1. Capability Assessment of PMO- RALG Presentation for the Development Partners Group Meeting Wednesday 27 th of October 2015 Supported by DANIDA

2. Objective of this Mandate Propose the approach, outcomes, deliverables and management framework that should be incorporated into Danida’s strategy for its institutional support to PMO-RALG in the implementation of HSSP IV.

3. Team Composisition 1.PMO-RALG Representative 2.Local Consultants (2) 3.Internaiotnal Consultant (1) 4.Danida Adviser (1)

4. How we went about it Documents review Creation of matrix that identifies principal Capability Gaps in relation to specific functions of PMO-RALG using: 2014 President-signed delegation of functions and activities of PMO-RALG as a baseline Other Documents including (Official Strategic Plans and Guiding Principles, Tools and guidelines, Descriptions of Systems, processes, policies, manuals, including Regional Health Mgt System) Interviews with key stakeholders Field Visits Mbeya (RAS, RMT, MC) Shinyanga (RAS, RMT, MC) Team Discussions

6. Issues adressed - Summary Ability to build and maintain an organisational architecture (that integrates well with policy and decentralised governance structures and supports operational arm of Health Division: ex. structures, clear delineation of mandate for improving health outcomes (policy-delivery), lines of responsibilities and precise understanding of functions), Accountability frameworks and processes (accountability to hold delegated persons or orgs accountable at all levels in most activities) Ability to develop, quality control, supervise and improve execution at all levels including outcomes: ex. through compliance of policies, regulations at all levels (transfer knowledge, monitor and motivate) Major capability issues involving multisector intervention (such as Nutrition and Social Welfare Services) (targets and programmes, and the execution of any effective actions) Ability to integrate management functions at operational levels (including evidence-based decision- making, access to, harmonization (interoperability) and strategic use of information for future-oriented planning, decision-making and policy development (financial, epidemiological, human resource, utilisation, surveys and research findings)) Generating value-added co-ordination (ensure all activities (ex. Development Partners) are “on plan” and follow all government systems (use of guidelines, monitoring and evaluation tools). Making the sum of the parts greater than the whole for all roll-ups of operational actions) Ability to ensure that appropriate resources are available in required amounts and when needed (ensure predictability of finances and human resources, just-in-time delivery of supplies and equipment etc) Ability to roll-down interpretations, analysis and adaptation of policy, regulations and process guidelines

7. Organisational Architecture Structures, borders and authorities. Lines of responsibility in policy- delivery as well as PMO-RALG-LGA interfaces. Understanding of functions and what they mean (ex. coordinate, interpret…) Delineation of mandate, performance targets and expected outcomes for improving health outcomes (including Basic Benefits Package, social services, nutrition). Integration of Zonal Resource Centres and Training Institutions (including those of PMO-RALG) into ongoing management. And the EFFECT of strengthening these.

8. Levels of intervention Central Level PMO-RALGRegional LevelCouncil Level

9. An example: Strengthening for RHMTs and CHMTs Co- opted members (Technical Teams) During the 1990's, Council Health Management Teams (CHMTs) were formed to take charge of health service delivery within the District Council as part of the health sector reform. CHMTs' key functions include organizing, supervising, monitoring and evaluating health services, and development of the annual Council Comprehensive Health Plan (CCHP). The new staffing level guideline 2014 – 2019 has thus concluded the formation and composition of the governance and technical committees.

10. Composition of RHMT/ CHMT RHMT/CHMT is composed of eight core members and additional co-opted members a.Core members are as follows:- District Medical Officer, District Health Secretary, District Dental Officer, District Nursing Officer, District Social Welfare Officer, District Health Officer, District Nutrition Officer, District Pharmacist, District laboratory Technician. b.Coopted members were drawn from the existing vertical projects and interventions to facilitate services delivery at LGA level. These members are chaired by Medical officer in charge, and core chaired by Epidemiologist.

11. Capabilities of the CHMT The key focus of the Health Sector Reforms has been to build capacity of the core members of the teams leaving aside the technical teams despite the fact that the key role of health service delivery is in their hands. This irregularity created a mis link between core and coopted members to an extent that coopted members were not part of the Council Health planning and had limitations in the use of data that they generate,this has an overall effect on quality of services offered to the community.

12. Findings Lack of clarity of roles and responsibilities of the teams Ability to ensure that appropriate resources are available in required amounts and when needed i.e ensure predictability of finances, human resources and supplies. Inadequate individual capabilities and recognized competencies (KSA).

13. Focus of the capability strengthening This capability strengthening seeks to remedy and mainstream the CHMT coopted members into governance and service management of their key intervention to ensure quality services provision.(cross cutting- lack of clarity at higher levels) Specifically the capability strengthening will address the following:-  Ensure more effectiveness and efficiency for the delivery of services at patient level.  Clearly define roles and responsibilities as technical members of the CHMT and rationally assign them to ensure accountability including social welfare and nutrition services.  Empower the technical teams with monitoring and supportive supervision skills to enable them tom assist lower level facility service providers

14. Focus cont…  To support clarity and implementation of the roles and responsibilities of the CHMT, RHMT technical teams as defined in the draft document of the TOR.  Support the technical teams to generate value added coordination by maximizing the linkage with the already strengthened governance teams by simplifying complicated and multiple situations (ensuring the parts work closely together).  Analyze and address the underlying causes of inefficeiency  Provide them with resource mobilization techniques to ensure that they able to explore the available potentials for implementation of their activities

15. Focus cont…..  Provide strategic management skills to create an enabling environment in service delivery points, focusing on systems building practices such as financial, human resources, logistics etc. reflecting the current and future needs of the public.

16. CONCLUSION The key ideas attached here are derived from the discussions we had and the capability assessment conducted on PMORALG HEALTH supported by DANIDA. PMORALG will lead the way forward through creation of Taskforce with the main key stakeholders.

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