Background

Since 1994 the Government of Tanzania has been striving to bring about in-depth reforms of the health sector, seeking improvement of the quality and accessibility of services throughout the country. The Health Sector Reform was approved by parliament in 1997 and is widely supported by the donor community. From 1998 a Memorandum of Understanding (MoU) has been signed formalising a Sector-wide Approach (SWAp) for Health Development. It forms part of a comprehensive reform process which comprises also the Civil Service Reform and the Local Government Reform.

In January 2003 the Tanzanian German Programme to Support Health (TGPSH) started its activities. This programme aims at supporting the health sector reform in Tanzania in achieving its goal “to improve the health and well-being of all Tanzanians with a focus on those at most risk and to encourage the health system to be more responsive to the needs of the people”.

Different German organisations contribute to TGPSH in the regions of Mtwara, Lindi, Tanga and Mbeya:

  1.  Deutsche Gesellschaft fuer Technische Zusammenarbeit (GTZ)
    • Capacity development at central, regional and district level
    • Policy and strategy development
    • Priority activities of Regional and Council health Management teams
    • Improvement of Zonal Training Centers / Zonal Health Training Institutes
    • Increased knowledge and competence on reproductive health and AIDS
    • HIV workplace programmes with the public and the private business sector 
  2.  KfW, German Development Bank
    • Rehabilitation programme for district hospitals and some HC in Tanga and Mtwara region
    • Social marketing of condoms and contraceptives
    • Health sector basket fund
  3.  Deutscher Entwicklungsdienst, German Development Service (DED)
    • Hospital Management Advisor at Regional Hospital Tanga, Mtwara and Lindi
    • AIDS Advisor to Lindi and Mtwara regions
    • Medical doctors in Mtwara and Lindi regions
    • Building Engineer for District Health Improvement Programme, Mtwara
    • Engineer for medical equipment for zonal workshop, Mtwara
  4.  Centrum für internationale Migration (CIM), Tanga 
    • Medical doctors at Regional Hospitals of Tanga and Lindi
    • Cooperation with the Christian Social Service Commission (CSSC)
  5. InWEnt - Capacity Building International, Germany
    • Training of trainers
    • Course development
    • Distant learning courses
    • Training overseas

The programme contains 6 components

The following highlights some core elements:

  1. District Health and Quality Management Component (DHQM): District Health Management Teams are supported to produce quality health plans that integrate the national policy and take into account the village/ward health plans. Quality circles at hospitals are established to measure and improve the quality of health care services. DHQM supports improvement of the quality of care through introduction of quality improvement committees, encourages self-assessment for improvement of performance and supports districts/hospitals to develop maintenance of infrastructure and equipment.
  2. Reproductive Health Component (REPRO): Peer educators and community-based distributors continue to be trained to increase people’s understanding of their reproductive health and knowledge of available reproductive health services. Students knowledge (and behaviour) on sexual and reproductive health and HIV/AIDS is improved through teachers and peer-educators training in primary and secondary schools (PASHA). 
  3. Multisectoral AIDS Control Component (MACC):  The council health management teams (CMHT) and council multisectoral AIDS committees (CMAC) are supported in the planning and implementation of multisectoral comprehensive HIV/AIDS control activities, including measures to change behaviour, STI (sexually transmitted infections) control, VCT, home-based-care, blood safety, operational research and monitoring the trend of the epidemic. In addition, HIV workplace programmes are promoted in the private business sector.  
  4. Health Financing Component (HFin):  Support for pro-poor health strategies includes working closely with councils which seek to introduce community health funds, and up-grading financial management skills. 
  5. Public-Private Partnership Component (PPP):  The establishment of fora to facilitate collaboration and joint planning processes between public and a private health-care service provider is being promoted.  Furthermore, ways to facilitate private sector provision of health services for the poor are being addressed by means of contractual arrangement: here the ongoing co-operation with the Christian Social Service Commission (CSSC) is a good example.
  6. Human Resources for Health Component (HRH): The qualifications and motivation of district health staff are being addressed. A modular training course has been developed which aims at capacity building of the council health management team members. Zonal Training Centres/ Zonal Health Training Institutes are supported in terms of infrastructure and capacity building. Distant learning courses and training overseas are offered.

Programme area

The programme covers four regions out of 22 in the country:  these are namely Tanga, Mbeya, Mtwara and Lindi.  The selection of these regions finds its rationale in the fact that all four regions have already benefited from German technical support for a number of years, but under the umbrella of different, individual projects. Now all these different projects are combined in one programme.

Results

The Tanzanian – German co-operation strategy in the health sector corresponds to the objectives of the Health Sector Reform Programme of Work (POW). The third Health Sector Strategic Plan (HSSP) 2009 - 2015 is already in place suceeding the second Health Sector Strategic Plan (HSSP) 2003-2008 which served  Phase II of the reform process.

The main aim of the Ministry of Health and Social Welfare and its partners is to improve service provision and client satisfaction. GTZ is a key player in the health sector in Tanzania based on its long project experience in the country prior to the commencing of the TGPSH. DED has been working in the health sector in Tanzania for over 20 years. KfW has been a main actor in the rehabilitation of health infrastructure, strong supporter of reproductive health and contributor to the health sector basket. InWEnt has been actively supporting continuing education and training institutions in the health sector in Tanzania. CIM provides management and technical experts to fill relevant positions in the partner institutions. The planned results of the programme will mainly concentrate on capacity building for district health services, sustainable rehabilitation and maintenance of existing health facilities, support for co-operation between public, private for-profit and non-profit providers of health care, development, dissemination and financing of decentralised models to fight HIV/AIDS, as well as assistance to develop cost-sharing systems.

 
 
2006 Copyright Tanzanian-German Programme to Support Health.