Public Private Partnership for Equitable Provision of Quality Health Services

This report presents the findings of an independent Technical Review that focused on the promotion of Public Private Partnership (PPP) for equitable provision of quality health services in Tanzania. The report is meant to contribute to the Annual Joint Health Sector Review 2005. The ToR has been broadly defined, signifying the interest that many stakeholders currently take in PPP. The Review Team (RT), with two international and three national consultants, undertook efforts to consult stakeholders for prioritisation of the issues included in the ToR. The RT had access to a large number of official documents such as laws, by-laws, policy documents, guidelines, etc. and a wide range of studies on PPP set in Tanzania complemented by international literature. The RT undertook efforts to interview relevant persons and committees, associations, organisations, ministries, donors, etc. at the national level as well as in four districts, two rural and two urban. Nevertheless, time constraints did force the RT to limit itself and consequently not all actors that constitute the private health sector could be contacted. It is hoped that the Annual Joint Health Sector Review 2005 will allow a representative participation of all actors in the field of PPP to discuss this review and compensate for any issue or actor that was left out unintended

Feasibility and Coverage of Implementing Intermittent Preventive Treatment of Malaria in Pregnant women Contacting Private or Public Clinics in Tanzania: Experience-based Viewpoints of Health Managers in Mkuranga and Mufindi districts.

Evidence on healthcare managers' experience on operational feasibility of malaria intermittent preventive treatment for malaria during pregnancy (IPTp) using sulphadoxine-pyrimethamine (SP) in Africa is systematically inadequate. This paper elucidates the perspectives of District Council Health Management Team (CHMT)s regarding the feasibility of IPTp with SP strategy, including its acceptability and ability of district health care systems to cope with the contemporary and potential challenges. The study was conducted in Mkuranga and Mufindi districts. Data were collected between November 2005 and December 2007, involving focus group discussion (FGD) with Mufindi CHMT and in-depth interviews were conducted with few CHMT members in Mkuranga where it was difficult to summon all members for FGD. Participants in both districts acknowledged the IPTp strategy, considering the seriousness of malaria in pregnancy problem; government allocation of funds to support healthcare staff training programmes in focused antenatal care (fANC) issues, procuring essential drugs distributed to districts, staff remuneration, distribution of fANC guidelines, and administrative activities performed by CHMTs. The identified weaknesses include late arrival of funds from central level weakening CHMT's performance in health supervision, organising outreach clinics, distributing essential supplies, and delivery of IPTp services. Participants anticipated the public losing confidence in SP for IPTp after government announced artemither-lumefantrine (ALu) as the new first-line drug for uncomplicated malaria replacing SP. Role of private healthcare staff in IPTp services was acknowledged cautiously because CHMTs rarely supplied private clinics with SP for free delivery in fear that clients would be required to pay for the SP contrary to government policy. In Mufindi, the District Council showed a strong political support by supplementing ANC clinics with bottled water; in Mkuranga such support was not experienced. A combination of health facility understaffing, water scarcity and staff non-adherence to directly observed therapy instructions forced healthcare staff to allow clients to take SP at home. Need for investigating in improving adherence to IPTp administration was emphasised. High acceptability of the IPTp strategy at district level is meaningless unless necessary support is assured in terms of number, skills and motivation of caregivers and availability of essential supplies