1. Christian Social Services Commission
ACHAP MEETING
Strengthening PPPs and Inter-faith
partnerships for Universal Health Coverage
Dr. Josephine Balati
25th February 2015

2. OUTLINE
• Introduction
• Functions of CSSC
•PPP Background and Rationale
•PPP Policy, Framework and
•Success and Challenges of
Strengthening PPP
•Partnership for UHC

3. |
Christian Social Services Commission
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• Established in 1992 jointly by the Christian Council of
Tanzania (CCT) and the Tanzania Episcopal Conference
(TEC).
• Mandated to chart out a common action, within the policies
and the laws of URT, aimed at expansion, improvement
and development of the provision of the health and
education services
CSSC
• For Health - work with a network of over 897 church health
facilities including 101 hospitals whereby 2 are Referral &
Consultant Specialized hospitals (KCMC and BMC), 37
District/Council Designated hospitals (CDHs), 59 Voluntary
Agency hospitals (VAHs), a total of 101 Health Centers and
697 Dispensaries. In addition, a network of 67 Health
Training Institutions).
• For Education - work with a network of 255 church
Secondary Schools and 52 Seminaries; 132 vocational
training Centers; 21 Teachers Colleges and 17 University
Colleges.
Introduction

4. |
Christian Social Services Commission
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• Vision: An enlightened and well educated community that
is enjoying quality life and is free from diseases of poverty.
• Mission: CSSC strives to support delivery of social
services by church institutions in Tanzania through
collaboration and partnership, advocacy, lobbying, capacity
building and selected interventions, with the compassion
and love of Christ.
CSSC
Objectives:
• Contribute to the physical, mental, social and spiritual
development of the Tanzania people through facilitation the
provision of quality social services to all the people regardless
of color, race, creed
• To foster promotion, improvement and expansion of
Education, Health and other social services all over Tanzania.
Introduction Cont...

5. |
Functions of CSSC
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Participate effectively in the formulation of
policies and/or present comprehensive
policy proposal to the government and
in so doing observe the policies for
such service as outlined by the
Government
Facilitate strategies to improve
planning, financing, coordinating,
orgniasing, expanding, or maintain
quality social services in health and
Education sectors
Harmonise or reconcile Churches policy
relavant to social services in Education
and health sectors
Administer, manage and monitor the use
of finances borrowed, granted,
generated or allocated through the
commission to support facilities
Facilitate monitoring of social
sectors programmes
designed by the Churches
Provide essential support
Church institutions providing
health and education services.
Strengthen technical services in Education
and Health sectors through reach and
consultancy services

6. |
Coordination of Service Delivery
• CSSC head office is located in Dar-es-Salaam.
•CSSC operations are being coordinated through five Zonal Policy Forum (ZPF)
Offices:
Eastern zone, Southern zone, Northern zone, Lake Zone and Western zone
respectively.
•Each office is managed by a Zone Chairperson – A Bishop, Zone Manager, 2
health coordinators and 2 Education coordinators, an accountant/cashier, office
management secretary and a data clerk.
•Each Zone office is responsible for coordinating the health and education
facilities in respective zone and also link with respective dioceses. In additional the
ZPF are responsible for representing the churches, liaising and working closely
with the Regional and District health/education teams, other stakeholders in
respective Regions and Districts.
• Zone Offices coordinates and conduct member churches ZPF meeting, FBO Facility
technical meetings and, interfaith and PPP meetings.
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7. |
Zones and Offices
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Lake Zone
Western Zone
Southern Zone
Eastern Zone
Northern
Zone
Lake Zone: Shinyanga
Mwanza, Simiyu, Geita,
Mara,Kagera
Northern Zone:
Arusha,K’njaro,Manyara
Eastern Zone:Dodoma,
Morogoro, Tanga, Dar,
Z’bar isles &Coast
Southern Zone:
Mtwara,Mbeya,
Lindi, Rukwa, Iringa,
Njombe, Ruvuma & Katavi
Western Zone:
Kigoma,Tabora,
Singida

8. |
Background - PPP in the health
•Public and Private Health sectors have been providing health
services in Tanzania before and after independence.
•The public sector was the main provider
•The Government imposed restrictions on private health care
services delivery in 1977.
•The Government re-introduced private Health Service practices
in 1991
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9. |
Rationale - PPP in the health
•Demand for health services has increased, due to increased
population growth
•New policies promote increased participation of the private
sector in provision of health services.
•Inadequate public fund –Only 10.3% (2012/13) of total
government budget is allocated to health sector
•Need to complement government efforts.
•Need to leverage private sector resources
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10. |
The Private Sector Contributes
at all Health Service Levels

11. |
PPP Policy, Legal Framework and Strategies
The Government has developed enabling policies and
environment as an effort to strengthen the delivery of health
services in Tanzania. Some of the key policy documents include;
•National Development vision 2025
•National Strategy for Growth and Poverty Reduction-MKUKUTA
•National Health Policy (2007)
•Health Sector Strategic Plan (HSSP III) of 2009-2015
•Primary Health Service Development Programme (PHSDP) of 2007-2017
•Tanzania five year development Plan 2011/12-2015/16
•Human Resource for Health Strategic Plan (2003-2013)
•Health Sector PPP Policy Guideline (2012/3)
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12. |
Strengthening PPP in the health sector
•Public-Private Partnerships (PPPs) in the health services delivery are part of
the implementation of health care programmes under the MoHSW and NGOs
which covers reproductive and child health, HIV and AIDS, Malaria, TB,
Health Basket funding support systems and management information system.
•Achievements for PPPs depend on existence of strong policies, laws, norms
and procedures (regulatory framework).
•The PPP Act No.18 (2010) and its Regulations (2011) provides the
institutional framework for the implementation of PPP Agreements between
the public and private sector; sets rules, guidelines and procedures for
governing public private partnership (PPP)
•Despite the good intention of key stakeholders to strengthen PPPs in the
health sector, there are still strong dissatisfactions in several areas. These
include knowledge gap in regulatory framework, coordination, financial
support, stakeholders’ commitment, human resource capacity and utilisation,
access to essential drugs to mention a few.
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13. |
The Regulatory Framework for PPPs
Success and constraints
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Policy Doc/Area Success Constraint
National Strategy for
growth and poverty
reduction (2007-2017)
Makes PPPs mandatory
Lack support instruments for managing
PPPs
National Health
Insurance Fund
Better access to services through
public- private arrangements
Conflicting interests , Dishonesty,
Distrust , Bureaucracy
Service Agreement (SA)
67 FBO hospitals have signed
SA,
-Inadequate adherence to terms of the
SA (financing, HR, Medical supplies,
capital development and sharing of
plans) both government and FBOs.
-SA linked to Basket Fund only instead
of actual services provided.
-Very few private for profit facilities have
signed SA
-inadequate fund for Implementation of
exemption policy

14. |
PPP Coordination
Success and constraints
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Organ/structure Success Constraint
Health Boards and Health
Facility Governing
Committees
Public and private sector
stakeholders meet & share
experiences, discuss and make
decision on issues related to health
services
-Effectiveness depends on
personalities
-In some regions the participation
of the private sector for profit is
very limited
-Limited awareness
-- Mistrust
- Lack of feedback
APHFTA (Association of
Private Health Facilities in
Tanzania)
Coordinates activities of member
private hospitals including training
- It is a speaking voice of private
practitioners
Some practitioners are not aware
of the role of APHFTA/ or not a
member
CSSC
-Coordinates and regulates the
functions of church (Catholic &
Protestant) based health facilities
-Networks with the government and
other private service providers
-The choice of the types of PPPs
is influenced by Christian based
ethics and code of conduct
-Some FBOs are not aware of the
role of CSSC/ or not member
churches
Others
The ministry of health and social
welfare has a management and
coordinating unit for PPP TWG,
The National PPP Forum
Roles and responsibilities are not
well known to some stakeholders,
Not all groups represented

15. |
PPP Commitment and accountability
Success and constraints
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Area Success Constraint
Commitment on resources
Health Basket Fund
-Not enough, non adherence to the
allocation formulae
- The private is not involved in
decision making
- dependency on Treasury
Bed Grant
- Only for faith based service
providers - Not adequate compared
to actual costs
Staff Grant Cover few staff only
Trust
There is hope that trust among partners
will improve
Generally both the private and
government officials mistrust each
other
PPP facilitation
-Some officials have good
understanding of the PPP concept,
policy and guidelines
-Provide cooperation and spearhead
PPP
-Low responsiveness of some
officials
-Unnecessary bureaucracy
- Lack of clear understanding the
concept, transparency and
facilitation of participation

16. |
Human Resource - Capacity and Utilization
Success and constraints
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Area Success Constraint
Staff Secondment
Some doctors work in church based
service providers through secondment
-No effective monitoring of the quality
of staff
-No harmonisation of reward systems
- Increasing staff turnover
Staff Salaries
The government pay salaries for
seconded staff in FBO facilities
(Designated and Referral hospitals)
-Staff outside secondment receive
different (low amount) of pay
-Relatively poor reward for staff
employed by faith based service
providers
-Inability to attract and retain
qualified staff.
Capacity
Some qualified doctors working in
government hospitals get part time jobs
in private hospitals. This improves
capacity of the private sector
These doctors have more than one
master. This reduces efficiency,
commitment and accountability
Patients have to bear the costs
Training
Joint Training, there training offered by
government as well as private sector
Not systematically planned /well
coordinated; sometimes depend on
personal relationships and
networking

17. |
Partnership for Universal Health Coverage
•Universal Health coverage is an agenda for action.
•One of the key objective of Health Sector Strategic Plan III which has just ended
was to mobilise adequate resources and ensure the sustainability of resources for
the health sector. To that end, government budget, donor funding, as well as
household contributions were all targeted as sources of funding to reduce the budget
gap.
•There is a need to reduce the budget gap in the health sector by mobilising
adequate and sustainable financial resources; a need to reduce reliance on
external/donor support; need to complement the government efforts and need to
leverage private sector resources.
•The Draft Health Financing Strategy is in place and the government continue to
engage various stakeholders to review and contribute their inputs before finalizing
the document.
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18. |
Way Forward
• Increase understanding of advantages of PPPs through increased
advocacy for PPPs at all levels
•Strengthen PPP implementation to improve the provision of health and
social welfare services
•Build capacity of Public and Private providers to identify, negotiate and
develop PPPs for health at all levels
•Strengthen forum for policy dialogue for PPPs at all levels
•Monitor and track PPPs in the sector at all levels
•It is important that local authorities develop strategies for reducing donor
dependency by setting budget allocation from their own revenues special for
supporting public- private sector partnerships.
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19. |
Thank you for your Attention – ASANTE SANA
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