CATHOLIC DIOCESE OF MBINGA
STRATEGIC PLAN OF THE HEALTH DEPARTMENT
JANUARY 2015-DECEMBER 2017
Prepared by:
Department of Health
Diocese of Mbinga
TABLE OF CONTENTS
Abbreviations……………………………………………………………….
Acknowledgement…………………………………………………………
Executive Summary………………………………………………………
CHAPTER ONE……………………………………………………………..
1.0 OVERVIEW OF THE HEALTH DEPARTMENT……………..
1.1 The Department Profile………………………………….
1.2 The Planning Team Approach………………………….
1.3 Purpose of Strategic Plan……………………………….
CHAPTER TWO……………………………………………………………..
2.0 SITUATION AND STAKEHOLDER ANALYSIS……………..
2.1 Programme Performance Experience……………….
2.1.1 The Diocese Medical Department……………………
2.1.2 Lack of qualified Staff……………………………………
2.1.3 Poor Infrastructure……………………………………….
2.1.4 Shortage of Medical Equipment and Supplies……
2.1.5 Transport and Communication……………………….
2.1.6 Income of the People…………………………………….
2.1.7 Movement of Health Professionals…………………..
2.2 General Environment Analysis………………………..
2.2.1 Political………………………………………………………
2.2.2 Economical………………………………………………….
2.2.3 Social………………………………………………………….
2.2.4 Technological………………………………………………
2.3 The SWOT Analysis……………………………………….
2.3.1 Strengths…………………………………………………….
2.3.2 Weaknesses………………………………………………….
2.3.3 Opportunities………………………………………………
2.3.4 Threats/Challenges………………………………………
2.4 Stakeholder Analysis…………………………………….
2.4.1 External Stakeholders…………………………………..
2.4.2 Internal Stakeholders……………………………………
CHAPTER THREE…………………………………………………………
3.0 VISION, MISSION AND CORE VALUES……………………..
3.1 Vision…………………………………………………………
3.2 Mission Statement……………………………………….
3.3 Core Values………………………………………………...
CHAPTER FOUR…………………………………………………………..
4.0 PLAN STRATEGY………………………………………………….
4.1 Strategies…………………………………………………..
4.2 Strategic Goals, Objectives and Activities……….
CHAPTER FIVE…………………………………………………………….
5.0 MONITORING AND EVALUATION…………………………….
5.1 Monitoring and Evaluation Protocol……………….
5.2 Action Plan Matrix and Budget………………………
Reference……………………………………………………………
ABREVIATIONS
AIDS Acquired Immune Deficiency Syndrome
AMOs Assistant Medical Officers
CBOs Community Based Organizations
CSOs Civil Society Organisations
CHSB Council Health Service Board
COs Clinical Officers
CSSC Christian Social Services Commission
DRF Drug Revolving Fund
FBO Faith Based Organization
HIV Human Immunodeficiency Virus
MDs Medical Doctors
NGOs Non Governmental Organizations
PPP Public Private Partnership TQIF Total Quality Improvement Framework
ACKNOWLEDGEMENT
The Department of Health would like to thank the Management of the Diocese for taking initiative to challenge the Department to launch its first ever Department Strategic Plan 2015-2017 since its establishment twenty eight years ago. A number of people at Diocese and Department levels made substantial contributions in the preparation of this Strategic Plan. The Department is grateful to all of them.
The Strategic Plan 2015-2017 of the Health Department is a result of many consultations with representatives from Health Facilities directly responsible for delivery of the department activities at Dispensary, Health Centre, Hospital and Department levels.
The preparation of the three year Departmental Strategic Plan 2015-2017 has been made possible by the excellent cooperation, commitment, seriousness and participation of the Administrators and Sister In-Charges of the health care facilities in the Diocese.
Credit also goes to all those who in one way or the other spent their valuable time to provide information needed during preparation and compilation of this final document of the Strategic Plan of the Department of Health. The following need particular recognition for their contribution in the planning process:
1. Mr. John Fusi - Facilitator
2. Fr. Raphael Ndunguru - Moderator
3. Fr. Meinrad Nyandindi - Secretary
4. Ms. Anna Mwenda - Member
5. Fr. Mamertus Ndunguru - Member
6. Sr. Shukrani Ngongi OSV - Member
7. Sr. Mwombezi Mwenda OSV - Member
8. Sr. Depores Kumburu OSB - Member
9. Sr. Hyasinta Ndomba OSV - Member
EXECUTIVE SUMMARY
The Medical Board of the Mbinga Diocese is is responsible for overall running of the Health services in the Diocese. The department was established to promote the development of health care services of communities targeting mainly those living in the remote areas. The inability of the Government to provide health care to its people particularly those in remote areas made it possible for the Diocese to support the Government in the provision of health services to achieve better economic, social and cultural conditions of the people.
This Strategic Plan of the Department of Health is a three year plan 2015-2017. It is a long term plan which is influenced by its environment and is a product of careful internal and external environment assessment. In other words, the Strategic Plan navigates the Department’s domain within its environment and its primary aim is to create an enabling and conducive environment for improving delivery of health services. It is assumed that the strategies selected are feasible, cost-effective and can be implemented within the plan period.
The Strategic plan contains five chapters. Chapter one is the general overview and provides detailed description of the profile of the Diocese, Health Department, and overall purpose of the Plan. Chapter two presents an in-depth assessment of the internal and external environments using SWOT analysis technique. Chapter three highlights the department’s Vision, Mission, and Core Values. The strategic plans are contained in Chapter Four. Each of the strategic goals has been worked out in some detail in order to provide a framework for developing the plan. The objectives to realize the strategic goals are indicated after each goal and these are further refined into activities. The Monitoring and Evaluation protocol is briefly outlined in chapter five to provide a framework for ensuring that the plan is implemented as planned. The description of monitoring and evaluation protocol includes the action plan which contains the time frame, performance indicator and officers responsible for each activity. Also, a brief description of the reviews of the plan and reporting arrangements are provided. At the end are the Action Plan Matrix and Plan Budget followed by references cited in the course of preparing the strategic plan document.
CHAPTER ONE
1.0 OVERVIEW OF THE DEPARTMENT
INSPIRATION OF THE DEPARTMENT
In the preparation of the Strategic Plan for the Health Department, the Planning Team was inspired by the following philosophy and quotations
PHILOSOPHY
Before all things and above all things care must be taken of the SICK, so that they may be served in very deed as CHRIST HIMSELF. For he said that: “I was sick and you visited me, and as long as you did it to one of these my least brethren, you did it to me.” (Matthew 25: 45)
QUOTATIONS
“Listen carefully, my daughters and sons....”
“First of all, every time you begin a good work; you must pray to GOD most earnestly, to bring it to perfection”
“No one is to pursue what she or he judges better for herself or himself, but instead, what she or he judges better for someone else”
(From St. Benedict`s Rule: chp. 36 - The Sick Brothers)
1.1 Department Profile
Mbinga Diocese is situated in the Southern part of Tanzania sharing the same boundaries with Mbinga and Nyasa Districts in Ruvuma Region. It is bordered by Songea Archdiocese to the East, Njombe Diocese (Ludewa District) to the North, Lake Nyasa (Malawi) to the West and the Republic of Mozambique to the South.
1.2 Demographic Pattern
Mbinga Diocese covers an area of 11,396 sq km, out of which 2,979 sq. Km is covered by water and 8,417 sq. Km is dry land and forest which is suitable for agriculture and other related activities. Administratively, the two Districts of Mbinga and Nyasa have 234 villages, 49 wards and 6 divisions.
According to 2012 National Population Census the current population of Mbinga Diocese (Mbinga and Nyasa Districts) is 499,843 out of which 243,794 are males and 256,049 are females.
1.3 Climatic Conditions
The climatic conditions in the two districts are heavily influenced by high plateaus that create a distinctive pattern of both temperatures and rainfall.
1.3.1 Rainfall
The rainfall pattern in the two districts is unimodal with average annual rainfall of 124 mm. The rainy season starts from December and extends to April leaving the rest of the year dry. On average the period from planting seeds to harvesting is six months with an exception of Hagati Plateau which extends up to nine months. The start of the rainy season is reliable, normally at the end of November.
1.3.2 Temperature
The average maximum temperature in the two districts is between 29oC and 31oC while the minimum temperature is 19oC although during the months of August temperatures can fall to 13oC particularly in the Matengo highlands
1.3.3 Vegetation
The original natural vegetation for the most part of Mbinga District is the Miombo woodland, mostly found in the hilly slopes and lower plateau areas. This type of vegetation favours well drained soils. In water-logged areas the woodlands are replaced with grassland. It is possible to assume that the areas of more than 1,700 m above the sea level was at least once covered with a dense forest of mountains type as is now replaced with farms.
1.4 Social issues
The major ethnic group is the Wamatengo who constitute the largest proportion of the District population. The main activity is farming although they engage in small livestock keeping. However, while many are farmers and livestock keepers, a few are involved in small business activities within the village settlements.
Mbinga town is an administrative and commercial centre in the Mbinga district. It is inhabited by people of middle and low income, and its main stay is business, mining, and traditional agriculture. In recent years, the District is witnessing an influx of people bringing new cultures and social values which is affecting family norms, and religious beliefs. There is also an escalation of communicable disease particularly HIV/AIDS and an increase in the number of orphans and widows.
1.5 The Team Approach
The process of developing this Strategic Plan was interactive, participative and through brainstorming where by the planning team was able to generate ideas, and suggestions which led to identification of strengths and weaknesses as well as opportunities and challenges. The Vision, Mission and Core Values, were revisited before Objectives, Targets and Strategies to address the Strategic Goals and key performance indicators for tracking results and outcomes were developed.
1.6 Purpose of the Strategic Plan
The purpose of the Strategic Plan is to set direction and guideline for preparation of annual plans and budgets as well as evaluation of the implementation of planned activities. It is also aimed at creating a common understanding among all staff in the Health Department and stakeholders in order to enhance collective contribution in realization of the Mission, Vision and Objectives of the Department. The Strategic Plan 2015-2017 of the Department of Health reflects the Strategic Plan of the Diocese and it is an important tool for implementation of the Strategies guiding provision of health services in the Diocese.
CHAPTER TWO
2.0 SITUATION AND STAKEHOLDERS ANALYSIS
2.1 Past Performance Experience
The Situation analysis provides a detailed analysis of the external and internal environment and how these influence the delivery of services to various stakeholders. It is from this analysis that the summary of strengths, weaknesses, opportunities and threats can be identified, and strategies for implementation established in the next three years. The Medical Department also recognizes other stakeholders within the Diocese who are providing similar services in different locations. However, health services provided by the Catholic Health Facilities are very distinctive both in terms of quality and coverage.
2.1.1 The Diocese Medical Department
Apart from the main work of preaching the word of God by administering parishes and apostolate works, the Diocese also takes care of social services through running education, health, water and care for children and the elderly. The Department is one of the oldest units of the Catholic Church supporting the Government through provision of a package of health services which range from curative, preventive, and rehabilitative to promotion of health care in the communities. With the emergence of new health problems and practices which do not promote health of the people, the department face stiff challenge in prioritization of its interventions. The HIV/AIDS pandemic and malaria continue to threaten the lives of many people. To address these problems and many more, there is a need to harness resources from both the private and public sectors. The Department runs 18 Health Facilities including 3 Hospitals: (Litembo, Ruanda, Lituhi), 4 Health Centres: (Maguu, Mpapa, Mpepai, Kigonsera), 11 bedded Dispensaries: (Tingi, Nangombo, Mango, Lundu, Lundumato, Mikalanga, Matiri, St. Vincent, St. Gabriel, Mpepo, Makwai) and a Diocesan Medical Store. Currently the Department has an establishment of 308 different cadres of health staff and a total bed capacity of 935 beds. The Medical Board is responsible for overall supervision and improvement of health services in the Diocese.
The past Program implementation experience has revealed a couple of challenges which should not be overlooked when preparing this strategic plan. Challenges which indeed are a serious concern include:
i. Lack of qualified staff in some disciplines
ii. Shortage of Human Resource
iii. Dilapidated Health Facility buildings
iv. Poor housing for staff
v. Lack of reliable transport and communication
vi. Movement of staff to other sectors
Overall performance of the program in terms of realization of its objectives was marred by serious constraints which are highlighted in the following paragraphs.
2.1.2. Lack of Qualified Staff
Lack or sometimes shortage of qualified staff has been observed to be a concern in almost all Health units. Cadres like Laboratory Technicians, Clinical Officers, Nurses and Doctors are most hit by shortage relative to the number of patients who have been on the increase and demand for qualified human resource. However, the situation has eased a bit and signs of improvement are emerging. Even if staff secondment and government subsidies have been frozen, the health sector policy requires Health Facilities to be manned by qualified and adequate numbers of health staff.
Another experience is the mass movement of health staff from these Health Facilities to either government owned health facilities or other sectors. Many quit Church owned Health Facilities for various reasons including opting for greener pastures elsewhere.
2.1.3. Poor Infrastructure
Some of the Health Facility buildings are outdated and need major repairs and renovation. Health Facility buildings and staff houses which were constructed more than fifty years ago need repair and renovation to accommodate current demand of health staff, patients and technological requirements. Restructuring and renovation of buildings is required in many Health Facilities although in some of the situations construction of new structures is inevitable for example when thinking about establishing a Dispensary or Nursing school.
2.1.4. Shortage of Medical Equipment and Supplies
Some of the equipment which are still in use are outdated and need to be phased out. On the other hand, there is need for acquisition of new equipment to cope with advancement in science and technology. Procurement of medical supplies from different suppliers is a necessity that cannot be ignored. In the past medical equipment and supplies were in the form of donations, but today they must be bought. This requires a u-turn in the logistics of procurement.
2.1.5. Transport and Communication
It is gratified to acknowledge that most of the health facilities can now be accessed through various means. Nevertheless, there are still problems in communicating with peripheral health facilities. Some of the roads are not passable particularly during rain season. On the other hand, some of the health facilities are in desperate need of means of transport for easy movement.
2.1.6 Income of the People
Income of the people in the Diocese is average due to many factors including falling market prices of coffee. As a result, diseases like malaria, Diarrhoea and malnutrition are endemic. Lack of entrepreneurship skills, clean and enough water, proper feeding and education on health issues is common among people in the community.
2.1.7 Movement of Health Professionals
The recent acceleration of movement of health professionals from Church Owned health facilities to other sectors is a serious concern for Managers and In-charges of health facilities that require appropriate retention schemes to retain them. Economic factors that exist elsewhere are pulling these professionals to leave for other destinations within and outside the district.
2.2. Environmental Analysis
2.2.1. Political Environment
The political environment has facilitated the formulation and implementation of socio-economic policies that contribute towards realization of poverty alleviation initiatives such as MKUKUTA, Millennium Development Goals and Kilimo Kwanza. This has created opportunities and challenges for development of which the Diocese has a role to play. Some of the Political Environmental factors which promote service delivery are:
(i) Good system of multiparty democracy in the country
(ii) Peace and stability in the country
(iii) Cordial relationship between the Diocese, Political and Government Leadership
(iv) Establishment of new Nyasa District, independent from Mbinga District
(v) Good government policies in service delivery
Some of the Political Environmental factors which hinder service delivery are:
1. Empty promises by some political and government leaders
2. Perception that Church owned Health Facilities are competitors rather than supporting government initiatives
Some of the government exemption policies create negative feelings among Church health service providers
2.2.2 Economic Environment
The government of the United Republic of Tanzania has embraced open economy and social policies characterised by increased emphasis on liberalization, and promotion of Public-Private Partnership (PPP) in development. The existence of entrepreneurs who can invest in small scale economic ventures, enhance income generating opportunities.
The main sources of income of the people are private and self-employment in the business and agricultural sub-sectors. Both farming and Livestock rearing are undertaken traditionally with low productivity levels. The major food crop is maize, complemented by other crops including beans and round potatoes. Unfortunately the falling price of coffee the district is witnessing has had adverse effect on the per capita income of the people and in particular the proportion spent on health care. The economic environmental factors include:
(i) Existence of Coffee as leading cash crop in the District
(ii) Irrigation schemes along Lake Nyasa which boost economy of people
(iii) Completion of tarmac road construction to Mbinga has opened up economic ventures in the District
(iv) Economic status of people is poor
(v) Falling market price of coffee
(vi) Existence of Coal mine in Ruanda will boost economy
(vii) Completion of Tarmac road construction to Mbinga has eased transportation
(viii) Deforestation attributed by use of modern technology in felling trees
(ix) Transportation of coal affects Environment particularly at Ndumbi
(x) Economic assistance (Fertilizers, Power Tiller) not reaching target people
(xi) Shift of Medical care from being a service to a commodity that can be supplied and demanded
(xii) Cost of drugs and treatment seems to be high from poor families point of view
2.2.3. Socio-demographic Environment
The existence of Non Governmental Organisations (NGOs) and Civil Society Organisations (CSOs) that support the government in the provision of health services provide an opportunity for the Diocese to work closely with these partners. However the influx of people into the district looking for jobs in the mining industry and other investments is bringing new challenges in community cultures and values. Other Socio-demographic environmental factors that also influence service delivery are:
(i) Split of Mbinga District into two Districts (Mbinga and Nyasa) will boost community social services (e.g., Health and Education)
(ii) Increasing number of Orphans and Widows
(iii) Extended family ties are slowly diminishing
(iv) Beliefs in witchcraft still rampart
(v) Traditional healers and services they provide are increasing
(vi) Interaction with people from outside the District is growing fast
(vii) Opportunities for children joining secondary education increasing
(viii) Awareness of people on health issues going up
(ix) Loyalty to Western lifestyle eroding cultural norms and values
(x) High migration of people into the District
(xi) Diminishing faith of the Believers
(xii) Community perception of free services provided by Church Health Facilities still exists in the community
2.2.4. Technological Environment
The technological environment is is growing faster than expected in terms of both information communication technology as well as in medical equipments. To some extent technology has increased efficiency and effectiveness in service delivery across the board. For instance internet services have increased whereby people now can use emails for communication and mobile phones have even made communication much easier with outside world. The wide use of solar power in many of the Faith-Based Health Facilities will accelerate development of health services. Detailed analysis of the technological environment reveals the following factors which also influence service delivery:
(i) Electricity power supply stations in Litembo, Maguu and other places will accelerate development
(ii) Existence and use of Solar Energy in Church owned Health Facilities result in efficient service delivery
(iii) Communication technology (TV, Phones, internet etc.) has improved communication
(iv) Globalization is affecting morals and cultures of people
(v) Employees` lack of skills in the use of technology
(vi) Community efforts to conserve environment through use of Solar and Hydro power
2.3. SWOT analysis
The Church recognizes stakeholders in the District who provide similar services in different areas. However, the services provided by the Catholic Church health facilities are very distinctive and remain the second largest next to the government health delivery system. The analysis of strengths, weaknesses, opportunities and threats (SWOT) carried out for the department revealed the following:
2.3.1 Strengths
(i) Qualified, accountable and experienced staff
(ii) Good relationship with the government and other internal and external stakeholders
(iii) Availability of physical infrastructure in place
(iv) Team working and good leadership
(v) Government policies and regulations to guide service delivery
(vi) A peaceful working environment
(vii) Availability of donors support
(viii) Availability of drugs and working tools
(ix) Quality and efficient services
(x) Existence of registered Health Facilities
(xi) Possession of legal title deed of the land for expansion by the Diocese
2.3.2 Weaknesses
(i) Few qualified specialized staff
(ii) Lack of career plans
(iii) Limited and unreliable sources of funding
(iv) Outdated buildings and working tools
(v) Donor dependence
(vi) Long delays in promoting staff
(vii) Lack of transport means
(viii) Lack of project proposal writing skills
(ix) Salary scales and allowances that do not conform to government directives
(x) Lack of time consciousness
2.3.3. Opportunities
(i) Availability of donor support
(ii) Peace and tranquillity in the country
(iii) Availability of government supports e.g., Basket Fund and Salary Grants
(iv) Existence of social security schemes e.g., NHIF, CHF, NSSF
(v) Existence of government employees in Health Facilities
(vi) Availability of training opportunities
(vii) Availability of modern medical equipment in the market
2.3.4. Threats/Challenges
(i) Support that come with tight conditions
(ii) High turnover of medical personnel to other sectors
(iii) Emergence of new health challenges e.g., HIV/AIDS
(iv) Increase in number of orphans and widows
(v) Increasing number of HIV/AIDS patients
(vi) Competition with pharmaceutical shops
(vii) Government policies that conflict with teachings of the church
(viii) Continuous withdrawal of donors
(ix) Globalization
2.4. Stakeholders Analysis
One possible explanation for inadequacies in implementation of different activities in recent years has been the failure to assess and manage the various external and internal stakeholders whose cooperation and support are necessary to implement business strategy successfully. With regard to what the Department of Health is doing, two main categories of stakeholders can be identified: external stakeholders and internal stakeholders.
2.4.1. External Stakeholders
The external stakeholders include:
(i) Patients and their families
(ii) Public Regulatory Agencies
(iii) People in the catchment areas
(iv) Christian Social Services Commission CSSC
(v) Government
(vi) Donors (internal and external)
2.4.2. Internal Stakeholders
Internal stakeholders are those who operate within the Department and Health Care Facilities such as:
(i) Employees providing services
(ii) Medical Board of the Diocese
(iii) Facility Management Teams
From stakeholders analysis it is revealed that stakeholders have specific expectations from services provided and following are general things they are mostly satisfied with:
(i) Good and polite language
(ii) Availability of drugs and other services
(iii) Good working environment particularly Health Facility Premises
(iv) Work Efficiency
Among things that stakeholders are dissatisfied include:
(i) High cost of medical care
(ii) Long waiting time/Long queues
(iii) Shortage of health staff
(iv) Lack of transport (Ambulance)
CHAPTER THREE
3.0 THE VISION, MISSION AND CORE VALUES
3.1 Vision
Vision is a concept for a new and desirable future reality that can be communicated throughout the Department. It is a clear hope for the future and usually challenging about excellence.
“To be a centre of excellence in the delivery of sustainable health care to our patients in the Diocese with the compassion of Christ”
3.2 Mission
Mission statement is a corporate philosophy that outlines the business identification and provides the fundamental purpose of the organization. It is a broadly defined statement of purpose which underscores the uniqueness of any organisation. The mission statement of the Department states:
“To improve the lives we touch through promotion and provision of quality, affordable, respectful and holistic care for all”
3.3 Core Values
It is prudent to estimate the significance of some of the essential values of the employees` work because without the courage of convictions, all moral and ethical consideration of situations, principles and obligations will probably fail. Ethical principles, values and talk have no meaning without the strength of character to put them into practice and behave according to accepted values. For the professional work in Church Health service the core values are traditional values which emphasize that without ethical competence health managers do not use their professional or task competence in the right way. The core Values of the Department that will regulate behaviour of managers and employees are:
(i) Excellence
We attain and maintain quality and excellence of patient care based on standards and best medical practices
(ii) Team work
We foster a working environment of collaboration, trust and mutual respect
(iii) Integrity
We are committed to the highest ethical standards of medical care
(iv) Compassion
The “Patient” will be at the centre of our services
(v) Transparency
We are open, honest and transparent organisation in the way we deliver services
(vi) Innovativeness
We harness and embrace change and modernization to enhance service delivery
(vii) Commitment
We value and support our staff and sympathize with patients who are under our care
Viii) Expertise
We use our knowledge and experiences gained to provide quality services
CHAPTER FOUR
4.0 Strategic Plans, Goals and Activities
4.1 Strategies
The overall goal of the strategic plan is to improve the health status of the people in the Diocese through addressing identified strategic goals and objectives which are feasible, cost-effective and which can be implemented within the plan period. The Strategic Goals are:
1. Increase the efficiency of the Diocese through provision of quality, accessible and affordable health care services especially in hard to reach areas
2. promote the efficiency of the Department through capacity building initiatives such as workshops, seminars and in-job trainings
3. Maintenance and extension of existing physical infrastructure
4. Enhance and maintain partnership and networking with stakeholders
5. Adequate and quality infrastructures
6. Improve quality of Health services through construction of facilities, training of health staff and acquisition of medical supplies
7. Strengthening institutional health administration
4.2 Strategic Goals, Objectives and Activities
Strategic Goal 1:
Increase the efficiency of the Diocese through provision of quality, accessible and affordable health care services especially in hard to reach areas.
One of the social services of the Diocese is the provision of the health care services. The government’s inability to provide health care services to all people especially in rural areas has forced the Diocese to support it through provision of quality, accessible and affordable health services. To realize this goal the Department of Health intends to address the following objectives during the plan period.
Objectives:
1. Raise the standard of 4 Dispensaries to the level of Health Centres by 2017
2. Improve establishment of Lituhi and Ruanda Hospital staff to provide quality services by 2017
Activities:
i. To upgrade 4 Dispensaries to Health Centres by 2017 (Tingi, Lundumato, Lundu and Nangombo)
ii. To increase the number of staff by 20% at Ruanda Hospital by 2017
Strategic Goal 2:
Departmental development through capacity building
interventions
The development of the Department of Health has been a concern of the Diocese in recent years, not only in terms of Human resource to provide services but also in terms of medical supplies. Recruitment of staff has always been restricted due to financial resources. As a result of this the Board has been implementing a number of capacity interventions to equip health staff with necessary professional qualifications for effective and efficient service delivery. During the plan period the following objectives will address development and capacity building initiatives of the department.
Objectives
1. Recruit 10 more certificate Nurses by 2017
2. Recruit 7 Diploma Nurses by 2017
3. Recruit 5 Clinical Officers by 2017
4. Recruit 4 Assistant Medical Officers by 2017
5. Increase 3 Medical Doctors by 2017
6. Increase medical Specialists from one to three by Dec 2017
7. Increase the number of Hospital Managers from 2 to 8 by 2017
8. Increase the number of 10 Paramedical staffs by Dec 2017
Activities
(i) To send 10 Medical Attendants for Certificate course in Nursing
(ii) To recruit 7 Registered Nurses
(iii) To recruit 5 Clinical Officers by 2017
(iv) To recruit 4 Assistant Medical Officers by 2017
(v) To recruit 3 Medical Doctors by 2017
(vi) To recruit 2 medical specialists by 2017 (Internist and Gynaecologist)
(vii) To send 6 staff for Hospital Management course by 2017
(viii) To recruit 5 Lab. Assistants by 2017
(ix) To recruit 2 Radiographer Assistants by 2017
(x) To recruit 2 Physiotherapists by 2017
(xi) To recruit 1 Ophthalmic by 2017
Strategic Goal 3: Maintenance and extension of existing infrastructure
Many Health buildings were constructed more than fifty years ago and are in bad condition. Provision of health services in such buildings poses many problems if one considers technological and patient demands. Dispensaries to be upgraded have no choice but to embark on massive renovation and extension schemes.
To address this goal the following objectives must be realized within the plan period:
Objectives
1. Renovation of 1 Dispensary by 2017
2. Extension of 7 Health Facilities by 2017
3. Renovation of 8 staff houses by 2017
Activities
(i) To renovate 1 Dispensary of Matiri by 2017
(ii) To extend 7 Health Facilities by 2017 (Mpapa, Makwai, Tingi, Mpepai, Ruanda, Maguu and Mpepo)
(iii) To renovate 8 staff houses by 2017 (Ruanda, Lituhi, Litembo, Lundu, Makwai, Tingi, Mpepai and Mpapa)
Strategic Goal 4:
Enhance and maintain Partnership and networking with stakeholders
In Tanzania about 40% of the health facilities are owned by private sector, and in Mbinga District health services provided by Faith based Organizations (FBOs) are the second largest. However, traditional and alternative health services are also present. A National Public Private Partnership (PPP) steering committee has been established, zonal and regional PPP forums are present in a number of zones and regions. At District level the CHSB facilitate PPP collaboration and although there is no guiding policy how to put the PPP concept in practice ways need to be established by stakeholders to enhance PPP and networking among themselves. To maintain partnership and networking with stakeholders the following objectives will address strategic goal number four
Objectives
1. Conduct 1 District PPP forum per year in each of the two Districts (Mbinga and Nyasa)
2. Establish Health Governing Committees in all health facilities by 2015
3. Improve Transparency in reporting matters by 2015
Activities
(i) To conduct 1 District PPP forum per year in each District
(ii) To establish Health Governing Committee in each Health facility by 2015
(iii) To fight against corruption and improve transparency in reporting matters by 2015
Strategic Goal 5:
Adequate and quality Infrastructures
The Tanzania Quality Improvement Framework (TQIF) guarantees defined standards of quality in the health sector. Adequate and quality infrastructures also guarantee quality in service delivery. It is expected that in the 2015-2017 plan period health infrastructures will be promoted and updated whenever necessary as prerequisite for improved service delivery. Successful implementation of objectives outlined below will make it possible for realization of this strategic goal.
Objectives
1. Increase number of ambulances from 2 to 3 by 2017
2. Establish Solar Power Systems in 3 health facilities by 2017
3. Look for Donors to support Hydro electric power projects at Litembo and Ruanda by 2017
Activities
(i) To purchase 1 ambulance for Ruanda Hospital by 2017
(ii) To establish 3 Solar Power Systems by 2017 (Mango, Nangombo, and Matiri)
(iii) To look for Donors to fund 2 Hydro electric power projects by 2017 (Ruanda and Litembo)
Strategic Goal 6:
Improve quality of health services through construction of facilities, training of staff and acquisition of medical supplies
To improve the quality of health services in the Diocese, availability of health facilities, medical supplies and equipment is crucial. Availability of these essentials is one of the important factors that motivate people to utilize services. Training of health staff on the other hand is important because efficient utilization of other resources depends on apart from others the quality and quantities of human resources. Despite efforts taken by the health department to ensure availability of these essentials, Health facilities still face shortages in terms of buildings, training opportunities, medical supplies and other essentials thereby affecting provision of quality services. This strategic goal will be addressed through implementation of the following objectives
Objectives
1. Construction of Litembo Nursing and Laboratory School by 2017
2. Conduct training and seminar by 2017
3. Purchase Medical Supplies
Activities
(i) To construct Nursing and Laboratory School at Litembo by 2017
(ii) To conduct 1 computer training and another one on Revolving Drug Fund (RDF) for In-Charges of health facilities by 2017
(iii) To conduct 1 seminar for nurses by 2017
(iv) To purchase Medical Supplies:
Ø X-ray machine for Ruanda and Kigonsera
Ø Ultra Sound machine for Kigonsera
Ø Sterilizer for Maguu Health Centre
Ø Full blood picture machine for Maguu and Kigonsera
Strategic Goal 7:
Strengthen Institutional health administration
The Medical Board and its institutions are responsible for carrying out a large range of functions of the Department and many of these are in support of health facilities providing services. Most of the functions are administrative in nature. In carrying out different functions there are many challenges and to overcome them administrators need additional exposure on management and administration. This can be done through workshops, meetings and supervisory visits to support managers and administrators in health facilities to overcome challenges they face. This Strategic goal can best be accomplished through implementation of the following stated objectives.
Objectives
1. Conduct 2 Diocesan Board Meetings annually by 2017
2. Conduct 1 workshop annually for all In-Charges of health facilities by 2017
3. Conduct 1 CSSC meeting annually at District level by 2017
4. Conduct 1 supervisory visit annually to health facilities by 2017
Activities
(i) To conduct 2 Diocesan Board Meetings by 2017
(ii) To conduct 1 workshop annually for In-Charges of health facilities by 2017
(iii) To conduct 1 CSSC meeting annually at District level by 2017
(iv) To conduct 1 supervisory visit annually to health facilities by 2017
CHAPTER FIVE
5.0. MONITORING AND EVALUATION
5.1 Monitoring and Evaluation Protocol
The Diocesan Medical Board will be responsible for monitoring the implementation of the Strategic Plan at Departmental level to ensure that the goals of the Strategic Pan are being achieved. Monitoring will show how the various interventions that are to be undertaken during the three years of the Strategic Plan cycle will lead to achievement of the Plan Objectives, how the interventions will be monitored, what kind of reviews will be done over the period and what type of evidence based evaluation will be undertaken. The Monitoring and Evaluation results will also show if the interventions have either led or are leading to achievement of the expected outcomes.
The Diocesan Secretariat will monitor the implementation of the Strategic Plan through the health facilities. At this level the In-Charges and Health Governing Committees will be responsible for monitoring implementation of activities in their respective areas. The monitoring of activities will be assisted by data generated by the various components of the Strategic Plan as it includes a wide range of information pertaining to delivery of health services at Diocese, Department and Health Facility levels. Much of these data will have to be collected by different health facilities.
The Health Department itself operates as a component of the Diocese, which has its own monitoring and evaluation framework. The work of the Department and that of the Diocese will therefore have to be coordinated for better results. In common the monitoring of Strategic Plan will be guided by the following fundamental criteria:
5.1.1 Implementation Schedule
Adherence to the implementation schedule set out in the plan in respect of time frame, attainment of activities, objectives etc.
5.1.2 Standards
Observation and fulfilment of standards set by the Government and the Diocese where they are applicable.
5.1.3 Consistence with Policies of the Government and Diocese
Adherence to the government and Diocesan policies as stipulated in relevant documents including Strategic Plan (2013-2017) of Mbinga Diocese
5.1.4 Cohesiveness
Attention to linkages between strategic goals in the plan strategy and specific actions/activities within each goal to ensure there is consistency
5.1.5 Indicators
In the action plan indicators are identified. Information on these indicators will be collected as planned and will be used for monitoring and evaluating specific activities. The strategic indicators are to be translated into quantified annual targets and outputs.
5.1.6 Stakeholder Performance
Performance of various stakeholders at Diocese, Department and Health Facility levels in relation to fulfilling their mandate, executing their roles and responsibilities and the effectiveness of their plans and activities i.e., delivering their services and attaining the stated goals and objectives .
The Diocesan Health Department will use these criteria to monitor the progress made in implementing the Strategic Plan as a whole, while the health facilities will use the same criteria for monitoring and evaluating the annual plans. The action plan contains specific performance criteria/indicators that will be used for monitoring purposes.
There will also be annual reviews of activities as part of the on-going process of monitoring and implementation of the plan at health facility level. Again, the work plan log frame will be used as a basis for monitoring and evaluation
5.2 Interim Review and End-Review
During implementation of the Strategic Plan two reviews are foreseen; the mid-term and end of period review. The reviews will provide in depth analysis of the seven strategic goals. Reviews and Reports prepared within the Department and Diocese will be tabled in relevant forums and will form the basis for joint review and analysis of implementation of the Strategic Plan.
5.3 Action Plan Matrix
The Action Plan is in matrix form and contains strategic goals, objectives, time frame for accomplishment of activities, responsible person, and outcome indicators. The matrix shows how strategic objectives will be achieved and how the results will be measured. The indicators in the matrix will be used to track progress towards achievement of planned outcomes and objectives. The result framework matrix is detailed below.
Strategic Goal
1. Increase the efficiency of the diocese through provision of quality, accessible and affordable health care services especially in hard to reach areas
Strategic Objective | Activity | Time | Responsible Person/ Department | Indicators |
- Raise the standard of 4 Dispensaries to the level of HealthCentres by 2017
| - To upgrade 4 Dispensaries to Health Centres by 2017 Tingi, Lundumato, Lundu and Nangombo
| 2017 | Diocesan Health Secretary | 4 Dispensaries upgraded to Health Centres |
- Improve establishment of Ruanda Hospital staff to provide quality health services by 2017 | - To increase the number of staff 20% at Ruanda Hospital by 2017
| 2017 | Ruanda Hospital Administrator | Staff recruited |
Strategic Goal
2. Departmental development through capacity building interventions
Strategic Objective | Activity | Time | Responsible Person/ Department | Indicators |
1. Increase 10 Certificate Nurses by 2017
| - To send 10 Medical attendants for Certificate Course in Nursing | 2017
| In-Charges | 10 Trained Certificate Nurses |
2. Increase 7 Diploma Nurses by 2017
| - To recruit 7 Registered Nurses
| 2017
| Diocesan Health Secretary | 7 Diploma Nurse graduates |
3. Recruit 5 Clinical Officers by 2017
| - To recruit 5 Clinical Officers
| 2017
| Diocesan Health Secretary | 5 Clinical Officers recruited
|
4. Recruit 4 Assistant Medical Officers by 2017
| - To recruit 4 Assistant Medical Officers | 2017
| Diocesan Health Secretary | 4 Recruited Assistant Medical Officers |
5. Recruit 3 Medical Doctors by 2017 | - To recruit 3 Medical Doctors
| 2017
| Hospital Administrators | 3 Recruited Medical Doctors |
6. Recruit 2 Medical Specialists by 2017
| - To recruit 2 Medical Specialists (Internist and Gynaecologist) | 2017
| Litembo Hospital Administrator | 2 Recruited Medical Specialists |
7. Increase the number of Hospital Managers from 2 to 8 by 2017 | - To send 6 staff for Hospital Management course
| 2017
| Diocesan Health Co-ordinator | 6 Number of Staff who have attended Hospital Management Course |
8. Increase 10 Paramedical staff by 2017
| - To recruit 5 Lab. Assistants - To recruit 2 Radiographer Assistants - To recruit 2 Physiotherapists - To recruit 1 Ophthalmic
| 2017
| In-Charges | Paramedical Staff recruited
|
Strategic Goal
3. Maintenance and extension of existing infrastructure
Strategic Objective | Activity | Time | Responsible Person/ Department | Indicators |
- Renovation of 1 Dispensary by 2017
| - To renovate 1 Dispensary by 2017 (Matiri)
| 2017 | Diocesan Health Co-ordinator/ Sr. In-Charge | Renovated Dispensary |
- Extension of 7 health facilities by 2017
| - To extend 7 health facilities by 2017 (Mpapa, Makwai, Tingi, Mpepai, Ruanda, Maguu and Mpepo)
| 2017 | In-Charges | 7 health facilities extended |
- Renovation of 8 staff houses by 2017 | - To renovate 8 staff houses by 2017 (Ruanda, Lituhi, Litembo, Lundu, Makwai, Tingi, Mpepai and Mpapa)
| 2017 | In-Charges | 8 Staff houses renovated |
Strategic Goal
4. Enhance and maintain partnership and networking with stakeholders
Strategic Objective | Activity | Time | Responsible Person/ Department | Indicators |
- Conduct 1 District PPP forum per year in each of the two Districts (Mbinga and Nyasa)
| - To conduct 1 PPP forum per year in each District (Mbinga and Nyasa)
| Annually | Diocesan Health Secretary | PPP Forums conducted |
- Establish Health Governing Committees in all health facilities by 2015
| - To establish health governing committees in each health facility by 2015
| 2015 | In-Charges | Established Governing Committees |
- Fight corruption and improve transparency in reporting matters by 2015
| - To fight corruption and improve transparency in reporting matters by 2015 | 2015 | In-Charges | Reports |
Strategic Goal
5. Adequate and quality health service infrastructure
Strategic Objective | Activity | Time |
Responsible Person/ Department | Indicators |
- Increase number of ambulances from 2 to 3 by 2017
|
- To purchase 1 ambulance for Ruanda Hospital by 2017 |
2017 |
Ruanda Hospital Administrator |
Purchased Ambulance |
- Establish Solar power systems in 3 health facilities by 2017
|
- To establish 3 solar power systems by 2017 (Mango, Nangombo and Matiri)
|
2017 |
In-Charges |
Solar Power Systems established
|
- Look for donors to support Hydroelectric power projects (Litembo and Ruanda) by 2017
|
- To look for donors for funding 2 Hydroelectric power projects by 2017 (Ruanda and Litembo) |
2017 |
Litembo and Ruanda Hospital Administrators |
Identified Donors |
Strategic Goal 6. Improve quality of health services through construction of facilities, training of staff and acquisition of medical supplies
Strategic Goal 7. Strengthening institutional health administration
| |||||||||||||||||||||||||||||||||||||||||||||
|
| BUDGET
| |||||||
GOAL NO. 1 |
| Increase the visibility of the Diocese through provision of quality, accessible and affordable health care services especially in hard to reach areas | ||||||
Objective | Activity | Resources Needed | Total in Tsh. | Source of Financing | ||||
| Diocese | Government | Donor | |||||
1 |
- To upgrade 4 Dispensaries to Health Centres by 2017 Tingi, Lundumato, Lundu and Nangombo
|
Personnel - AMOs Building materials for renovations and purchasing medical supplies
|
85,500,000 |
ü |
ü |
ü | ||
2 |
- To increase the number of staff 20% at Ruanda Hospital by 2017.
|
Staffing - Trained Nurses |
55,000,000 |
ü |
ü |
ü | ||
BUDGET
|
| ||||||||||
GOAL No.2 | Departmental development through capacity building interventions
|
| |||||||||
Objective | Activity | Resources Needed | Total in Tsh. | Source of Financing |
|
| |||||
| Diocese | Government | Donor |
| |||||||
1 | - To send 10 Medical attendants for Certificate Course in Nursing | Human resource Financial resource | 18,000,000 | ü | ü | ü |
| ||||
2 | - To recruit 7 Registered Nurses | “ | 15,000,000 | ü | ü | ü |
| ||||
3 | - To recruit 5 Clinical Officers | “ | 33,720,000 | ü | ü | ü |
| ||||
4 | - To recruit 4 AMOs | “ | 26,976,000 | ü | ü | ü |
| ||||
5 | - To recruit 3 MDs | “ | 41,400,000 | ü | ü | ü |
| ||||
6 | - To recruit 2 Specialists (Internist andGynaecologist ) | “ | 45,120,000 | ü | ü | ü |
| ||||
7 | - To send 6 staff for Hospital Management course | “ | 12,000,000 | ü | ü | ü |
| ||||
8 | - To recruit 5 Lab. Assistant | “ | 18,000,000 | ü | ü | ü |
| ||||
9 | - To recruit 2 Radiographer Assist. | “ | 6,000,000 | ü | ü | ü |
| ||||
10 | - To recruit 2 Physiotherapist | “ | 6,000,000 | ü | ü | ü |
| ||||
11 | - To recruit 1 Ophthalmic | “ | 3,000,000 | ü | ü | ü |
| ||||
BUDGET
| |||||||||||
GOAL No.3 | Departmental development through capacity building interventions
| ||||||||||
Objective | Activity | Resources Needed | Total in Tsh. | Source of Financing |
| ||||||
| Diocese | Government | Donor | ||||||||
1 |
- To renovate 1 Dispensary by 2017 (Matiri)
|
Building materials |
125,000,000 |
ü |
ü |
ü | |||||
2 |
- To extend 7 health facilities by 2017 (Mpapa, Makwai, Tingi, Mpepai, Ruanda, Maguu and Mpepo)
|
Building materials |
545,000,000 |
ü |
ü |
ü | |||||
3 |
- To renovate 8 staff houses by 2017 (Ruanda, Lituhi, Litembo, Lundu, Makwai, Tingi, Mpepai and Mpapa)
|
Building materials |
88,000,000 |
ü |
ü |
ü | |||||
BUDGET
| ||||||
GOAL No.4 | Enhance and maintain partnership and networking with stakeholders
| |||||
Objective | Activity | Resources Needed | Total in Tsh. | Source of Financing |
| |
| Diocese | Government | Donor | |||
1 |
- To conduct 1 PPP forum per year in each District (Mbinga and Nyasa)
|
Accommodation, transport cost and training materials |
850,000 |
ü |
ü |
|
2 |
- To establish health governing committees in each health facility by 2015
|
Supervision visits |
1,200,000 |
ü |
ü |
|
3 |
- To fight corruption and improve transparency in reporting matters by 2015
|
Reporting skills |
- |
ü |
ü |
|
BUDGET
| ||||||
GOAL No.5 | Adequate and quality health service infrastructure | |||||
Objective | Activity | Resources Needed | Total in Tsh. | Source of Financing |
| |
| Diocese | Government | Donor | |||
1 |
- To purchase 1 Toyota Land Cruiser ambulance for Ruanda Hospital by 2017
|
A car |
68,000,000 |
ü |
ü |
ü |
2 |
- To establish 3 solar power systems by 2017 (Mango, Nangombo, and Matiri)
|
Solar power systems |
30,000,000 |
ü |
ü |
ü |
3 |
- To look for donors for funding 2 Hydro electric power projects by 2017 (Ruanda and Litembo) |
Feasibility studies Project proposals |
3,400 Mill. |
ü |
ü |
ü |
| BUDGET
| ||||||
| GOAL No.6 | Improve quality of health services through construction of facilities, training of staff and acquisition of medical supplies | |||||
| Objective | Activity | Resources Needed | Total in Tsh. | Source of Financing |
| |
|
| Diocese | Government | Donor | |||
| 1 | - To construct Nursing and Laboratory School at Litembo by 2017 | Building materials Furniture | 995,200,000 | ü | ü | ü |
| 4 | - To conduct 1computer training and Revolving Drug Fund (RDF) for In- Charges of health facilities by 2017 | Accommodation, transport and training materials | 2,250,000 | ü | ü | ü |
5 | - To conduct 1seminar for all Nurses by 2017 | Training materials | 3,500,000 | ü | ü | ü | |
6 | - To purchase Medical supplies Ø X-ray machine for Ruanda and Kigonsera Ø Ultrasound machine for Kigonsera Ø Sterilizer for Maguu HC Ø Full-blood picture machine for Maguu and Kigonsera
| Medical supplies |
30,000,000
9,000,000 7,500,000 24,000,000
|
ü |
ü |
ü | |
BUDGET
| ||||||
GOAL No.7 | Strengthening institutional health administration
| |||||
Objective | Activity | Resources Needed | Total in Tsh. | Source of Financing |
| |
| Diocese | Government | Donor | |||
1 |
- To conduct 2 Diocesan Board Meetings
|
Accommodation and transport costs
|
650,000 |
ü |
|
|
2 |
- To conduct 1 workshop annually for In-Charges of health facilities
|
Accommodation, transport costs and training materials
|
1,800,000 |
ü |
|
|
3 |
- To conduct 1 CSSC meeting annually at District level
|
Accommodation and transport costs
|
2,350,000 |
ü |
|
|
- References
2. MOHSW. (2008), Health Sector Strategic Plan III 2009-2015
3. Catholic Diocese of Mbinga. (2013), Strategic Plan 2013-2017
4. MOHSW. (1999), Health Sector Reforms Plan of Action 1999-2000
5. MOHSW. (2007), The National Health Policy
6. Department of Health, Mbinga Diocese (2008), Health Programme
7. The Bible. (1967), Revised Standard Version
On behalf of the Health Department Team,
Fr. Raphael Michael Ndunguru
Diocesan Health Co-ordinator