Tanzania National Community Based Health Program
Proposed model for Program Design
Helen Semu
AD HPS
Ministry of Health and Social Welfare
Essential pre-conditions
(GoT driven, partner support)
1. By Nov 2015, MOHSW completes the generic Program
Design and launch the program
2. By November 2015, MoF commits to prioritize salary for
at least 2000 CHW per year from 2016/7
3. By December 2015, POPSM commits to prioritize
positions for at least 2000 CHW per year from 2016/7.
4. By December 2015, PMO-RALG commits to prioritize
training of at least 2500 CHW per year from 2016/17 .
5. By December 2015 LGAs in RMNCH-BRN Regions
commit to prioritize absorption of at least 80% of the required
CHW per year and establish district-led CBHP.
6. By April 2016, partners and GoT achieve a CHW-cost
sharing agreement.
7. By Dec 2015 Strategize and deploy partners to work with
LGAs BRN-RMNCH regions to achieve the strategic goals
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The components of Program Design
Identified and approved by the community, village GoT
Recruitment by LGA (WDC)
Training by National curriculum, HTI/setellites
Employed by LGA, NGOs, Private sector
Service delivery
– Standardized remuneration for existing CHWs to deliver a
minimum package of RMNCAH mostly health promotion,
disease prevention and referral (economic analysis proposed)
– Salaried – comprehensive and integrated package (health
promotion, preventive and referral, basic curative,
rehabilitative, disease surveillance, reporting vital statistics)
• Deployment and management by the LGA
– Nearby facility staff
– Village government
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CBHP Policy Guidelines
“Essential
health services cannot be provided by people working on a
voluntary basis if they are to be sustainable and accountable. While
volunteers can make a valuable contribution on a short-term or part-time
basis, trained health workers should receive adequate wages and/or other
appropriate and commensurate incentives”.
– Task shifting: rational redistribution of tasks among health workforce
teams [Global recommendations and guidelines, recommendation
14]. Geneva: World Health Organization; 2008. task shifting
guideline, MOHSW, 2015
In March 2014, MOHSW approved CBHP Policy Guidelines which calls for a Community Health
Worker cadre that:
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Is chosen by their community and reports to their community;
Is formally trained according to government standards, paid and employed by the government
and enrolled in a scheme of service
Provides an integrated and comprehensive package of interventions to include RMNCAH services
Connects people across the household to facility continuum and engages health promotion,
preventive, basic curative, rehabilitative services and surveillance.
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National CBHP Strategic Plan 2015-2020
From 2015 to 2020…
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Operationalize the CBHP country wide:
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Start scale up in “BRN – RMNCH regions (5)
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Finalize tools to guide the program implementation - ongoing
Assess the capacity of HTI/Setellites – partly done
Equip to enable training – plans underway
Start training
Build sustainable systems for national. replication and scale up
Five strategic objectives:
1. Strengthen management and coordination mechanism of
CBHP at all levels.
2. Formalize CHW cadre
3. Strengthen institutional capacity to mobilize and manage
resources for CBHP
4. Strengthen advocacy, communication and social mobilization
5. Strengthen support systems for effective planning and
implementation of CBHP services at all levels.
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Strategic goal 1: By June 2020, in at least 75% of LGAs,
increased capacity to manage and coordinate the CBHP
Outcome1.1:Strengthened the
capacity of existing structures
by 75% from the baseline by
2020
Partners: USAID, MUHAS,
JSI, JhPiego, BMAF, BMGF,
CHAI, IRISH AID, UNICEF,
WB, DANIDA, WHO
Outcome 1.2: By 2020,
100% of partners planned
activities for CBHP are
integrated into national
and councils plans
Status of progress: 40%
mostly national level
Outcome 1.3: Mult sectoral
collaboration for
implementing CBHP
established in 75% of LGAs
by 2020
Next steps: solicit partners
collaboration, financial
and technical support MoU
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Strategic Goal 2: By June 2020, at least 1/3 of required CHWs trained
with the national curriculum be employed and deployed by the GoT
Partners: WHO, DDCF,
Outcome 2.1: By Dec 2015, roles
THET, Columbia, Comic
and responsibilities of CHWs be
Relief, IHI, *, BMGF, CHAI,
adopted in the SoS for MA
UNICEF, USAID, JhPiego,
Outcome 2.2: The National
Solidamed, SDC
curriculum for training CHWs in
use in 80% of the HTI/satellites by
Status of progress:
June 2020,
55% accomplished mostly
Outcome 2.3: 1/3 of trained CHW’s
national level
are deployed by public and NGO’s
implementing CBHP
Next steps:
Outcome 2.4: By 2020, t least 80%
Solicit collaboration,
of existing CHWs volunteers have
technical and financial
capacity to delivery a minimum
support for program
package of RMNCAH
design, implementation in
Outcome 2.5: 80% of deployed CHWs
BRN regions, knowledge 7
are retained in service by 2020
management and roll out
Strategic goal 3: By 2020, 80% of LGAs sustain CBHP
Outcome 3.1: By 2020 80% of
LGAs have increased the
capacity to mobilize
resources for CBHP
Outcome 3.2: By 2020, 80%
of LGAs have increased
capacity to manage CBHP
Outcome 3.3: By 2020,
75% of existing structures
increase accountability on
resource management
Potential partners:
1mCHWs Campaign,
BMGF, CHAI, USAID,
JSI, Comic Relief, THET,
WHO, UNICEF, JhPiego,
UNFPA,
Status of progress: 10%
Next steps: Develop
strategies, toolkits for
advocacy and capacity
building on resource
management at
national and LGA level. 8
Strategic goal 4: By 2020, 80% of LGAs will have
the capacity to advocate, communicate and
social mobilization for CBHP.
Outcome 4.1 : By 2020, 80% of legislations and by-laws for
improved community health will be enforced
Outcome 4.2: by 2020, 75% of community structures are
accountable for CBHP services (social mob)
Outcome 4.3: By 2020, 90% of care takers of children aged 5 years
and below improved early health care seeking behavour (ASBCC)
Partners: UNICEF, WHO have provided support which somehow
touches the CBHP components
Status of progress: 20% a lot of in country programs/ projects to
learn from and use for CBHP
Next steps: to determine partners to support the interventions.
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Strategic goal 5: 80% of support systems for planning
and implementation of CBHP at all levels strengthend
Outcome 5.1: By 2020, communitybased health component of HMIS
established and functional
Outcome 5.2: Build capacity for
effective and applied M&E and
Operations Research of CBHP
Outcome 5.3: by 2020, 80% of CHWs
work plan are successful implemented
(supportive supervision)
Outcome 5.4: At least 80% of CHWs
experience an uninterrupted supplies
each year
Partners: Columbia/IHI,
MUHAS/JHU, BMG/CHAI,
USAID/JSI
Status of progress: 15% BRN, is strengthening
logistics scheme and
supervision systems, etc.
M&E, research: Lessons
learned from pilot work
conducted by partners.
Next steps: program
design which will involve
knowledge management,
operational research and
M&E plan for CBHP.
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Asanteni sana
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