Health Promotion Experience of HPSS Project
Dodoma, Tanzania
Participatory Methods for Identification of Determinants
of Well-being and Community Action Planning: Piloting
Multiple Approaches and Strategies for Health
Promotion, in Dodoma Region, Tanzania
Presented at the Culture Health & Wellbeing international conference in
Bristol, UK 24-26th June,2013
Presented by: Ally-Kebby Abdallah
Introduction to Dodoma Region
 Located at the center
of Tanzania
 Semi-arid region with
many tribes; Gogo,
Rangi and Sandawe
are the major tribes,
there are other small
ethnic groups, like
Maasai, Bargaig etc.
 Dodoma has seven
districts.
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HPSS: A project
“Health Promotion and System Strengthening”
(HPSS) Project
 Funded by SDC, mandated to Swiss TPH
 Implemented in Dodoma Region (7 districts)
 Preparation Phase: June 2010 to May 2011
 Phase 1 of implementation: June 2011 – Jan.
2015
 Phases 2 and 3 envisaged for 2015 - 2020
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Objectives of the HPSS
 Purpose:
Access to, quality and utilization of health
resources and services in Dodoma Region are
improved and delivered by an effective and well
governed health system.
Objectives:
1. The population of Dodoma Region has developed
and carries out health promotion activities which
are suited for improving their health status
2. The health system in Dodoma Region is
strengthened in its capacities to provide
appropriate and quality health care
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Working Areas of the HPSS
Components: Health Promotion, Health System
Strengthening, Operational Research
Working Areas:
• Community based health promotion activities
• Health financing
• Drug Management support
• Maintenance and Infrastructure Management
support
• Operational Research
• Mainstreaming of project activities on gender,
HIV/AIDS, social inclusion
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A Systemic Approach for Improving Health
Supportive supervision assessment
and amendment of checklists
Strengthening of health
technology management
Operational Research
Improvement of
financial management
of health facilities
Strengthening of
accountability of
medicines
Strengthening of medicines
management and supply
Improvement of public financial
management of cost sharing
funds in districts/municipalities
Training in health technology
management
Health insurance
•CHFs
•NHIF
•Reinsurance
Training in medicines
management
Community health
promotion fund
Training in participatory planning
methods and social mobilization
Resource Center for health
education and social mobilization
Support of development of health
facility plans
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HP Expected Outcomes
Outcome
The population of Dodoma Region has developed and
carries out health promotion activities which are suited
for improving their health status
Outputs
1.Institutional structures (government and nongovernment) for supporting community activities in health
promotion are strengthened and made functional
2.Communities are supported to define and
operationalize thematic areas for health promotion.
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Problem Analysis
History of HP Approach in Tanzania
 Expert led approach
 Top down
 High cost
 Community passive
 Lack of ownership (maintenance / sustainability)
 Not in line with the Ottawa Charter
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Piloting Approaches in Dodoma
Prevention, health promotion and health
education
•represent complementary strategies to improving
a population’s health.
•cannot be separated
•many countries use a combined approach to
reduce risk and promote health
Basel 2013
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The Concept of Health Promotion
Basel 2013
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Health Promotion Approach
Addresses an issue at several levels
and addresses several of the five key action areas
Basel 2013
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The Ottawa Charter 1986: defined Health Promotion
 a process of enabling people and groups to
increase control over, and to improve their
health and quality life
1.Build Health Public Policy
2.Create Supportive Environments
3.Strengthen Community Actions
4.Develop Personal Skills
5.Re-orient Health Services
Basel 2013
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Transformation of Approaches Under the HPSS Mandate
Apply community
empowerment
processes through
PRA whereby
communities identify
health concerns and
plan solutions
Training of Health
Promotion Officers/
CBOs/CHWs etc
Develop plans and
Guide:
disseminate
existing GoT policies
TWG meetings: platform for
experience sharing and
discussion of HP technical
matter
Influence regional and
district
authorities
’
planning
Use experience and operational research
results to influence region to orient health
services
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Participatory Process on Identifying Health
determinants and needs
 Conducted Participatory
Health Problem analysis
and Planning for
Community Action for
Health Promotion in all
wards of Dodoma
Region.
Districts
Bahi
Developed
Plans
20
Chamwino Dodoma
Urban
40
33
Kondoa
Chemba
51
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and Kongwa
26
Mpwapwa
30
14
Problem Identification Processes
 Community Stories
 Health Problems in
Community
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Problem Analysis
 Invite community
members to
mention/list
health/diseases that
affecting the
community and write
them down.
 Divide the group into
sub-groups (men,
women and if possible
young and old)
 Facilitate the groups
to present findings in
plenary.
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Problem Analysis Tools
 Different analysis
tools used by
facilitators
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Enabling the voting process
 Then draw up these
priorities on a large
sheet of paper
 Give each member of
the group 3 stones,
pieces of paper or
leaves as votes
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Title of Presentation
07 April 2015
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Facilitate
 As people record their
priorities, remain nearby to
answer any questions as
needed.
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Tribes and age set
community
 Very hierarchical
societies: young and
old/ women and men
Education and wealth
Status level
 Poor Vs better off
 Educated-service
providers
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 Count the votes
 Discuss the results of
the ranking with the
group
 Record any further
information
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Participatory Approaches addressing Culture Barriers
Gender and
engagement in process
 disaggregated by
gender and age
groups for effective
identification and
discussion.
 Male facilitator for
male groups; female
facilitator for female
groups.
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Participatory Approaches addressing Culture Barriers
Gender and
engagement in process
 disaggregated by
gender and age
groups for effective
identification and
discussion.
 Male facilitator for
male groups; female
facilitator for female
groups.
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Results/Outcome
 Participatory processes for identifying community
health problems, causes, and priority setting for
action planning has been conducted and completed
in over 200 villages of Dodoma region.
 The exercise revealed the following;
 Malaria is still a number one community concern in most
villages.
 Water bone diseases (especially typhoid and diarrhea)
rank number two in most villages.
 Eye and skin infection are ranked third in the majority of
villages.
 HPSS has developed a more rapid and cost effective
method compared to traditional PRA approaches.
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PRA Benefits of the Approaches
 Communities empowered to understand & act on
their health concerns.
 Determinants of health from the communities are
well understood
 Communities has managed to identify own
resources (manpower with skills and materials)
 Specific health needs identified by different social
groups.
 Cultural barriers addressed
 Community ownership of interventions
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Community Plan
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Preliminary Results from the Communities
 18 food stall
owners
prosecuted
over poor
hygiene
19,270 people
reached by CHWs
and CDO/HOs in
14 villages
2 working
group
meetings
conducted so
far: Agreed
regional HP
strategy
 Provision of
subsidized latrine
slabs
 Chlorinated and
protected water
sources in villages
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Challenges
•Global/national trend in resource allocation to biomedical
and curative strategies rather than holistic HP approaches
and prevention
•Limited support from key decision-makers
•Lack of HP infrastructure
Ensuring sustained commitment to health promotion
principles and approaches
Ensuring implementation of participatory methodologies
Proactive ownership and future development of health
promotion course by the Zonal Training Centre
Identifying suitable indicators for measuring effectiveness
•Reduction in CCHP fund for CAH (from 5-10% to 2-5%)
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Asante Sana!
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