Gone are the days when a brief absence of a Regional Medical Officer (RMO) or the District Medical Officer (DMO) brought to standstill nearly all health services including routine technical meetings and decisions. “These days there is a lot of delegation of powers and representation in all important functions, thanks to the five trainings on Institutional Capacity Building (ICB) provided by Tunajali program last year,” said Dr. Ezekiel Mpuya, the Iringa RMO.
Dr. Mpuya was referring to a series of trainings which were conducted between July 2010 and March this year to develop the capacity of members of the Regional Health Management Team (RHMT) for Iringa Region and Council Health Management Teams (CHMT) for Njombe, Mufindi, Manyoni, Dodoma Municipality and Kilombero districts. The five districts and one region were piloted by USAID’s funded Tunajali program.
The trainings were in fulfillment of the Care and Treatment program’s vision and mission: “To support the Regional and district Health Management Teams to improve access to quality prevention, care, treatment and support services to those infected and affected by HIV and AIDS through focused capacity building and improvements to existing health delivery system.”
Malfunctioning CHMTs necessitated ICB training
With blessings from MoHSW to pilot the ICB work for CHMT and RHMT, Tunajali program, through a consultant established gaps and areas for capacity building in five major areas and developed a joint strategy and action plan to tackle the gaps. In governance; inadequate awareness on their roles and responsibilities among CHMT members and inadequate support to Care and Treatment Centres (CTCs) were among the challenges facing the health service system.
In management; plans and resource allocation was haphazardly done and by only a few people due to inadequate skills, lack of coordination among stakeholders, unclear priority setting and inadequate resource base. The style of management was poor: no delegation of powers, delayed decision making and lack of information sharing among CHMT members. In addition, weak supportive supervision at district and health facility were compounded by weak support from above and among members, poor and inadequate working tools including transport, motivation and medical facilities and absence of supervision plans resulting in inconsistent visits. Policies and guidelines were not within reach of the RHMT and CHMT members while their reports were not well written amid poor presentation and use of data generated.
To remedy the situation, Tunajali piloted the ICB training in Iringa region’s RHMT and five CHMTs of Mufindi, Njombe (Iringa region), Manyoni (Singida), Dodoma Municipality (Dodoma) and Kilombero (Morogoro region)
Indeed, there are early indications of improvement in the way the piloted CHMT and RHMT operates-just eight months after initial training. The capacity building modules were: Roles and Responsibilities, Policies, Guidelines and Team building; Leadership Management and Report Writing; Performance-based management; Planning Process and Data Management and Financial management and Financial Reporting.
Now we are talking and valued
Dr. Nicholas Sanga, District Eye specialist-a co-opted member of Mufindi CHMT could not hide his emotions on the improved working relationship between official CHMT members and co-opted ones. “Our relationship between CHMT and co-opted members is very healthy…in the past we were not included in planning, supervision and decision-making. Now things have changed as we all participate in special activities such as Vitamin A supplementation campaign in our district. We join CHMT members in mobile and outreach work in the communities… I work with my staff including clinic attendant as a team and we don’t feel neglected at all.”
Evelyne, the Mufindi District Cold Chain Coordinator (DCCO) commenting on improved teamwork among CHMT members said: “I thought cold chain matters and immunization were solely mine but now any CHMT member going for supervision, can report to me on what is working or not –they can ask what is the problem at the health facility and collect data for presentation to the CHMT. In the past I used to do it all by myself and I failed, I told DMO and there was no way out.”
Improved planning of Comprehensive Council Health plans (CCHP) in which all departments actively take part has been echoed by members as one of the immediate success of ICB training.
Amina Luganga, Mufindi District Nursing Officer (DNO): “I can now schedule my work plan and prepare a better report. As DNO I can work with DCCO without problems. One can take up another department’s functions when one is not around… Before the training on Planning process, I did not know where to start in developing a plan, implementation and assessment, now I know what it takes to have a good workplan….Now we can develop a 3, 6 month and one year plan and assess your own performance…I can now supervise and train my nursing staff in the health facilities…”
Better planning and performance-based management is on the increase
On performance-based management, several CHMT members were happy to have received the training as they have greatly improved their units and health services. Dr. Cyrialis Mutabuzi, Municipal Medical Officer, Dodoma Municipality, had this to say: “Before the training OPRAS was not understood to many CHMT members. They were not able to plan and follow it. After the ICB training, most of CHMT members including co-opted ones can now fill in the Open Performances Review and Appraisal System (OPRAS) form which is a tool to monitor and supervise staff. On report writing-now CHMT members know why the report and what to report and when. And this trend is taking our Municipality health department to a more accountable level of implementation of our work to the people we serve.”
Financial accountability is improving
From Tunajali’s point of view, there is improvement in financial management. Dr. Josiah Tayali is the program’s Regional Manager for Singida. “Utilization of funds from Tunajali has greatly improved in Manyoni Council. As soon as Manyoni Council has completed activity, they immediately liquidate the expenditure by sending the financial and activity report to our regional office which was not the case in the past.”
In Dodoma, the program’s Grants Officer, Erasto Charles commended the Makole Health Centres in Dodoma Municipality for having rejuvenated after the training. “The centre has been able to access funds for quarter 1 and 2. For the first time, they do not have any outstanding query…they have responded to all but one query of which they are working on to ensure they liquidate or give details within two weeks.”
“Most of the Municipal facilities have received their quarterly allocations because they can liquidate faster than it used to be. Nowadays even when there is no DMO and you go there, they now cooperate and respect Tunajali program team than before. Before the training Tunajali program was viewed by health staff as a small team which colludes with some health facility staff on care and treatment and grants issues…now, the entire health system in the district know what Tunajali is and team work has been cemented”, explained the Grants Officer.
At the regional level, the immediate results of the ICB training have been observed too. Dr. Robert Salim, the Singida Regional Medical Officer (RMO) could not hide his feelings: “I can notice the gradual improvement in working relationship among Manyoni CHMT members…they no longer fear one another like it was in the beginning. In the past the DMO was everything, sometimes uneasy to meet and consult his subordinates but nowadays, things have changed for better. On the planning field, I have noticed improvement as they now know how to use the planning guidelines…they now know to interpret ministry (MoHSW) policies and incorporate them in the Comprehensive Council Health Plan-CCHP.”