Report: special meeting on Community Directed Health Interventions (CDHI) and integration of community-based health programs in Tanzania, 8th -11th June 2005

I I i ,j J>Ki iar}E REPORT SPECIAL MEETING ON COMMUNITY DIRECTED HEALTH INTERVENTIONS (CDHD & INTEGRATION OF COMMUNITY - BASED HEALTH PROGRAMS IN TANZANIA 8th - llth JUNE 2oo5 llational 0nchoGetoiasis Control Ptoglamme illnistry 0I llGalth P.0. Box 0083 llal Gs Salaam,Ianzania []B I GA]I P B ll G RATII M I ]ll R ll 1I G II ll G T B G I[56 G ll ]ITR ll 1 tfiPll GI wil0/[P0c, 0uAG[00uG0u, [untfi ltl ]Aso ) ,l +t I 1 i -!4 ,- ) f I ! / '\r t;'I u I ,..,F. rt> i u/ IJt I I List of Abbreviations: APOC: African Program for Onchocerciasis Control CBPs: Community Based Programs CCHP: Comprehensive Council Health Plans CDD: CommunityDirectedDistributors CDHI: Community Directed Health Initiatives CDI: CommunityDirectedlnterventions CDTI: Community Directed Treatment with Ivermectin ComDT : Community Directed Treatment CORPS: Community Own Resource Persons DOTs : Direct Observed Treatment EPI: Expanded Program on Immunizfiion FLHF: Front Line Health Facility HSAM: Health Education sensitization Advocacy and mobilization ITNs: Insecticide Treated Nets LF: Lymphatic Filariasis MKUKUTA: Mkakati wa Kukuza Uchumi na Kuondoa UmasikiniTanzania MSD: Medical Stores Department NACP: National AIDS Control Program NGDOs: Non Govemmental Donor Organizations NTLP: National Tuberculosis and Leprosy Program NOCP: NationalOnchocerciasis ControlProgram NSGRP: National Strategy for Growth and Reduction of Poverty OCP: Onchocerciasis Control Program PRSP: Poverty Reduction Strategy Paper PORALG: President's Office Regional Administration and Local Government TDR: Tropical Disease Research TWG: Technical Working GrouP TASAF: Tanzania Social Action Fund WHO: World Health Organization 2 Table of contents: page Background Objectives. Key issues identified, conclusions and Recommendations... .J .6 References.. Annexes: I. II. List of participants. Meeting program & time table ,7 l4 l5 19 fr- -) 1. BACKGROUND The success of the community-directed treatment with Ivermectin (CDTI) of the African Programme for Onchocerciasis Control (APOC) with its strong focus on empowering communities to play a leading role in the fight against disease has aroused considerable global interest in two areas. First is to explore ways in which the approach can be used by other health programs and secondly how to integrate different programs to enhance efficiency and achieve cost-effectiveness through use of common services. In 2004, a meeting organized by The Bill & Melinda Gates Foundation, "challenges to integration of community based programs" recommended that a conceptual framework for integration that will identify actions needed at internotional, national, district and community levels be developed.In April2005, the WHO Strategic and Technical Meeting on Intensified Control of Tropical Diseases held in Berlin recommended the adoption of community-directed treatment (ComDT) approach to immediately intensify the control of some tropical diseases. Any policy and/ or program ownership is anchored in the process of its development. Since, countries where the diseases are endemic and the local authorities are the main partners in health services delivery they are definitely vital in the process of development of integration policies in particular if we want them to own the programs. The government needs to be in a lead position in discussions on integration of health programs; providing information on their numbers, coverage, achievements, bottlenecks and suggesting how they can effectively be integrated. Government may seek technical expertise from consultants but the actual drawing of the policy needs to be within the government in order to maintain ownership. Except for few, such as the interagency meeting held in Uganda in 20011 representatives of endemic countries have not been provided opportunities of participation in international discussions on policies, processes and future agenda on integration of disease control programs. ' In 2001, InterAgency Meeting held in Entebbe, Uganda provided a forum for decision and policy makers and funding agencies to discuss the use of a common strategy for all community-based programs. This meeting was sponsored by the Ministry of Health and APOC. 4 To address this gap, the Ministries of Health of four African countries, Tanzania, Uganda, Cameroon and Nigeria in partnership with APOC will hold a special meeting on integration of community-based programs (CBPs) in respective countries. The overall aim of these country specific meetings is to address exisiting fragmented approaches used by different programs, often in the same locality; discuss sustainainbility of the varied approaches of community-based programs; acute shortage of health workforce at frontline health facility; high attrition rates of community members due to variations in externally funded incentive schemes in the same communities , competitng with each other thereby confusing existing local systems. These meetings are to discuss mainstreaming CBPs into national financing schemes, intervention tools available in the country and make recommendations taking note of the prevailing environment in terms of policy, infrastructure and available human resource and community set up. 2. OBJECTIVES OF THE MEETING The objectives of the meeting were as follows: 1. To provide a forum at which senior decision and policy makers, national coordinators of community-based programs, the NGDOs and donor agencies supporting or financing health programs in Tanzania, to dialogue on sustainable methods of control of CBPs. 2. To discuss factors that constitutes barriers or promotes integration of community- based interventions at all levels. 3. Discuss policy to promote planning and budgeting integration of community- based programs as component of the Poverty Reduction Strategy Papers (PRSPs). 4. To review the attributes and benefits of Community-Directed Intervention (CDI) approach. 5. To harmonize support to community members engaged in disease control programs and agree on types of incentives (if any) communities should receive from external partners without disrupting existing indigenous systems and activities of other health interventions. 5 This meeting brought together players in different community-based programmes; senior decision and policy makers, the NGDOs and donor agencies. Community involvement and participation in the different programs were carefully examined and experiences shared in the progress made towards integration. A number of community-based projects are being implemented at community level and this meeting was one of the forums to compare notes and ensure that good practices are teased out and encouraged. The meeting reviewed experiences of integration of CDTI and other interventions under four main headings: l. PRSP in Tanzania and community based health care: cuffent government policies 2. Horizontal and vertical integration of community-based programs, 3. Strategy for integration of community-based programs, incentives by external partners to community resource persons and 4. Monitoring and evaluation of integrated programs. The mode of conduct of the meeting was by presentations, group work and plenary discussions. 3. KEY ISSUES IDENTIFIED, CONCLUSIONS AND RECOMMENDATIONS 3.1 TANZANIAN NATIONAL POLICIES ON INTEGRATION The process for integration in the health sector begun in 1996, as part of the implementation of first health sector Program. For integration of procurement, storage and distribution of medical supplies, the Ministry of Health encourages all health programs to use the Medical Stores Department (MSD). Accordingly, many of the programs, NOCP, EPI, NACP, NTLP and Reproductive and Child Health Program are making use of the MSD. The two major outcomes of the process is the integration of the generic functions of the previous vertical programs and the development of the Comprehensive Council Health Plans paved way for intensiffing integration in the health sector. 6 In 2001, the Tanzania Ministry of Health with assistance of a Technical Working Group (TWG) assessed and documented experiences in Tanzania and elsewhere on integration of services. The report of the Study, entitled " Enhancing integration of Health services in Tanzania. Guiding Principles" acknowledged that what needs to be done to integrate health services in Tanzania is largely known. The challenge is to mobilize long term political commitment, develop country's own technical capacity and a culture of integation of health care services at all levels. 7 3.1.1 Community based programs in Tanzania: PRSP and integration A number of diseases2 in poor disadvantaged communities are prevalent and contribute greatly to the vicious circle of poverty. Yet they do not receive the same emphasis in the National Strategy for Growth and Reduction of Poverty (NSGRPy MKUKUTA3 and from donor community. These diseases trap affected populations in extreme poverty conditions and compromise the effectiveness of efforts made by other sectors to improve socioeconomic development. lnTanzania, health services are decentralized to local authorities (City, Municipal, Town and District Councils) and mechanisms that at different levels should facilitate and enhance integration include: i) Central: Basket Financing Committee, Joint MoH Planning Sessions, MoH Technical Review, Health Sector Reform Review ii) District/Council: Council Health Planning Cycle, Council Health Service Boards iii) Ward: Facility Goveming Committee, Ward Development Committee These mechanisms use information sharing, joint planning or exchange of experiences meetings and improved communication. Nevertheless, recent developments in particular harmonization of development assistance has necessitated the need of re-examining policies of integration to bring more efficiency and aid effectiveness. For example, the interaction of the government and donors in the health sector need to refocus attention and allocation of sustainable financing schemes to neglected control programs using integrated approaches. Effective intervention tools are available for most community-based interventions. What is required is government increasing pro-poor commitment for continued and sufficient investments in control efforts using strategy and tools that have proven effective. The meeting also noted increasing interest of the donor community to improve efficiency and delivery of services to poor population through integrated approaches. 2 Onchocerciasis, Trachoma, lymphatic filarisis, schistosomiasis are some examples ' V1<UKUTA - Synonyms name in Swahili for National Strategy for Growth and Reduction of Poverty (NSGRP) 8 The meeting recommends that (D These diseases of poor disadvantaged communities such as mentioned above be taken as indicators within National Strategy for Growth and Reduction of Poverry (NSGRP). (ii) Donors and communities should be encouraged to mobilize and earmark resources within the existing system for the control of CBPs through integrated approaches. (iii) Internal resources be mobilized for community-directed health interventions (CDHIs) through cost sharing, community health financing schemes and integration into Council Comprehensive Health Plans (CCHPs). (iv) National Governments should be involved at all international forum including high-level discussions and decisions on issues of integration. Such a move will enhance the capacities and all national governments to be on the driving- seat on integration of community-based interventions. The meeting recognizes the existence of a National Policy and inclusion of Community Based Programmes into the PRSPs. However, to ensure long term financial sustainability of these programs, It is recommended thot: (D The Local Government Authorities to allocate funds for advocacy for Community-Based Programs in Comprehensive Council Health Plan (CCHP). (ii) Donor agencies and APOC should provide financial support to projects to enable Community Based Programs to undertake advocacy activities. (iii) Allocation of a portion of the village fund to support multi-purpose community-resource persons (CORPS). 3.2 HORIZONTAL AND VERTICAL INTEGRATION OF COMMUNITY-BASED PROGRAMS IN TANZANIA The meeting agreed to the following working definition: "Integration in the health context is the implementation of two or more health problem interventions such that the tasl<s and resources (human and materiols) for accomplishing them are organized and 9 monaged within the same health system for programme fficiency and ffictiveness and with mutuqlly complementary advantage without one intervention harming the other or the heolth system." Integration has two objectives: efficiency and convenience to the community. In Tanzania, the foundation for integration of community- based programs that will improve the health conditions of poor communities is in place. What is needed is how to move forward the existing government policies and implementation of integration to the national health system structure with a strong community participation on integration. Effective implementation of existing policies has to be agreed upon by the Government in collaboration with partners. 3.2.1 Factors that foster or hinder integration in Tanzania The meeting recognized the existence of the National Strategy for Growth and Reduction of Poverty, the Sector-Wide Approach and theTanzania Social Action Fund (TASAF) as factors that foster integration in the country. The administrative structure in the country, with a hierarchy of households, hamlets, villages, wards, divisions, districts and regions, presents a strong base for integration of multiple programs. However a number of factors acting as forces which hinder integration were identified. These include the need for some programs to maintain a certain level of expertise/standards, external resistance from donors and NGOs and internal resistance such as attitude of public service employees. More consultations will be needed with the Local Government Authorities. The meeting recommends that special effort should be given to integration in the following areas: o Empowering of communities to play a leading role in the identification of priority problems, interventions and monitorin g pro gress. o Organization and management of health interventions o Training and health education, sensitization, advocacy and mobilization (HSAM). o Supervision and monitoring of interventions o Use of transport and logistic support. l0 The meetingfurther recommends that adequate resources be made available in TASAF II to fund activities in the above areas. 3.3 STRATEGY FOR INTEGRATION OF COMMUNITY-BASED PROGRAMS In the last few years, using the community-directed treatment (ComDT) approach, APOC operations have ably demonstrated how to reach the poor or put differently what delivery system can ensure that poor and very remote populations have access to the benefits of health services. The concept of the community-directed treatment approach in the delivery of medicines evolved from research undertaken by TDR/OCP4 to develop sustainable strategy for mass treatment with Ivermectin. The meeting reviewed different modes of delivering services, community participation and involvement, different forms of support or incentives to community resources persons by external partners. The meeting adopted the APOC definition for CDHI: "A health intervention that is undertaken at the community level under the direction of the community itself'. 1) The concept of Community-Direction of a health Intervention is introduced by the health services and its partners (NGDOs) in a participatory manner, highlighting community ownership from the onset. 2) From then on, the community takes charge of the process, usually through a series of community meetings combined with implementation by selected community members. 3) The community, the health services and other partners have specific roles in CDI 4) The meeting called for a national policy on the use of a common strategy in approaching communities and strongly recommends the adoption of community-directed treatment (ComDT) strategy by all community-based programs. o TDR - Special Programme for Tropical Disease and Research in WHO Geneva OCP - Onchocerciasis Control Programme in West Africa closed in2002. l1 3.3.1 Role of the frontline health facility in community-directed interventions (CDI) and integration of CBPs The acute shortage of health work force at the frontline health facility (FLHF) level is a major threat to the sustainability of community-directed treatment with Ivermectin when additional programmes are integrated into the prevailing one. The meeting noted in the presentation by APOC that among the evaluated 48 projects in 10 countries from 2002- 2004, the FLHF was found to be the weakest of the projects' four operational levelss. This is seen to pose treat to the sustainability of CDTI especially if we consider integrating additional programs into CDTI. The meeting noted that the FLHF is weak in terms of number of staff, skills and level of empowerment. It also noted even with the present limitation it is possible for FLHF to do much more given better recognition and the need of the districtto decentralizeto FLHF. The meeting also noted that in some districts in Uganda community members have been trained to assistthe FLHF staff to supervise Ivermectin distributors as an interim method of addressing acute shortage of health workforce at FLHF level and improving the quality of supervision of Ivermectin distribution by CDDs. The meeting recommended that this practice should be considered and evaluated. It was further recommended that: (i) In interim the local health service encourage communities to select and support its members for training by the health system to serve the community in the FLHF as supervisor of CD services within the community. (ii) Government to strengthen the FLHF by making special efforts of investing in manpower development using all resources available as a way of ensuring successful out comes for all health programs (iii) The use of community development workers who are staff of the Local Government employed for mobilization and sensitization of communities in CDHI. 5 Projects' operational levels: Regional, Districts, FLIIF, Community 12 Integration of community-based intervention is feasible, cost-effective and is expected to lead to a better health care delivery to the community. However, there are many difficulties toward achieving effective integration. Competing factors include well funded programmes which are mostly vertical activities that do harm the concept of integration. It is recommended that the approach of integration should be shared with those vertical programmes and NGDOs who care about single disease activities only. Integration of different health interventions remains a country, district, community speciftc process. To be effective, integration requires consideration at the level of planning, advocacy and training. The meeting looked into the feasibility and possibility of integrating Community-Based programs such as Onchocerciasis, DOTs, ITNs, Trachoma and LF in Tanzania. It was agreed that integrating these programs with community-directed treatment with Ivermectin (CDTD is feasible. However, integration should be based on local conditions including endemicity of disease through mapping and priorities of the communities and district. Furthermore, it was noted that there has been integration in some districts in areas like planning, procurement, distribution, transport, supervision and monitoring. 3.3.2 Attributes and limitations of using community directed approach The meeting was huppy to note that the Government of Tanzania has been supporting CDTI through release of counter part funds. It is strongly recommended that governments especially at district level release counter part funding to sustain the program. Given that external funding for CDTI will soon be coming to the end (2010), The meeting strongly recommended that(D The National Strategy for Growth and Reduction of Poverty (NSGRP/ MKUKUTA), TASAF II and SWAP should be instruments or platforms to be used for advocacy, capacity building and recourse mobilization to ensure long term sustainable support to CDTI inTanzania. (i, The use of local funds e.g. from Community Health fund and Local Government funds for long term sustainability of CDTI inTanzania. 13 CDTI has become a novel approach for delivering health intervention. However, the strategy has been taught fragmentally in the Public Health institutions. The meeting recommended that: APOC would commission university public health specialists to draw a curriculum for a course on ComDT as part of the master-degree in public health. Such a course will thus be pilot tested in 3 African Universities before further adopted in other African or non African Universities, training studies in public health. This will no doubt broaden the pool of African trainers in ComDT. 3.3.3 Incentive schemes by programs The meeting noted with concern that some programs provide monetary or in kind incentives while other programs do not provide incentives. This creates a state of confusion within the community. It was agreed that local ownership of incentive scheme is crucial for its implementation and sustainability. The meeting also noted the published result of the multi-country study by TDR which concluded that additional work to community-directed distributors did not jeopardize their performance or the treatment coverage achieved by distributors. The meeting recommends (i) Community members engaged in any community-based intervention should be selected by the community itself. (ii) To encourage integration and harmonization of intervention approaches, community members selected should be able to deal with a number of interventions decided upon by the community. (iii) Operational research to come up with proper policy recommendation. To be successful this study need to involve major partners involved in funding the health system project at community level. The meetingfurther recommends the major players in healthfund the research. t4 3.4 MONITORING AND EVALUATION OF COMMUNITY-BASED PROGRAMS IN TANZANIA The meeting noted that different programs have developed Monitoring and evaluation tools. The integrated approach requires harmonized monitoring and evaluation instruments. Integration policies would need to look on how the health programs are best fitted in administrative and technical management and whether the training of health personnel is oriented to meet the need of different health programs. The meeting recommends that: The Ministry of Health in collaboration with PORALG should review different monitoring and evaluation tools with a view of developing consolidated simple tool. Closing of the meeting In closing, the meeting noted that reports of similar meetings are widely distributed in a format which shows implementers, indicators, and the responsible officers for different recommendations. Therefore, it is suggested that the recommendations of this meeting be treated in same way and APOC would appreciate getting a feedback of the progress made. l5 References: 1. National Strategy for Growth and Reduction of Poverty (NSGRP) final draft (January 2005) Vice Presidents Office 2. TASAF II Operational Manual (May 2005) URT Government Project Preparation Team 3. Enhancing Integration of Health Services rn Tanzania: Guiding Principles (March 2003) Ministry of Heolth 4. Challenges to Integration of Community-Based Programs: Bill & Melinda Gates Foundation July 29-30 2004, Meeting Summary Report 5. Strategic Plan for Integration of Health Services rnTanzania. April 2003 Ministry of Health 6. Guidelines for Implementation of Community Based Health Initiatives in the Context of Health Sector Reform inTanzania. November 2004 Ministry of Health 7. The Opportunities and Obstacles to Development- A community participatory planning methodology: Rural process, Urban process , Hand book President's Office Regional Administration and Local Government 16 Annex 1: List of participants 3. NO NAME TITLE AND ADDRESS TELEPHONE FAX NUMBER E.MAIL 1. Dr. Faustin Njau Head, HSRS, Ministry of Health +25522212061 faustinniau@africaolin .co.lz 2. Dr. Uche Amazigo WHO/APOC - OUAGADOUGO Burkina Faso 226-50 342959 amaziqouv@oncho.oms, bf Mr. Ebeneza Mlinga PO-RALG BOX I 923 DODOMA +255262322681 +255262322168 emlinqa@vahoo.com Dr. Grace E. B. Saguti National Eye Care & Onchocerciasis Control Program, MoH Box 9083 DDAR ES SALAAM +25522 2130009 +255 22 21 30009 qracejenoo@yahoo.co. uk 5. Dr. L. E. G, Mboera Director of lnformation NIMR, DAR ES SALAAM +255222121374 +255222121360 lmboera@nimr.or.tz b. Dr, E. Tarimo Box33277 DAR ES SALAAM +255748 318574 7 Ms. R. Minja Ministry of Com. Dev. Box 3448 DAR ES SALAAM +255748 839528 miniarose@vahoo.com Dr. N. G. Mwakyusa 0pthalmologist MoH NECP Box 9083 DAR ES SALAAM +255744 31U27 +255 22 21 3009 tukku29@vahoo,com 9. Mr.0. C. Kaitaba NECP/NOCP MoH P.O. Box 9083 DAR ES SALAAM +255744 889390 +255 22 21 30009 ockaitaba@vahoo.com 10. Ms Harriet Lutale CBHS/RCHS Ministry of Health Box 90883 DAR +255744 421358 +255222152977 lutaleSSharrie@yahoo.com 11 Mr. PamphilS. Tarimo CBHC +255744 405999 +255222157977 ftarimo2003@vahoo.com 12. Dr. A, Hingora NSPS (PC) HSRS, MoH Box 9083 DAR ES SAIAAM +255744222261 ahinqora@hsostz,oro 13. Dr. B. Pose Ser. Repr, Health Programme Coordinato/AMREF +255745 745856 Barbara P@am ref . tz, oro 14 Dr, F. T, Mokiti DMO Kilosa +255232623312 +2557482U750 +255 23 263050 mfrdon@hotmail,com 15. Dr. A, Byamungu NOTF Uganda anelvbvamunqu@vahoo.com 8 t7 16. Dr. Suleiman Kimatta Project ffiicer Health UNICEF Box 4076 DAR +255222150811 skimata@unicef,o.o. 17 Dr. Mancelline Ntep NOTF Cameroon (237) e81 08 01 2226970 (237)2226970 18. Mr. Pius Mabuba SSI Tanzania Box 2513 DAR ES SALAAM +255 2701 098 +255222701097 pmabuba@siqhtsavers.or,tz 19 Prof. 0. B. Akogun FED University YOLA Nigeria 23/7220460 olaakooune@vahoo.com 20 Dr. Edith Ngirwamungu lTl - CR Box 78834 DAR ES SALAAM +255222127102 +255222122350 edith@trachoma.or.tz 21 Dr. Peter Kilima lTl - R6gional Office Box 78834 DAR ES SALAAM +255222121240 +255222122350 Kilima@trachoma.or.tz 22. Dr. Sabas Kimboka DCHN, TFNC, BOX 977 DAR ES SALAAM +2552221244U +255222116713 skimboka@muchs.ac,tz skimboka@hotmail.com. 23 Dr. R. B. M. Kalinga District Health Serivce Coord. MoH, Box 9083, DAR +255741 400230 rKalinoa2000@vahoo,com 24 Ms. Deborah J W Mgedzi Secretary, NECP/OCP, MoH Box9083 DAR ES SALAAM +25522 2130009 +255 22 21 3000 deborahmoedzi@vahoo.com 25 Dr. Fredrick C. Kigadye Director, CSSC DAR ES SALAAM +25522741 4551122 fkioadve@cssc.or,tz 26 Ms Yasinta Kisisiwe PNO Health Education MoH +255748 289031 Kisisiwe2@hotmail,com 27 Ms Manisha Tharaney HKI- Cr BoxU424 DAR ES SALAAM +255748 200088 =255222150527 mtharanev@hkis.orq 28 Dr. DanielR. Nyagawa CR - IMA Tanzania Box 9260 DAR ES SALAAM +255744 478'108 danielnyaqawa@interchurch.oro 29 Dr. William Mwengee WHO/EPI +255744 886441 mwenqeew@tz, af ro.who. int 30 Dr. Nakijwa Kanyika CDTI Morogoro, Project Coordinator, Box 110 MOROGORO +255741295'119 kikwesha2002@vahoo.co. uk 31 Mr, G. W. Kikwesha Assistant Admin Secretary MOROGORO +255744 816591 +255 23 260073 32 Prof. M. Homeida Sudan Onchocerciasis 002491 83 33 Mr. S. L. Mhagama DOC - Box42 MBINGA +25526224762 +255748738286 +255262U0262 S mhagama@yahoo.com v Mr. William Kisoka NlMRBox 9653 DAR ES SALAAM +255746 310504 +255222121360 wkisoka@vahoo.com 35. Dr. J. Y. Jiya N.C. NOCP NIGERIA 234 803 4030212 234 952381 90 iuvaiv@vahoo.com 36. Martha A, Rinay RCHS Ministry of Health DAR ES SALAAM +255744 383824 +255222152977 Mnnav2003@vahoo.com 37 Prof, O. O, Kale WH0 Consultant NIGERIA 08022912224 2312100397 ookale@vahoo,com .. I 18 38 Dr. Pierre Bigirimana Health Specialist CIDA 1 81 99942634 39 Dr. A. M. Seha Head, Epidemiology unit Ministry of Health Box 9083 DAR ES SALAAM 40 Dr, U, Nyandindi Programme Manager NSHP, Ministry of Health Box 9083 DAR ES SALAAM +255744 31 0438 unvandindi@hotmail,com 41 Dr. Azma Simba Ministry of Health NMCP +255744 974798 Dr. Amri WHO Tanzania P.O. Box 92929 DAR ES SALAAM 43 Ms, M, J. Mwaffisi Permanent Secretary Ministry of Health Box 9083 DAR ES SALAAM 44 Mr. Quintus Kassese PPO - TASAF +255744 298097 +255222123582 qkassese@hotmail.com 45 Dr. Edward Maganu WR Tanzania +255 222111718 wrtan@tx.afo.who.int 46 Mr. N. Mwamwaja Communication Officer Ministry of Health Box 9083 DAR ES SALAAM +255744 272514 nsachrism@vahoo,co, uk 47 Mr, Denis Mbekenga VPO - PED +255748il4577 +255 22 21 1 3856 Dr. Emmanuel Malangalila Senior Health Specialist World Bank +255 222114575 +255 22 21 1 3039 emalanqalila@wb.orq Dr. Edward Kirumbi NECP/NOCP Ministry of Health Box 9083 DAR ES SALAAM +255744 327799 +255 22 21 3009 ekirumbi@vahoo.com 50 Mr. Nicholaus Ambon NOTF Accountant Ministry of Health Box 9083 DAR ES SALAAM +255745 253780 michyTT@vahoo,co.uk 51 Mr. K. G. Kagaruki NCCO - EPI Ministry of Health Box 9083 DAR ES SALAAM +255744 383992 +25522 2450089 kagarukik@yahoo,com 52 Ms. Mariam Ally Ser. Repr. Health Programme Coordinato/AMREF BarbaraP@am ref . tz,oro 42 d," 49 l9 mbekenoa denis@hotmail,com 53. Dr. H. A. M, Ngonyani Head - HSIU +255744264359 h noonvani2002@vahoo. com 54. Ms Eva Muro FAA/APOC -WHO Office Box 9292 DAR ES SALAAM +255744 382276 +255 222113180 muroe@tz. afro.who. int 55. Dr. Neema Rusibamayila Coordinator- lMCl Ministry of Health Box 9083 DAR ES SALAAM +255744 866267 nrusibamavila@vahoo.co, uk 56 Dr, Joseph Kamwihangiro Project Manager - AMREF +255744772446 iosephi@amref.tz.orq 20 Annex 2: Meeting agenda and timetable MEETING AGENDA DAY TOPIC DAY 1 8th June 2005 o Opening session and speeches from the Government and guest Speakers. a Poverty Reducti on Strate gy in T anzania-Current Government policy o Integration of Community Based Programmes. DAY 2 9th June 2005 o Strategy for integration of CBHI Limitations of CBHI approacha DAY 3 10th June 2005 a Monitoring and Evaluation of Integrated Programmes and Sustainability issues, adoption of recommendations 2t TIMETABLE DAY 1 Wednesday 08/6/05 TIME ACTIVITY RESPONSIBLE 8.30 - 9.00 Secretariat 9.00 - 9.15 Arrival of Guest of Honor Official welcome of participants & Introduction Overview of Objectives & expected Outcome of the Meeting Dr Saguti DPS 9.2s -9.50 Messages from: o APOC Management r UNICEF, o World Bank, o CIDA. o WHO a a a a a Dr Amazigo Representative 9.50 - 10.00 National Chair of the NOTF to Welcome the PS Dr. Kigadye 10.00 - 10.15 Opening address by PS on behalfofHon. Minister for Health Honorable Minister for Health, Ta'nzania 10.15 - 10.20 Vote of Thanks CMO 10.20 - 10.30 Group Photograph 10.30 -11.00 Coffee & Tea-break ALL Session 1: Agenda: PRSP in Tanzania & Community-Based Health Carez current Government PolicY Chairperson/ PS Ministry of Health M. J. Mwaffisi 11.00- 11.15 National Strategy for Growth and Reduction of Poverty (formerly known as Poverty reduction strategY). Dr. Njau ll.l5 - 11.30 Community-Based Health Care-current Government policy DPS 11.30 - 11.45 Plenary discussion and identifying key issu PS MOH Session 2 Agenda: Horizontal and vertical integration of Community-Based Prosrams (CBPs) Chairperson/ PS Health M. J. Mwaffisi 11.45 - 12.00 National ownership of policies on integration development of processes and outcomes Dr Njau 12.15 - 12.30 Factors that foster or constitute barriers to integration of Community Based s in Tanzania. Dr Mwengee 12.30 - 1.00 Discussion ALL 1.00 - 2.00 Lunch Break ALL 2.00 -2.10 2.r0 -3.40 Presentation by CIDA Group work on strategy and plan of action to: - Develop a framework for integration, identifying actions required at national, regional, district and community levels to foster integration. (3 groups to be facilitated by Dr. Mwengee, Dr. Njau and Dr Dr. P. Bigirimana ALL 3.40 - 4.00 Tea Break ALL 4.00 - 5.00 Presentations & Discussion Chairperson-Dr. Njau 5.00 Closure for the & Facilitators Secretariat 22 DAY 2 Thursday 0916105 TIME ACTIVITY RESPONSIBLE Session 3 Agenda: Strategy for integration of Community-Based Intervention. Chairperson/ PS Ministry of Health M. J Mwaffisi 8.30 - 8.45 Presentations on Program case studies- Onchocerciasis Dr Saguti 8.45 - 9.00 Presentations on Program case studies - IMCI Dr Rusibamayila 9.00 - 9.15 Presentations on Program case studies - Trachoma Dr Mwakyusa 9.r5 - 9.30 Sustainability of Community-Based Intervention: Extent of frontline health facility GLHF) crisis and lessons of APOC Dr Amazigo 9.30 - 10.00 Discussions on (i), (ii) and (iii). Recommendations Chairperson Prof. Homida 10.00 - 10.30 Coffee & Tea break ALL Session 4 rgenda: Attributes and Limitations of using Community-Directed Approach Chairperson/ PS Health M. J. Mwaffisi 10.30 - 11.15 Community-directed treatment strategy- Attributes and Limitations Dr Saguti/ Dr Amaziso ll.15- 11.30 Multi-country study on Community-Directed Interventions: preliminary findings from two sites Mr. Kisoka and Prof. Akogun 11.30 - 11.45 Hybrid approaches: harmonization of community-based programs' support to peripheral health personnel and community members engaged in disease control Dr Hingora l 1.45 - 1.00 Group work on harmonization of different programs' support to peripheral health personnel and community members engaged in disease control (2 groups, group I - support to peripheral health personnel, chairDr. Hingora and group 2 - support to community members engaged in disease control, chair Prof. Akogun) ALL 1.00 - 2.00 Lunch Break ALL 2.00- 3.30 Plenary Group work presentation on harmonization of different programs' support to community members engaged in disease control and Recommendations PS 3.30 - 4.00 Tea Break ALL 4.00 - 5.00 Closure and Facilitators meeting Secretariat z3 DAY 3 FRIDAY 101610' TIME ACTIVITY RESPONSIBLE 9.00 - 9.30 CIDA PRESENTATION Dr P. Bigirimana Session 5 Agenda: Developing and monitoring sustainabr!!ry Chairperson DR Kallinga 9.30 - 9.45 Presentation on Developing and monitoring sustainability plans Dr Uche Amazigo 9.45 - 10.00 Plenary discussions & Recommendations Dr. Kalinga 10.00 - 10.30 Tea Break ALL l r.00 - 12.00 1. Adoption of recommendations on PRSP inTanzania & Community-Based Health Care (Session I ) 2, Adoption of recommendations on Horizontal and vertical integration of Community Based Programs (Session 2) Chairperson Prof. Kale 12.00 - 1.00 Adoption of recommendations on Strategy for integration of community -based intervention (Session 3) Chairperson Prof. Homeda 1.00 - l.30 Adoption of recommendations on Attributes and Limitations of using Community Directed approalbLlg!!&n) Chairperson Prof. Akogun 1.30 -2.30 Lunch Break ALL Session 6 Agenda : Monitoring and evaluation of integrated programs in Tanzania Chairperson DR Kallinga 2.30 -3.00 1. Current situation and available methods inTanzania2. Sustainable financing of monitoring and evaluation in Tanzania Representative Local Government 3.00 - 3.30 Plenary on monitoring and evaluation of integrated programs Discussion and Recommendations Dr Amazigo 4.00 - 4.30 Adoption of recommendations on monitoring and evaluation. Dr Kalinga 4.30 - 5.00 Tea break ALL 5.00 Closure CMO 24