Morogoro Health Project - JICA-Net · PDF fileJapan International Cooperation Agency . BBBEE...

Morogoro Health Project April 2001 – March 2007

PPrroojjeecctt PPrrooggrreessss aanndd LLeessssoonnss LLeeaarrnneedd -- PPrroojjeecctt SSuummmmaarryy BBooookklleett --

June 2006

Ministry of Health and Social Welfare Morogoro Region

Japan International Cooperation Agency

BBBEEETTTTTTEEERRR MMMAAANNNAAAGGGEEEMMMEEENNNTTT,,,

BBBEEETTTTTTEEERRR HHHEEEAAALLLTTTHHH,,,

BBBEEETTTTTTEEERRR FFFUUUTTTUUURRREEE,,,

FFFOOORRR TTTHHHEEE PPPEEEOOOPPPLLLEEE OOOFFF TTTAAANNNZZZAAANNNIIIAAA

PPPrrrooojjjeeecccttt PPPrrrooogggrrreeessssss aaannnddd LLLeeessssssooonnnsss LLLeeeaaarrrnnneeeddd

－－－ PPPrrrooojjjeeecccttt SSSuuummmmmmaaarrryyy BBBooooookkkllleeettt －－－

TTTaaannnzzzaaannniiiaaa ––– JJJaaapppaaannn MMMooorrrooogggooorrrooo HHHeeeaaalllttthhh PPPrrrooojjjeeecccttt AAAppprrriii lll 222000000111 ––– MMMaaarrrccchhh 222000000777

This document illustrates the key finding of project progress and lessons learned, entirely carried out by the Tanzania – Japan Morogoro Health Project between April 2001 and May 2006. The Project was implemented by the joint efforts of Ministry of Health and Social Welfare, Prime Minster’s Office and Japan International Cooperation Agency. It has been funded by the Government of Japan through Japan International Cooperation Agency with an optimal cost-sharing with the Government of Tanzania through the Health Sector Basket Fund. All rights reserved. It may, however, be freely reviewed, quoted, reproduced or translated, in part or in full, provided the prior written permission of Japan International Cooperation Agency is obtained. It is not for sale or for use in conjunction with commercial purposes. JICA Tanzania Office

P.O.Box 9450, Dar es Salaam, Tanzania

Tel: (+255)- (0)22-2113727 Fax: (+255) – (0)22-2112976

E mail: [email protected]

Website: http://www.jica.go.jp/tanzania/index.html

The views expressed herein are solely the responsibility of Tanzania-Japan Morogoro Health Project, and do not imply the expression of any opinion whatsoever on the part of Government of Tanzania, Government of Japan and Japan International Cooperation Agency. Design, layout and photographs by T. Sugishita, Tanzania – Japan Morogoro Health Project. Printed and bound in Tanzania.

1

MMeessssaaggee ffrroomm PPrroojjeecctt MMaannaaggeerr

FFoorreewwoorrdd Morogoro region like all other regions in our country has been experiencing the same health and health delivery problems. It is these problems which led the region to sit and look critically at ways of improving the health delivery problems and ultimately the health state of the people in the region. It is during these moments that the Morogoro Health Project was conceived.

The Tanzania - Japan Morogoro Health Project aims at improving the health state of the people by strengthening the managerial capacity of the Regional and Council Health Management Teams in the region. Since its inception, the project has been concentrating on improving the areas of health management information systems, exchanging and dissemination of information, planning and monitoring and evaluation including research operation. This booklet gives the readers an overview of the history and the progress of the Project in a nutshell. Our region has gained a vast experience through the implementation of the Project. Although it is too early to boast that the goal of the Project has been achieved, when reading through this booklet, one will see that we are seeing a light at the end of the tunnel. We are welcoming your comments and questions, so that we can improve our management and services overall.

Dr. M.M.Z. Massi Regional Medical Officer

Morogoro

RMO Office: P.O.Box 110, Morogoro, Tanzania

Tel: (+255)- (0)23-2613099 Fax: (+255) – (0)23-2613099


2

CCoonntteennttss

☞1 Message from Project Manager

☞2 Contents

☞2 Acknowledgement

☞3 Project Design and Strategies

☞11 Project Progress 2001 – 2006

☞19 Project Working Groups

☞35 Project Lessons Learned

☞41 Project Development Package

☞45 Appendix:

Project Design Matrix Version 5.0

AAcckknnoowwlleeddggeemmeenntt Management development in a health system has proved challenging to those who are committed and devoted to the Tanzania – Japan Morogoro Health Project. The prosperity of the Project is respectfully due to the enduring effort of the Regional and Council Health Management Teams headed by Messhack M. Massi (Regional Medical Officer). .

The Booklet articulates the progress and the orientation of the Project in a brief and concise manner. The preparation could not have been possible without valuable contributions from a large number of individuals and organizations concerned to the Project.

The Project is particularly grateful to Ministry of Health and Social Welfare, Tanzania, and Regional Secretariat, Morogoro Region, for their intimate support and collaboration. In particular, the Project expresses its sincere appreciation to Gabriel L. Upunda (Chief Medical Officer, MOHSW) and Godfrey S. Ngaleya (Regional Administrative Secretary, Morogoro Regional Secretariat) for their entire technical and intellectual advice.

The Project also thanks Embassy of Japan and Japan International Cooperation Agency, particularly, Katsuya Ikeda (Ambassador of Japan, Embassy of Japan) and Toshihiro Obata (Resident Representative, JICA Tanzania Office) for their full technical commitment and financial support.

Personally, I am most grateful to the Japanese Expert Team (Erika Fukushi, Mari Tsuda, Nobuyuki Goto, Katsuya Suzuki), Counterpart Advisor (Ferdinand Fupi Msofe) and Project Secretary (Stanley Z. Mazengo) for their infinite endeavor and creative challenge in the daily operation of the project activities.

Last but not least, the Project warmly acknowledges the good will of the future project development by all the implementers, supporters and contributors.

Tomohiko Sugishita

Chief Advisor, Tanzania – Japan Morogoro Health Project

- 3 -- 2 -

PPPrrrooojjjeeecccttt DDDeeesssiiigggnnn aaannnddd SSStttrrraaattteeegggiiieeesss

TTTaaannnzzzaaannniiiaaa ––– JJJaaapppaaannn MMMooorrrooogggooorrrooo HHHeeeaaalllttthhh PPPrrrooojjjeeecccttt

AAAppprrriiilll 222000000111 ––– MMMaaarrrccchhh 222000000777

4

MMoorrooggoorroo RReeggiioonn

MMoorrooggoorroo MMuunniicciippaall CCoouunncciill

MMoorrooggoorroo DDiissttrriicctt CCoouunncciill

MMvvoommeerroo DDiissttrriicctt CCoouunncciill

KKiilloossaa DDiissttrriicctt CCoouunncciill

KKiilloommbbeerroo DDiissttrriicctt CCoouunncciill

UUllaannggaa DDiissttrriicctt CCoouunncciill

AAFFRRIICCAA TTAANNZZAANNIIAA MMOORROOGGOORROO

MOROGORO REGION (ranking among 21 Regions) Area: 73,039 km2 (2/21) Population Growth: 2.6% (11/21) Average Household size: 4.6 (11/21)

Population: 1,759,809 (6/21) Life Expectancy at Birth 45(M) 48(F) Total Fertility Rate: 5.15

HIV prevalence (age15-49): 5.4% (13/21) Immunization coverage: 90% (1/21) HBS 2001/02, National Census 2002, DHS 2004/05; National Bureau of Statistics

HMIS 2005; Ministry of Health and Social Welfare

Tanzania HIV/AIDS Indicator Survey 2003/04; TACAIDS

5

HHiissttoorryy && MMiissssiioonn

HHiissttoorryy The Project for Strengthening of District Health Services in Morogoro Region – Morogoro Health Project - is a technical cooperation jointly implemented by Ministry of Health and Social Welfare (MOHSW), Morogoro Regional Secretariat and Japan International Cooperation Agency (JICA).

Since the government of Tanzania and the Ministry of Health strived to decentralize its administrative system by empowering the local government authorities according to the Health Sector Reform Policy and Guidelines (1994). There emerged a need for more and more comprehensive management capacity for Regional and Council Health Management Teams (RHMT/CHMTs) to respond to the needs of equitable and quality health service delivery to the community. Therefore, the Project was formulated and inaugurated in April 2001 to meet this urgent request both from the government and community in accordance with the sector reforms.

The Project was ended in March 2006 as a five-year technical cooperation period funded by the Government of Japan through Japan International Cooperation Agency. However in October 2005, the project was evaluated by the Joint Project Final Evaluation Team and extended for one more year until March 2007 for the sake of consolidation, assimilation and dissemination of the project achievements and lessons learned.

MMiissssiioonn This is a project owned by the people of Tanzania and promises self-reliant and autonomous development in health service delivery by listening to the real voices of the community people.

According to the sector reform agenda, the Project is aiming to achieve better quality health services thorough health management development of RHMT/CHMTs in Morogoro Region.

OObbjjeeccttiivveess The Project focuses on the “Evidence-based Health Management” by empowering management functions of RHMT/CHMTs to enhance their basic and applied management capacity to innovate and develop the health systems and service delivery overall. By applying Project Cycle Management (PCM) to day-to-day practices, the effort should be incorporated into the Comprehensive Council Health Plans (CCHPs) to deliver demand-driven and tailor-made health interventions by assuring better health status for the people in Morogoro Region.

6

SSttrruuccttuurree

TTaannzzaanniiaa ccoouunntteerrppaarrtt aanndd JJaappaanneessee eexxppeerrtt tteeaamm The administrative structure in the Health Sector has been reformulated and restructured under the Health Sector Reform. The main body of health administration in the local government is the Health Management Team, which consists of essential technical and administrative officers.

In Morogoro Region, there are seven Health Management Teams – one Regional Health Management Team (RHMT) and six Council Health Management Teams (CHMTs) in respective District Councils. The Project mainly targets these RHMT/CHMTs as the project counterpart for the body of management capacity development in the health sector.

The Project is also supported by Japanese Expert Team (JET), consisting of five technical advisors dispatched as a long-term expert between in two and in three-year contract. The JET is a professional technical team as well as a consultative catalyst, which fosters an autonomous and self-reliant development of Tanzanian. It means that all the activities are initiated and managed by the counterparts, and the JET only functions as a technical, financial and coordination supporter. This consultative approach nourishes the ownership and sustainability in future autonomous management development.

7

SSttrraatteeggyy

IImmpplleemmeennttaattiioonn ssttrraatteeggyy The Project has been strategically implemented by following virtues.

Emphasis on the project ownership and self-reliant development

Strengthening office functions for RHMT/CHMTs

Strengthening basic and applied management capacity simultaneously

Strengthening horizontal coordination between health management teams

Coordination between the health sector and the local government

Innovative and sure-footed approach in the health system

Focus on day-to-day practices at workplace

Mastery of Project Cycle Management

Catalytic and consultative functions of Japanese Expert Team

Cost-sharing with the local government

Close and steady collaboration with local resources and institutions

Promoting local to local networking

Logistics and coordination transfer to the counterpart

Minimum input of infrastructures, machineries and materials

8

PPrroojjeecctt CCoommppoonneenntt

TTrraaiinniinngg aanndd pprraaccttiiccee mmiixxttuurree The Project enhances the efficiency and effectiveness of management trainings by mixing various components in different technical fields. In particular, the Project emphasizes on the importance of making the most use of local consultancies and resource institutions in order to sustain a future technical backup and cost-effective maintenance. The main components are;

RHMT/CHMTs: The main body of project implementation. Total 63 counterpart members.

JET: Five Japanese technical advisors in long-term contract. They function only as catalysts

to enhance autonomous development of counterpart members.

Working Groups: Seven technical working groups consisted of focal persons from respective

RHMT/CHMTs. They aim to develop applied management skills and apply their acquired skills

to day-to-day practices at original workplaces.

Local consultancies and resource institutions: Universities, research institutions,

professional organizations, private companies etc. Total 16 agencies are fully involved in direct

technical support to the Project.

Professional management training in Japan: Short-term and tailor-made management

training courses in Japan. Total 21 counterpart members were dispatched to different courses

at various institutions and local governments in Japan.

Short-term technical expert: Short-term and professional advisors in different technical fields.

Total 12 short-term Japanese experts were dispatched to the Project from academic and

private institutions. .

9

PPrroojjeecctt DDeessiiggnn MMaattrriixx

PPrroojjeecctt DDeessiiggnn MMaattrriixx The Project has its own project management tool, Project Design Matrix (PDM), which displays all project outputs and indicators for monitoring and evaluation in a logical framework. PDM is determined by a participatory workshop jointly by Tanzanian counterparts and Japanese Expert Team after problem analysis, stakeholder identification, objectives setting and programming. The first PDM was stipulated in December 2001 by Project Cycle Management Workshop attended by RHMT/CHMTs and district authorities. It has been revised several times according to the project progress and the final version, PDM Version 4, was laid down in November 2003 during Mid-term Evaluation Workshop by all the members of RHMT/CHMTs and JICA Mission Team. Currently, PDM Version 5 has been determined in March 2006 by RHMT/CHMTs and all the Working Groups to intend effective project operation during the extension period until March 2007. The details of PDM Version 5 are attached to the APPENDIX in this booklet. The PDM Version 4, which represents the project outline during the last half of the implementation period and all project activities were conducted in line with this matrix, is summarized below. PDM Version 4 (November 2003 – March 2006)

OVERALL GOAL

“Quality of health services in Morogoro Region is improved.” PROJECT PURPOSE

“Managerial capability of RHMT and CHMTs in Morogoro Region is improved under the

consensus of Health Sector Reform and Local Government Reform agenda” PROJECT OUTPUTS

1. Health Management Information System is improved.

2. Experience among RHMT, CHMTs and other regions is adequately shared.

3. Planning, implementation, monitoring and evaluation are improved. PROJECT ACTIVITIES

All the activities are incorporated into each PROJECT OUTPUTS to achieve PROJECT

PURPOSE and, ultimately, OVERALL GOAL.

10

MMaannaaggeemmeenntt CCyyccllee

CCaappaacciittyy ddeevveellooppmmeenntt && MMaannaaggeemmeenntt ccyyccllee The Project aims to strengthen capacity development in health management and believes that it is a basis of an autonomous and self-reliant development in the health sector overall.

Hence the Project emphasizes an importance of Project Cycle Management, acquired by all local health managers in the process of personal and team capacity development. This essential component is also a foundation of District Health management and future development in the local government.

11

PPPrrrooojjjeeecccttt PPPrrrooogggrrreeessssss 222000000111 --- 222000000666

TTaannzzaanniiaa –– JJaappaann MMoorrooggoorroo HHeeaalltthh PPrroojjeecctt

AApprriill 22000011 –– MMaarrcchh 22000077

12

OOvveerrvviieeww

PPrroojjeecctt pprrooggrreessss 22000011 –– 22000066 The Project was inaugurated in April 2001 and ended in March 2006 as a five-year technical cooperation period. In this proposed period, the Project experienced preparation, induction, implementation and dissemination processes and gradually developed project activities. The Project was evaluated in October 2003 by the Project Mid-term Evaluation Mission Team from JICA Headquarter. According to the suggestions, the Project reformulated its implementation strategies, reorganizes the JET structure and reoriented the counterpart members.

In October 2005, the project was evaluated again by the Joint Project Final Evaluation Team comprised of delegations from the Government of Tanzania and Japan. After discussions, the Project was successfully extended its implementation period by one year until March 2007 to consolidate, assimilate and disseminate acquired managerial skills within and beyond Morogoro Region. After the project termination, Tanzania Morogoro Health Project is expected to sustain important activities in a self-financing and autonomous manner by RHMT/CHMTs supported by the District Councils, the Central Ministries and funding partners.

13

AAccttiivviittiieess

AAccttiivviittyy pprrooggrreessss The Project was launched in April 2001 and there were some difficulties in the preparatory and induction period, because the project concept was novel and inexperienced. However, this issue was seriously discussed between the Tanzanian counterpart and the JET. Through time all the project implementers were gradually recognized the real concept and orientation of capacity development in health management. The actual implementation of training courses and workshops were started in the early 2003 and it has been dramatically developed soon after the establishment of Working Groups in November 2004.

The Project conducted capacity development for RHMT/CHMTs through various kinds of activities such as trainings, seminars, workshops and working groups. These activities are strategically scheduled and planned by RHMT/CHMTs, technically supported by local resources and institutions.

So far, the Project has conducted 194 activities, spent 519 days and involved a total of 2,679 people in the five-year period since the commencement.

14

BBuuddggeett

BBuuddggeett pprrooggrreessss aanndd ccoosstt--sshhaarriinngg Following a dramatic development of project activities, the total operational cost has rapidly increased. The Government of Japan accordingly increased the project budget through JICA.

On the other hand, operational cost-sharing with the District Councils has been promoted since the beginning. While the Local Government has gradually acknowledged the significance of the project progress, the amount of operational cost-sharing has been increased through incorporation to the Comprehensive Council Health Plan.

The cost-sharing mainly contributes to the operational cost for project activities such as Daily Subsistence Allowance, other allowances, public transports, or drivers’ allowance for counterpart members. In the extension period, almost all the project activities are fully or partially funded by the Local Government by reaching the amount of 30% of total implementation cost. Like Newsletter Editorial Board and Working Group, some essential activities are ensured by full financing from the District Councils, which implies that the WG is ready to take off in a self-reliant and autonomous development.

15

CCrroossss--ccuuttttiinngg AAccttiivviittyy

MMeeeettiinnggss,, ccoonnffeerreenncceess aanndd eexxcchhaannggee vviissiittss The Project introduced various types of trainings, workshops, meetings and conferences for RHMT/CHMTs and established a systematic way of making RHMT/CHMTs discuss, learn and work together to enhance the communication performance all the time.

Strategic Business Management training: RHMT/CHMTs were exposed to a management training such as leadership, team-building, effective communication, time management, customer care, performance management and so on. These tailor-made modules were jointly developed by Mzumbe University and the Project in 2003.

Exchange Study Visit: The Project initiated Exchange Study Visit between CHMTs by encouraging mutual and practical way of learning and action in management styles and best practices. This is an initial exploration of a local to local communication and networking.

Morogoro Health Sector Stakeholder Conference: The conference aims to share information and experiences among all stakeholders in the health sector including the Local Government, academic institutions, NGOs and faith-based organizations. The first conference was held in October 2005 and to be sustained annually in an autonomous manner.

Joint RHMT/CHMTs Biannual Meeting: The meeting aims to share information and experiences by evaluating financial progresses and performances overall. The first meeting was held in 2002 and it has been continued biannually. Currently, all the implementation cost will be fully incurred by the District Councils from next conference.

16

IImmppaacctt

BBeehhaavviioorraall CChhaannggeess According to the consecutive trainings and practical implications, local health managers have assimilated themselves to be able to master the project cycle management and to apply their innovative skills to day-to-day practices at workplace. The counterparts are showing their

leadership to subordinate colleagues, building an effective management team, and sharing ideas and experiences confidently and voluntarily. Even Hospital Management Teams and Frontline Health Workers are involved by the project activities to improve their professional skills in their clinical and preventive services with high motivation.

UUsseerr ssaattiissffaaccttiioonn The project impact to the community can be determined by an increase of utilization and satisfaction articulated by the quality of services, clinical outcomes and staff attitudes.

The Project conducted independent interviews to patients, clients and guardians at health facilities in August 2003 (sample size: 636 interviews). It revealed that 93% of respondent were satisfied with health and clinical services offered by the government relatively better than other agencies (faith-based-93%, private-83%, traditional-70%).

However, the interview also revealed that retention and self-motivation were owing to accessibility, trust, hospitality rather than drug availability, skills and cost. This is important evidence that quality of health service is recognized by fostered reliability and gentle staff attitude rather than system, skills or materials. This insight implies that any management trainings should concern how to develop human and local network incorporated with technical and management skills.

17

IImmppaacctt

HHeeaalltthh IInnddiiccaattoorrss Ultimately, overall management skills should improve health status of the people. This end outcome could be assessed by the benchmark trend of important health indicators such as Infant Mortality Rate (IMR), Under 5 Child Mortality Rate (U5MR) and Maternal Mortality Rate (MMR). All these indicators are essential to the monitoring of National Growth and Development Policy (MKUKUTA) stipulated by Millennium Development Goals (MDGs).

According to the available HMIS data, those

essential health indicators are remarkably improved during the four-year period between 2001 and 2005. This trend indicates a significant improvement of a health status of the people in Morogoro. It is safely said that the project orientation is in the right truck and impacts overall people’s health to some extent.

AAcckknnoowwlleeddggeemmeenntt bbyy tthhee LLooccaall GGoovveerrnnmmeenntt The significance of the project outcomes has been gradually recognized by the Local Government since the inception of the Project Working Groups. Because visual outputs and practical tools are produced and utilized, the government authorities such as Regional Administrative Secretary (RAS), Assistant Administrative Secretary (AAS), District Administrative Secretary (DAS), District Executive Director (DED) and other decision makers have shown more and more interest and commitment to the Project. It reflects more financial contribution to the project operation and fosters the ownership and self-reliant development.

18

EEvvaalluuaattiioonn

HHeexxaaggoonn--SSppiiddeerr--WWeebb--DDiiaaggrraamm The Project has developed a unique but essential monitoring and evaluation tool to measure overall management development. This is called Hexagon-Spider-Web-Diagram (HSWD), which can visualize acquired comprehensive managerial capacity evaluated by a self-reflexive manner. There are six essential management entities such as schedule, knowledge, human and material resources, financial, coordination and project management, which are measured by the participatory workshop method. The Project conducted HSWD Workshops in 2003 and 2005, in which all the counterpart members were involved and evaluated themselves. The results were also assessed and analyzed by themselves. The result showed that overall scores were slightly progressed, especially in the areas of schedule, knowledge, resource and project management. However, financial and coordination management stand the same score. The trend has shown their slow buy steady development and surely impacted overall capacity building in the management team.

19

PPrroojjeecctt WWoorrkkiinngg GGrroouuppss



20

PPrroojjeecctt WWoorrkkiinngg GGrroouuppss

FFoorrmmuullaattiioonn ooff tthhee WWoorrkkiinngg GGrroouuppss The Project formulates Working Groups (WGs) according to the demanded outputs by Project Design Matrix. It aims at an evolution and consolidation of acquired management skills into daily practice. The WGs consist of focal persons from respective RHMT/CHMTs supported by technical advisors from JET and local resources. The WGs were initiated and organized after the Project Monitoring Workshop in September 2004. There are seven WGs currently under full scale operations since November 2004.

Health Management Information System WG (OUTPUT 1)

Two-way Information Network System WG (OUTPUT 1)

Homepage Building WG (OUTPUT 1)

Newsletter Editorial Board & WG (OUTPUT 2)

Health Information Resource Center WG (OUTPUT 2)

Operational Research Management WG (OUTPUT 3)

Active Monitoring & Evaluation WG (OUTPUT 3)

The operation is based on the “task-oriented”, “constant” and “time-bound” management with self-reliant administration by RHMT/CHMTs. It involves technical support from local resources, financial support from District Councils, JICA and other financial agencies, political guidance from the Central Government and network coordination by JET. The WGs are implemented through following essential steps.

1. Articulation and elaboration of problems and solutions in the current health system.

2. Selection of optimal focal person from each management team.

3. WG team building by a catalytic JET.

4. Networking with local resources for the sake of timely and entire technical support.

5. Policy and technical guidance from Ministry and Local Government.

6. Financial shooting for operational costs by campaigning to policy makers.

7. Regular meeting and special training to achieve expected outputs.

8. Feedback obtained skills and products to original workplace and colleagues..

9. Maximization of the performance of daily practice and administration at workplace.

10. Strategic improvement of the team management and health system overall.

21

PPrroodduuccss

LLiisstt ooff mmaajjoorr vviissuuaall oouuttppuuttss aanndd pprroodduuccttss Strategic Health Management Training Modules

Morogoro Health Sector Stakeholder Conference

Joint RHMT/CHMTs Regular Meeting

Customer Satisfaction Interview Survey

Hexagon-Spider-Web-Diagram 2003/2005

Study Visit to other Regions

Integrated Supportive Supervision Checklist (ISSC)

Morogoro Health Abstract 2005 (MHA 2005)

Morogoro Health Information Database

Two-way Information Network System

(TWINS; Communication network with radio calls)

Radio Operation and Maintenance Manual

Morogoro Health Facility Information Directory

Project Internet Homepage (Version 2)

Project Newsletter (Volume 1 -6)

District Health Information Resource Centers

Health Information Resource Center Guidance

Resource Center Management Training Modules

Health Information Resource Directory

Project IEC Tools (Posters, Brochures etc)

Exchange Study Visit between CHMTs

Operational Research Report Morogoro 2005

Operational Research Training Modules

Operational Research Management (1st , 2nd round)

Operational Research Results Presentations

Project Operational Indicators

Project Cycle Management Training Modules

M&E Management Training Modules

22

HHMMIISS WWoorrkkiinngg GGrroouupp

IImmpprroovveemmeenntt ooff hheeaalltthh iinnffoorrmmaattiioonn ppeerrffoorrmmaannccee

Health Management Information System (HMIS) Working Group aims at the rearrangement and reformation of the current health information system. It targets specially the improvement of the information collection, analysis, storage and feedback to enhance the performance of health information systems towards the evidence-based district health management.

<Major Training Courses> Basic and advanced computer skills training

Data collection and supervision training

Data analysis and feedback training

Database Management training

Geographic Information System (GIS) Management training

Geographic Positioning System (GPS) Management training

Health Mapping Management training

GIS/GPS Short-course training in UCLAS

HMIS Study Visit to RHMT/CHMTs in Iringa Region

<Local Consultancies> Mzumbe University (Computer, Database training)

University College of Land and Architectural Studies (UCLAS; GIS/GPS training)

ESRI（Environmental Systems Research Institute, Inc.; Software support）

ATMA (System support and maintenance)

<Acquired Management Skills> Basic and applied computer skills

Database management skills

Data analysis, storage and feedback skills

Supervision skills

GIS/GPS management skills

Health mapping skills

23

HHMMIISS WWoorrkkiinngg GGrroouupp <Visual Achievements>

Effective work stations equipped with Information Technology and Management skills

Morogoro Health Abstract 2005 (MHA 2005)

Integrated Supportive Supervision Checklist (ISSC)

Morogoro Health Information Database

ISSC District Health Report

Computer LAN System at Morogoro Regional Hospital

<Major Outputs and Products> “Morogoro Health Abstract 2005” is an annual summary handbook of district and regional health information based on the current HMIS, ISSC and other relevant data sources available in Morogoro Region. It also includes health facility information and health maps. MHA aims to enhance the optimal district health planning and intervention, comparison to different disease distributions and reference guide to the health facility

users and customers. This spearhead challenge is involving the HMIS section of MOHSW and local consultancies supported by Mzumbe University, UCLAS and so on.

“Integrated Supportive Supervision Checklist (ISSC)” is a standard format for the CHMT supervision tool for the inspection of health facilities according to the “National Supervision Guideline” from Ministry of Health and Social Welfare. The Checklist contains health facility data, patient and client data, disease data and environmental data. This is a uniform implementation at the regional level and complied into the Morogoro Health Information Database.

“GIS: Health Mapping” is a robust tool for health information management in terms of data collection, analysis, storage and feedback for the visualization of evidence-based District Health Management. It also promotes the importance of data management and the motivation for the data collection and utilization for RHMT/CHMTs and health facility staffs. This activity is fully supported by UCLAS and other local consultancies.

24

TTwwoo--WWaayy IInnffoorrmmaattiioonn NNeettwwoorrkk SSyysstteemm ((TTWWIINNSS)) WWoorrkkiinngg GGrroouupp

EEffffeeccttiivvee ccoommmmuunniiccaattiioonn ssyysstteemm wwiitthh rraaddiioo ccaallllss

The WG aims to strengthen the communication functions to improve information sharing and the referral system. The Project has installed total 32 radio calls and other communication gears at central administration offices (RMO/DMO offices) and remote health facilities. The installation was conducted in conjunction with the “community sensitization” and “operator on site training” by the WG members. In overall, the WG targets to unify all the radio stations (68 stations) in Morogoro Region to integrate into Two-Way Information Network System.

<Major Training Courses> Basic and advanced communication skills training

Radio call management training

Radio call operation and maintenance on site training

<Local Consultancies> Mzumbe University (Communication skills training)

ROKO, AGLEX (Operation and maintenance training)

<Visual Achievements> 32 radio stations at central administration offices and

remote health facilities

Radio Call Operation and Maintenance Manual

Morogoro Health Facility Information Directory

<Major Outputs and Products> “TWINS” is an efficient and effective communication network based on the Cascade System. All the stations are equipped with communication gears including radio calls supplied by solar battery or electricity. After community sensitization, security and accessibility within the radio station area are ensured by the community sharing the cost of installation and maintenance.

25

HHoommeeppaaggee BBuuiillddiinngg WWoorrkkiinngg GGrroouupp

HHoommeemmaaddee hhoommeeppaaggee ffoorr tthhee PPrroojjeecctt

The Project established a self-reliant management system for homepage building and revision by the WG members. It is maintained by regular information updates and inputs. All the WG members are equipped with technical skills of homepage maintenance and ready to revise current information such as HMIS, project progress, products and other materials. This is exactly a source of information dissemination and a forum of local health managers.

<Major Training Courses> Basic and advanced homepage building and maintenance skills training

Information gathering and compilation training

<Local Consultancies> Mzumbe University

(Homepage building and maintenance training)

<Visual Achievements>

Project Homepage Version 1, 2

Homepage building and maintenance manual

<Homepage URL> http://project.jica.go.jp/tanzania/5481081E0/

<Major Outputs and Products> “Morogoro Health Project Homepage” is a project internet homepage maintained by the WG members. It includes project information, progress reports, district information (HMIS etc.), publications (newsletter, operational research report etc.), links and contact address. It enables the Project to disseminate lessons and obtained information to other regions and beyond Tanzania and also to communicate each other between local health managers. All the WG members are equipped with homepage building skills and ready to update a page design and information.

26

NNeewwsslleetttteerr EEddiittoorriiaall BBooaarrdd && WWoorrkkiinngg GGrroouupp

HHeeaalltthh pprroommoottiioonn aanndd eedduuccaattiioonn

MHP Output 2 objectifies “Experience and health information among CHMTs and RHMT and other regions are adequately shared” to enhance the performance of health information resource mobilization, utilization and sharing by integrated communication skills.

The Project formulated the Newsletter Editorial Board with focal persons from respective health management teams and worked on the Newsletter publication and other Information, Education and Communication (IEC) activities.

The Project Newsletters are edited and published with a variety range of interesting articles from CHMTs and rural health facilities articulating local health issues. By regarding this “localness”, some health facilities are utilizing these articles for their health promotion and education to patients, clients and guardians every morning hours before their clinical services. While the significance of the health promotion by the

Newsletter has been recognized by the District Councils, the WG can manage their regular publication (biannual) under full financial support from the Councils. This is the most self-reliant WG in this project period.

27

NNeewwsslleetttteerr EEddiittoorriiaall BBooaarrdd && WWoorrkkiinngg GGrroouupp

<Major Training Courses>

Editorial Board Management training

Newsletter Editing skills Training

Newsletter Editing and Publication on the Job Training

IEC Material Production skills on the Job Training

<Local Consultancies> Mzumbe University (Editorial skills training, publication)

Sokoine University of Agriculture (Editorial Board Member)

Private lawyers (Editorial Board Member)

Colour Print Tanzania (Publication)

<Acquired Management Skills> General IEC skills

Basic and applied editorial skills

Publication skills

Financial and accounting skills


Newsletter Volume 1 - 6

Newsletter Editorial Board Financial Account

Newsletter Editorial Management Guidance

<Major Outputs and Products> “Morogoro Health Project Newsletter” is a biannual communication tool for sharing experiences among local health managers and a day-to-day health educational tool to enhance the performance of health promotion activities. The articles are collected from CHMTs and Frontline Health Workers. Since the beginning, five editions have been published and distributed to all the health facilities in Morogoro Region and stakeholders. The Editorial Board can manage their activity under an autonomous and self-reliant manner. Currently all the editing and publication process are fully financed by the District Councils through the Editorial Board Account at the Regional Hospital.

28

HHeeaalltthh IInnffoorrmmaattiioonn RReessoouurrccee CCeenntteerr WWoorrkkiinngg GGrroouupp

RReessoouurrccee mmoobbiilliizzaattiioonn,, iinntteeggrraattiioonn aanndd uuttiilliizzaattiioonn

The Project formulated Health Information Resource Center WG by responding to a real demand of information mobilization, integration and utilization at the workplace of RHMT/CHMTs. This demand has been articulated by the Sector Reform intending a better district health planning based on the available health information and data.

This urgent demand has been realized by the technical support from Center for Educational Development in Health, Arusha (CEDHA). The WG members were exposed to Resource Center Management trainings by senior librarian and resource management specialist and worked on an establishment of District Health Information Resource Center.

Every CHMT develops their own resource center management committee and integrates scattered health learning materials (HLMs) into designated position in their workplaces. While the importance of Health Information Resource is recognized by district authorities, Kilosa (November, 2005) and Municipal (May, 2006) Councils succeeded to inaugurate their own resource centers fully funded by the Local Government. Following these successes, other districts have gradually developed their own resource centers by convincing

their authorities. These achievements are really the project visual outcomes by joint efforts of the WG, RHMT/CHMTs, CEDHA and Local Government.

<Major Training Courses> Resource Center management training

General Librarian skills training

Resource Center on site technical supervision

Health Information Resource Center on the job training

Resource mobilization on the job training

<Local Consultancies> Center for Educational Development in Health, Arusha (Resource Center)

National Library (Dar es Salaam) and Regional Library (Morogoro)

29

HHeeaalltthh IInnffoorrmmaattiioonn RReessoouurrccee CCeenntteerr WWoorrkkiinngg GGrroouupp

<Acquired Management Skills>

Resource center management skills

Health information mobilization and integration skills

Library management skills


Resource Center Management Manual and Guidance

District Health Information Resource Centers (Kilosa, Municipal)

Regional/District Health Information Resource Centers

District Health Information Resource Management Committees

Health Information Resource Directory

<Major Outputs and Products> “Kilosa District Health Information Resource Center” is the first health information resource center in the region and inaugurated in Nov. 2005. The Resource center is equipped with health learning materials, conference room, photocopy machine and computer with internet connection. The building rehabilitation, furniture, internet connection are fully funded by the District council. The

Project only supports management training, supervision, consultation and internet initial installation cost. The Center also adopts user charges for library and internet users.

“Morogoro Municipal Health Information Resource Center” is the second resource center established in May 2006. It is also equipped with textbooks, official documents and furniture in a modern conference room. Moreover, the center was furnished and equipped fully supported by the Municipal Council expected to produce “Evidence-based Health Planning and Intervention” by the municipal authorities. This innovation highly motivates CHMT and health facility staffs.

30

OOppeerraattiioonnaall RReesseeaarrcchh MMaannaaggeemmeenntt WWoorrkkiinngg GGrroouupp

DDiissttrriicctt HHeeaalltthh MMaannaaggeemmeenntt ffoorr nneegglleecctteedd llooccaall iissssuueess

The Project objectifies “Evidence-based District Health Management”, which accounts for deliberate and autonomous solutions for demanded health problems in the community, and has been articulated by the decentralized health system. Currently, the active and creative Operational Research WG is a unique but essential challenge by the local managers in the Sector Reform agenda.

The WG members have been exposed to consecutive training courses on operational research theory, quantitative and qualitative research methods, report writing, presentation skills etc. since August 2004 supported by local academic and research institutions. Simultaneously, the local health managers executed overall research activities of their own accords. The research topics were varied and reflected by local health priorities such as cholera outbreaks, health seeking behavior of pregnant mothers, attitudes towards febrile convulsion (Degedege), social marketing for ITNs and etc. The research was accomplished by involving all the health management teams, health facility staffs frontline health workers and the community.

The research results were entirely analyzed, complied into a final report and presented to central and local government authorities and various scientific conferences. Following that, concrete intervention plans based on the research results were elaborated by CHMTs and incorporated into the Comprehensive Council Health Plans (CCHPs) for their future actions.

31


<Major Training Courses>

Basic and Advanced Operational Research training

Operational Research on the job management

<Local Consultancies> Mzumbe University (research training and supervision)

Ifakara Health Research and Development Center (research training and supervision)

National Institute for Medical Research (quality assurance and ethical clearance)

<Acquired Management Skills> Advanced operational research skills

Community involvement skills

Data analysis and report development skills

Presentation skills, Publication skills

Financial mobilization and accounting skills


Operational Research Report, Morogoro 2005

1st and 2nd Round Operational Research Implementation

Health action plans based on the research result in CCHP 2005/6

Presentation materials at scientific conferences (TPHA, NIMR-AJSC, IEA etc.)

<Major output and product> “Operational Research Report, Morogoro 2005” is the first operational research report compiled by the WG. The research fully involved RHMT/CHMTs, health facility staff, frontline health workers and the community. The results were incorporated into CCHPs and funded to their tailor-made interventions.

“Operational Research Presentation Workshop 2005” is the first research presentation workshop organized by the WG. All the research results were presented to various stakeholders including authorities from the Local Government, Regional Secretariat, MOHSW and NIMR.

32


OOvveerraallll mmaannaaggeemmeenntt ddeevveellooppmmeenntt

Since the operational research management is acquired and exercised by the local administrative structure, the overall skills of district health management have been substantially progressed beyond expectations.

Effective and practical application of local evidence derived form the mutual effort between the local health managers and the community fulfills the real demand of priority local issues, which has been neglected in the central administrative system. The operational research management by the local government could be an initial exploration of capacity development in district health management overall.

<Issue Concerned>

Since maintenance of research quality and ethical consideration are demanded by the

scientific universe even for this operational research management done by local health

managers, the WG should strive to obtain research approval and ethical clearance by

National Institute for Medical Research (NIMR), MOHSW, or certain academic

institutions. This issue calls for more elaborate discussion with stakeholders.

33

AAccttiivvee MM&&EE WWoorrkkiinngg GGrroouupp

MM&&EE ffaacciilliittaattoorr ffoorr RRHHMMTT//CCHHMMTTss

Monitoring and evaluation (M&E) are essential skills for health managers to improve the performance of health intervention. The WG aims to streamline M&E activities in workplace, especially in the management process of Comprehensive Council Health Plans (CCHPs). In this regard, the WG members were trained as “M&E facilitator” in their respective teams by applying “Project Cycle Management” method to other team members’ duties.

<Major Training Courses> M&E facilitator training

Indicator management on the job training

Project Cycle Management training

Case Study Method training

Facilitation on the job training in CCHP 2006/7

<Local Consultancies> Mzumbe University (M&E training)

<Acquired Management Skills> Team facilitation skills

Active M&E skills

Project Cycle Management skills

Objective-oriented planning skills


Project operational indicators

Project Cycle Management materials

Case Study Method materials

CCHP 2005/2006, 2006/7

<Major Outputs and Products> “Project Cycle Management” is a demand-driven, participatory and objective-oriented management tool for project planning, monitoring and evaluation. The Project applies this method to all project activities to enhance the effective performance of RHMT/CHMTs through objective-oriented CCHP to respond to real community demands.

34

IInntteeggrraattiioonn

IInntteeggrraattiioonn ooff aallll tthhee wwoorrkkiinngg ggrroouuppss All the WGs should be integrated into the “Evidence-based District Health Management” in order to respond to the community timely, efficiently and effectively. Indeed, these seven WGs are the essential components of district health management and are functionally and complementary interacted each other. The Project supports these WGs in a catalytic manner and fosters self-reliant and autonomous development of RHMT/CHMTs.

35

PPPrrrooojjjeeecccttt LLLeeessssssooonnnsss LLLeeeaaarrrnnneeeddd



36

LLeessssoonnss LLeeaarrnneedd There is a series of lessons learned and experienced by the RHMT/CHMTs and JET throughout the project operation. These lessons could be generalized to other relevant projects or programs concerning to the context of management development in health or even in other sectors in Tanzania or rather in Sub-Saharan Africa.

LLeessssoonnss iinn ggeenneerraall

Teamwork and leadership are key management characteristics to build a genuine health management team and to promote a sustainable health system development inclusively. After exposed to the strategic management development course conducted at Mzumbe University, all the health management teams showed firm teamwork with highly motivated spirit. All the members became to understand their roles and responsibilities in the team and demonstrated leadership to their team members and subordinate colleagues. Following this behavioral change, the Project itself has developed diverse activities and generated optimal outputs according to the project objectives.

Basic and applied management skills should be practiced in day-to-day routine

activities at workplace. The Project concerns not only the induction of management trainings but also the ceaseless application to the workstation. The RHMT/CHMTs strategically develop their team capacity through the interaction between the Working Groups and the day-to-day practices. The combination between basic and applied management skills is a robust arrangement to assimilate what they have learned and to ensure persistent capacity development in a self-reliant manner.

The introduction and establishment of Working Groups arrangement fuels the pace to

work out local priority issues by helping and competing each other. The Project determined seven task-oriented WGs according to their stumbling management problems in the decentralized health system. The WGs are ready to respond quickly to complicated commissions by bestowing their basic and applied management skills to intervene and improve the conventional system. Also, the WGs support professional team building by a delegation and feedback of applied management skills acquired by focal persons sharing with other team members.

37

LLeessssoonnss LLeeaarrnneedd

Information and communication are the essential components for evidence-based district health management. The current information and communication system is still in a central orientation and difficult to utilize these information for district health planning and intervention. Here, in particular, the central emphasis is put on information collection and upstream rather than integration, utilization and feedback. The Project introduced several tools to strengthen these neglected functions of information and communication systems. It enhances the motivation and performance of the Frontline Health Workers as well as RHMT/CHMTs in effective and timely data management and enables a smooth communication in interactive district health management.

Maximum involvement and utilization of local resources and networks are essential to

successful capacity development in a self-reliant and sustainable manner. The Project is keen to strengthen the partnership between RHMT/CHMTs and the Local Government, between the WGs and local institutes, and between local health managers and stakeholders.

Here, the roles of RMO/DMOs are important to show their leadership to their team members, local authorities, local institutes and stakeholders in integration, coordination and dissemination by encouraging and establishing abundant local networks. Not only policy and technical dissemination, but also management supervision, quality assurance and horizontal coordination are owing to immense possible management functions of RHMT/CHMTs. The Project puts emphasis on resource mobilization and harmonization to enable the Project financial and technical sustainability.

38


The role of RHMT is an essential management liaison between and beyond CHMTs. RHMT functions as the basis of district health management in communication, integration and dissemination of knowledge and experiences of CHMTs. In the dynamics of sector reformation, the Project experienced a drastic transition of roles and responsibilities of RHMT in the government structure, shifting from “policy disseminator” in the central government to “policy implementer” in the local government. Due to this political environment, RHMT is owing to greater responsibilities in district health management supported by PMORALG administratively and by MOHSW technically. Hence the Project pays much attention to the Regional Secretariat, which shows more commitment to the Project activities and is willing to learn from the achievement of basic and applied management. Following this political commitment, the Project puts more emphasis on the management development of RHMT. The ongoing reform requires RHMT to be a “Professionally Developed Management Team”, which is expected to coordinate management training, practical implication and supportive supervision for subordinate CHMTs. Moreover, RHMT should show its leadership to build integrated local networks for the purpose of mutual communication and learning.

However, in spite of increasing expectations and responsibilities to the function of RHMT, self-financing mechanism is still limited in comparison to CHMTs, which is supported by Health Sector Basket Fund. This disparity constrains the project sustainability as well as the self-reliant development of RHMT as a whole. This critical issue should be elaborately discussed in the central government and an urgent remedy is really demanded.

Integration and sophistication of all the available health information systems and practical management tools are urgently demanded by local health managers. The complexity prevents the autonomous development in district health management. In addition, all the good or bad experiences and lessons learned by stakeholders should be summarized and assimilated into the future health policies and guidelines.

39


Here, the Project identified structural problems in the conventional health information system and various management tools available in the health sector. There are incoherent data systems and management styles driven by different agencies. They are sometimes complicated, disorganized and ad hoc both at the central and local levels. There is a limited regular maintenance mechanism including delegation, supervision and integration. There is a lack of comprehensive management skills, especially in the local level as well as in the central level, including verification, analysis, M&E and feedback. A significant information and communication gap between the central and the local is crucial to hinder the development of local health sector overall.

Especially, most of the current information systems are developed in the system at the national level such as Demographic and Health Survey, Demographic Surveillance System and other relevant data management system suitable for the national growth monitoring, pressurized by the National Development Policy and Millennium Development Goals. However, the information system at the local level including Health Management Information System, National Sentinel Surveillance and other relevant system are relatively put behind and poorly supported. There is a limit of data availability, which interrupts the evidence-based district health planning and monitoring. All in all, the current health information system is neither decentralized to the local health managers nor reflected to the policy orientation emphasized by the sector reformation.

The Project introduced several management tools such as Morogoro Health Abstract and Operational Research Management, which aim to enhance local health information utilized in optimal district health management in planning, intervention, and M&E. They enable information integrity and prioritization timely performed by local health managers as the basis of their day-to-day management. They target even the public and the community, who are willing to know their health status and to initiate own health intervention and preventive action. Consequently, they motivate local health managers, health facility staffs and even community people to foster their strong commitment and action to improve the health system and health status overall.

40


LLeessssoonnss iinn ssppeecciiffiicc

Acquired Project Cycle Management, that is a method of objective-oriented and participatory planning and active M&E, is a key trait for local health managers to respond to real community demands by carrying out timely and thoughtful solutions efficiently and effectively. There is no good health activity without active and operational indicators.

Exchange Study Visit, Joint RHMT/CHMT Regular Meeting and even the WGs’ activities

are explorations of “local to local” network and local communication forum to exchange ideas and experiences between CHMTs and other local health managers. The Project strengthens this dialogue function through promoting a sense of creativity, competition and esteem by learning each other under mutual objectives.

Operational Research Management is a robust tool to motivate local health managers

and providers and to account for deliberate and autonomous solutions for neglected local issues. Since it is acquired and exercised vigorously by local health managers, the overall management skills have been substantially progressed. Effective and practical applications of local evidences derived from mutual efforts between health manager and community respond to real local demands. Operational research management could be an initial exploration of capacity development in health management overall.

The Project has been promoting “objective-oriented” CCHP through Project Cycle

Management method rather than “activity-oriented” or “budget-oriented” planning method. The CHMTs elaborate local health priorities by means of district-level health information including ISSC, HMIS and operational research results. Also, they implement health interventions by the incorporation of active M&E with operational indicators. All the outcomes should be integrated into the team objectives logically and strategically.

41

PPPrrrooojjjeeecccttt DDDeeevvveeelllooopppmmmeeennnttt PPPaaaccckkkaaagggeee



42

DDiisssseemmiinnaattiioonn

LLooccaall ttoo llooccaall nneettwwoorrkk Tanzania-Japan Morogoro Health Project is keen to disseminate these lessons and products to essential stakeholders, in particular, local health providers in Morogoro Region and the RHMTs/CHMTs in other regions. During and even beyond the project extension period, all health management teams are ready to conduct basic and applied management training to Hospital Management Teams (HMTs) and Frontline Health Workers (FLHWs) through special training courses, daily activities and supportive management supervision.

Also, the seeding to other regions can be systemically attained by strengthening of “local to local” networking through study/dissemination visit, IEC material, presentation at professional/scientific conference and other means of communication. The Project aims at an affluent improvement of local communication and network in the whole country.

43

DDeevveellooppmmeenntt PPaacckkaaggee Tanzania – Japan Morogoro Health Project introduced various management trainings for RHMT/CHMTs members and established a systematic way of making RHMT/CHMTs work together, through regular meetings and joint activities. In particular, an induction of task-based working groups is a successful strategy of comprehensive capacity development in the health management team and the health sector overall in a self-reliant and autonomous manner.

The Project is trying hard to develop the project package, which enables people to understand the project outline, structure and component concisely. The Project is willing to exploit this project development package to enhance the project achievements and lessons aiming to fulfill the nationwide development.

The package includes following steps to be realized during the operation.

1. Local resources identification and involvement

2. Strategic basic management training

3. Applied management training and practice

4. Project Cycle Management and active M&E

5. Task-oriented Working Groups

6. Invention of actively demanded management tools

7. Daily practice at workplace

8. RHMT Management Supervision

9. Health systems intervention

10. Dissemination to others

11. Autonomous funding and financing

12. Objective-oriented CCHP

13. Local to local/central networking

14. Health systems development

15. Quality health service delivery Thereafter, local networks and authorities sustain the project operation and development.

44

PPoolliiccyy IImmpplliiccaattiioonn

CCoollllaabboorraattiioonn,, iinntteeggrraattiioonn && jjooiinntt ooppeerraattiioonn Tanzania – Japan Morogoro Health Project was elaborated by the context of health management capacity development demanded by the decentralized government structure jointly initiated by MOHSW and JICA. However, followed by a dramatic progress of sector reformations, the Project is mainly executed and developed by the effort of the Local Government, especially by the Regional Secretariat and District Councils. MOHSW simultaneously gives us an entire technical commitment to enhance the national health policy and guidelines. Since the Project aims at the capacity development in the health sector in a comprehensive and self-reliant manner, the lessons and achievements by the Project could be consolidated, assimilated and disseminated by the Central Government, MOHSW and PMORALG, with a careful treatment, arrangement and integration of all the triumphs and products exploited by public and private agencies including development partners, international organizations, academic institutions, NGOs, CBOs and private sectors. In this regard, the policy implication of the project lessons should be polished and amplified by the mutual effort among MOHSW, PMORALG and Development Partners. Collaboration with all the stakeholders and policy makers, integration of relevant management tools and joint operation under the same orientation shared by Ministries and Partners are urgently demanded by local health managers and hence people in the community. This concept can be represented by the quadrant matrix shown below in the right-beneath corner.

45

AAAppppppeeennndddiiixxx::: PPPrrrooojjjeeecccttt DDDeeesssiiigggnnn MMMaaatttrrriiixxx VVVeeerrrsssiiiooonnn 555...000



46

PPrroojjeecctt DDeessiiggnn MMaattrriixx VVeerrssiioonn 55..00 ((11)) Narrative Summary Objectively Verifiable Indicators Means of Verification Important Assumptions

OOOvvveeerrraaalll lll GGGoooaaalll Quality of health services in Morogoro region is improved.

Constructive opinions from the health facility users are increased for the improvement of

quality health services during and after the Project execution.

RHMT Management Supervision

Report

PPPrrrooojjjeeecccttt PPPuuurrrpppooossseee Health management skills of the target groups are

improved in a self-reliant and sustainable manner.

P-1 Average of total scores of Hexagon-Spider-Web-Diagram in Sep. 2005 (3.42) is

improved to the average score of 4.00 in Feb. 2007.

P-2 Average of total scores of ISSC is improved during the extension period.

HSWD Workshop Results

ISSC Reports

- All reforms are implemented timely and smoothly.

- New government (elected in Dec. 2005) sustains the government policy along

with the previous regime.

OOOuuutttpppuuutttsss::: 1. Health information systems with reporting and feedback

are improved effectively and efficiently.

1-1. MHA is produced regularly and timely.

1-2. Rate of HFs among all the HFs, which utilize Morogoro Health Database Guidelines

for the data management of MHA2006, is increased during the extension period.

Morogoro Health Abstract (MHA)

Questionnaire to Health Facilities

(HFs)

2. Accessibility to health information is improved. 2-1 Monthly cumulative number of IRC users is increased during the extension period.

2-2 Number of submitted articles for Newsletters is increased from the first issue until the

last issue of the extension period.

IRC visitor record

Record of Editorial Board meetings

3. Planning, monitoring and evaluation for evidence-based

health management by CHMTs and RHMT are improved.

3-1 Number of direct interventions in CCHPs based on the OPR results is increased from

the first to the second OPR execution.

3-2 Number of CHMTs, which utilize "M&E Handbook for District Health Management", is

increased during the extension period.

CCHP 2005/2006, 2006/2007,

2007/2008

Questionnaire to CHMTs

4. Project achievements are consolidated and assimilated

in RHMT/CHMTs and disseminated to various

stakeholders and beneficiaries.

4-1 Number of visual outputs produced by the Project activities is increased since the

project commencement in April 2001.

4-2 Number of occasions with stakeholders to disseminate the Project achievements and

lessons learnt is increased during the extension period.

Visual outputs

Records or memorandums of the

meetings

5. Project logistic and coordination management is

developed in a self-reliant and sustainable manner.

Number of working groups among seven MHP working groups, which are able to conduct

meetings in an autonomous manner, is increased during the extension period.

Record of logistic and coordination

management checklist.

- Government guidance and commitment for project activities (HMIS, Operational

Research etc.) remains as the same orientation.

- Newly adopted health policy and guidelines do not interfere the MHP outputs.

- Ministry of Health and Social Welfares monitors the Project progress.

- Ministry of Health and Social Welfares is willing to take over the Project

achievements.

- Prime Minister's Office Regional Administration and Local Government monitors

the Project progress.

- Prime Minister's Office Regional Administration and Local Government is willing

to take over the Project achivements.

- Health Sector Basket Fund run by development partners is effectively financed,

budgeted and disbursed for the smooth execution of CCHPs.

47

PPrroojjeecctt DDeessiiggnn MMaattrriixx VVeerrssiioonn 55..00 ((22)) AAAcccttt iiivvviiittt iiieeesss::: Inputs: Important Assumptions

1-1. HMIS, TWINS and MHP Homepage Working Group (WG) members conduct WG meetings

regularly and autonomously.

1-2. HMIS WG members develop database for Integrated Supportive Supervision Checklist (ISSC).

1-3. HMIS WG members revise the format of ISSC according to the development of database.

1-4. RHMT/CHMTs members produce “Morogoro Health Abstract (MHA)” annually supported by

health mapping.

1-5. RHMT/CHMTs members provide feedback of customized MHA to Frontline Health Workers

(FLHWs).

1-6. TWINS WG members conduct supervision for FLHWs to utilize communication gears on the

purpose of regular HMIS reporting.

1-7. MHP Homepage WG members revise MHP Homepage regularly.

2-1. Information Resource Center (IRC) Working Group (WG) members conduct WG meetings

quarterly and autonomously.

2-2. RHMT/CHMTs secure the premises and solicit funds for IRC management.

2-3. RHMT/CHMTs manage IRC for provision of user services.

2-4. RHMT/CHMTs develop networks for health information resource mobilization.

2-5. Editorial Board (EB) members operate the autonomous EB funding system.

2-6. EB members produce Newsletters and other IEC materials.

TANZANIA:

Allocation of Tanzanian

Counterparts

Running expenses necessary for the

implementation of the Project

Cost-sharing with District Councils

for the Project activities

Provision of necessary facilities

Other measures defined in R/D of

March 2006

JAPAN:

Dispatch of Long term experts

Acceptance of Tanzanian

Trainees in Japan

Running expenses necessary for

the implementation of the Project

activities

Other measures defined in R/D

of March 2006

- District Councils uptake the Project outputs in their future budget plans.

- Cost-sharing with District Councils for the Project activities is sufficiently executed.

- District Councils ensure the smooth financing for the MHP activities.

- Trained members of RHMT/CHMTs are willing to disseminate their lessons learnt to HMT,

FLHWs and other stakeholders.

- HMTs and FLHWs are ready to uptake the management trainings done by RHMT/CHMTs.

- RMO/DMOs offices allocate enough time for MHP activities.

- RMO/DMOs arrange human resources for the implementation of MHP activities by

regarding not to disturb their CCHP activities.

- Government guidance and commitment for project activities (HMIS, Operational Research

etc.) remains as the same orientation.

- Newly adopted health interventions do not interfere the MHP activities.

- MOHSW and other implementation agencies do not disturb the MHP activities by the

schedule overlap and confusion from their sudden notice and execution.

48

PPrroojjeecctt DDeessiiggnn MMaattrriixx VVeerrssiioonn 55..00 ((33)) AAAcccttt iiivvviiittt iiieeesss::: Preconditions:

3-1. Operational Research (OPR) and M&E Working Group (WG) members conduct WG meetings regularly and autonomously.

3-2. MHP conducts trainings for RHMT/CHMTs in planning, monitoring and evaluation skills.

3-3. RHMT/CHMTs conduct OPR on their priority health issues.

3-4. RHMT/CHMTs develop post-research action plans based on OPR results and integrate them into CCHP.

3-5. M&E WG members develop and compile M&E tools.

3-6. RHMT/CHMTs monitor and evaluate the activities and objectives in CCHP.

4-1. RMO/DMOs coordinate all the Working Groups to produce optimal achievements by collaborative efforts.

4-2. RHMT/CHMTs produces “Annual Health Sector Work plan in Morogoro region”.

4-3. RHMT/CHMTs conduct Joint RHMT/CHMTs Meeting biannually and Morogoro Health Stakeholder Conference annually.

4-4. RHMT conducts management supervision to CHMTs quarterly.

4-5. RMO/DMOs conduct project dissemination visits to other regions and districts.

4-6. RHMT/CHMTs members exhibit project achievements in various technical meetings and conferences.

4-7. RHMT/CHMTs disseminate project achievements and lessons by using IEC materials.

5-1. RHMT/CHMTs strengthen project logistics and coordination handed over to RHMT/CHMTs by On-the-Job methods.

5-2. RHMT/CHMTs conduct Workshop for logistics and coordination.

5-3. RHMT/CHMTs compile logistics and coordination Manual.

5-4. RHMT/CHMTs ensure maintenance and repair of handed over equipments in their workplaces.

- Government policy and guidelines remain as long as the same orientation.

- Political environment for financial allocation of district health services including Health Sector

Basket Fund remains in the same guidance.

- Tanzania counterpart members remain as many as in numbers, which should not disturb the

teamwork of RHMT/CHMTs.

- Sufficient financial resources for monitoring visit are available (e.g. personnel, fuel).

- RHMT and CHMTs manage to allocate personnel and tasks for the smooth implementation of

the Project activities.

- Economic and social stability continue during the Project period.

Abbreviations: MHP: Morogoro Health Project RHMT: Regional Health Management Team CHMTs: Council Health Management Teams CCHPs: Comprehensive Council Health Plans MOHSW: Ministry of Health and Social Welfare PMRALG: Prime Minister’s Office Regional Administration and Local Government R/D: Record of Discussions WG: Working Group

RMO: Regional Medical Officer DMO: District Medical Officer HMT: Hospital Management Team FLHWs: Frontline Health Workers HSWD: Hexagon Spider Web Diagram HMIS: Health Management Information System TWINS: Two-way Information Network System MHA: Morogoro Health Abstract

ISSC: Integrated Supportive Supervision Checklist IRC: Information Resource Center IEC: Information, Education and Communication EB: Editorial Board OPR Operational Research M&E: Monitoring and Evaluation

49

TThhee PPrroojjeecctt wweellccoommeess yyoouurr ccoommmmeennttss aanndd iiddeeaass ccoonncceerrnniinngg ttoo tthhiiss bbooookklleett aanndd tthhee pprroojjeecctt oovveerraallll.. TThhee llaatteesstt iinnffoorrmmaattiioonn ccaann bbee aallssoo oobbttaaiinneedd tthhrroouugghh tthhee ccoonnttaacctt aaddddrreesssseess bbeellooww..

Tanzania – Japan Morogoro Health Project

P.O.Box 1193, Morogoro, Tanzania

Tel: (+255) – (0)23-2614002 Fax: (+255) – (0)23-2614148

Mobile: (+255) – (0)744-335599


Website: http://www.project.jica.go.jp/tanzania/5481081E0/

50

PPrroojjeecctt PPrrooggrreessss aanndd LLeessssoonnss LLeeaarrnneedd -- PPrroojjeecctt SSuummmmaarryy BBooookklleett --

TTTaaannnzzzaaannniiiaaa ––– JJJaaapppaaannn MMMooorrrooogggooorrrooo HHHeeeaaalllttthhh PPPrrrooojjjeeecccttt

P.O.Box 1193, Morogoro, Tanzania


Printed by Colour Print Tanzania Limited

Date post:	24-Feb-2018
Category:	Documents
Upload:	tranlien
View:	218 times
Download:	4 times

Morogoro Health Project - JICA-Net · PDF fileJapan International Cooperation Agency . BBBEE...

Documents