Star Television broadcasted Service Agreement signing between Igogwe, Itete Hospitals and Rungwe District Council

The signing Ceremony for the service Agreement between two Voluntary Agency  hospitals namely: Igogwe and Itete hospital Versus Rungwe District Council was held on 5th October 2011 at Youth Centre in Tukuyu and broadcasted by Local Television called Star Television on 6th October 2011, during the evening news at 20hrs.  Here is the clip containing the information.

Igogwe and Itete Hospitals Signed Service Agreement with Rungwe District Council

The long waited Service Agreement between two Voluntary Agency Hospitals in Rungwe District Council namely: Igogwe and Itete hospitals was colourfully signed today with Local Government – Rungwe District Council at Youth Centre in Tukuyu.

The agreement was signed by: Bishop Evaristo Chengula- Bishop of Catholic Diocese of Mbeya and Otinel A. Mlimba on Behalf of Dr. Israel – Peter Mwakyolile- the   Bishop of ELCT Konde Diocese with District Executive Director for Rungwe District Council.  The event was witnessed by DMO Rungwe, Rungwe District Council Legal Advisor. From the side of the Church- the Health Secretaries for Konde Diocese and Catholic Diocese of Mbeya were present together with management teams from two hospitals.  Importantly, the CSSC Zonal Team- the Zonal Secretary and Technical Advisor participated in the signing of Service Agreement ceremony.

  Before signing the agreement, brief speeches were delivered.  The DMO for Rungwe District gave an overview of Service Agreement.  That, this Service agreement will be for two main services: Reproductive and Child Health (RCH)- that means, pregnant women and under five years children (Out Patients) will access free services for one year and second component is to Establish and Strengthen Organizational Structures and Institutional capacities for Improved Health service Management at all levels.  Through this agreement, the hospitals will benefit by having staff as they will be employed by the government and posted there.   

Based on that information, the Church leaders acknowledged the Government for agreeing to sign Service Agreement with these two hospitals.  Basically, the hospitals are providing services to the community of Rungwe without any segregation.  The Bishop argued the management team to work hard in ensuring the services is provided according to quality standards as expressed in the agreement for the betterment of the People they serve.

As a response to that, the District Executive Director commented the efforts of the two hospitals in Rungwe namely: Igogwe and Itete Hospitals.  He added that, the agreement would help in solving one of the challenging area- staff shortages, as the agreement would be used to employ staff to the hospitals.  Again, he noted that this agreement will definitely improve collaboration as both parties will have to discuss the progress of the agreement and that is in the spirit of Public Private Partnership.

Finally, one of Rungwe PBF Pilot Project outputs which is to harmonize PBF approach  between the State and the Church through Service Agreement Signing has been met today.  It is hoped that agreement will be successful and ultimately the health Care of the People in Rungwe get improved.

See the Group Photo after Signing the Service Agreement: Seated In front at the middle -Bishop Evaristo Chengula from Catholic Diocese of Mbeya, to the right side is District Executive Director, Rungwe District Council; Mr.N. Mahyenga and to the left side, General Secretary; Konde Diocese. Mr. Otinel  A. Mliba.

Second Year Rungwe PBF training Closing Ceremony

The second year Rungwe PBF Training was officially closed today by Dean Rev. Geoffrey Mwakihaba- Assistant Bishop of ELCT Konde Diocese as the guest of honour.

Before his speech, the course participants read a brief note which was mainly thanking the EU and Cordaid for financing PBF project, which resulted to training health staff in Rungwe so that they become change agents in propagating the PBF in the area.  They noted that they have benefited much from training on how to implement PBF project.  They added that the training was user friendly as it was conducted in Kiswahili which is a national language understood by all the people.

Additionally, they shared the information from the field visit on application of PBF especially to facilities whose staff were trained on PBF and those had who chances to attend other training conducted by the project at Rungwe.  Some of the application included development of strategic plans, costing of services and better management of income and expenditure.   They also noted community participation through facility governing committees and initiatives of signing service agreement between two hospitals in Rungwe (Itete and Igogwe ) with District Council- hopefully September 2011.

Thereafter, Dr. Manongi- PBF Training Coordinator from KCMC gave a brief note of training modules covered all in Swahili, and further said that they have incorporated the comments from last year’s training as a result they have a first draft PBF Manual- in Swahili which however need to  be rechecked by PBF practitioners so that the concept are kept intact from the original manual (Soeters, 2011) book on PBF in Action Theory and Instruments. She elaborated that this year the average pass mark has greatly increased as compared to last year training.  Definitely, the reason for the improvement could be due to maximum use of Swahili in the training sessions, which is understood clearly by all the participants.   She, welcomed the guest of honour for his speech and to hand over certificates to the participants.

In his closing speech, the guest of honour acknowledged the financial support from EU and Cordaid for Rungwe PBF Pilot Project.  Furthermore, he commended the great efforts of KCMC team for conducting this  intensive ten days training for Rungwe Team on New health financing approach  which is performance Based Financing.  He argued the trainees to bring change in their facilities on Performance by being Pioneers and advocates on this new approach.  He assured them that this is possible as they have acquired required knowledge and skills to effect that and they have all the backing from the owners of the health facilities and the local Government authority.  Thereafter, he submitted the certificate of attendance to all 20 participants for the PBF Course.

Finally, the participants departed with high morale on PBF and enthusiastic to bring difference in the health facilities they work, and they put on T-shirts and caps provided by Rungwe PBF pilot Project as part of Promotion for PBF in the District.

See the group Photo of the Trainees and trainers in a smiling face with the Guest of Honour (in a Clerical Shirt).

ON GOING RUNGWE PBF PROJECT TRAINING IN SWAHILI ''BUILDING CRITICAL MASS FOR PBF MOVEMENT IN TANZANIA''

On 12^th September 2011, the second year training for Rungwe Performance Based Financing (PBF) Pilot project started at Romanc Catholic church Youth Centre based in Tukuyu. The training will be ten days, from 12^th Sept to 22^nd September 2011. The training is being facilitated by KCMC team, Zonal PBF Coordinator and one facilitator from Igogwe Hospital. The training objectives are enable participants: firstly, to provide participants with an understanding of the relationships between national policies, health policy and economic policies and how they are influenced by Performance Based Financing. Secondly to understand the objectives, theories, best practices and instruments of Performance Base Financing and thirdly  to provide participants with knowledge and skills to enable them to improve the implementation of PBF in their work place.

What make this training peculiar is that it is mainly conducted in Swahili language, unlike last year which was in English and Swahili.

There are 20 participants, 14 are from Faith Based organization (FBOs) health facilities and 6 are from government owned health facilities.

The training was officially opened by the District Medical Officer (DMO), Rungwe District – Dr. N. Sungwa.  In his opening speech, he thanked the KCMC team for coming all way to conducting PBF Training in Rungwe.  Again, he thanked the participants for the response to attend this important course.  The DMO expressed that PBF pilot project is promising, but its implementation is tricky as basic prerequisite are not in place, referring to the policies which either need to be changed or adapt new ones.  However, he argued participants to study hard as the course is important for widening their scope on new health financing and for institutions they represent to effect change.  Additionally, he pointed out efforts done by the district, which include adopting some PBF principles, to start with they have set target to reach on Vaccination and Outreach; whereby if the staff reach target of over 80% they will be paid some kind of bonus.

Importantly, he noted the efforts to sign service agreement between Itete and Igogwe Hospitals with Rungwe District Council next month on maternal and neonatal Child health and under five years.

The DMO further said that, he expect to see the performance of health facilities whose staff  are taking part in this training to increase in terms of service coverage such as vaccination coverage, institutional delivery, and drugs supply. He, challenged the trainees to be change agents when they go back to their facilities. Finally Dr. Manongi, the PBF Training Coordinator from KCMC, thanked the DMO for the motivating and a well articulated opening speech.

See the Group Photo for PBF Trainees and  Trainers with Guest of Honour after Course opening.

Seated in front of participants: Second from right is the DMO Rungwe,

and followed by PBF Training Coordinator from KCMC- Dr. Manongi and

the Chairperson for the course on the left side. First from the right is the course

 participant.

National Health Costing Study Training

MOHSW in collaboration with CSSC conducted one week training on National Health Costing Study which was held Dar-Es-salaam at GIZ conference room at National Insurance Investment House from 25^th to 29^th July 2011.  The trainees were from: CSSC, MOHSW, and NIHF. Moreover, the training was facilitated by OPM (Oxford Policy Management) team. The study is financed by two organizations namely: GIZ and USAID.

The objective of the study is to provide MOHSW with cost information on RCH, Communicable and non- Communicable diseases.  Thus, MOHSW is expected to use the data to:

      To develop realistic estimates for over-all costs for prices setting on health sector

      Financial planning on medical care: short term, medium and long term

      Improve management of health facilities in terms of pricing/ cost sharing schedules

Stakeholders involved in the Costing study:

There are many stakeholders involved in this exercise.  They are basically categorized into three main groups: The financing agents in this case are GIZ and USAID. Those involved in health care include: MOHSW, NHIF, CSSC, APHFTA, NSSF/ SHIB.  The technical Consultants are OPM and Abt Associates inc.

In terms of roles: CSSC is responsible for the pre-test of the instruments, Pilot test, and conduct the collection in 154 health facilities in 5 zones covering all regions of Tanzania Mainland. On the other hand, OPM was engaged on developing the Instruments, Training the team from CSSC, MOHSW, NIHF and APHFTA. It will also carry out the analysis of the data after data collection from all five zones.  Moreover, Abt Associates Inc. will be responsible for quality control of the instruments during the study.

Coverage:

The study will be done in five clusters:  Cluster 1-Shinyanga, Cluster 2-Mbeya, Cluster 3- Iringa, Cluster 4-Kilimanjaro and Cluster 5- Dar- Es-salaam cluster,covering  27 Districts with a total of 154 health facilities both Public, FBO and Private.  Additionally, CSSC is taking the Lead for the data collection, whereby Mr. Runge is the Project Manager and Ms. Mecky Isasi is the Project Coordinator.

See the Photo of the participant during training Proceeding:

PBF Team meeting with CHMTs and HMTs members on 7th June 2011

On 7^th June 2011, PBF Rungwe Pilot Project team had meeting with Council i.e. Rungwe District) Health Management Team (CHMT) and Tukuyu Hospital Management Team ( HMT) members at DMO mini conference room for 2 hours, whereas a total of 19 members participated in the meeting.

The objective of the meeting was share PBF Rungwe Pilot Project information and advocate for PBF project principles adaptation in Rungwe District- especially in the health Department.  The meeting was opened by DMO Rungwe- Dr. Sungwa Ndagabwene.

Zonal PBF Coordinator- Mr. Sule, T.Michael made a brief presentation on PBF: which contained information on CSSC, PBF Multi-country network, Project objectives, expected results, PBF principles, project progress, challenges and proposed solutions.

After the presentation, the participants came up with questions and comments,  some of which   included the following:

-   What does Government say about motivating the staff?, as staff motivation is the key to performance of the health care.

-         The project is almost half of its implementation period, what can be expressed as success of PBF in the District?

-         How can staff be motivated fairly without bias, as bias can demotivate the staff badly

-         Comment: The members were argued to have mind set change in regard to performance, as for accountability.  As leaders we are supposed to help the staff to have their rights.

The raised questions were answered accordingly by Zonal PBF Coordinator and thanked the participants for their active participation in the meeting and argued them to think over some PBF principles which they could start with in the hospital.

However, the DMO Rungwe thank the PBF Team for the presentation and said that this give them a challenge on how to improve health care provision from input to output based financing.  He noted that they will discuss ways to adapt some PBF elements in the hospital management. 

From the above information, it is apparent that change is a process and will take some time, however, when the key leaders have the right information it is quite easy to accept the change in their work place

ITV Broadcasted National PBF Forum held in Tukuyu 4th March 2011

ITV Broadcasted National PBF Forum held in Tukuyu on 4th March 2011, on 11th March 2011- Under the period Called ''Events from here and there in Tanzania''

Second District PBF Forum held on 30th May 2011

PBF Rungwe Pilot Project organized quite successfully the second District PBF forum.  It was held at Tukuyu RC youth Hostel on 30^th May 2011.  The first one was held last year in August.  The objective of the forum was to update forum members on PBF Rungwe Pilot Project progress and to give feedback on challenges faced by Igogwe and Itete hospitals in CCHP plans preparation as part of Service Agreement arrangement.  The forum was opened by Rev. Geoffrey Mwakihaba – ELCT Konde Diocese Assistant to Bishop, and attended by 14 members.

Two presentations were made during the forum:  The first one was on PBF Rungwe Pilot Project Progress, challenges and proposed solutions by Zonal PBF Coordinator. On the other hand, the second presentation was made by Dr. Carina Dinkel from Itete hospital on Comprehensive Council Health Plan (CCHP)-the experience of Igogwe and Itete hospital.

After the presentations, the participants raised questions which were quite objective.  For example:  They were concern on: How can the Project help on Staff motivation, Is service Agreement understood well by Policy makers and implementers, Is SA worth striving for when it was realized that the Government has no fund to finance Service Agreement (Referring to Local Government as highlighted by DMOO), that District Council has no fund for Service Agreement and that Church leaders should  consult higher level Government Officials so that Service Agreement is given Vote in Government Budget.  Additionally, DMO commented that Policy making and implementation are two different things.  SA arrangement is a policy issue which need Political Commitment in order to have funds to finance it.

On CCHP Plan, Igogwe and Itete hospital experience.  Dr Carina indicated the difficulty faced by hospitals, and made reference to the guideline, which state that: The CDH and VA hospitals receiving Basket Funds or sign the Service Agreement are restricted not to charge MNCH services .Page 44, Point 3.2 e)  again, As the CCHP guideline was distributed as draft and there are also passages like: “CDH and VAH will receive funds from the Health Basket. The Health Block Grant will not be given to CDH and VAH because they receive their allocation directly from the central government (Service Agreement)“ 3.5, c), d), e) CCHP draft.

On this topic, that was a point of very active discussion.  The DMO intervened by saying that:  The CCHP Guideline used was a draft in the first place, though it was used for preparation of 2011/2012 Plans.  He noted that there were many things which were not so clear in the document.

The members were of the opinion that, CCHP Guideline need to give explicit clarification on how VAH will proceed on accessing government funding in health care provision.

After many hours of discussion and brainstorming on way out for Service Agreement, the forum members came up with one major recommendation which was: request Bishops to consult higher level Government official- they name Head of State to enable church facilities to have special vote in the Government budget for Human Resource for Health and Medical Supplies.  This request will be channeled through CSSC Zonal office.  With Such conditions in place, Service Agreement was said practical and feasible.

This was the most fruitful forum, which bring in board all key stakeholders who had open mind and sought after solutions for the project instead of pointing fingers on other parties, that is why it was aforementioned as very successful forum.

See the Group Photo of the Forum Members after the session.

                Seated in front from left-DMO Rungwe, next Chairperson of the forum

          and on the right, Chairperson of Moravian Church of Tanzania- South Province.

PBF Team Visit to Dioceses and Hospitals in Southern Zone

PBF Rungwe Pilot Project team and CSSC Zonal Secretary made a visit to three churches and four hospitals in Southern Zone for one week- from 22^nd to 27^th May 2011.  The aim of the visit was: to advocate and share information on PBF Rungwe Pilot Project  to church leaders and hospitals in Southern Zone of the CSSC.

The team started with Tunduru – Masasi RC Diocese and Met with the Bishop and discussed with him PBF project and its benefit towards health care provision.   The Bishop was quite positive towards the project concept.

 Later, we met the management team of Mbesa Hospital which is under the Christian Mission in Many Lands (CMML), the hospital is in Tunduru District and has 120 beds, 113 staff out of which 4 are doctors who are expatriates. PBF team presented the concept, which was appreciated by the team, who question it application in an environment whereby it is difficult to sign Service Agreement with local Government.  It was explained that this was a process which we need to keep on with plus contacting right people to influence policies.  The management team explained that, their staffs have 2 years contracts.  Above that, they give certain amount of money for hard working staff as part of motivation.  They were advised to apply the PBF principles in motivating the staff which are clear and transparent for all the staff.

Moreover, we had the chance to meet management of Nyangao hospital in Lindi, which had CDH status since 2009.  The PBF Team presented the PBF concept to the team and hence had  discussion.  Through the discussion, It was noted that hospital is doing quite well and has reasonable staffing level.

 On the other hand meeting with ELCT Iringa Diocese officials was quite a success.  We presented the concept, the officials understood  and accepted it.  They indicated that through PBF it is definite to improve performance in workplace and thus make their facilities competitive.

Additionally, we meet with Officials of the Moravian Church of Tanzania- South West Province, whose office is based in Mbeya.  Here the team liked the idea and had questions related to issues on motivation.  However, the later confirmed that this approach could also be applied in other sectors such as education as some of successful private schools do in the area.

We had a good discussion with Ifisi hospital management team which is under Evangelistic Church of Mbalizi and located in Mbeya Rural District of Mbeya Region.  Generally, the management raised many issues such as: how PBF can work in CDH environment, the motivation package, impact of project etc.  The team discussed with management team about the issues raised and they promised that they will study how to apply some of the key parameters of PBF in their hospital management.

Lastly, we visited Mbozi Mission hospital in Mbozi District of Mbeya Region. This is one of the famous hospital in the region as it was opened as a hospital back in 1961.  Again, the management raised interesting questions related to the project and stressed on sustainability of the project which were accordingly answered through discussion. 

From the Visit made it was noted that:  the church leaders are ready to support this health care financing model which is result oriented.  On the side of the management team, they considered that the hospitals can apply this approach when they have reliable source of funding such as stable Service Agreement with Local Governments. 

April 2011 Supportive Supervision

In this quarter the supportive supervision was done in 11 health facilities out of 12 health facilities planned.  The exercise took a total of 5 days.

As planned, the supportive supervision aimed at making follow up of issues raised as performance indicators in the health facilities.

In most of these facilities, Zonal PBF Coordinator either met the management of the health facilities or in charge of the health facility plus the assistant, which was common for the Dispensary level.

 From the general assessment, it was noted that there has been an improvement in the health facilities in the areas of record keeping.  It was manifested by better keeping of vital records at the facility level, which included: Reports, patient’s records, and general filling system which was formerly in very poor shape especially dispensaries.

Moreover, ledgers for medical supplies were found well recorded.  Again, information on HMIS was recoded and reports i.e. quarterly reports submitted to the DMO as required. 

Additionally, it was noted that most health facilities Facility Governing Committees for are meeting, though some dispensaries found it difficult to call these meetings on quarterly basis as a result of financial constraints.

On the other hand, the management meeting active for hospitals, but for Dispensaries and health centres there is no formal meeting neither minutes as they say they meet and discuss issues which crop up but not formalized.  No minute was seen from Dispensary and Health centre.  However, they were advised to have these important meeting and document issues discussed.

The issue of staff turn over was extensively discussed.  It was noted that hospital and health centres are currently hit hard by this situation.

Moreover, Institutional deliveries are still quite low in many health facilities.  Probably the trend will change at the hospital level as the hospital are instructed by DMO to have free services for pregnant women and under five children as per CCHP Guideline.  Again, the big challenge was noted on the Post natal Care, which was affiliated with traditions and culture in most cases.

Therefore, it is anticipated that the supportive supervision will improve the capacity of health facilities in ensuring performance of the day to day activities and thus contribute towards better health care provision.

National PBF Forum at Land Mark Hotel in Tukuyu on 4th March 2011.

On 4^th March 2011, CSSC organized National PBF Forum for PBF Rungwe Pilot Project.  The forum was held at Land Mark Hotel in Tukuyu Township – in Rungwe District.  The over-all objective of the forum was Promoting PBF as a concept and sharing the implementation of PBF multi- country pilot project in Rungwe district. Additionally, the specific objective of the forum included:  To introduce the concept of PBF to stakeholders as well as linking PBF with SA (Service Agreement), Experience sharing on Output Based Financing Versus Input Based Financing (Rwanda experience),  to share experience on P4P implementation by CSSC, to give an overview and  Rungwe PBF Project achievement, and share the Service Agreement (SA)- Sumbawanga experience.

The forum delegates were from within the country and abroad. From within, they were from: PMORALG Office, MOHSW in particular Consultants, GIZ representative, Office of Regional Administrative Secretary- Mbeya Region, DMO Rungwe, FBO leaders, members of the District PBF Forum, representatives of APHFTA at national and regional level, CSSC Southern Zonal Office and representative of CSSC.  From abroad these two key members attended the forum as facilitators:  Dr. Albert Beekes from ETC- the Netherlands and Mr. Christian Habineza- Regional PBF Coordinator.

CSSC Zonal Secretary- Fr. Lukas Komba gave introductory remarks on behalf of CSSC Director by welcoming all the participants of the forum.  He briefed the participants on background of CSSC, its Vision and geographical coverage of the CSSC Southern Zone i.e. 8 regions of Southern Tanzania.  He thanked EU and Cordaid for financing the project and commented that PBF is the best financing model which aimed at improving the provision of health services through a shift from input based to output based financing.  Then he commented the good cooperation from the Tanzania Government on health sector.  He finally welcomed the Assistant Regional Administrative Secretary- Mr. Emmanuel S. Mwandepa    who opened the forum.  In his opening speech, he extended his gratitude for CSSC and Cordaid for implementing the PBF Project in Rungwe District.  He urged the Health facilities to make costing so that Service Agreement (SA) arrangement with Local Government will be possible.  However, he noted that in order for PBF to be successful, these have to be in place: data management at the facility level, training service providers on basic accounting, marketing and making PBF project known to all stakeholders and have clear indicators for performance assessment.

Moreover, during the forum proceeding, various topics were presented:  Dr. Albert Beekes from ETC presented a topic on:  PBF Concept and link with  Service Agreement  (SA,) Mr. Christian Habineza on Rwanda PBF experience, Sule, T.Michael  on Overview of PBF Rungwe Pilot Project and achievement, Ms. Madina on CSSC P4P Experience, Mr. Godwin Mzurkwao- Service Agreement (SA) Sumbwanga experience and Dr. Bonnet from MOHSW on Sustainability model of donor funded programs.  The participants raised questions after every presentation for clarifications and more details, which presenters responded accordingly.

However, the forum mainly discuss on how to make Service Agreement (SA) feasible. Members of the forum revisited new Comprehensive Council Health Plans (CCHP), 4^th Edition, which so to say is still a draft, In the document, Voluntary Agency hospitals (VAH) budget line replaced with SA.  Indeed,  the discussion was on implication of  the guideline to VAH, which generally was considered as negative for health care delivery.  However, members came up with list of recommendations and way forward which will be work upon by CSSC, PBF Coordinator, and PPP Forum at the Regional level etc.  The key issues on recommendations and way forward included:   How Service Agreement (SA) can be funded using other sources apart from basket fund e.g. council’s own sources. Other issue was Signing of Service Agreement (SA) and how to integrate PBF into Service Agreement and finally to encourage discussion on application of PBF principles and encourage PBF pilots in Tanzania.

Finally, the forum was officially closed by Mr. Severine Kahitwa-Acting Director Local Government   from PMORALG. He commented that the PBF National Forum has been an eye Opener for the participants. Yet, it is a new Concept in health Care financing which needs to be learnt as much as possible in order to improve health care services in Tanzania.  Below is the group photo.

 

The guest of honour posed for group photo with the members of National PBF Forum.  

In the front seated, second from right. Mount Rungwe made a beautiful background.

FBO Technical team and Church Leaders Meeting

In this first quarter of the second year-2011, PBF Rungwe Pilot project conducted two important meetings.  The first one was FBO Technical meeting which was held in Tukuyu on 7^th February 2011.The meeting was attended by in charges and hospital secretaries  of two hospitals in Rungwe i.e. Itete and Igogwe hospital.  The meeting was facilitated by the Zonal Team and Project team in Rungwe.  The aim of the meeting was to thoroughly review the New Comprehensive Council Health Plans, famously known as CCHP. Additionally, to have have inputs for the planned other meetings: Church leaders meeting and Local Government meeting with church leaders. Fr. Lukas Komba- Zonal Policy Forum (ZPF) Southern Zone Secretary presented paper on CCHP Revised Version (Draft) 4^th Edition of 2010.  Then, the members had the chance to discuss various issues related to the document.  However, the major issue raised in the discussion included:  The fundamental change in CCHP whereby Cost centre for Voluntary Agency Health facilities (VA) which ranged between 10-15% )replaced by Service Agreement. Any way this has implication in the services to be delivered by the health facilities in Rungwe. The other one, was having strong FBO representation in the Council Health Service Board(CHSB), which is the decision making body on health in the district, and to lobby for FBOs Health facilities access drugs from Medical supply department(MSD).

Moreover, the  church leaders and in charges of hospital and hospital secretaries met on 9^th February 2011 in Tukuyu,  The aim of the meeting was to familiarize the church leaders on CCHP New Guideline as well. The Zonal PBF Coordinator gave a brief report on Progress reached so far on SA preparation.  That is:  costing exercise for 4 health facilities and Strategic planning for 6 health facilities. These two documents are on final stages.  These two documents are the basis for SA negotiation. Thereafer, Zonal Policy Forum Secretary presented the paper on CCHP.  After these presentations, the members discussed extensively the CCHP document and came up with these proposals: that the church leaders approve the strategic plans in March 2011, and that the church leaders start discussions with the Local Government Authorities, and lastly from 30^th June official discussions on SA start for FBOs health facilities in Rungwe.

Finally, It is worth noting that CSSC has planned National PBF Forum on 4^th March 2011 in Tukuyu, whereby key stakeholders have been invited. The forum is expected to contribute towards fast tracking PBF implementation in the district through SA signing.