Self-reliant Capacity Development

for District Health Managers Harmonization of TAs and SWAp

A Case of Morogoro Health Project, Tanzania

Dr. G.J.B. MteyDr. G.J.B. Mtey & Ms. Erika FukushiMorogoro Health Project

LenCD Forum, Nairobi, Kenya3rd October, 2006

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Better ManagementBetter ManagementBetter HealthBetter HealthBetter FutureBetter Future

Mt. Ulugulu

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Contents

1. SWAp and Health Sector Reform in Tanzania

2. Morogoro Health Project (MHP)

3. Complementary Roles of SWAp & MHP

4. Effective Approaches for Self-reliant CD

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SWAp & Health Sector SWAp & Health Sector Reform in TanzaniaReform in Tanzania

Mkambarage Dispensary

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Fragmental budgeting

On budgeting

Sector Programming

Bipolar Sector Budgeting

Integrated Sector Budgeting

National budget

planning

Sector budget planningTransparent budgetingUnknown budgeting

MTEF Planning Management

Multiple budget complex

On project budget

Sector Basket Fund Project type budget (known)

Sector budget integration

TANZANIATANZANIA

Steps towards SWAp/GBS

Integrated National BudgetingIntegrated National BudgetingNational budget

integration (GBS)

6

0

50

100

150

200

250

300

2000 2001 2002 2003 2005

Other foreignBasketGOT

million US $

24.2%

19.3%

13.9%

7.3%

Health Sector Public Expenditure Review 2003/ Annual Health Sector Review 2005

26.0%

Sector Basket Fund in Tanzania

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Health Sector Reform in Tanzania

PAST NOW

Central Government

International Society

Community

RHMT

CHMT

Central Government

International Society

Community

RHMT

CHMT

MHP

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Morogoro Health ProjectMorogoro Health Project

Morogoro Morogoro RHMTRHMTMunicipal Municipal CHMTCHMTMorogoro Morogoro CHMT CHMT Mvomero Mvomero CHMTCHMTKilosa CHMTKilosa CHMTKilombero Kilombero CHMTCHMTUlanga CHMTUlanga CHMT

&

Project Advisor TeamDr. Sugishita

Dr. FupiMs. Fukushi

Ms.TsudaMr. Goto

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Morogoro Health Project (MHP)(April 2001-March 2007)

OBJECTIVE

• Health management skills of the Regional/Council Health Management Teams (RHMT/CHMT) and other Frontline Health Workers (FLHWs) are improved in a self-reliant and sustainable manner.

OVERALL GOAL• Quality of health services in Morogoro region

is improved.

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Management Skills

MHP

Morogoro Health Project

• Leadership• Teamwork• Delegation • Resource Mgt.• M&E

• Community involvement• Active listening• Communication• Feedback & dissemination• Customer care

• PC skills• Data analysis• Financing• Documentation• Presentation

• FLHWs involvement • Data collection• Supervision• Motivation• Facilitation

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Development with MHP

Development without MHP

Daily Practice in workplace

Capacity Development

Team-work

TrainingWGs

MHP Development Package(Trainings + Working Groups + Support in Daily

Practices)

Leadership

FeedbackTraining

WGs

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Complementary Roles of SWAp & MHPComplementary Roles of SWAp & MHP

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Complementary Roles of SWAp and MHP in HSR

• Demand-driven prioritization and budgeting• Decentralized power of decision-making• Evidence-based planning • Sound M&E framework and managing system• Linkage between funding and outcomes• Sector-beyond coordination and collaboration• Effective use of rapidly increased budget for LG by SWAp• Smooth disbursement of the available funds• Scrutiny of different financial management practices• Timely reporting and visual presentation

MHP responds to various demands in Health Sector Reform at Local Government in collaboration with SWAp.

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Basis Political Basis Financial Basis Management Basis

ObjectiveSelf-reliant effort

for poverty reduction

Self-reliant budgeting at Local

Government

Sustainable management

capacity development at

Local Government

ImplicationAdministrative

reform and Power decentralization

Sector basket fund in health sector

Strengthening of office function and human resources

Response

National Policy

（ PRSP, MTEF etc)

Available fund at Local Government

(26% x 48%)

JICA Morogoro Health Project

Enabling Health Sector Reform

Three Basis for sustainable CD

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Development Budget to Recurrent Budget

MHP integrated development budget for project operational costs into recurrent budget for the Local Government through Health Sector Basket Fund in the Health SWAp. This delegation is welcomed by Tanzanian side and Basket sponsors, because it promotes a self-reliant capacity development with a highly motivated way due to additional incentives.

Development budgetby JICA

Recurrent budget

by LG of TZ

Initial period

Development budgetby JICA

intermediate period

SWAp

HSBF

CCHP

Recurrent budget

by LG of TZ

Technical assistance (management training)

terminal period

Regular budgeting

IncentiveMotivation

CCHP SWAp

HSBF

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Effective Approaches Effective Approaches for Self-reliant CDfor Self-reliant CD

Kimamba Health Center

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A person or project that cause a change.“I see my role as being a catalyst for change.”

CatalystCatalyst

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Management trainingManagement training Working GroupsWorking Groups

Day-to-day ActivityDay-to-day Activity Communication forumCommunication forum

Self-reliant Self-reliant DevelopmentDevelopment

System System InnovationInnovation

Local to Local Local to Local NetworkNetwork

Potential CapacityLeadership, Teamwork, Communication

EncouragementEncouragementEnforcementEnforcement

ExposureExposure

EnhancementEnhancement ExcitementExcitement

Effective Approaches for Self-reliant CD

EmpowermentEmpowerment

ExerciseExercise

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7E Catalytic Approach for CD

3.Excitement

4.Exercise

2.Exposure

6.Empowerment

5.Enhancement

Think together, learn together! Think together, learn together! 1. Encouragement

7. Enforcement

To be exposed to new knowledge and experiences*Basic Management Trainings*Exchange/ Study visit *Involvement of stakeholders

To be exercised to consolidate applied skills in day to day routine activities. *Application of PCM method (project management tool) in Planning, implementation and M&E.

To be enhanced conventional skills to develop better management tools through local to local networking.*Working Group management*Utilization of local resources

To be empowered to innovate healthsystems in a self-reliant manner.*Continuous process of personal, organizational and system development.

To be excited to develop applied management skills. *Identification of district ignored problems through OPR, IT, communication and IRC tools.

To be enforced management tools in an institutionalization manner.*Dissemination, integration and sophistication in areas, organizations or sectors

CATALYSTS

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Innovation & Development

Central GovernmentCentral Government Development PartnersDevelopment Partners

RegionRegion RegionRegion

RegionRegion

RegionRegion

RegionRegion

RegionRegion

RegionRegion

RegionRegion

MorogoroMorogoro

Interactive Local Communication & Networks

System innovation at local levelSystem innovation at local level

Management Management EmpowermentEmpowerment

CommunicationCommunicationForumForum

Integration and Sophistication

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Lessons Learned Overview

• Basic and Applied Management skills

• Teamwork and Leadership

• Working Group Arrangement

• Visual Products

• Utilization of Local Resources

• District to District Networking in the Region

• Focus on Practices (Do it again and again and again!)

• Role of Catalysts

• Evidence-based District Health Management

• System innovation

• Cost-sharing in Collaboration with SWAp

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Innovation towards the health Innovation towards the health system, system, in which everybody feels happiness.in which everybody feels happiness.

I can do it !!I can do it !!

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The Way to Our FutureThe Way to Our Future

Tanzania – Japan Morogoro Health ProjectTanzania – Japan Morogoro Health ProjectP.O.Box 1193, Morogoro, TanzaniaP.O.Box 1193, Morogoro, TanzaniaTel: 023-2614002 Fax: 023-2614148Tel: 023-2614002 Fax: 023-2614148

Mobile: 0754-335599Mobile: 0754-335599E mail: E mail: morogorohealthproject@yahoo.com

erikafuku@yahoo.co.jperikafuku@yahoo.co.jpWebsite: Website: http://www.project.jica.go.jp/tanzania/5481081E0/

(Access to (Access to “Google”“Google” and search with “Morogoro Health Project”) and search with “Morogoro Health Project”)