By Travis Holmes,2014-05-13 21:29
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    FROM 7-12 NOVEMBER, 2005.


    Deputy Secretary PO - PC Regional Administration Secretary, Iringa region

    Honourable District Commissioner, Iringa District

    Representative of the Basket Fund

    The Excellency Mayor of the Iringa Municipal

    District Executive Director, Iringa Municipal

    Stakeholders of the Basket Fund

    Directors from PORALG

    Directors from Ministry of Health

    Directors of the Referral Hospitals

    Representatives of Universities

    Regional Medical Officers

    Representatives of International Organizations

    Representatives of the Non-governmental organizations

    Stakeholders of the health sector

    Delegates of the District Medical Officers meeting Tanzania Mainland

    and Zanzibar

    Invited Quests

    Ladies and Gentlemen

First of all I would like to express my heart felt thanks for being given this

    opportunity to address this very important third meeting of the District

    Medical Officers from Tanzania mainland and Zanzibar. I would also like to

    take this opportunity to express my thanks to Tanzania Public Health

    Association (TPHA) for organizing this meeting and the regional

    administration leadership for accepting to host this meeting. Accept my

    sincere thanks to you all.


The main theme for the first District Medical Officers meeting held in

    Morogoro on 9 June, 2003 was on “Quality Health Service Delivery in

    Tanzania: The District Focus.

This main theme directed on actions for strengthening and improving

    health services delivery countrywide with focus at district level. During

    the same meeting, various presentations were discussed and clarifications

made. Clear objectives were made with recommendations and resolutions

    for action in the following year for everyone.

    The second District Medical Officer’s meeting was held at Uhuru Hostel in Moshi and the main theme was “Strengthening the District Health

    Delivery System”. In that meeting organizational structures and the

    health system in general were discussed and came up with strengthening

    strategies and processes. Recommendations and resolutions were also

    given for implementation and evaluation after one year that is 2005.


The main theme for this third meeting of the District Medical Officers is on

    “Experience in Implementing Comprehensive Health Plans:

    Towards meeting the Millennium Development Goals”.

This time some District Medical Officers from Zanzibar and Regional

    Medical Officers are participating in the meeting. This third meeting is

    very important and provide opportunity for you as main supervisors and

    executives of the health sector meet and discuss important issues related

    to health policy and provision of health services to the community.

Being the top leaders for the health sector at the district level you have

    been given the mandate for the Minister who has mandate for health

    policy formulation and implementation and supervision and management

    of health services in the country.

My expectation for this meeting should be a continuation of the two

    previous meetings and provide adequate opportunities for prepared issues

    and presentations that address experiences and better lessons learnt. It is

    important that they are discussed in details and answers given as well as

    policy issues clarified.

It is also important that a consensus and agreement is reached with clear

    direction and common understanding of all issues and activities agreed to

    be addressed so that the next meeting you will be able to evaluate the

    implementation results.

It is also the favourable time to deeply re-evaluate for positive results

    from the recommendations and resolutions of the two previous meetings

    implemented through the Comprehensive Council Health Plans.


I am informed that the main theme of this meeting which is on

    “Experience in Implementation of Comprehensive Council Health

    Plans: In meeting the Millennium Development Goals” is a


continuation of the previous meeting main theme on “Strengthening

    District Health Delivery Systems”.

As mentioned before, this meeting has been organized to enable the

    District Medical Officers and Regional Medical Officers to exchange ideas

    and experiences in delivery of health services through sound

    implementation plans.

I am delighted to see that your meeting program will discuss experiences

    in implementing district plans and ways to reach the millennium goals. I

    am also glad to see that the discussion on successes and experiences are

    related with the implementation of health sector reform.


The objectives and issues of this meeting include:

    (1) To exchange ideas and experiences on DMOs responsibilities and

    execution of tasks

    (2) To discuss successes and problems related with provision of

    health services

    (3) To inform and remind the DMOs on their main roles in provision

    of health services in relation to health sector reform

    (4) To provide implementation report for the 2004 DMOs meeting

    resolutions and recommendations

    (5) To provide report of the joint Annual Health Sector Reform

    Review meeting

    (6) To discuss ways to reach the millennium goals

    (7) To share experiences including successes and problems during

    the implementation of Comprehensive Council Health Plans for

    the period 1999 2005

    (8) To share experiences from other health sector stakeholders in

    implementing the health policy countrywide


I hope this meeting will provide evaluation report on the implementation

    of the previously agreed resolutions and recommendations

    (1) It was observed that the majority of the DMOs do not well advise

    the DEDs on account No. 6 expenditures and purchasing

    procedures. Therefore the resolution was to increase cooperation

    with DEDs and increase efficiency

    (2) It has happened that councils do not acknowledge receipt of

    supplies, government grants, money from NHIF and CHF, and

    other supplies resulting to audit query. The resolution was to


    ensure that such reports are provided and information entered

    into relevant registers

    (3) It was observed that majority of Councils have not established

    Council Health Boards and Health Facility Committees. The

    resolution was to ensure that the council health boards and

    health facility committees are established and launched.

    (4) It was noticed that many government health facilities are not

    providing health insurance services. Therefore deliberate efforts

    are initiated to ensure that all facilities under the councils provide

    the services for health insurance.

    (5) It was observed that majority of the councils do not submit their

    quarterly implementation and finance reports


    The essential health package and priority areas should guide your

    discussions on the successes of the implementation of the comprehensive

    council health plans which include:

    (1) Maternal and Health Services

    (2) Control and prevention of all communicable diseases (3) Control and prevention of all non communicable diseases (4) Control and prevention of special local diseases like river

    blindness, schistosomiasis, etc.

    (5) Control and prevention of diseases through health education to

    the community, and

    (6) Strengthening of infrastructure and institutions in the

    implementation and delivery of health services in the country


Currently there are reforms taking place in various disciplines

    worldwide including the health sector. Tanzania like other countries in

    the world is not an exception. The reforms should aim at increasing

    efficiency and effective delivery of quality health for the benefit of the

    community. Tanzania has agreed to address the millennium

    development goals.

Let me quote the millennium development goals which we agreed to

    implement and are basis of our discussions in this meeting:

    (1) Goal 1: Eradicate Extreme Poverty and Hunger

    (2) Goal 2: Achieve Universal Primary Schools


    (3) Goal 3: Promote Gender Equality and Empower women

    (4) Goal 4: Reduce Child Mortality

    (5) Goal 5: Improve Maternal Health

    (6) Goal 6: Control HIV/AIDS, Malaria and other diseases

    (7) Goal 7: Ensure Environment Sustainability

    (8) Goal 8: Develop Global Partnership for Development


The Ministry of Health or the Health Sector being the main pillar in

    provision of health services in collaboration with PORALG and councils is

    obliged to give correct directions in improving and strengthening health

    services in the country. In order to implement the objectives the Ministry

    of Health decided to organize and conduct the annual meetings for the

    District Medical Officers to enable fruitful discussions on problems and

    successes to improve the health services on yearly basis.


The main issues to be addressed in the delivery of health services and

    implementation of health sector reforms are:

    (1) To satisfy the “client” by solving the health problems and

    provision of quality health care

    (2) The reforms have been developed by us to improve health

    services for our people and solve our problems and improve

    health services in the country. Hence, need well supervision.

    (3) In order for the reforms to be successful, the support from other

    sectors like water, food, education, works, etc is necessary. Good

    cooperation with reforms in other sectors is necessary. It

    necessary to make sure you build good cooperation with these

    sectors for sustainable development.

    (4) The reforms should target at equity in delivery health services

    for all citizens

    (5) The main challenge in provision of health services is to ensure

    that primary health care services begins from the community,

    dispensaries, health centres, district hospitals, regional hospitals

    and finally referral and national hospitals. It is important that the


    community and other stakeholders participate in provision of

    health care services

    (6) Improvement of health services through development of

    comprehensive council health plans adhering to health policy and

    essential health package

I would like to remind you on the Client Service Charter. It is important

    that we read and understand and explain to our colleagues and

    implement it. I hope you also discuss it.


In our policy and health sector strategy planning 2003 - 2008 we have

    five years objectives of which this meeting for districts to include in their

    comprehensive health plans in order to reach the following specific


    (1) To reduce infant mortality from 99 per 1,000 live births to 85 per


    (2) To reduce under five mortality from 137 per 1,000 live births to

    127 per 1,000.

    (3) To reduce maternal mortality from 578 per 100,000 pregnant

    women 450 per 100,000

    (4) To increase DPT vaccination coverage of 2 years old children

    from 71 percent to 81 percent including elimination of polio

    (5) To increase the number of pregnant women delivering at health

    facility under supervision of nurse midwife from 50 percent to 80


    (6) To control leprosy by 2005 and no longer a disease of public

    health importance in the community

    (7) To control elephantiasis and hydrocele by providing drugs and

    other treatment

    (8) To conduct HIV/AIDS campaigns at district, division to hamlet


    (9) To fight malaria, tuberculosis and other communicable and non

    communicable diseases



    The implementation of the objectives should also take into consideration the millennium development goals for correct council planning. It is a challenge for the health sector and other stakeholders within and outside the country. The Ministry of Health, PORALG, Regions and Councils and other stakeholders need to develop implementation strategies, specific steps and transparent processes for coordination and monitoring.


    There are existing problems affecting provision of health care services in the country. These problems include inadequate funds for health services and poor implementation leadership at all levels. In order to increase availability of funds, the government introduced various sources to enable the councils to improve the services. The established sources of funds are:

(1) User fees

    (2) Drug Revolving fund

    (3) Community Health Fund

    (4) National Health Insurance Fund and

    (5) Other sources at council level


    DMOs and RMOs and in-charge of health facilities are encouraged to supervise all sources of funds. Councils and regions are emphasized to give more efforts for strengthening health care services to people through the NHIF and CHF as are key sources of funds accessible for health facilities to improve health services. There are some councils and regions still weak and should learn from others who are doing well. Supervision of resources is weak with some facilities as such contribute to poor health care services.

    The Ministry of Health encourages councils to look for other sources of funds to increase their revenue and motivate their personnel. Councils should not only depend on government grants.


    Let me take this opportunity to again emphasize that the aim of the government is to provide quality health care services as the development cannot be achieved if health status of people is poor. The councils should be strengthened to be able to provide acceptable health services. For that


reason the Ministry of Health will continue to provide guidelines so that

    regions and councils are able to provide acceptable health care services.

For the councils not providing health services at acceptable levels, the

    government will not hesitate to take regulatory and disciplinary actions

    including demotion respective leaders.


This week the discussions will focus on experienced successes and

    problems during the implementation of CCHP for the period of 1999

    2005. However, I would like to cite some successes realized during that

    period in the health sector:

    (1) Councils have reached at a stage of developing plans relevant to

    the policy (CCHP)

    (2) To great extent the implementation of these plans adhere to laid

    down guidelines and procedures.

    (3) Despite some weaknesses the councils are able to provide

    finance and implementation reports

    (4) Councils are developing their plans adhering the essential health


There also problems observed in the development and implementation of

    the CCHP:

    (1) Councils have experienced difficulties to incorporate all

    stakeholders in the plans

    (2) Some stakeholders are not transparent on funds available for

    their district activities

    (3) Some councils not adhering to government priorities and

    essential health package in development of their plans

    (4) Non adherence to procedures and regulations in purchasing

    equipment, supplies, drugs included in the CCHP

    (5) Expenditures non adhering to CCHP

    (6) Non recording of equipment and supplies into registers

    (7) Development of CCHP not related to district health problems

    (8) Delay in development of CCHP and finance and quarterly

    implementation reports

    (9) Poor quality of CCHP

    (10) No linkage and continuation of executing yearly plans. There

    are also general problems in the health sector:




Currently the funds allocated from the government are not

    adequate for health needs. The population has increased.

    Since independence there is a tremendous population increase

    for health needs. Similarly the increased costs for drugs and

    medical equipment had made the problem worse. Therefore

    the meagre resources available should be used efficiently for

    intended activities. You are the main supervisors.



There is a big deficit of qualified health staff countrywide. This

    problem contributes to poor provision of health services. To

    solve the problem regional secretariat and municipal, city,

    town and district councils are having discussions with the

    management and public service for employment approval. The

    requirement estimates should be included in the

    comprehensive council health plans. This year there had been

    an agreement with the public service for councils to recruit

    clinical officers. Deliberate efforts are made for recruitment of

    other cadres to fill the vacancies in the 5 years period.

For Medical doctors the Ministry of Health advised the Public

    Service to initiate bonding in employment contract. This will

    enable to have medical doctors at district level.



    Service buildings, medical equipments and facilities in

    the health facilities are not in good conditions. The

    government has started rehabilitating the buildings and

    equipment. The regions and districts are also

    encouraged to have planned preventive maintenance.

    The government is also providing new technological

    equipment to regional and district hospitals. These new

    equipment are costly and need to be properly






Another major problem in our health facilities are lack of

    ethics and commitment. Some of the health workers are not

    honest and are involved in misconduct not reflecting their

    technical ethics. The Ministry of Health has always

    emphasizing on good conduct and adherence to ethics. The

    Ministry expect the RMOs and DMOs to supervise health

    personnel on ethics. The government is against the misuse

    and mismanagement of equipment and medical facilities as

    are purchased using the people tax. For the health personnel

    who are still mismanaging government resources are urged to

    stop as such habits jeopardise the provision of quality health

    services to the community. The health facilities and health

    personnel belong to the community.




I would like to emphasize on the issue of leadership,

    management and good governance in our councils and at all

    service delivery levels. It is important that the management

    has capacity to strengthen and ensure the management and

    administration is able to supervise and coordinate the

    activities for implementation. The leadership requires people

    who are ready to learn and listen for advice from the

    community. Capacity building requires implementers to work

    in collaboration with the community for sustainable





Corruption, abusive language to patients and health staff

    being absent from their working station, missing equipment

    and drugs, mismanagement of working facilities is a public

    outcry. The government has provided directions to deal with

    corruption and ensure the community is aware of the funds

    available from the government as the funds belong to them.

    The experience has shown that majority of the councils do not


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