1. Big Results Now: Implementation progress to date Joint Annual Health Sector Review 2015 Technical Review Meeting 18 th November 2015

2. 1 The focus areas of BRN Healthcare NKRA and the initiatives aims to achieve 4 broad outcomes for quick transformation 6 initiatives 4 initiatives BRN Healthcare HRH RMNCH Health facilities Health commodities 80% of primary health facilities to be rated 3 Stars and above 100% balanced distribution of skilled health workers at primary level 100% stock availability of essential medicines 20% reduction in maternal mortality ratio and neonatal mortality rate in 5 regions

3. 2 Key: Regions with HRH distribution, Health Facilities, Commodities & RMNCH initiatives Regions with HRH distribution, Health Facilities & Commodities initiatives Regions with Health Facilities & Commodities initiatives * Baseline assessment to be done across all mainland regions The BRN initiatives intends to harmonise the implementation plans focusing at the most under-served regions Source(s): BRN Healthcare Lab 2014 Legend % Health MDG coverage index, 2010-2012

4. 3 HRH Distribution : 100% balanced distribution of skilled health workers at primary level Analysis of Postings done in FY 2014/15 1 Conducting analysis on funded Post received from POSPM for FY 2015/16 Determine the HRH needs for – FY 2016/17 HRH Analysis for 2015/16 and 2016/17 2 Total No% Posted staff9,735100% Reported, out of which : 8,312 85% Not reported at all1,42315% Prioritize application of employment permits to regions with critical shortage of skilled HRH Conducting Pre feasibility Study in collaboration with PharmAcess on PPP model to be used under HRH Initiative Results will be out by December 2015 Revision of Service Level Agreement is in Draft final stage, to be finalized by November 2015 Provide HRH through PPP 3 Reported and available 7,73093% Reported and left5827%

5. 4 National Average Density of Skilled HRH per 10,000 population increased from 7.74 to 9.3 On average, 4 regions improved from below National average to above national average (Katavi, Kagera, Mtwara & Mwanza) 3 regions became worse from above to below baseline National average of 7.74 – (Manyara, Lindi & Mbeya) 9.3 Density of Clinician and Nurses per 10,000 Population After 2014/15 Posting BeforeAfter Regions critically below 2014’s National average of clinicians and nurses density 910 Regions at borderline of 2014’s National average for clinicians and nurses density 41 Regions above 2014’s national National for clinicians and nurses density 1214 7.74

6. 5 Requested POPSM Implementation Guideline on Pay and Incentive policy (2010) for the 29 LGA’s To be used as basis to advice the LGA’s on the implementation Trained 40 National TOT for WISN Develop National Workload Standard to be used 1 st Training for Dodoma and Ruvuma Region to be held on 9th to 21 st November 2015 HRH Distribution : 100% balanced distribution of skilled health workers at primary level Redistribution of health workers 4 Enforcing retention & incentive policy at LGA 6 PMORALG submitted request to POPSM for permit for Fy 2015/16 for budgeting of subsistence allowance for LGA’s Request for Ring fencing of subsistence allowances will then be submitted to MOF Ring Fencing of Subsistence Allowances 5 PMORALG issued a remind note to LGA’s to plan and budget for orientation and induction of new staff Reinforce Orientations and induction for newly hired staff 7

7. 6 The mechanism is in the process of being developed Stakeholders meeting is expected to take place in December 2015 Plan to have the system in place by March 2015 Star Rating Completed in Mwanza, Shinyanga and Geita Regions Start assessment's for Mara, Simiyu and Kigoma Regions as from 8th November 2013 To complete assessments in 12 BRN Regions by February 2016 Health Facilities : 80% of primary health facilities to be rated 3 Stars and above Star Rating Assessment 1 National Health Facilities User Satisfaction Level Scoring System 3 3652 (64%) out of 5699 have validated bank Accounts PMORALG to conduct visits as from 8th November 2015 to validate the banks accounts in the LGA’s Opening of Accounts in lower Health Facilities 2

8. 7 Star Rating MwanzaGeitaShinyangaTotal% 0 Star 1517040 26136.8% 1 Star 16171147 37953.5% 2 Star 371217 669.3% 3 Star 102 30.4% 4 Star 000 00.0% 5 Star 000 00.0% Total Facilities 350153206 709 Target 280122165709 0-2 : 99.6% of all facilities Star Rating Assessment Findings

9. 8 Tender evaluation and Board for Private Distributors of health commodities is completed. Tender award in November 2015 MSD is in process to conduct feasibility study on local manufacturing Plant under PPP Toolkit for best practices of health commodities is in place and implemented in Serengeti, Busega, Chato, Kwimba, Kigoma and Muleba districts. Pilferage tool is under development Donation guideline approved & to be disseminated Health Commodities : 100% stock availability of essential medicines Improving governance, accountability and sense of ownership of Health Commodities supply chain 1 To complement MSD in the procurement & distribution of medicines by engaging private sector 3 Prime vendor on MSD zonal basis is on going Government strategic review of MSD is in progress to see how best MSD can be strengthened The dialogue for MOU among MOHSW (vertical program actors), MSD and MOF is on progress Strengthen management of MSD working capital 2

10. 9 5S -KAIZEN-TQM for health commodities manual and facilitators guide developed. Pending availability of funds, editing, pilot testing of the documents and translation into Kiswahili will be done prior to implementation Assessment of health facilities readiness to implement e-LMIS done in 6 districts (Serengeti, Busega, Chato, Kwimba, Kigoma and Muleba districts). Roll-out of eLMIS at district hospitals completed in 17 regions. ICT unit is working on analysis and further rollout. Health Commodities : 100% stock availability of essential medicines Introduction of ICT mobile applications platform at lower level facilities 4 Scale up 5S-KAIZEN-Total quality Management (TQM) initiatives to improve inventory management from district level to lower health facilities level 6 ICT Planning is on going. Development of SMS platform pending funding from Global Fund Use of SMS to report stock outs and quality of health services by service users and civil society 5

11. 10 Region Number of CEmOC FacilitiesNumber of BEmOC Facilities BaselineTargetGapBaselineTargetGap Geita21210135643 Kigoma42319910091 Mara322192511388 Mwanza7342713123110 Simiyu1141346157 Total171058864453389 Region Target for CHW Baseline of CHWs # of New CHW to be trained Geita5,3861,5983,788 Kigoma4,3581,4242,934 Mara3,9732,0741,899 Mwanza5,5434,3181,225 Simiyu3,9243,390534 Total23,18412,80410,475 Mapping was completed in Simiyu and Kigoma regions in July 2015, while the mapping for the other 3 regions of Mwanza, Mara and Geita was completed in Aug. RMNCH : 20% reduction in maternal mortality ratio and neonatal mortality in 5 BRN regions EmONC assessment completed in 5 RMNCH regions 1 Community Health Workers (CHWs) 2

12. 11 Anticipated challenges in implementation & mitigation measures Anticipated challenges Shortage of funds to implement all the initiatives Delayed disbursement to the Ministry, implementing agencies and to the LGAs Buy-in from all stakeholders for smooth implementation Suggested mitigation measures Integrate budget into MTEF through government funding; identified funding gaps to be negotiated from the partners for respective LGAs To streamline the disbursement of funds at central level to LGA Continuous communication and syndication with all levels of stakeholders to galvanize support for BRN

13. 12 Asante Sana