Today, the Swiss Government-funded Health Promotion and System Strengthening (HPSS) project joins the World Health Organisation (WHO) and the Government of Tanzania in observing World Health Day (WHD).
Coincidentally, this year’s WHD falls not only on WHO’s 75th anniversary year but also HPSS’s 12th and final year of implementation.
HPSS looks back with pride at its contributions to the country’s many public health successes that have improved the quality of life of Tanzanians during that period.
“We subscribe to this year’s WHD theme: Health For All, which envisions that all people have good health for a fulfilling life in a peaceful, prosperous, and sustainable world”, said Manfred Stoermer, HPSS Project Director.
Since 2011, the HPSS project has partnered with the Tanzanian Government in developing innovative solutions for strengthening the health system and supporting their integration into national institutions, systems, and policies.
Employing a systems-strengthening approach, HPSS supports the Government in health financing, medicine supply management, health promotion, health technology management, and research.
Each of these components includes ICT development support for integrating the solutions into the governmental structures.
The Government of Tanzania continuously strives to ensure high-quality, accessible, and affordable health services to the citizenry. Therefore, many reforms have taken place in the health system financing structure, including the provision of free healthcare services and the introduction of cost-sharing arrangements.
In terms of health financing policies and systems to ensure equitable access to healthcare services through health insurance coverage, HPSS has been directly involved in the improvement and implementation of the Community Health Fund (CHF), a pro-poor financing mechanism mostly targeting the informal sector.
With the support of HPSS, the government has developed the CHF into the “CHF Iliyoboreshwa”, a viable health insurance system that offers its members access to over 6000 public health facilities ranging from dispensaries, health centres, district hospitals, and regional referral hospitals across the country.
CHF Iliyoboreshwa annual premiums are only TSh 30,000 per family of six persons in all regions except Dar es Salaam where the annual premium for a family of six is TSh 150,000. Currently, the scheme has a membership of over four million Tanzanians.
The CHF scheme was primarily established to mobilize financial resources from the community for the provision of adequate quality and affordable healthcare services to its members.
Recognizing the shortcomings of the original CHF which allowed its members to access health services at only one health facility, the government has transformed it into the CHF Iliyoboreshwa, a full-fledged health insurance scheme that allows members to access public health services anywhere across the country.
CHF Iliyoboreshwa also ensures that new members do not have to travel long distances to get registered because enrolment officers have been distributed in every village and town street.
Payment of premiums is done through mobile phone transfers. A digital solution is also in place where members whose membership has expired can do self-renewal using mobile phone applications in the comfort of their locations.
HPSS supported the development of an innovative “CHF Insurance Management Information System” (CHF-IMIS) which is now accessible internationally as open-source software for health financing.
Meanwhile, as plans are at an advanced stage to enact the universal health insurance (UHI) legislation, HPSS affirms its commitment to support this government endeavor.
The government has assured people that the health benefits they have been accessing through the CHF Iliyoboreshwa will continue to be improved when the new law comes into force.
“We will not abandon CHF, but rather strengthen it to ensure more people continue to access quality health services”, said Dr. Grace Magembe, Deputy Permanent Secretary at the Ministry of Health.
HPSS subscribes to the fact that access to healthcare is determined by various factors including the availability of medical supplies. It is in this regard that the project underscores the importance of access to medicines and their rational usage.
This is also in line with the national blueprints: Big Results Now (2015-2020) and Health Sector Strategic Plan V (2021-2026) which emphasize the importance of well-stocked health facilities in terms of medicines, supplies and staff.
Medical Stores Department (MSD) is the backbone of the public medicines supply in Tanzania. But they face challenges in filling orders for health facilities at times hence the gap is complemented by private suppliers.
In light of this, HPSS has been supporting the government in designing and implementing the Jazia Prime Vendor System, a complementary supply chain that ensures a seamless availability of medical supplies during stockouts at the MSD.
Speaking recently at a training for regional and council health management teams on Jazia Prime Vendor System implementation manual, Regional Administrative Secretary for Mbeya, Rodrick Mpogolo hailed the government for its continued efforts in improving health service delivery.
“Jazia Prime Vendor System which complements medicines supply has proved to be the surest way of ensuring regular availability of drugs in public health facilities”, he said.
Meanwhile, most regions in the country have recorded over 90% availability of health commodities in the public health facilities, courtesy of the Jazia Prime Vendor System.
However, making medicines available at health facilities is futile if they are not used in a rational way. Therefore, HPSS also emphasizes the importance of responsible prescription and usage based on national Standard Treatment Guidelines and has provided tools and clinical training.
A special focus of HPSS efforts has also been on mitigating antimicrobial resistance.
Regarding health technology, HPSS strongly believes that healthcare delivery largely depends on adequate and functioning medical equipment and facilities and that strengthening the management of infrastructure, physical resources, and maintenance of equipment is critical.
“Strengthening the management of medical infrastructure and equipment including the timely planned preventive maintenance, repair and renovations is absolutely necessary in order to improve the overall health system and make the optimal use of existing investments in the health sector”, said Ally Kebby, HPSS Project Manager.
To realize this, HPSS has supported the government to establish the national calibration and training canter in Dodoma and the establishment of 11 medical equipment maintenance workshops in many other regions including Iringa, Arusha and Shinyanga.
The introduction of the Medical Equipment and Infrastructure Management Information System (MEIMIS), a computerized inventory, helps the government to keep records of every medical equipment or device.
As part of its mandate, HPSS has been championing health promotion efforts in the country along the WHO Ottawa Charter which defines health promotion as a comprehensive approach within and beyond the health sector that enables people to increase control over their health.
The empowerment of individuals and strengthening the actions of families, groups and communities for health has been an important agenda for the project, especially in supporting school health and sanitation.
HPSS project has played a leading role in developing health promotion related training materials and facilitating training for Health Officers, Community Development Officers and School Health Coordinators.
To ensure that strengthened national expertise is sus¬tained and developed in the future, HPSS partners with the University of Dodoma (UDOM) in developing health promotion courses.
“We feel honored to be partners with HPSS and con¬tribute to the health promotion agenda”, said Dr Stephen Kibusi, Dean of the School of Nursing and Public Health at UDOM
Digital health solutions supported by the projectare being used from the national level all the way to the council level for managing health insurance, medicine supplies, and health facility equipment.
Silvanus Ilomo, Director of ICT at the Ministry of Health said digitalization of the health systems has contributed to better management of health services in public health facilities.
“With digital health solutions, it’s now easy to capture important data, accurately and timely. This helps to speed up strategic decision-making”, he said.
In the entire life cycle of HPSS, research efforts aimed at addressing policy knowledge gaps have been a regular undertaking.
Swiss Tropical and Public Health Institute (Swiss TPH) is charged with the responsibility of implementing the HPSS project on behalf of the Swiss Government.
As a renowned international research institution in pub¬lic health and health systems development, Swiss TPH taps into its experience of setting up collaborative mechanisms to develop joint research agendas aligned with national needs and priorities.