Case study: Quarterly reviews hold health facilities accountable in Tanzania
Review meetings have improved planning, implementation, monitoring, and evaluation of health programs.
In 2017, Tanzania decentralized its health system. More than 6,000 facilities across the country became responsible for their own program planning and financial management. CHAI and our partners recognized the critical need to ensure health facilities could appropriately plan and budget for the healthcare services they provided.
Our goal was to introduce quarterly review meetings for immunization teams at health facilities across Arusha, Dodoma, and Geita. CHAI worked with the regional governments to conduct a baseline assessment identifying the programmatic and financial key performance indicators (KPIs) to measure health facilities’ progress. We also developed a Performance Management Review (PMR) tool for councils and health facilities to record that progress. In preparation for the quarterly reviews, health facility in-charges, guardians (who oversee between one and three health facilities), district immunization and vaccine officers, and other key Council Health Management Teams (CHMTs) updated the performance management review tool and KPIs. The resources were shared with all participants five days before the meeting. The first quarterly meetings took place across all three regions in May 2019. Critical stakeholders across health facility, council, and regional levels were required to attend.
During the reviews, health facility guardians presented progress against indicators from the previous quarter and shared implementation challenges affecting performance. Participants reviewed the actual status of work completed compared to what was originally proposed in the quarterly plans. Extensive analyses examined which activities were implemented, which were not, and the factors that impacted performance. Budgets were also reviewed to determine how much money was approved for activities that were supposed to be implemented, how much money was received by the health facility and based on what was implemented, how much money was used. Meeting participants then prepared action plans for the next quarter, which included possible solutions to address the factors that resulted in low performances in the previous quarter.
CHAI helped the council health management teams introduce and institute evidence-based quarterly performance review meetings for health facilities using the performance management review tool in 21 councils across the regions of Arusha, Dodoma, and Geita. The meetings create inclusive forums to discuss progress, identify challenges, and develop mitigation plans to improve the performance of immunization programs.
The meetings also provide accountability by involving key stakeholders from all levels of the health system, from decision-makers to health facility guardians and frontline workers. Some of the factors that facilitated the success of CHAI’s efforts include:
- All health facilities developed action plans to address the challenges faced in their implementation of health facility annual plans.
- Health facilities used tools and templates to review their performance and develop reports that were signed by the health facility governing committee’s chair. Chairs are individuals selected to serve as community representatives. They help councils oversee the implementation of activities, work closely with the facility in-charge of administrative issues, and lead committee meetings.
- Health facilities were willing and receptive to sharing financial data for reviews.
Tanzania is looking to scale performance management review meetings to other health areas, such as family planning and maternal, newborn, and child health. CHAI continues to develop and refine a package of tools that can help Tanzania roll out the program more widely. We are also confident other countries could use this package of tools to deliver sustainable, scalable, government-led performance management programs in order to:
- Increase accountability for results across national and regional management levels.
- Ensure performance review meetings consistently occur so data can be collected and effectively used to inform programmatic and financial decision making.
- Promote the integration of immunization with other health service interventions.