Minutes, DPG Health Meeting 6Th September 2017, German Embassy, Umoja House

Minutes, DPG Health meeting 6th September 2017, German Embassy, Umoja House

Present

Norzin GrigoleitGerman EmbassyDPH Chair
Madani ThiamCanadaMember
Hope LyimoGIZMember
Laurel FainUSAIDMember
Darius CosmosDANIDAMember
Gradeline MinjaDANIDAMember
Adrian FitzgeraldIRISH AIDMember
Theopista John KabuteniWHOMember
Kyaw AurgUNICEFMember
Pascal KanyinyiKfWMember
Kira ThomiasCanadaMember
Dr. Ritha NjauWHOMember
Siobhan MaloneGates FoundationMember
Britt HKjolasNorwayMember
Emmanuel BainganaUNAIDSMember
Andrew WilliamIOMMember
Ida Mae FernandezIOMMember
Natalie PatekmuelleCanadaMember
Dr Rutasha DadiConsultantGuest

AGENDA

Presentations:
Health needs among refugee and other migrant population and their host communities in Northwest Tanzania
Prevention and Control Plans for Viral Hepatisis in Tanzania
Welcome and Introduction of members
Adoption of the Minutes and Agenda and matters arising
Updates on SWAp events
Critical issues from TWGs/Thematic Areas
Updates on key events
AOB
Next DPG-Health meeting, 4th October 2017 at 12pm at Umoja House (may coincide with the DPGH retreat)

Presentation 1: Rapid assessment of the health needs among migrant populations and their host communities in Kigoma and along Lake Tanganyika

The assessment examined the health needs among migrant populations including refugees and their host communities along the continuum of care in Kigoma region and along Lake Tanganyika. The emphasis was on current health needs, facilitative factors and barriers to access and use health care services among migrants and host communities, assessing the capacity of health facilities in the selected sites to respond and meet the needs of different migrant populations, mapping of stakeholders and interventions present in the selected sites and identify possible partners and referral opportunities and finding out the nature of the migration dynamics in Kigoma region and along Lake Tanganyika. The districts visited were Kigoma MC, Buhigwe DC and Kasulu DC. The methodology included qualitative and quantitative analytical methods. The most common causes of death were malaria, ARI, Intestinal worms, TB and HIV, Malnutrition and NCDs.

Gender Based Violence is highly prevalent particularly sexual violence. It was observed that these were habits which were practised by the immigrants in their countries of origin. Other health challenges observed included inadequate number of health facilities per population. For example, at Kibirizi in Kigoma there was no health facility for a population of 10,000 people. There is also a gap in human resources for health with poor distribution of those who are available. There are 22 Medical Doctors – for 3.5 million people. Kigoma is severely under-served.According to 2016 Kigoma Region Health Profile:Kakonko is the poorest district in Tanzania and has a Medical Doctor ratio of 1:186,000. It was observed that the refugee camps are better staffed when compared to the host community. The quality of services was also poor with harsh language by the health care providers,long distances to travel to reach the health facilities, lack of medical supplies, shortage of health workers, and long waiting time.

There is no robust Gender Based Violence (GBV) program especially among host communities along the Lake Tanganyika shores. There is also a knowledge gap in GBV. Health and Non-health service providers have not received specific training on GBV, Infection, Prevention and Control (IPC), Emergency Preparedness and Response. When Ebola was declared to have been present in DRC earlier this year, there was no active preparedness in terms of IPC or emergency preparedness against Ebola in Kigoma. There are cases of resistance to TB drugs however there is no active TB screening or no contact tracing. There is no robust vaccination program especially among the migrants along the Lake Tanganyika shores. Although CPR is very low among refugees estimated at 10%, contraceptives services offered once a week with the support from Kibondo hospital (for Nduta) and there is estimated around 500 deliveries per month.

Stakeholder Mapping: Although many organizations provide services in selected sites, some organization standout as implementing and providing comprehensive range of continuum of health care in the host and migrants communities. Some organizations are working within the refugee camps and very few are working in both host and refugee camps. Migration dynamics include: Migrants who settled in Kigoma permanently – moved in 1960’s; Kibirizi - more migrants than host population; Seasonal fisher folk migrants; Poorly manned entry and crossing points with no records or data kept at the village and Ward leaders on people’s movements even among those coming from neighbouring countries.

Recommendations: Capacity building; individualknowledge and systems strengthening, cultural responsive programme for GBV prevention., Local Government Authorities (LGA) should establish mobility registers at community level of people coming in and going out of the village for more than one time to be determined; use local temporally identification card for those who remains in the village for a determined period and explore partnership with other agencies/organizations on mobility data-to complement existing migrants data/information.

Discussion: In the discussions that followed, clarity was sought on the fact that the majority of respondents were male but GBV was high. The response was that in the key informant interviews most of the respondents were men while in the FGDs the majority were women. With regards to inadequate human resource for health – all cadre including the social workers were a problem. There were only two social workers in Kigoma region. A member observed that in the past two Demographic Health Surveys (DHS) the prevalence of malaria in Kigoma and other regions around the Lake zone and the southern part of the country had remained high (over 30%) while in the rest of the country prevalence was going down. The National Malaria Control Programme (NMCP) together with partners including WHO are conducting an operational research to find out the factors that are causing the persistent high prevalence of malaria in these regions. It was observed that with regards to refugees there people who have been there for years and have not applied for Tanzanian citizenship. They regard themselves as citizens of Tanzania. In Nduta camp there are 400-500 births per month. There are no community based interventions at present. Partners are willing to support this area.

Presentation 2: Prevention and Control Plans for Viral Hepatitis in Tanzania

The aim of this presentation was to give an overview of the prevention and control of viral hepatitis in Tanzania. Viral Hepatitis is highly prevalent in Eastern Asia. However in the African region it may be lower in prevalence because the causes of death are not being traced systematically. It is known that >95% of those with hepatitis B and C can be cured at the onset of treatment. Globally mortality due to the three major communicable diseases: malaria, TB and HIV has been on the decline, but mortality due to viral hepatitis is going up. The first ever global strategy, 2016-2021on viral hepatitis has been developed. Tanzaniais considered a high burden country for HBV (5-20%) – amongst 28 countries and HCV (2-5%) in the general population.

Issues observed: Blood donors screening and infant vaccination are the only interventions available to the general public. The majority of people are not aware of the disease, there is limited screening and testing facilities; and treatment only available at the National Hospital and Health reporting system do not capture the disease.Tanzania is taking the following measures: measures to determine the burden of the viral hepatitis in the country, create awareness on Viral Hepatitis, prevention, care and treatment to health care providers and communities, provide knowledge and skills on Viral Hepatitis, prevention, care and treatment to health care providers, increase accessible, reliable and affordable screening, diagnostic, preventive, care and treatment services, to create surveillance and integrate in existing reporting system that will provide national data for evidence-based decision making. And adopt supportive policy guidelines and systems to complement preventiveand control measures.

Discussion: In the discussions that followed, a clarification was given on the capacity gap. Routine screening on Viral hepatitis is not done. The MoH is developing new guidelines on this disease. With regards to cost per treatment, the MoH needs to invest in tackling this emerging diseases including purchase of test kits, the medicines for managing those who are positive, the ARVs are used to treat viral hepatitis. There is lack of adequate knowledge on the magnitude of this disease in the country. Measures have to be put in place to determine the prevalence of viral hepatitis. Screening of both HBV and HCV can be done at the same time with the availability of the required test kits. It was observed that those donating blood do not always get the results of their screened blood in time.

Main DPG-H meeting:

Welcome and Introduction of members

The meeting was chaired by DPG H Chair from the German Embassy who welcomed all members to the meeting, followed by a round of self-introductions. She also welcomed the new members; Kyaw Myint Aung – Chief of Health, UNICEF and Adrian Fitzgerald – Development Specialist-Health and Nutrition, Irish Embassy.

2.Adoption of the Minutes, Agenda and Matters Arising

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

3.Matters arising/action points: None.

4.Updates on Swap events

The Chair gave an update of the SWAp meeting which took place on the 22ndAugust 2017. The meeting was chaired by the Permanent Secretary, MoH. The respective leads of the Technical Working Groups (TWG) from the MoH made presentations of the implementation made so far. The presentations were informative; however there wasn’t enough time for discussions. The issue of more interaction between DPGH and the focal points of the TWGs was raised at the meeting. It was agreed during the meeting that a specific topic could be selected from one of the TWGs and a presentation made by the respective focal point at subsequent DPGH meetings.

A presentation was also given on Health Systems Strengthening. One of the observations made in the presentation was the lack of the application of systems thinking approach by individual health systems domain to attain desired outcomes. Also mentioned during the discussions was that a mid-term review of the HSSP IV would be conducted in 2018/19.

Updates were given by the PS on-going move of the Ministries to the new capital, Dodoma. So far 200-300 people will be relocated to Dodoma. It was envisaged that the whole MoH will have relocated by February 2018. Observed that one challenge in having the TWG meetings is that some MoH officials were already in Dodoma and therefore fixing these meetings was not easy. Discussions were made on the situation of the development partners with respect to their movements to Dodoma: German Embassy – no representation; USAID – sufficient funding has been set aside for traveling to Dodoma. Video conferencing is also encouraged.

5. Technical Working Groups/Thematic Areas Updates

Health Financing (HF): The Health Financing Strategy and the document on the Single insurance are still with the technical committee of the parliament. However they have not been ratified. Members of this TWG observed that the TWG lead of HF presented a topic at the SWAp meeting that had never been discussed by the TWG. Furthermore the sub-committee has very few people and they are usually in Dodoma, hence there is a lot of inefficiencies. This topic should be included in the up-coming retreat. Observed that the theme for the joint field visit between the DPs and the MoH was Maternal and Reproductive health. The suggested date for the field visit was end of September 2017. However the respective TWG had not confirmed the date.

Quality Management: A training package on quality improvement is being developed by the MOH with the support of partners. The ASSIST project who was the financier of the project stopped the funding abruptly. The MoH is now looking for means to continue this work. Most of the former ASSIST experts have joined hands to establish a consulting firm called HODO Quality Improvement and Performance Associates (HQIP Associates) with their office located within CSSC premises.

Quality assurance in health emergencies – lack of guidelines in emergency situation. There are no guidelines on QI in such situations and this may result into spreading of the disease or taking longer to control it. WHO-country office has been requested to lead in preparation of first steps towards development of national strategies to address QI in health emergencies.

During the last meeting of the Technical Committee on Accreditation of Health facilities (TCAHF) which took place on 4th Aug, a sub-committee was formed to document the ministry of health choices among the different options pertaining to type of accreditation body, main task and other existing structures. This work will be presented to the TWG next week.

Mapping of partners working in quality improvement – MSH is implementing this activity. Quality of Care Framework – a meeting was held and a core team was formed to improve the list of priorities and develop an action plan. There will be core team which will do a national plan. In the discussions it was pointed out that the cholera treatment centres were poor in IPC. It would be important for the quality assurance unit to work closely with the epidemiology unit and emphasize on IPC at the treatment centres. It was observed that the TWG on RMNCAH had held a stakeholders meeting with regards to quality of care for new born health – standard for managing this group is being developed.

RMNCAH: the last meeting was in July 2017. The group participated in the recent TC-SWAp meeting. The draft TORs for the field visit are being prepared. The TWG was scheduled to meet on the 7th Sept 2017 however this meeting has been postponed. Observed that the TORs were circulated but most members had not seen them. The field visit is scheduled for 25th – 29th September 2017.Confirmed that the health sector reform secretariat is handling the field visit and the RMNCH is not directly involved.

PFM: PER assessment for the health sector was done and there were 30 indicators. The recommendations were not clear as to which one was the responsibility of the government and which ones were for the health sector. Consultants are analysing both performance frameworks – one from the government and the other from the health sector. It was not clear as to what are the next steps with regards to CHF – as the cabinet papers are not ready. Also observed that there is conflict between PORALG and MOHCDGEC on ICHF.There is sector contribution – Tzs 30,000m raised of the matching funds for the ICHF. However will the government manage to match these funds? The best way is to do it in a stepwise manner. Who is going to manage the funds at Regional level? PORALG wants the funds to be managed by RAS.

Health Basket Fund: Side Agreement is in circulation, Canada received the document from the government. However, it did not sign and returned it to the government so that they would be the first to sign it. Approval has been granted for the remaining funds to go to direct facility funding. Approval has also been given for the refurbishment of health facilities and CEMOC in selected districts. Members were reminded of the additional funding from DANIDA through CRDB dividends which would also be part of the basket funding – Tsh 19.5 billion.

Global Fund: Grant making for the Malaria and TB/HIV grants has been on-going for the last three weeks. The RSSH component of the Malaria grant had to be re-written as it was not approved for the grant making. The reiterations were done with the support of a consultant from WHO. However, the Malaria grant would continue with grant making as planned. Today the RSSH grant was being discussed at the TNCM before being sent to GF, Geneva for the TRP to review and give recommendations.

DPG AIDS: World AIDS day will be commemorated on the 1st December 2017. It will be preceded by the release of the preliminary results of the survey being carried out on the impact of HIV in the country on the 30th November 2017. In relation to the AIDS Trust fund, the government allocated funds Tsh3 billion but only 1.1 billion has been released to date. The World AIDS will also focus on innovative ways of fund raising for the trust fund. Suggestions were made on looking for fiscal space in taxes – tax levy in telephone, oil companies and roads. The committee is also engaging the former President Mkapa in these discussions. TACAIDS partners should come up with proposals which are workable. Observed that the country spends about 600 million USD for HIV and only 3% is the government’s contribution. However, it was not easy to quantify the government’s contribution.