1.8 Dr. Upunda Presentation LMG Health Conference 29 Jan13

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Presentation on LMG in Devolved Health Systems: Learning from an International Experience

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1.8 Dr. Upunda Presentation LMG Health Conference 29 Jan13

  1. 1. The First National Conference on Health Leadership, Management and GovernanceThe Devolution Experience in Tanzania Dr. Gabriel L. Upunda 29 January 2013
  2. 2. Getting Started IN NOVEMBER 1993 THE TANZANIAHEALTH SECTOR REVIEWED BY WIDECROSS SECTION OF STAKE-HOLDERS
  3. 3. Identified Problems• Inadequate Resources to the Sector• Inadequate Managerial Capacity• Poor Implementation• Dual Responsibilities of DMO both the central and local governments• Lack of an appropriate research priority policy at all levels• Overall declining economic performance in the country
  4. 4. Major Areas of Consideration• Ideological Issues• Organisational Issues• Managerial Issues• Financial Issues• Public/Private Mix• Research• Legal Aspects
  5. 5. Devolution• The decision to devolve was by the central government• The Ministry of Health and Social Welfare, Regional Administration and Local Government, and Other Ministries had to abide to it.
  6. 6. Challenges for Devolution• Different Ministries misunderstanding or not understanding the concept of devolution• Central Ministries reluctant to leave power to lower Institutions (Regions, Districts)• Low budget• Low Managerial Capacity as specially at District level• Lack of Legal Framework
  7. 7. Challenges• Public / Private Partnership operating at very low level• Standards not set for public and private medical premises
  8. 8. Reforms• IDEOLOGICAL REFORMS• ORGANISATIONAL REFORMS – Administrative structures reforms – District Health Boards – Refinement of the referral health system• MANAGERIAL REFORMS – Dual responsibilities for district health services management – Financial Management – Human Resource Management – Logistical Support
  9. 9. Reforms• FINANCIAL REFORMS – The diversification of sources of health financing – Allocation of public expenditure• PUBLIC/PRIVATE MIX REFORMS – Amendment of Legislation – Health Facilities – Resource Control and Human Resource Development• RESEARCH REFORMS• REVISION OF THE HEALTH POLICY
  10. 10. Reforms• FORESIGHT – Empowering district, community and household initiatives – Seeking alternative financing option – Continuous revision of the implementation of various Acts, Ordinances and regulations
  11. 11. But since 2000……….
  12. 12. Summary• Health reform is a dynamic process. There is no template• There are many interested parties when a country goes into this process.• Always be prepared to adapt rather than adopt.
  13. 13. Thank you.

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