Tanzania delegation Study Tour to Church Health Association of Zambia (CHAZ)

Last month,the Christian Social Services Commission (CSSC) organized four days study Tour for six Tanzanian officials to Sister Organization in Zambia namely Church Health Association of Zambia (CHAZ)  from 7^th to 11^th April 2013 to learn how they successfully implemented PBF Pilot Project through selecting specific role and challenges they faced.  The tour was congruent with the project over-all objective which is to improve the functioning of the health sector through exchange of experiences of PBF approach from seven countries in the Network. It is worth expressing that Zambia and Tanzania are only Anglophone Countries in the Network, and thus have more or less similar health sector set up.  

On 8^th April 2013 the CHAZ Executive Director Ms. Carin Sichinga briefed the Tanzania delegation about her organization. Of much interest was the strong collaboration with the Government which was reflected by: Government seconding health workers to church health facilities, Supply All Essential Drugs to Faith Based Organization Health Facilities, and finally the Government Covers 75% of the running cost of the Faith Based Organization Health Facilities. It was also realized that CHAZ is the second principal recipient of the Global Fund.

There after the delegation spent two days visiting four health facilities which are implementing PBF Pilot Project on the Northern part of Zambia in Mpika namely Chilonga Hospital (owned by Catholic Church) and Mpika District Hospital. Other facilities visited are two Health Centres- Chibansa  and Chalabesa.

Moreover, the delegation also had an opportunity to visit to Local Purchasing Agency - Development Aid from People to People in Zambia (DAPP) in the project area, and Result Based Financing project (RBF) under Ministry of Health (MoH) of Zambia.

The following were the main issues observed, which were of interest to the delegation from Tanzania:

There is strong Public Private Partnership between Government of Zambia and CHAZ in health Care Provision which make Church health facilities to provide health services to the population according to Government regulation.

On the project set-up, it is well incorporated in the organizational set-up and linked to the National Level whereby one can exactly see separation of functions vital in the governance of the project.

Being Pure PBF, it was realized that all the health facilities have Business plans, and LPA monthly counter verify the quantitative data and Quality review is done accordingly by the District Medical Office team. At the end, the health facilities receive performance payment, out of which 50% is for staff motivation, 40% for investment and 10% for promoting community participation.

From the quick observations and the health facilities management site reports, it was noted that the staff were quite motivated due to bonus payment and improved infrastructures in the facilities. However, the issue of sustaining the spirit of the staff was further discussed with CHAZ and expressed that they are working on ways to sustain that.

For the case of RBF project, they have similar incentivized indicators and have wider coverage. Above that, the delegation appreciated the way they monitor Health Management Information System, of which they have a data base which is entered once at health facility and accessed by the HQT. That means, no one can temper with data easily. Of much interest was an experience sharing with PBF pilot Project under CHAZ. However, it was also realized that RBF has no strict separation of function as in PBF Pilot Project implemented by CHAZ. However, they explained that they will have project review soon to consider some improvement.

The following were the results of the four days Study Tour to CHAZ in Zambia:

First and foremost, the members of the delegation gained knowledge of implementing pure PBF project whereby the players have separate functions which promote accountability, transparency and efficiency. Second they understood how to align the organization when collaborating with other stakeholders in implementing PBF and lastly, they have captured the challenges in separation of functions in PBF projects.

The delegation was composed of the following:

-          Rt.Rev.Bishop Dr. Israel-Peter Mwakyolile- Chairman of the Zonal Policy Forum of CSSC- Southern Zone- Head of the delegation

-          Mr. Josibert J Rubona – Director of Planning and Policy MoHSW.

-           Mr. I. Lyimo- CSSC Zonal Manager-Northern Zone

-          Dr.Sungwa Ndagabwene-  District Medical Officer- Rungwe District

-          Dr.Bernard Njau-Lecturer Kilimanjaro Christian Medical Centre (KCMC)

-          Mr.Sule,T.Michael- Zonal PBF Coordinator

See the Photo: the delegation from Tanzania, staff from CHAZ  and  Mpika District Hospital Management

Dissemination meetings for Rungwe PBF Pilot Project to Councils and Hospital Management Teams in Mbeya Region

These meetings aimed to disseminate information on Rungwe PBF Pilot Project implementation.  It was done through the Presentation of PBF as health financing Model, and give them feedback on the implementation of Rungwe PBF Pilot Project.

These meetings were conducted in these Councils: For Mbeya City, Kyela, Mbarali, Ileje, Chunya and Mbozi. It was one day meeting for each council. A total of 144 participated. It was conducted in June for Mbeya City and October 2012 for the other remaining Councils.

The Zonal PBF Coordinator presentation was in two parts: PBF as health financing model and Implementation of Rungwe PBF Pilot Project (challenges, success and recommendations). After the presentation, the members have very active and open discussions, and these were the burning issues raised:

-      The Government should adopt PBF  as the Health National Policy as it will solve the performance issue and staff motivation

-      The Health Training Institutions should have PBF in their Curriculum so that the health workers will have insight on the health financing Model

-      The Government should work out the separation of functions for transparency and efficiency in the health sector

-      The Councils and Hospitals Management Teams need more training on the subject  to have full understanding of the Concept and its application to the service delivery in their facilities

-      Staff should be oriented on Entrepreneurship so that they can apply the business principles such as customer care for quality improvement

-      For the sake of  harmony, more clarification on bonuses be made as issues related to staff remunerations can cause conflict in the work place

-      It is important to use internal sources of fund to effect the innovative health financing approaches including PBF, as depending on the donor will undermine sustainability of projects

-      The Government has to review the staff recruitment and employment and let  the Local Government recruit and employ the staff they need for improving accountability

Generally, it was apparent that the management Teams were in favour for change. They will like to   improve Health Services delivery based on Performance due to the staff motivation.  Yet, the hesitation of the Government in adopting new Policies was also noted which needed more advocacy in various decision making levels starting from the local to the national level

The team members promised to apply some PBF Principles to improve health service delivery.

Below is the Group photo of the Council Health and Hospital Management Teams after  the meeting in Mbozi District Council.

 

The PBF Training in October 2012 was a Success!

The third and last round for PBF Training for Health Workers in Rungwe was officially closed on 4^th October 2012 by Zonal Chairperson of the CSSC- Southern Zone Rt. Rev. Bishop Dr. Israel- Peter Mwakyolile at Catholic Youth Centre in Tukuyu. The training took ten days from 24^th September to 4^th October 2012. A total of 14 PBF modules were covered.

The official closure had many colourful events: A word of thanks from 20 trainees from Health facilities in Rungwe- both Public and Faith Based. They thanked the Donor for sponsoring the training course and acknowledged the facilitators from KCMC and CSSC for imparting them with knowledge on PBF which will enable them bring change in the health facilities they work.

Thereafter, the PBF Training Coordinator Dr R. Manongi noted that, this has been the best class as compared to other three classes- 2010 and 2011. She said as trainers, which is something one can be proud of.  She promised that they will work on ways to have tailor made PBF Courses to different stakeholders in the Country beside incorporating PBF  in their curriculum.

The PBF Exams Coordinator Dr. Declare Mushi gave an overview of the average scores from the year 2010-2012. It is interesting to express that the average score increased from 59% in 2010, to 69% in 2011 and 72% in 2012. The improvement in the average score was attributed to many factors, but two were noted as determinants:  The use of Swahili in the facilitation plus the Swahili Manual for PBF increased the comprehension of the trainees on one part and on the other part, the facilitators gained experience on facilitating the PBF Training.  Therefore, it was apparent that language proficiency is one of the important determinants in the trainees understanding in training.

In his Speech, the Guest of Honor commended the trainees for the efforts they put in the course which resulted in such achievement.  He added that, at this point the important thing is the application of the PBF in improving the Health Care in our facilities.  He urged them to be change agents and improve performance in their health facilities.

He thanked the trainees from KCMC and PBF Pilot Project as Coordination office for CSSC for the good and hard work which is demonstrated by the average scores. He noted that the trained 60 staff located in various health facilities can act as a catalyst in bringing change in ways things are done. He shared efforts done by CSSC for bringing in board the decision/ policy makers as the High Level PBF Conference held in Dar-Es-salaam in March 2012 for the aim of making PBF as Health Financing Model. Additionally, he informed the participants that the Regional Health Management Team – in Mbeya are in favour of PBF as health financing Model as compared to traditional Health financing model. Finally, he awarded 20 trainees certificates of merits.