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3.  Background  District Health Services  Council Health Services Boards and Health Facility Governing Committees (CHSB and HFGC)  Regional Referral Hospital Services  Regional Level Support (RHMT)  Progress made by the District and Regional Technical Working Group  Challenges  Way Forward and Recommendations 9/5/2015 3

4. The Health Sector Strategic Plan III (2009- 2015) features three strategies dealing directly with decentralization:  District Health Services  Referral Hospital Services  Central Level Support including RHMT The TWG No. had four milestones to oversee its implementation- Milestones No 1, 2,8, and 9 9/5/2015 4

5. Progress has been made in several areas, which includes the following: Revision of CCHP guideline Revision of CHSB guideline Review of the reporting system (incl. planrep and epicor) Revision of priority areas in the National Essential Health Package 9/5/2015 5

6.  Milestone No 1: the February 2007 CCHP guideline as well as the assessment tools were revised in line with Health Sector Strategic Plan III (2009- 2015), MKUKUTA and other agreed Sector strategies.  The CCHP guideline was pretested at the LGAs level by inclusion of the priority areas into their CCHPs for 2010/2011.  The review also took into account HSDW under MMAM, inclusion of Social Welfare services and Social Protection and certain audit issues. 9/5/2015 6

7.  The CCH plans 2010/2011 and performance reports for FY 09/2010 have been reviewed and compiled  Many were submitted late,  with incomplete and inconsistency data.  The findings highlighted the need to focus and further strengthen the CHMTs and RHMTs to be able to analyse and reconcile data and translate the strategies and priorities defined in the HSSP III at district level.  In addition work is underway on the overall reporting system in order to achieve efficiency gains at all level (district, region and central) through improving the Planrep tools and its interface with Epicor. 9/5/2015 7

8.  The revision of the priority areas in the Essential health package has resulted into increasing the priority areas from six to eleven.  The revision of the Essential Health Package guideline and target indicators will be finalized by 2011, using the findings of the Demographic Health Survey and in line with the MKUKUTA II monitoring table and revised Performance Assessment Framework (PAF) indicators.  Supervision reports lack consistency as such:-  Few reports stated objectives of the supervision visits  Findings differ with the stated objectives 9/5/2015 8

9. Milestone No 9  Guidelines for establishment of CHSB were revised The Facilitator’s guide manual for orientation of CHSB members on their roles was also developed and pretested in six regions.  The overall training will be conducted based on LGAs request.  However, Ten out of 20 new LGAs were sensitized on understanding their roles and responsibilities. 9/5/2015 9

10.  Milestone No 2  Twelve Regional Referral Hospitals (RRH) developed annual health plans and Strategic plans supported by their respective RHMTs  others were able to develop their plans applying skills acquired through initial HMT trainings. The status is as follows:  Staff Competence and experience varies between regions some regions  Managerial skills depend on the individual efforts hence management commitment varying between regions. 9/5/2015 10

11.  The RRH plans were reviewed, and it was found to be of acceptable standard, however further training is required.  Weak planning skills and inadequate funding was found to be the big challenge facing the HMTs.  Activities which were planned in year 2009/2010 under the RRH services including training of Regional referral HMTs in strategic and annual planning were not implemented, because funds were disbursed late in June 9/5/2015 11

12.  Milestone No 8  The government has approved eight RHMT core members in the RS Team. The RHMT activities and budget have been reflected in the RS MTEF 2010/2011.  RHMTs received allocation from basket fund timely. Block grant was so far released only for Regional hospitals and few regions allocated limited funds to RHMT for supervision only. 9/5/2015 12

13.  The TC-RRHM in collaboration with the MOHSW conducted different interventions to strengthen capacity to Regional Health Management Teams.  In 2010/2011 all 21 RHMTs prepared their own Strategic Plans (SPs).  These SPs were reviewed and feedback was given to the regions.  Annual Planning templates for RHMT was developed and used for developing RHMT plans for 2010/11 reflecting ten core functions of the RHMT including supportive supervision to CHMTs. 9/5/2015 13

14.  RHMTs are able to compile and analyze data from CCHPs however, they still need further capacity building in report writing.  RHMT performance reporting template is to be developed to maintain uniformity of reporting implementation of their quarterly and annual performance.  In collaboration with TC RRHM, MOHSW has introduced the new system of incorporating Zonal Health Resource Centres staff in conducting Central Management Supportive Supervision to the regions since August 2010.  Further training and strengthening of the RHMT to perform their mandate of supporting CHMT and evaluating CCHPs and progress report will be a priority area for the TWG. 9/5/2015 14

15.  The group has been very active since its inception.  It has met six times deliberating many issues pertaining to the delivery of the health services, issues concerning DHS, RRHs, RHMTs, CHSBs and HFGCs.  And other tasks assigned by TC SWAP/ BFC. 9/5/2015 15

16.  Gap between expected range of services and actual services delivered  Shortage of skilled staff  Old and dilapidated infrastructure and equipment  Financing gap between actual needs and allocation  Construction of health facilities  Establishment of LGAs structures limiting comprehensive planning for health services  Variable pace among key hospital reform issues e.g. governance and community oversight through boards and financial reforms.  Inadequate capacity building in planning, data analysis and reporting 9/5/2015 16

17.  Orientation of the CHPTs and RHMTs on the revised CCHP guidelines.  Revised CCHP guidelines to be included in the Planrep software.  Update on reporting system – including planning and reporting tools  Review the National Essential Health Package guidelines and performance indicators  Train the regional referral hospital management teams, in planning, and managing hospital resources. 9/5/2015 17

18.  Finalize Hospital plan format/template.  Train and support CHMT and RHMT teams in planning and reporting with the revised guideline.  Finalization of the RHMT assessment of CCHP reporting templates.  Finalization of CHSB guidelines.  Finalization of RHMT performance reporting template  Allocate budget for implementation of the above tasks/proposals 9/5/2015 18

19. Thanks for listening LGAs have not received funds todate 9/5/2015 19