year* over 2015/16 to 2020/21
 Without innovative financing, the range is 2─2.5 trillion TZS
p.a.*
 With innovative sources, health as a % of the GOT budget
(excluding CFS) would average 15% from 2016/17
 Without innovative financing, given declines in some on-
budget sources and slow growth in domestic sources, the
same average figure would be 10%
Implications
 With Scenario 2 we alleviate the financing gap BUT still
remain with a gap in relation to total HSSP IV cost
 This has implication for level of ambition of the sector
program targets
 Argument for fast tracking the HFS is stronger
 Emphasis on innovative cost cutting, synergies and value
for money from coordination, Alignment &
Harmonisation, integration
 Effective use of resources (fiscal decentralization,
accountability, cost-effective interventions, resource
mapping)
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HSSP IV Implementation
Arrangements
 CCHP 2016/17- October 2015- Mainstreaming Health
and Social Welfare programs into CCHP Interventions,
activities and Indicators.
 RMOs,DMOs sensitisation –September 2015
 Mainstreaming to MOHSW -MTEF and PMORALG
Health Workplans
 SWAp Code of Conduct Updated.
 HSSP IV Common Management Arrangementunderway.
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Q-People
engagement
Quality is @ the Core
Thanks 4 ur attention
Q Service
Provision
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Q
Leadership