Análisis microestructural y composición química

SERVICE DELIVERY

Establish dialogue with the private sector as a routine part of LGA/District Health Management Team functions.

Limited communication and weak dialogue are hindering opportunities for stronger private sector contributions to the Tanzanian health system. The exclusion of private health actors from key forums and planning activities effectively excludes valuable skills, capacity, and resources from essential health services. Encouraging DMOs and other local government health

leadership to make PPD and program coordination a routine part of council meetings will increase opportunities for face-to-face multi-sectoral collaboration. In addition, opportunities exist to expand the composition of CHMTs to accommodate increased representation from the private sector. Making private sector engagement in CCHP processes mandatory and inclusive will also promote more effective council health plans based on collaborative and comprehensive planning. CHMTs would also benefit from supportive guidance on facilitating multi-sectoral dialogue, while scaling up the inclusion of PFP and additional PNFP health facilities in the CCHP dialogue and preparation process. Further, LGAs and public health facilities should encourage private sector participation in existing public sector technical dialogue. Fostering opportunities for knowledge exchange via hospital-based M&M meetings, quarterly maternal mortality audits, and other technical forums discussing disease and surveillance trends will provide opportunities for multi-sectoral collaboration, cross-sector capacity development, and CPD. By including (for example) PRINMAT nurses and midwives in maternal mortality audits, and by expanding the involvement of lower-level CSSC facilities in CCHP processes, LGAs can increase valuable community-level knowledge while maximizing the opportunities for

community-based health personnel to strengthen their skills.

Increase private sector training opportunities in key health services.

Open all training opportunities to all types of private providers, whether they are donor-funded or government-funded. The private health sector is ready to engage in the delivery of essential services such as HIV/AIDs, but is limited by their ability to access training or CPD opportunities. Starting with the vertical programs (e.g., intensive IMAI or RCH training for private health sector actors), private sector personnel should be mobilized to address key health challenges facing the Tanzanian health system. At present, private sector actors (particularly in rural areas, where service expansion is needed most) have limited opportunities to access CPD or skills expansion trainings that would allow their inclusion in vertical program responses, due to the cost of

access barriers – effectively limiting the expansion of private sector service packages. In mobilizing private sector resources to respond to key health challenges (HIV/AIDS, malaria, RCH) there is a need to emphasize ―private sector only‖ training programs to increase service delivery coverage. In some councils, public staff have provided short-term coverage to private health facilities in times of extended staff absence due to illness or HRH shortage. Formalizing this practice should be explored to allow private sector staff to attend trainings. In addition to formal trainings, both sectors should seek to organize private-public sector exchange

attachments in order to increase multi-sectoral capacity in key specialties (e.g., cardiology, nephrology).

Increase public-private attachment and shared CPD opportunities.

Increasing clinical/technical attachment and CPD opportunities at public facilities, and exploring mentorship opportunities via the vertical disease programs, could significantly scale up the number of health personnel involved in priority health areas. Public and private actors should also explore opportunities for public-private sector clinical dialogue and exchange attachments in key specialties (cardiology, nephrology, etc.) to foster information exchange and clinical skill development in both sectors. This could be done through increased private provider

involvement in existing morbidity and mortality meetings, maternal mortality audits, and other clinical forums.

Support the Tanzanian Medical Laboratory Scientists Association (MLSA) to facilitate the coordination and harmonization of diagnostic / equipment use across the public and private sectors.

The MLSA is eager to identify and support opportunities to coordinate diagnostic/equipment use between the sectors and improve the efficacy of diagnostic referral between public and private diagnostic providers. In the event of reagent stock-outs, equipment failures, or limited utilization of existing equipment, improving knowledge of (and access to) existing equipment resources between the sectors can improve patient care and eliminate the need for facilities in both sectors to heavily invest in equipment already available elsewhere. The private health sector currently possesses equipment and expertise that could be made available to the public sector through purchasing agreements; conversely, public sector referral or equipment loan for small- scale private clinics could spare them having to rent ultrasound and other key service

equipment at exorbitant prices. The MLSA should be supported to convene a one-time membership forum in order to create a compendium of available diagnostic resources across the sectors and identify coordination prospects. The MLSA as a membership body can encourage informal or formal ―contracts‖ or ―purchasing agreements‖ in order to better share diagnostic resources across the sector. Linking these agreements to financing mechanism (e.g., NHIF) may also minimize OOP expenditures to patients while providing much needed

diagnostic capacity to both sectors.

Pursue existing PPP opportunities for non-clinical supportive service provision in health facilities.

The public sector currently employs personnel to provide supportive health facility services, such as cleaning, waste disposal, catering, and security. LGAs describe this responsibility as time-consuming – absorbing administrative capacity from hospital and council leadership that could be spent on health service delivery. PPP opportunities exist to outsource these services to private companies, allowing management at facility and council level to focus on service

5. PRIVATE SECTOR HUMAN