1 / 47

Dr . Anna Nswilla Assist Director Health Services OR - TAMISEMI Dodoma

DIRECT HEALTH FACILITY FINANCING (DHFF) presented at the 1 st Annual M&E Conference 11-15 th December 2017 at SeaScape Hotel, Mbezi Beach, Dar es Salaam. Dr . Anna Nswilla Assist Director Health Services OR - TAMISEMI Dodoma. Presentation Outline. Why DHFF? Introduction

erabon
Download Presentation

Dr . Anna Nswilla Assist Director Health Services OR - TAMISEMI Dodoma

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. DIRECT HEALTH FACILITY FINANCING (DHFF) presented at the 1st Annual M&E Conference 11-15th December 2017 at SeaScape Hotel, Mbezi Beach, Dar es Salaam Dr. Anna Nswilla Assist Director Health Services OR - TAMISEMI Dodoma

  2. Presentation Outline • Why DHFF? • Introduction 2. Background 3. Rationale & Expected Results 4. Potential Risks 5. Minimum Requirements to qualify for DFF 6. Governance Structure 7. Facility Planning

  3. Presentation Outline 8. Public Financial Management 9. Financial Allocation 10. Overview of process from preparation to Implementation 11. Implementation Oversight

  4. Why DHFF?

  5. Functional HF

  6. Status of Health Services

  7. Health Centre

  8. Types of washrooms at the HFs

  9. 1. Introduction • The GoT is committed to deliver fair, equitable and quality health services to all Tanzanians. • The district health services constitute the backbone of the health care in the country and delivers essential health care at dispensary, HC and DH level. • The CHMTs oversee and administer the health services at the council level.

  10. 1. Introduction • The CHMTs are planning for the entire services in the councils through the CCHPs • At the moment, the flow of funds goes through the Health Sector Account at the LGA • The GoT has decided to move towards DHFF to health facilities in order to ensure timely and availability of funding which will enhance performance and flexibility at the level of Service Delivery.

  11. 1. Introduction • HBF to LGAs earmarked to support CCHPs has always been disbursed to Council Health Account • and mandating the council health administration to oversee the utilisation of the financial resources mainly in supporting a CCHP • at all Cost centres (DMO’s/CHSB, CH, HC, Disp, VAH and Community

  12. 1. Introduction • During 2016 JAHS Policy Meeting, the GoT and partners agreed on a policy commitment stating that Direct Health Facility Financing (DHFF) should be implemented in the entire country. • PO-RALG, MOHCDGEC and Partners have now agreed that this financing model should be used in all heal th facilities in FY 2017/18.

  13. 2. Background • The decision to move towards DHFF builds upon the fact that timely availability and funding at the level of Service Delivery can unlock important barriers to effective and efficient health care delivery and contribute to better health for the population.

  14. 2. Background • Fortunately, Health Facilities in Tanzania already have an experience of managing funds e.g.in relation to the 1997 CS reform initiatives; funds collected as user fees, NHIF and CHF • provided a tangible experience to facilities to generate funds for purchasing medical supplies, soap, water, minor repairs, fuel, salary for support staff like watchman etc.

  15. 2. Background • Also 10 mil. given to HFs with 0 stars in the BRN regions to improve the state of the facility. • Facility staff worked well together with the community and the status of the facilities and service delivery is improving. • Experiences from the GoK established a joint funding mechanism with partners disbursed directly to more than 6000 health facilities.

  16. 2. Background • The results from GoK proved to contribute to a strong and positive impact on these facilities, particularly on areas of improved quality of care, staff motivation and patient satisfaction even when the fund represented less than 1% of the total health sector budget. • There was a positive correlation between the budget made available to the facilities and increased performance

  17. 2. Background • In addition, it was observed that the communities became more active in running the health facilities resulting in better accountability. • However, there are preconditions that need to be in place such as predictability of fund, capacity and capabilities and issues relating to wider system functioning as availability of medicine, equipment and human resources.

  18. 3. Rationale ad Expected Results The rationale for implementation of DHFF in Tanzania is: • Strengthening Decentralisation of Health Services Management • Improve service delivery and utilisation of health facilities • Improving Efficiency and Effectiveness of the Health Basket Fund. • Responding to the Performance Initiative of the basket fund

  19. 3. Rationale and Expected Results • It is expected that the move to DHFF will improve the quality of services at the facility and ultimately at council level. • Enhance Community ownership of health services; mobilisation of resources, planning, improve data use, oversight, and Social Accountability

  20. 3. Rationale and Expected Results • Strengthen the PHC Implementation Strategy (MMAM) through elevated participation of community initiatives • in collaboration with health facility needs into a Comprehensive Facility Plan to be addressed by Facility generated funds, Health Basket Funding and complemented by NGO funds

  21. 3. Rationale and Expected Results • Improve health service efficiency through addressing the challenges encountered and reported by health facility staff, management and HFGCs related to time wastage in reaching Council headquarters & delayed disbursement for issues needing quick decision making especially life serving ones. • Make Health facilities direct accountable for utilization of financial resources and for results • while Enhancing the Accountability of the Council Director and Regional Administration in Overseeing Functionality of the Decentralisation.

  22. 4. Potential Risks • Dispensaries and health centres have not been systematically oriented on Financial Management • Facilities with Zero and One Star rating (86%) and this is related to among others; • Lack of qualified HRH, dilapidated buildings, lack of water supply, insufficient sanitation facilities etc.

  23. 5. Mitigation of Risks • An Intensive Capacity building to all Facility Planning and Management Teams as well as the CHMTs, Council, RHMTs/RAS and ZRC in managing this change is a pre-requisite. • In this transitional Reform Stage all SWAp stakeholders have to work together to ensure that the desired Joint SWAp Policy Commitment is realised.

  24. 6. Minimum requirements • All health facilities in the country will have the possibility to receive DHFF. • However, the following have to apply as minimum requirements: • Availability of Health Facility Government Committees (CH, HCs and Dispensaries) for the oversight of the relevant health facility with commitment and with sound leadership

  25. 6. Minimum requirements • Availability of an annual facility health plan (Done) to translate into FFARs • At least one qualified Staff e.g Nurse/Clinical Officer and Health Attendants • Availability of data (HMIS) related to service performance • Active Facility Account has been opened by the Treasury – MoFP- Funds has been disbursed

  26. 6. Minimum requirements • Availability of a health revenue collector and accounting officers for all financial resources movement – Permit to 535 Acts Assistants – HC with satellite dispensaries • Availability of a mobile phone /functional communication channel

  27. 7. Governance structure • Platform SWAp arrangement. MOHCDGEC and PORALG lead the planning and the implementation of the concept. • RS and CDs shall remain key in Managing the Accountability. • Furthermore, the elaborated Facility Plan (with both Community and Facility identified needs) will form a basis for the Concept. • The 2016 Facility Planning Guideline provides both Technical and Financial Management framework.

  28. 7. Governance structure • Members of the HFGC participated in the development of the Facility plans • as important resource to bring in Community gender sensitive needs together with facility specific needs composed the planning inputs • The Technical Facility Management finalised the plan and budget and among other tasks the HFGC approves the health facility plans and expenditures,

  29. 7. Governance structure • Overseeing patient complaints, availability of medicine and taking care of the facility infrastructure, water and security • The Community Score Card shall be employed as an instrument of fostering accountability – Monitoring tool • The Committee should receive relevant information regarding DHFF.

  30. 7. Governance structure • Day to day management of the DHFF will remain a core function of the HFGCs, CHMTs and RHMTs • while the technical and Financial Audits coupled with Community oversight will remain to be desired. • DHFF calls for a more pronounced Accountability of the Council Director as an Accounting Officer for all Resources in the Council. • The DT and Facility Health Accountants deserves to be accountable in supporting the facilities and in maintaining proper Financial management records.

  31. 7. Governance structure • Since the DHFF started with the HBF the concept will be discussed in the structures set up around the basket e.g. the PMSC & AfSC and BFC. • The TWG-SWAp mainly D,R, Nat H (1), Health Financing(2) and Public Financial Management (3) follows the planning and implementation process and provide advice, technical assistance and capacity building to all the related actors

  32. 8. Facility Planning • The main Reform in the planning process is the move from Council level managing the HBF for the facilities to facilities which prepared the plan and will manage the funds. • The planning guideline for HFs and the guidelines for CCHPs are the guiding documents. • The councils remains as an overseer and responsible for support in development of each health facility plan • The funds flow from Ministry of Finance direct to the facilities’ accounts started this FY 2017/2018.

  33. 9. Public Financial Management • The Health Accountants has been recruited and stationed at Health Centre level with a task of supporting the Health Centre and the satellite dispensaries in all matters of Financial accounting. • Capacity building to these personnel will take place in order to make sure that funds are used appropriately and accounted for.

  34. 10. Resource allocation • Resource allocation formula considers: Equity; 60% population,10%poverty, 10% under-five mortality and 20 % capped land factor. • Allocation ceiling at HFs: Utilization 50%; Service population 30%, and Distance to HQ 20% • The higher ‘Facility Utilisation’ takes into consideration the intention to improved quality while the ‘Distance’ dimension facilitates referral of complicated cases RALG

  35. 10. Resource allocation

  36. 10.Flow of funds at HF level

  37. 11. Institutional Arrangements • The MOHCDGEC- Formulation of health policies, strategies, regulations and policy oversight. • PORALG - coordinating, providing administrative support to LGAs and here health facilities to implement quality services to the population.

  38. 11. Institutional Arrangements • PORALG - providing advice, information and capacity building to RS and LGAs approaches, systems and planning methodologies. • Regional Administration provides technical support to LGAs for the implementation of health services,

  39. 11. Institutional Arrangements • Identify capacity building needs and monitor, supervise, and evaluate health services and conduct data quality audits. • Both CHMT and RHMT are under PORALG. The RHMT is responsible for Assessing Comprehensive Council Health Plans.

  40. 12. Implementation Oversight • First round implementation starts in FY 2017/18. • The progress of the DHFF will be overseen by the HMTs, CHMTs, RHMT (Facility level), RHMTs, DPs, PORALG and MOH (National) and will follow the already established government procedures. • Universities to com with simple forms of tracking the implementation and finally improve the initiatives

  41. 12. Implementation Oversight • After receiving the funds, Health Facilities will have to start implementation and provide quarterly reports to the CHMTs. • The latter will provide both Technical and Financial support. • Continued Mentoring and Coaching will facilitate improved Skills for the implementers. • Quarterly Technical and Financial reports will be shared all along the ladder.

  42. 13. Todate progress made on implementation the of Policy decision on DHFF

  43. 13. Summary

  44. This is what DHFF want to achieve –RBF and Accountability

  45. Health facility environment

  46. Good Staff House – Incentive for retention

  47. Ahsanteni kwa Kunisikiliza • Kwa pamojatunawezasananikuamuanakutekeleza

More Related