HEALTH POLICY

AND PLANNING
CMT06104 Session 1

KABEREGE BONUS, MD
Contents

Definition
Background
Objectives
Statements
Linkage
Hospital reforms
Key points
references
Definition of a Policy
A policy is a Statement on how the government
is to achieve its goals and objectives with
regard to a specific area such as health,
education, agriculture. It can be described as a
deliberate plan of action to guide decisions and
achieve rational outcome(s).
Policy may also refer to the process of making
important organizational decisions, including
the identification of different alternatives such
as programs or spending priorities, and
choosing among them on the basis of the
impact they will have.
Definition of Health and Health
Policy

Health is a state of complete physical,

mental, and social well being and not
merely the absence of disease and
infirmity.

Health policy is a visionary program of

action adopted by the government to
have a healthy society, with improved
social wellbeing that will contribute
effectively to personal and national
Background of the current National Health Policy

The National Health Policy of 1990 was revised and

approved in 2007.

Ongoing socio-economic changes, new government

directives, emerging and re-emerging diseases and
changes in science and technology necessitated
updating the policy.

The resource constraints (especially human resources)

constitute the major problem for not being able to
cope adequately with health problems.
Background continue

The vision of the government is to have a healthy

society, with improved social wellbeing
that will contribute effectively to personal and national
development.

The mission is to provide basic health services in

accordance to geographical conditions, which are of
acceptable standards, affordable and sustainable.

The health services will focus on those most at risk and

will satisfy the needs of the citizens in order to increase
the lifespan of all Tanzanians.
Objectives of the National Health Policy
The health services in Tanzania focus on those most at risk and
satisfy the needs of the citizens in order to increase the lifespan of
all Tanzanians.

Specifically the government aims to:

 Reduce morbility and mortality in order to increase the lifespan

of all Tanzanians by providing quality health care

 Ensure that basic health services are available and accessible

 Prevent and control communicable and non-communicable

diseases

 Sensitize the citizens about the preventable diseases

Objectives continue

 Create awareness to individual citizen on his/her responsibility

on his/her health and health of the family

 Improve partnership between public sector, private sector,

religious institutions, civil society and community in provision
of health services

 Plan, train, and increase the number of competent health staff

 Identify and maintain the infrastructures and medical

equipment

 Review and evaluate health policy, guidelines, laws and

standards for provision of health services
National Health Policy Statements

The 2007 National Health Policy provides policy statements

regarding provision of health services in different areas. These
policy statements are the key areas of focus for the National
Health Policy. They are as follows:

Preventive services: Control disease incidences and disability.

Epidemics: Control communicable diseases, especially diseases

coming from outside the country.

Non-communicable diseases: Promote healthier lifestyles and

treat adequately

Maternal and child health: Reduce maternal and child mortality

in line with Millennium Development Goals (MDGs).
Statements continue

Reproductive health: Make services available, especially for

youth and men.

Primary health care: Make it accessible for all citizens.

Health education and advocacy: Convey that every individual

can improve his or her health status.

Environmental health: Promote a sustainable healthy

environment for the whole community.

Occupational health: Protect and improve workers’ health status.

Curative care: Deliver safe health care services to the

community.

Medicines and supplies: Ensure quality and availability of

sufficient medicines and supplies.
Statements continue

Safe blood transfusion: Make safe blood available

throughout the country

Mental health: Promote mental health in the

community and prevent illnesses.

Traditional medicine and traditional midwifery

Increase coordination and partnerships

Cells and genome: Develop proper use of technology

of genetic engineering.
Statements continue

Control of food, medicines, etc.: Ensure goods are

safe and meet defined standards.

Diagnosis of diseases: Provide accurate diagnosis

and forensic investigations.

Quality improvement and standards: Attain agreed

minimum standards.

Coordination in health sector: Create participatory,

transparent and sustainable system for all
stakeholders.

Human resources development: Provide sufficient

staff with required mix of skills.
Linkage of the National Health Policy with National and
International Initiatives

Vision 2025

Tanzania Vision 2025 is a document providing direction and a

philosophy for long-term development.

Tanzania wants to achieve by 2025, a high quality of livelihood for

its citizens, peace, stability and unity, good governance, a well-
educated and learning society and a
competitive economy capable of producing sustainable growth and
shared benefits.

The document identifies health as one of the priority sectors

contributing to a higher quality livelihood for all Tanzanians.
Linkage continue (Vision 2025)

This is expected to be attained through strategies, which will ensure

realization of the following health service goals:

Access to quality primary health care for all

Access to quality reproductive health service for all individuals of

appropriate ages

Reduction in infant and maternal mortality rates by three quarters of

levels in 1998

Universal access to clean and safe water

Life expectancy comparable to the level attained by typical middle-

income countries

Food self sufficiency and food security

Gender equality and empowerment of women in all health parameters

National Strategy for Growth and Reduction of Poverty
(MKUKUTA)

The MKUKUTA aims to foster greater collaboration among all sectors

and stakeholders.

It has mainstreamed cross-cutting issues (gender, environment, HIV

and AIDS, disability, children, youth, elderly, employment and
settlements).

All sectors are involved in a collaborative effort rather than segmented

activities; therefore this document is of crucial importance for the
Ministry of Health, Community Development, Gender, Children and
Elderly (MOHCDGCE) strategies.

The MKUKUTA seeks to increase ownership and inclusion in policy

making, through addressing laws and customs that delay development
and negatively affect vulnerable groups.

The strategy identifies three clusters of broad outcomes:

1. Growth and reduction of income poverty
2. Improvement of quality of life and social well-being
3. Good governance
Millennium Development Goals (MDGs)

There are eight MDGs to be achieved by [Link] goals respond to

the world's main development challenges. The eight goals are:

1. Eradicate extreme poverty and hunger

2. Achieve universal primary education

3. Promote gender equality and empower women

4. Reduce child mortality

5. Improve maternal health

6. Combat HIV and AIDS, malaria and other diseases

7. Ensure environmental sustainability

8. Develop a global partnership for development

Health Sector Reforms (HSR)

Health Sector Reforms (HSR) started in 1994; the HSR is on-going and
continuous.

The aim of health sector reform is to improve access, quality and

efficiency of health service delivery systems.

Primary health care is adopted as the most cost-effective strategy to

improve the health of the people.

The major focus of the HSR is to strengthen the district health services,
and strengthen and re-orient secondary and tertiary service delivery in
hospitals in support of primary health care.

HSR also aims at strengthening support services from the central level, in
the MOHSW, and in agencies and training institutions.

The HSR introduced a programmatic approach, replacing the project

approach, in order to promote continuity of activities.

Initially a work plan was developed that defines the priorities of the
reforms; this was replaced in 2003 by the Health Sector Strategic Plan
(HSSP) II.
Primary Health Care (PHC)

Primary Health Care is a vision, first adopted in Alma Ata

(1978) and recently revived (WHO, 2008) as “PHC now more
than ever”.

PHC is not the same as primary level services. The main

principles of PHC are (which were the same in 1978 as they are
today):

Community participation

Multi-sectoral action

Appropriate technology

Acceptability and affordability through focus on essential

services that should be available to all through fair sharing of
the financial burden of illness.
Primary Health Care continues

PHC reforms (2008) are comprised of four interlinking groups:

1. Universal coverage reforms moving toward universal access

and social health protection

2. Service delivery reforms reorganizing health services as

primary care around people’s needs and expectations

3. Public policy reforms integrating public health actions (multi-

sectoral approach) with primary care and by pursuing healthy
public policies across sectors

4. Leadership reforms that replace the approaches of ‘command

and control’ and laissez-faire disengagement of the state,
with a leadership style appropriate for the complexity of
contemporary health systems
Health Sector Strategic Plan Three (HSSP III)

The MOHCDGCE has developed a framework to reform the health

sector in order to improve the impact of health services at all levels in
the country.

The emphasis of the strategic health plan is on council health services,

where most of the essential health services are provided close to the
communities, and on hospital services to save lives of people who
cannot be treated in first line health facilities.

The thrust is to significantly improve the quality of essential health

services, and to make Council Health Management Teams (CHMTs),
council health providers and hospital management boards more
accountable to the community.

The HSSP III promotes delegation of authority.

This means that the dispensaries, health centers and hospitals should
be the key actors in the planning process.

It also means that they will be held responsible for implementing what
they have planned.
Health Sector Strategic Plan III continue

To improve health status of the people, the types of services described

below are emphasized.

The following types of services provide a continuum of care for patients

and clients:

Health promotion
This includes activities to increase behaviour change and to ensure that
lifestyles of individuals are conducive to personal development and
environmental safety.

Community participation and ownership

These are the keys to success of the primary health service delivery
programme.

Preventive health services

These prevent diseases by promoting optimal nutrition and control of
infectious disease transmission, reduce epidemics and improve working
environments to maintain the highest standards of occupational health.
HSSP III (Types of Services) continue

Care and treatment (curative services)

These services correctly treat diseases and conditions to reduce
complications or death by improving quality and quantity of care to
patients and ensuring availability of basic services and supplies.

Rehabilitation services
These are services to patients such as physical rehabilitation,
mental rehabilitation and psychological support to vulnerable
groups.

Provision of care to the chronically ill and the elderly

This includes catering for life-long treatment like hypertension,
diabetes, AIDS patients on ARVs, renal conditions, cancer and any
other chronic conditions.

Note:
Now we have HSSP IV (Reaching all Households with Quality
Health Care)
Levels in the Health Sector

The health sector consists of components or levels in the health

sector:

Council health services (in district or municipality), consisting of:

1. Household and community health
2. Dispensaries and health centers (public and private)
3. District hospital and other hospitals (public and private)

Regional health services, consisting of:

4. Regional referral hospitals
5. Regional health management teams

National level services, consisting of:

6. Specialized hospitals and special hospitals (public and private)
7. Training institutions, Zonal Health Resource Centers (ZHRCs)
8. Ministries, departments and agencies
Hospital Reforms

Hospital reforms refer to:

‘A strategy to strengthen management systems, structures,

values, methods and capacity’

‘Introduction of quality improvement mechanisms in hospitals so

that these reforms are able to solve health care delivery problems
themselves as well as improve quality of health services provided
in line with the ongoing health sector reforms’

There has been growing concern that the services delivered at

hospitals are not up to expected standards.

Therefore MOHCDGCE over a period of time, realized that there

are various needs and difficulties that are common to hospitals all
over the country.
Hospital Reforms continue

The main areas of concern to address include:

1. Inadequate planning

2. Inadequate management and control of resources

3. Inability to deliver the range and level of diagnostic and treatment

services expected from the hospitals

4. Shortage of human resources and inappropriate mix of skills

5. Low work morale

6. Poor attitudes towards patients

7. Inadequate funding for a long time which led to deterioration of

equipment, infrastructure and transport

8. Poor preventive maintenance planning of hospital facilities and

equipment
Objectives of the Hospital Reforms

Overall objective:

‘delivery of quality health services and client satisfaction’

Specific objectives are to:

1. Develop annual hospital plans and budgets that are in line with
National Planning Guidelines

2. Set supportive monitoring and accountability systems within the

hospital structure

3. Provide quality health services

4. Establish effective committees in line with National Guidelines

5. Manage health resources effectively

6. Develop preventive maintenance mechanisms of hospital

infrastructure
Structures in Support of the Hospital Reforms Process

In support of the hospital reforms, the MOHSW in collaboration

with the Prime Minister’s Office Regional Administration and Local
Government (PMORALG) has agreed to form service provision
support structures. These are;

1. Council Health Service Board (CHSB)

2. Council Health Management Team (CHMT)

3. Council Hospital Governing Committee (CHGC)

4. Regional Health Management Team (RHMT)

5. Regional Referral Hospital Boards (RRHB)

6. Regional Referral Hospital Management Team (RRHMT)

Key Points

1. Health policy is a visionary program of action adopted by the

government to have a healthy society, with improved social
wellbeing that will contribute effectively to personal and national
development.

2. The mission of the government is to provide basic health services

in accordance to geographical conditions, which are of
acceptable standards, affordable and sustainable.

3. Health policy links with other national and international

initiatives such as:

a) Vision 2025

b) National Strategy for Growth and Reduction of Poverty (NSGRP /

MKUKUTA)

c) Millennium Development Goals

d) Primary Health Care (PHC)

References

1. UNDP. (2005). A Practical Plan to Achieve the Millennium

Development Goals; Investing in Development’ Millennium
Project. New York: United Nations Development Programme.

2. MOHSW. (2004). District Integrated Management Cascade. Dar

es Salaam, Tanzania: Ministry of Health and Social Welfare.

3. MOHSW. (2008). Health Sector Strategic Plan (HSSP) III. Dar es

Salaam, Tanzania: Ministry of Health and Social Welfare.

4. MOHSW. (2007). National Health Policy. Dar es Salaam,

Tanzania: Ministry of Health and Social Welfare.
 THANKS
FOR
LISTENING