Minutes, DPG Health meeting 11th January 2017, Embassy of Switzerland

Present

  1. Dr. Thomas TeuscherSwiss EmbassyDPG H Chair
  2. Julia HannigGerman EmbassyDPG H Incoming Chair
  3. Carol HannonIrish EmbassyDPG H Outgoing Chair
  4. Leticia RweyemamuWHODPG H Secretariat
  5. Janean DavisUSAIDMember
  6. Shannon YoungUSAIDMember
  7. Gradeline MinjaDANIDAMember
  8. Darius CosmasDANIDAMember
  9. Fin Poulsen DANIDAMember
  10. Kirsten HavemannDANIDAMember
  11. Mariam AllyWorld BankMember
  12. Nina SiegertP4HMember
  13. Zelalem Tadesse FAO Member
  14. Majaliwa MarwaUNFPAMember
  15. Jacqueline MatoroSwiss EmbassyMember
  16. Marianna BalampamaSwiss EmbassyMember
  17. Dr. Peter NyellaIrish EmbassyMember
  18. Susanne GrimmGIZMember
  19. Erick MsoffeGIZMember
  20. Madani ThiamCanadaMember
  21. Kira ThomasCanadaMember
  22. Sudha Sharma UNICEF Member
  23. Dr. Andrew WilliamIOMMember
  24. Dr. Richard Banda WHO Member
  25. Dr. Martin Muita WHO Member
  26. Joshua LevensPEPFARMember
  27. Brian RettmannPEPFARMember
  28. Dr. Vamsi VasireddyCDCMember
  29. Dr. Philippe BoncourFrench EmbassyMember
  30. Britt KjolasNorwayMember
  31. Siobhan MaloneGates FoundationGuest
  32. Alberto GallacchiDFF ExpertGuest

AGENDA

  1. Presentation: Direct Facility Financing
  2. Welcome and Introduction of members
  3. Adoption of the Minutes + Agenda
  4. Updates on SWAp events
  5. Critical issues from TWGs/Thematic Areas
  6. Updates on key events
  7. AOB
  8. Next DPG-Health meeting, 1st February 2017 at 12pm

MATTERS ARISING/ACTION POINTS:

  • USAID/PS3 workshopon output-based provider payment systems: Shannon Young (USAID) will share the meeting report.
  • Nomination of DPs to GF Proposal Development Task Force: DPG Chair to facilitate final consensus among DPsandsend feedback by Monday 16th Jan 2017.
  • Zika: WHO to share the study reports on Zika.
  • Review of MMAM: DPG H Secretariat will share the draft ToR for the MMAM review which has been shared by MOHCDGEC for partners’ inputs.
  • NHA tool: Marianna will share the NHA 2015/16 tool to be filled by DPs and NGOs that they support.

Presentation: Direct Facility Financing (DFF), Alberto Gallacchi, DFF Expert-Kenya

DFF started in Kenya in 1990s to respond to the challenge of tedious health funding mechanisms and ineffectiveness resulting from political split of health Ministries. Communities were interviewed on their needs and thereafter developed plans. The crucial success factor was enhancing access to medicines and commodities. Health management skills were provided to the nurses and members of facility committee which helped them to manage facility finances. Health Sector Services Fund (HSSF) came as a result of a pilot project in a Coastal province in Kenya in 2010. Fixed amounts of funds were sent to health facilities upon submission of approved plans and issuing of Authority to Incur Expenditure (AIE). All health facilities were gazetted as legal entities to receive government funds. The positive balance was retained by the facility and rewards shared in a transparent manner. HSSF is not a parallel system, it is a Fund totally imbedded in the government system. Funds were disbursed directly from the central government (Treasury) to the units i.e health facilities based on approved plans.

The aim of the HSSF is to improve quality of services by increasing predictable resources availability. The funds are used for health supplies, equipment, and maintenance of recipient units; increasing staff management capacity and community participation. The Health Facility Management Committee maintains overall control of the facility and the Facility-In-Charge is the Secretary to this Committee. The DMO and District Accountant are informed by Treasury when the funds are sent to the facilities but they do not control them. District Accountants supervise adherence to government financial procedures at health facilities. Further, a list of amounts received by each health facility is published in local newspapers. . In 21 months i.e. Oct 2010 to June 2012, 3362 facilities were included in HSSF. The HSSF Audit results showed that of 2100m Kshs disbursed to 3362 units, 297m Kshs were questioned of which 264m were cleared. Only 33m or 1.6% of the total disbursement was unaccounted for in 247 units. This indicated that financial accountability was good through DFF.

To apply this system in TZ, it is crucial to think about conducive bank reconciliation and diminishing the bulky paper financial management systems through an electronic system. HSSF is a viable funding mechanism. Its funding predictability is vital for facilities’ continued functionality and has demonstrably improved quality of care, staff motivation, patient satisfaction and stimulated community participation. More information on the Direct Facility Financing presentation is found at DPG-Health website:

Discussion:

During the discussion several questions were asked and responded accordingly. Did the evaluation look at correlation between level of community participation and audit results? Yes there was community scorecard. Community members were motivated with what was happening in facilities as everything was put on the blackboard including expenditures. Were there any delays of funds? There were no delays and if there was an issue with facility account in getting the money, the facility concerned will be informed by the central government. Were the FBOs forgotten in this HSSF system? FBOs have completely a different governance system which goes through the Bishop. If the facility is retained the money, they have the right to receive another money for next financial year as far as their performance is according to the rules. The HSSF is registered in the district budget but on the operational part, the district is not allowed to touch the money. But on reporting, the facility is supposed to report to the district accountant as well. They follow the same government reporting/accounting system. The plans are approved by the facility committee and then the approval goes to the national level. Once approved at the National level, there is no need for further approval for spending the money like what is done in Tanzania where the facility needs an approval of the District Executive Director (DED). Which banks were used for opening facility accounts? The banks which have branches everywhere were used for the facility accounts. Were there any inefficiency noted with the health facilities e.g. in purchasing power? It is the district which purchases for the facility and then the facility pays the district.

Main DPG-H meeting:

  1. Welcome and Introduction of members

The DPG H Chair welcomed all members to the DPG H meeting followed by a round of self-introductions.He welcomed FAO (which works on among others, health security) as DPG H new member. He also welcomed the Gates Foundation who requested to join the DPG H and advised the members that there is a need for a fruitful discussion on the DPG H membership, as from the DPG Main it seems that members are bilateral and multilateral organisations. He wanted the members to think on who would be our constituencies in today's global health agenda.

Also, on behalf of DPG H members, the Chair thanked Kirsten Havemann who finished her term with DANIDA, for her contribution to the health sector. Kirsten thanked the members for being good colleagues and she urged everyone to take his/her responsibilities for a better change.

  1. Adoption of the Minutes, Agenda and Matters Arising

Minutes of the previous meeting were approved. Agenda for this meeting was adopted.

Matters arising from the previous meeting:

  • Presentation on NHA detailed analysis-members were informed that the available findings are preliminary, some indicators are missing. The detailed analysis will be done when the final report is received.
  1. Updates on SWAp events:

The policy meeting took place on 7th Dec 2017 where the 2016/17 and 2017/18 policy priorities were endorsed. The signed document has been shared with all DPG H members. The Chair requested members to go through it.

Critical issues from TWGs/Thematic areas:

TWG/Thematic Areasupdates have been uploaded on the DPG H website including: Health Financing, Cholera, Aflatoxicosis and Zika.

HF TWG – Actuarial study results were presented at the December TWG and comments have been collected from stakeholders. The report is being revised and the final version is expected by the end of Jan 2017. On Single National Health Insurance (SNHI), a guided workshop has been suggested for selected representatives of the different departments from MOHCDGEC, PORALG health department and health focal persons from MOFP. The aim is to enhance awareness of the envisaged SNHI implementation plan and create understanding as to how different implementation items link to the different sector work. USAID/PS3 supported a workshop for MOHCDGEC, NHIF and PORALG on output-based provider payment systems in mid-December 2016 in Dodoma. Shanon Young (USAID) will share the meeting report.

HBF- There will be a meeting with HBF development partners on performance tracking in preparation of the upcoming Performance Management Subcommittee meeting. Partners are welcomed to suggest other agenda items. The meeting will be held on 26th Jan 2017.

AFSC: The AFSC is waiting for PORALG to compile the second quarter financial report so that they can convene a meeting.

Global Fund: DPG AIDS and DPG Health have been invited by TNCM to nominate 3 DPs to sit on GF Proposal Development Task Force. From the discussion, it is that we get one DP from DPG AIDS, another from DPG H and one from multilateral. WHO will be in the Task Force due to its technical role in the three diseases. So far we have received names of volunteers from UNFPA, UNAIDS, IOM and USAID. It was advised that we should think of having a routine check-in system like what is done in DPs pre-TNCM meetings. It was further advised that those who wish to volunteer should have enough time for this exercise and should be conversant with the Swahili language which is frequently and comfortably used in the proposal development process. DPs were requested to continue think about it and send the feedback by Monday 16th Jan 2017.

A government delegation went to Geneva for a meeting with GF on what they can do differently in the next proposal including the USD300 million which has not been used by MoH. In the upcoming funding cyclehere will be no roll over of funds. Anything unspent by Dec 2017will not be carried over.

DPG AIDS: The new draft key populations guideline was submitted to the Interministerial Committee by the Review Taskforce in Nov 2016. The guideline was to be released by Dec 2016, but this has not happened.GF, WHO and UNAIDS have been asked to follow up with MoH on this matter.

PEPFAR Country Operational Plan (COP) process has started and the 1st meeting was in Dec 2016 to look at what is the baseline denominator for people on ARVs treatment..The next meeting will be on18th Jan 2017 where the guidelines will come out.TheCOPs process timeline: guidelines draft-18th Jan; Planning sessions-23rd to 26th Jan;Review process- April, 2017.

DPG Nutrition: Will meet next week.

Cholera updates: There has been a recent increase in number of cholera cases in Tanzania Mainland. Currently, there are 19 new cases from Morogoro, Dodoma and Dar es Salaam. Cumulatively there are 24,267 cases and 374 deaths with Case Fatality Rate (CFR) of 1.5% since 2015. Zanzibar has not reported any case for the past 6 weeks. The challenges among others include weak surveillance system, multi-sectoral collaboration is also weak especially the water sector, some deaths occurred at CTC and at the community. One of the activities that has been taking place to respond to the outbreak is weekly teleconference between PORALG, MOH and hotspots Regions and Districts. (For more information, the presentation is uploaded on the website).

Discussion: DPs wanted to know if the government has prioritized water source issues in the budget.. It was responded that at least now the water sector has been convinced that cholera is not only health sector problem but a water problem. The Water sector has come with the budget to address the water issues but it is very small. Hope more consideration will be given in the next fiscal year.

Aflatoxicosis: There is one case of suspected aflatoxicosis reported on 30th Dec 2016. This makes a total of 69 cumulative cases and 20 deaths.The challenges have been on coordination of responses which is slow and not clear and no expertise. Aflatoxicosis health sector response plan is currently being developed. (The presentation is uploaded on the website)

Discussion: During the discussion DPs wanted to know whether there is a system for routine checkup of the national grain stores. It was responded that there should be a system for doing that, and that there is currently activities’ going on within the Ministry of Agriculture on sensitizing communities for safer harvesting.

Zika updates: The meeting was informed that there was a BBC Swahili language service report on zika disease in Tanzania based on the findings of a survey by NIMR. Zika was found in Tanzania in 1952. There is no zika disease outbreak in Tanzania however; there is evidence of zika virus infections due to the two studies that were conducted. The proposed actions are to finalize draft National Preparedness and Response plan on zika virus disease, conduct a prevalence survey including of the vector. The issue of zika virus is very sensitize especially politically. WHO to share the study reports on zika (For more information, the presentation is uploaded on the website)

Updates on key events/Upcoming events

  • Zanzibar Mid Term Review (MTR) of HSSP III from 23rd Jan - 17th Feb 2017.
  • Zanzibar Annual Health Sector Review is expected at the end of February 2017.
  • Denmark State Secretary for Development Policy will visit Tanzania from 18th -20th January 2017.
  • There will be GF Mission in the last week of March 2017 for Point 7 countries (Norway, Denmark, Sweden, the Netherlands, Ireland and Luxemburg).
  • Launch of Regional coverage of NGOs working in maternal health by Global Affairs Canada next week.
  • WB Regional Vice President will visit Tanzania from 25th -26th January 2017.
  • Zanzibar will conduct Joint External Evaluation (JEE) of Global Health Security in mid-March 15th 2017.
  • Visit of His Excellency Manuel Sager, the Director-General of the Swiss Agency for Development and Cooperation on 23-25 February 2017.
  1. AOB
  • GIZ requested to present on community scorecard in the next DPG H meeting.
  • MOHCDGEC is planning for review of MMAM strategy. They have shared the draft ToR for the review process for DPs comments. They are also seeking financial support for this exercise. DPG H Secretariat will share MOHCDGEC email and draft ToR with DPs.
  • The MOHCDGEC have shared the NHA tool to be filled by DPs and NGOs. Marianna will share the tool with the DPs.
  1. Next meeting:

The next meeting will be held on Wednesday 1st February 2017 at 12.00pm at Swiss Embassy.

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