April 30, 2019

This publication was produced for review by the United States Agency for International Development. It was

prepared by the Public Sector Systems Strengthening (PS3) Activity located in Dar es Salaam, Tanzania, under

Contract AID-621-C-15-00003 with USAID/Tanzania. The USAID/Tanzania Public Sector Systems Strengthening

Activity (PS3)

PUBLIC SECTOR SYSTEMS STRENGTHENING

(PS3) IN TANZANIA

YEAR 4 QUARTER 2 REPORT

JANUARY 1 – MARCH 31, 2019

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The USAID/Tanzania Public Sector Systems Strengthening (PS3) Activity’s overarching goal is to support the

Government of Tanzania to strengthen the public system to promote the delivery, quality, and use of services,

particularly for underserved populations. Led by Abt Associates, PS3 is implemented in partnership with Benjamin

William Mkapa Foundation, Broad Branch Associates, IntraHealth International, Local Government Training Institute,

Tanzania Mentors Association, University of Dar es Salaam and Urban Institute.

April 2019

Contract No: AID-621-C-15-00003

Submitted to: Elizabeth Williams, Contracting Officer Representative

Cover Photo: A nurse at Gamasara Dispensary in Tarime Town Council Ms. Veronica Mwita, attending to a

mother a child. Gamasara Dispensary is one of health facilities that benefit from DFF (Photo PS3)

DISCLAIMER

The contents of this report are the sole responsibility of the PS3 Activity and do not necessarily reflect the views of

USAID or the United States Government.

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CONTENTS Contents ......................................................................................................................................... 3

Acronyms ...................................................................................................................................... 4

Executive Summary and Quarterly Achievements ........................................................ 8 Year 4 Quarter 2 (Y4Q2) Activities and Achievements ............................................ 8

Introduction ............................................................................................................................... 13 Implementation Approach ........................................................................................................... 13

1. Information Systems ............................................................................................. 14 1.1 Strengthening Public Sector-Wide Information Systems ................................... 14 1.2 Sector-Specific Information Systems ............................................................................ 16 1.3 Management of Strengthened Information Systems ............................................ 18 1.4 Strengthen System Interoperability, Improve Data Access and Use ............. 19

2. Finance ....................................................................................................................... 21 2.1 Support Development of National Health Insurance Architecture ................ 21 2.2 Strategic Purchasing and Shift to Output-Based Payment ................................. 22 2.3 Strengthen Service Provider Financial Management ........................................... 25 2.4 Strengthen Resource Allocation and Tracking......................................................... 27

3. Human Resources................................................................................................... 30 3.1 HR Planning and Distribution .......................................................................................... 30 3.2 HR Retention ............................................................................................................................ 32 3.3 Improve HR Performance Management and Efficiency ...................................... 33

4. Governance and Citizen Engagement ............................................................. 36 4.1 Improve Sharing of Information with Citizens ........................................................ 36 4.2 Strengthen Citizen Feedback and Complaint Management ............................... 37 4.3 Strengthen Committee Functioning, and Realign Roles and Relationships38 4.4 Strengthen Public Finance Management .................................................................... 40 4.5 Use of Distance e-Learning to Institutionalize Capacity Building and Increase

Sustainability ............................................................................................................................ 41

5. Operations Research ............................................................................................. 42

6. Collaborations ......................................................................................................... 44

7. Communications and Knowledge Management ......................................... 46

8. Monitoring and Evaluation (M&E) ................................................................... 47

9. Challenges ................................................................................................................. 48

10. Program Management .......................................................................................... 49

11. Contract and Financial Management ........... Error! Bookmark not defined.

List of Tables and Figures Figure 1: Three System Dynamics ................................................................................................13 Figure 2: Percent of regions’ total health facilities with GoTHOMIS installed ..............17 Table 1: Status of iMES Development ..........................................................................................20 Figure 3: Steps to improve purchasing and provider payment to prepare for SNHI .23 Figure 4: FFARS, MSD Epicor and eLMIS Interoperability ...................................................26 Table 2: Installation of WISN plus POA at PORALG ................................................................30 Table 3: e-OPRAS Implementation Schedule (February-June 2019) ...............................34 Table 4: Review and convert existing LGA staff orientation manual to DeL style .......41 Table 5: PS3 Collaborations with USAID and Development Partner Projects ..............45

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ACRONYMS

API Application Programming Interface

ASDP Agricultural Sector Development Program

BMF Benjamin Mkapa Foundation

CAG Controller Auditor General

CBMIS Central Budget Management Information System

CDC Centre for Disease Control

CDDs Community Development Departments

CDR Council Development Reports

CFR Council Financial Reports

CHF Community Health Fund

CHSSP Community Health and Social Welfare System Strengthening Program

CSO Civil Society Organizations

DANIDA Danish Development Agency

DC District Council

DFF Direct Facility Financing

DFID Department for International Development

DHFF Direct Health Facility Financing

DHIS2 District Health Information System

DPP Department of Policy and Planning

DPs Development Partners

eGA e-Government Agency

EQUIP-T Education Quality Improvement Programme

FFARS Facility Financial Accounting and Reporting System

FY Fiscal Year

GCU Government Communications Unit

GePG Government Electronic Payment Gateway

GF RSSH Global Fund Resilient and Sustainable Systems for Health

GFG Good Financial Governance

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GHSC Global Health Supply Chain Project

GIZ Tanzania German Programme to Support Health

GOT

GoTHOMIS

Government of Tanzania

Government of Tanzania Health Operations Management Information System

HBF Health Basket Fund

HCMIS Human Capital Management Information System

HFS Health Financing Strategy

HIM Health Information Mediator

HLG Higher Local Government

HMIS Health Management Information System

HR Human Resource

HRH Human Resource Management

HSSP Health Sector Strategic Plan

HTTP Hypertext Transfer Protocol

IAG Internal Auditor General

ICT Information and Communication Technology

IDEA Interactive Data Extraction and Analysis

IGFT Intergovernmental Fiscal Transfers

IPRS Implementing Partners Reporting System

IPSAS International Public Sector Accounting Standards

IS Information Systems

IT Information Systems

JICA Japan International Cooperation Agency

KCMC Kilimanjaro Christian Medical Centre

KfW Kreditanstalt fur Wiederaufbau

LAN Local Area Network

LANES Literacy and Numeracy Education Support

LGA Local Government Authority

LGRCIS Local Government Revenue Collection Information System

LGTI Local Government Training Institute

LLG Lower Local Government

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MC Municipal Council

MCSP Maternal, Child, Survival Program

MOEST Ministry of Education, Science and Technology

MOFP Ministry Of Finance and Planning

MOH Ministry of Health

MOHCDGEC Ministry of Health, Community Development, Gender, Elderly and Children

MSD Medical Stores Department

MUHAS Muhimbili University of Allied Health Services

NHI National Health Insurance

NHIF National Health Insurance Fund

NIMR National Institute of Medical Research

OPRAS Open Performance Review and Appraisal System

OR Operations Research

OSR Own Source Revenue

P4H Providing for Health

PFM Public Finance Management

PFMRP Public Financial Management Programme

PHC Primary Health Care

POA Priority Optimization Analysis

POPSM President’s Office Public Service Management

PORALG President’s Office, Regional Authority for Local Government

PORAMD President’s Office Records and Archive Management Department

PS3 Public Sector Systems Strengthening

PSU Project Support Unit

RBF Results-Based Financing

RS Regional Secretariat

SBAS Statistical Budget Analysis Software

TFDA Tanzania Food and Drug Authority

TMA Tanzania Mentors Association

TOT Training of Trainers

TSC Teacher’s Service Commission

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UCC University Computing Centre

UDSM University of Dar es Salaam

UHC Universal Health Coverage

UNICEF United Nations International Children's Emergency Fund

USAID United States Agency for International Development

WB World Bank

WDCs Ward Development Committees

WHO World Health Organization

WISN Workload Indicators Staffing Need

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EXECUTIVE SUMMARY AND QUARTERLY ACHIEVEMENTS

The purpose of the USAID Public Sector Systems Strengthening Activity (PS3) is to support the

Government of Tanzania (GOT) to strengthen national systems to promote the delivery, quality,

and use of public services, particularly for underserved populations. PS3 is a five-year USAID-

funded activity that strengthens Local Government Authority (LGA) systems to promote

inclusive and evidenced-based planning, management, and implementation of services across

sectors, including health, education and agriculture. PS3 is led by Abt Associates in partnership

with Benjamin William Mkapa Foundation (BMF), Broad Branch Associates, IntraHealth

International, Local Government Training Institute (LGTI), Tanzania Mentors Association (TMA),

University of Dar es Salaam (UDSM), and Urban Institute. This quarterly report covers the

project period of January 1- March 31, 2019.

Year 4 Quarter 2 (Y4Q2) Activities and Achievements

Major achievements in Y4Q2 included:

HCMIS and e-OPRAS: Human Capital Management Information System (HCMIS--often called

the Lawson system) is the centralized President’s Office Public Service Management (POPSM) HR

system currently used largely as the payroll system for all public workers. In Y4Q2, POPSM and

PS3 dialogue culminated in agreement that PS3 would support strengthening public worker

performance management through automation of Open Performance Review and Appraisal System (OPRAS) as one element of a comprehensive redesign of HCMIS. POPSM, PORALG, and

PS3 strengthening of HCMIS extends HR data to facility level. GOT and DP knowledge of where

public workers are located enables better planning, distribution, retention and performance

management at national, regional, LGA, and facility level. Access and use of better HR information

from one source will improve HR management including planning, production, allocation,

distribution, recruitment, deployment, motivation, retention, career development and

performance management at all levels of government across all public sectors.

To begin the process, this quarter, POPSM and PS3 reviewed more than 4,200 replies to

questionnaires sent out by POPSM to OPRAS stakeholders (ministries, LGAs, public institutions,

agencies) on challenges and obstacles that have rendered the existing OPRAS ineffective, and

developed a draft report on the findings. In parallel, the team refined OPRAS forms. Next

quarter, POPSM and PS3 information system teams will use the refined OPRAS form to program

e-OPRAS. Also in Y4Q2, POPSM, PORALG/RS/LGAs and PS3 continued to support

implementation of the improved teacher’s OPRAS form. By end of Y4Q2, GOT and PS3 had

completed training all Head of Schools in all LGAs, and had begun teachers’ training and filling out

OPRAS forms for 2019 calendar year.

Internal Audit: PS3 is supporting GOT to create a new PFM and sector purchasing intersection

to both improve financial control and enable a shift to output-based payment to buy the right

product or service, increase efficiency, extend coverage, and improve management and service

delivery. In Y4Q2, substantial progress was made in strengthening LGA internal audit system as

MOFP/Internal Auditor General (IAG), PORALG and PS3 embarked on developing a web-based

internal audit document management system for use by both Ministries, Departments and

Agencies (MDAs) and LGAs.

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The process produced improvement in roles and relationships by involving PORALG Financial

Tracking Unit as the process owner of internal LGA audits (in the past LGA internal audit

functions were performed solely by MOFP/IAG without involvement of PORALG). Dialogue also

resulted in a positive evolution from the initial strengthening LGA internal audit system strategy,

as the original solution Teammate, an automated internal audit system and process management,

was limited in impact due to its “off-the-shelf” and “standalone” status. A web-based system

through a centralized server comparable to other strengthened public finance management (PFM)

systems (e.g. PlanRep, FFARS) would be more efficient, effective and timely. Thus, MOFP/IAG,

PORALG and PS3 are developing a secure web-based system that will be integrated or made

interoperable with other financial management systems. It was agreed with MOFP/IAGD to use

PFMRP V funds initially budgeted for Teammate training to cover the cost of requirements

gathering which is Stage 1 of system development. Cost-sharing for other stages of system

development is planned including PS3 funding for system design, development and user testing

and PFMRP V funding for the cost of deployment which involves training internal auditors

(estimated at TZS 270 million).

iMES: In Y4Q2, PORALG, PS3 and other stakeholders embarked on the development of the Integrated Monitoring and Evaluation System (iMES), which is a cross sectoral system which will

act as a PORALG Munngano Gateway data warehouse. It will be core to system interoperability

and data sharing between GOT systems in order to maximize access, use and analysis of

information and also production of timely and relevant reports contributing to improving

management and service delivery. The development teams selected the District Health

Information System (DHIS2) as the platform to build iMES upon.

GoTHOMIS and eLMIS interoperability: In Y4Q2, GOT and PS3 supported increasing

interoperability of GoTHOMIS, electronic logistics management information system (eLMIS),

health management information system (HMIS), and National Health Insurance Fund (NHIF)

claims management. Technical experts programmed and configured GoTHOMIS/Muungano

Gateway and eLMIS/Health Information Mediator (HIM) interoperability allowing the systems to

exchange data. Both systems were equipped to send drug request and requisition (R&R) data to

each other. End-to-end or between system testing for GoTHOMIS and eLMIS was conducted,

and as a result, both GoTHOMIS and eLMIS successfully sent data to each other via Muungano

Gateway and HIM.

NHIF: This quarter, National Health Insurance Fund (NHIF) and PS3 held a technical workshop

for the purpose of refining NHIF payment systems, harmonizing information systems, and

organizational development in preparation for its future role as single NHI purchaser. Results of

the workshop included: development of a detailed plan to further improve and automate the

PHC capitated rate payment system and integrate it into NHIF; agreement to shift hospital and

outpatient specialty payment from fee-for-service to a formula-based budget neutral payment

system; development of a detailed plan to refine NHIF hospital payment system, including six

steps encompassing both financial/cost and clinical sides of the process; development of a new

hierarchy to classify hospital cases for payment and preliminary specification of new hospital

payment groups; plans to link payment and information system development including

harmonization of information systems; and beginning the process of further specifying NHIF roles

and relationships in the context of both DHFF and single NHI.

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Service Outputs and Gender: GOT and PS3 supported the refinement of gender service

outputs and gender disaggregation of resource allocation. Activities focused on deepening

integration of gender, social welfare, and nutrition activities and objectives in the planning and

budgeting process by supporting LGA Community Development Officers (CDOs), Social Welfare

Officers (SWOs), and district nutritionists to budget based on the defined service outputs and

generic activities included in PlanRep. To ensure gender mainstreaming in all sectors, four cross-

cutting gender related service outputs have been defined: enhanced gender mainstreaming across

sectors; improved women’s access to labor saving technologies; improved women participation

in decision making; and improved gender based violence services.

Other activities during Y4Q2 included:

In IS, PS3 supported all RS and LGAs to submit to PORALG their fiscal year (FY) 2018/19 mid-

year budget reallocations using a PlanRep budget reallocation module. This new PlanRep

functionality being implemented for the first time supports management and service delivery

improvement by addressing one of front line service provider’s most common complaints about

rigidities in public finance management (PFM), specifically inability to reallocate across budget line

items if plans or situations change (e.g. cholera outbreak). PORALG and PS3 continued to respond to user questions and requests for technical support through mechanisms like onsite

mentoring, Help Desk, WhatsApp groups, and phone calls. PORALG sent an official letter to

regions, LGAs, and facilities explaining how budget reallocation will be conducted and the

timeframe.

PS3 also supported all RS, LGAs and service providers to successfully enter plans and budgets for

FY2019/20 into the PlanRep system. PORALG and PS3 refined interoperability and integration of

PlanRep, LGRCIS, Epicor and FFARS, specifically integrating Epicor and FFARS for the purpose of

making facilities visible in the LGA Epicor accounting system. PS3 supported TSC to solidify use

of e-Office at TSC headquarters in Dodoma and begin to develop plans to extend to regional and

district level. The PORALG and PS3 Help Desk system now has 20 GOT staff who are resolving

emerging system issues and providing user support services. A PORALG, LGA, health facility and

PS3 cost share supported further extension of local area networks (LANs) to facility level and

installation of GoTHOMIS in 15 health facilities. PORALG and PS3 improved Muungano Gateway

by adding a mediator to enable data to be transformed from one protocol to another, and made

further improvements to the Muungano Gateway management console.

In Finance, national implementation of FFARS continued to improve, with its use across all

24,898 health facilities and schools jumping to 99.6% (99.8% in PS3 regions and 99.5% in non-PS3

regions) PORALG and PS3 continued development of FFARS mobile application, focusing on

testing performance, and further refined the system based on user experience. Integration

between FFARS, MSD Epicor accounting system and eLMIS continued. Ministry representatives

and PS3 developed a response to latest cabinet secretariat and inter-ministerial technical

commission (IMTC) proposal to merge single NHI and Workman Compensation Fund (WCF).

GOT and PS3 continued dialogue and strengthening of DHFF management framework, provided

comments on the revised Comprehensive Council Health Plan (CCHP) guide, and continued

multi-sectoral activities to refine service outputs to enable better public service planning and

budgeting. PS3 worked with MOHCDGEC to finalize a combined NHA report for FYs 2013/14,

2014/15 and 2015/16.

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In HR, a critical step towards institutionalization of WISN plus POA was taken when PORALG,

MOHCDGEC, PS3 and Touch Foundation agreed on how WISN plus POA would be integrated

into GOT systems and corresponding alignment of roles and relationships. It was agreed that

WISN plus POA will be commissioned to PORALG accompanied by a transfer of knowledge and

skills to PORALG and other GOT IT and program staff. MOHCDGEC, University of Dar es

Salaam (UDSM), and Touch Foundation are leading on developing WISN plus POA on DHIS2

platform. PORALG and PS3 are linking HR planning to general planning (PlanRep) and mentoring

LGAs on the use of WISN plus POA for staff requests, distribution and redistribution. PS3

worked to engrain new staff orientation as an anchor of the posting process at LGA and lower

local government levels through both LGA mentoring and institutionalizing it in a cost-effective

distance learning format. TSC and PS3 worked to decongest files in TSC HQ for the purposes of

preparing for records automation and enabling TSC to easily access the information necessary to

make recommendations on promotions, rewards, discipline, and transfers.

In Governance, GOT and PS3 developed an Android web-based application to make LGA

websites more accessible to civil servants and citizens, the application was tested and is being

refined. The web-based application will be accessible to all stakeholders anywhere in Tanzania where there is internet connectivity. Governance mentors continued to advise LGA council

management teams, information officers and ICT officers on uploading to websites and posting

information in public places to increase transparency and share information with citizens.

PS3 governance mentors continued to strengthen committee functioning by addressing gaps

identified by benchmarking. Performance of sampled Facility Governing Committees/Boards

(FGCs/Bs) from Phase 1 LGAs was monitored and showed positive results with a focus on

compliance to guidelines and DFF and FFARS systems and processes. PS3 also benchmarked and

mentored LGAs on how to support lower local government committees to prepare meeting

schedules, follow-up to ensure meetings are held, and copies of minutes are submitted to the

Councils. Consequently, in 20 out of 26 Phase 1 LGAs, files were opened for every village and an

officer was appointed to the process. Also, the gender team sensitized Phase I LGAs on using the

gender checklist to enhance policy dialogue and improve gender planning and budgeting in the

context of the Gender Responsive Planning and Budgeting Initiative supported by UN Women.

Finally, building on the user testing of LGA Councilor distance learning conducted in Y4Q1, PS3

developed a plan for councilor training in six Phase I LGAs. This training is intended to provide

LGTI with practical experience in preparation for country-wide training of newly elected

councilors after the next elections.

In OR, PS3 continued the facility OR study, a deep qualitative study exploring the dynamics of

change in health facility and school management and governance processes, by cleaning and

organizing field notes; data coding and analysis; and generating and presenting preliminary findings

to PS3 technical teams and USAID. PS3 also continued with analysis and report writing for a study

on use of websites by RS/LGAs, and continued dissemination of the Special Seat Councilors

report by sharing with GOT including PORALG and MOHCDGEC.

PS3 M&E activities during Y4Q2 focused on completing and submitting to USAID revisions of

PIRS to solidify PS3’s integration into USAID Implementing Partners Reporting System (IPRS).

PS3 also further developed data visualization maps or charts and corresponding narratives for all

93 LGAs, and established criteria or indictor operating definitions and set targets for four

nutrition indicators assigned to PS3 by USAID. In addition, the M&E team continued working with

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component teams to follow-up on indicator results to inform and refine system strengthening

interventions, and to tighten up indicator data collection and management.

This quarter, program implementation challenges arose as changes in implementation and

rigidity of PEPFAR financial management rules created a PS3 PEPFAR funding timing problem. PS3

is working closely with USAID/Tanzania to address this challenge on both revenue and

expenditure sides. One strategy to help make the problem an opportunity is next quarter PS3

will prioritize organizing and developing communication products to enhance both dissemination

and the final GOT and PS3 user support and institutionalization push. Challenges are also arising

due to RBF program delays instigated by the MOFP. While not good news, it creates

opportunities to further integrate and harmonize DHFF and RBF. In Y4Q2, GOT, other DPs,

other USAID projects, and PS3 made progress in resolving technical challenges to interoperability

between PORALG information mediator (Muungano Gateway) and MOHCDGEC HIM, related

interoperability between GoTHOMIS, PlanRep, HMIS, eLMIS, and NHIF claims management, and

harmonization of remaining inconsistencies between LGA general planning and budgeting

guidelines (PlanRep) and the Council Comprehensive Health Plan (CCHP) guideline.

This quarter, program management began the long process of gradually reducing implementation program costs, a difficult task as GOT commitment and ownership is creating

demand for even more activities. Given GOT and other DP cost-share and leveraging funds, PS3

has been able to increase technical assistance and maintain high project activity levels, and will

continue to do so for as long as possible.

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INTRODUCTION

The purpose of the USAID Public Sector Systems Strengthening Activity (PS3) is to support the

Government of Tanzania (GOT) to strengthen national systems to promote the delivery, quality,

and use of public services, particularly for underserved populations. PS3 is a five-year USAID-

funded activity that strengthens Local Government Authority (LGA) systems to promote

inclusive and evidenced-based planning, management, and implementation of services across

sectors, including health, education and agriculture. PS3 is led by Abt Associates in partnership

with Benjamin William Mkapa Foundation (BMF), Broad Branch Associates, IntraHealth

International, Local Government Training Institute (LGTI), Tanzania Mentors Association (TMA),

University of Dar es Salaam (UDSM), and Urban Institute.

This quarterly report covers the project period of January 1-March 31, 2019.

Implementation Approach

Implementation Strategy and Sequencing

Two basic assumptions drive the PS3 implementation strategy: 1) it is very difficult to improve

service delivery without sufficient human and financial resources at the service delivery level; and

2) service delivery is strengthened by facilities’ autonomy to manage their information, plans, finances, staff, service outputs and outcomes.

To that end, PS3 is working to establish the following three system dynamics which are critical

to delivery, quality, and use of public services, particularly for

underserved populations:

▪ Interoperable systems to facilities: Providing lower

local government and facilities (schools and health

facilities, among others) systems which work, and are

interoperable with other essential public management systems, makes facilities visible across all public sectors

and all levels of government. The interoperability also

improves the facilities autonomy, transparency,

accountability, efficiency, and management practices.

▪ Money to facilities: Changing the way money is

allocated to facilities, so facilities receive financing directly

based upon their outputs, helps the facilities improve the

management and delivery of services to the population.

▪ Public workers to facilities: Using evidence to prioritize which facilities receive staff ensures equal service workload. It also increases

efficiency, equity, and management of delivered services.

In order to move human and financial resources to facilities and to increase facility autonomy,

PS3 works within four system functions: 1) Information Systems, 2) Finance, 3) Human Resources,

and 4) Governance and Citizen Engagement. To support these functions, PS3 also conducts

Operations Research.

Figure 1: Three System Dynamics

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Institutionalization for Sustainability

PS3 prioritizes institutionalization of systems strengthening for sustainability in every aspect of

the project. Its implementation strategy includes building relationships with GOT at all levels,

focusing on linkages, integration, collaboration and leverage. Institutionalization is complex, but

GOT and PS3 have a clear goal in mind: by the end of the project, all responsible LGA and facility

staff will be using the strengthened systems and management processes on a daily basis to perform

their routine work. The expected outcome of PS3’s institutionalization is that after GOT and

USAID complete investments in strengthening systems and improving management, GOT will

incorporate and take ownership of the majority of future operating costs, staff performance of

responsibilities, and institutional management. PS3 expects that the GOT and USAID PS3 capital

investments will produce efficiency gains through strengthened systems that will be vital to

sustaining improved management and extending coverage of services for the population.

1. INFORMATION SYSTEMS

Information systems (IS) improves public sector service delivery through catalyzing efficiency

gains, reducing costs, streamlining processes, improving management, leveraging technology and

innovation, and placing useful and relevant information in the hands of decision makers and

citizens. GOT and PS3 are making systems interoperable, extending IS to the service provider

level, and building capacity to use data for decision-making. PS3 focuses on: sector-wide systems

(section 1, below), health systems (section 2), system management and maintenance (section 3),

and system interoperability and information access and use (section 4). As systems are extended

to the facility level, PS3 envisions empowering providers with autonomy and accountability to

manage public services, increased transparency of resource allocation, a focus on quality of data

and evidence-based decision-making, and maximized public sector service outcomes and impact.

1.1 Strengthening Public Sector-Wide Information Systems

1.1.1 Implementation of Redesigned PlanRep

The first major activity in Y4Q2 was to support RS and LGAs to do budget reallocations for

FY2018/19 plans and budgets. PORALG and PS3 developed a PlanRep budget reallocation module

and corresponding user guide to

enable users to more easily revise

plans and reallocate budgets to adjust

to changes in current year priorities or

conditions. All LGAs have submitted

their reallocation requests to

PORALG and they have been posted

to financial systems. PORALG and PS3

continued to respond to user

questions and requests for technical

support through mechanisms like onsite mentoring, Help Desk,

WhatsApp groups, and phone calls.

National PlanRep facilitators from PORALG and PS3

instructing some of Kigoma Ujiji MC Officials during the

PlanRep refreshers training

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The second major Y4Q2 PlanRep activity was to

support all RS, LGAs and service providers to

successfully enter plans and budgets for

FY2019/20 in the PlanRep system that has been

refined for this second year of implementation. In

addition, during the live plan and budget entry

process, the PORALG and PS3 technical team

incorporated user feedback from this experience

into continuous system improvement. The LGAs

are now awaiting assessment of their plans and

budgets. As shown in the text box, LGAs are

finding the system is resulting in substantial cost

savings in the planning process.

Also this quarter, PORALG, MOFP, and PS3 together:

▪ Improved or added Comprehensive Council Health Plan (CCHP) and Medium Term Expenditure Framework (MTEF) reports to provide accurate data and cater to user needs

▪ Improved the Council Financial Report (CFR), Council Development Report (CDR) and MTEF summary reports to match refinements and MOFP budget guidelines

▪ Developed MTEF assessment criteria to standardize the assessment process. Also the process now involves the RS team before submitting to PORALG

▪ Reorganized PlanRep to ease maintenance and ensure system adheres to standards

▪ Created replica of database for reports, including separation of uploads from the server

▪ Analyzed requirements for Central Budget Management Information System (CBMIS) and PlanRep integration

▪ Mentored new PORALG programmers on new system refinements and improvements

1.1.2 Strengthen LGA Epicor Accounting System and Local Government

Revenue Collection Information System (LGRCIS)

In Y4Q2, PORALG and PS3 refined interoperability and integration of PlanRep, LGRCIS, Epicor and FFARS as the next step in system refinement, user support, and institutionalization of basic

management systems. The major activity was integrating Epicor and FFARS for the purpose of

making facilities visible in the LGA Epicor accounting system. Epicor was improved to

accommodate the FFARS chart of accounts, meaning that FFARS can send a summary of actual

revenue and expenditure transactions to Epicor. The data sent will create general ledger (GL)

journals in Epicor to summarize revenue, expenditures and bank adjustments. As a result, every

transaction made in a facility will have a corresponding transaction in LGA Epicor accounting

system in summary form. System-wise, this is an important achievement as previously users had

to create month-end dummy bank adjustments to acknowledge the expenditure done at facility

level. After the integration work, bank adjustment dummy entries will no longer be required.

Box 1: PlanRep saves money and manages

expenses in Njombe TC

“With improved PlanRep system, we have

saved 10 million in FY2017/18 in the planning

and budgeting process. With the money saved,

we shifted priorities to improve development

projects in our Council. PlanRep also gives us

easy access to accounting information (Epicor

10.2) and helps improve reports including

Action Plan Reports, Council Development

Reports, Council Procurement Reports.”

- Illuminata Mwenda Njombe TC Director

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Also in Y4Q2, PORALG and PS3 identified

and addressed an operational system

problem. Users created their budgets in

PlanRep but when they were sent to

Epicor and FFARS, they realized that the

wrong sub-budget classes, fund sources

and GFS codes were used. They reported

it to PORALG which investigated, found

considerable unused budget in Epicor,

reversed transactions and fixed related

system performance problems. End users

were informed about these fixes through

standard mechanisms developed by

PORALG ICT and PS3 including User

Manual or other system documentation,

onsite mentoring, Help Desk, WhatsApp groups, and phone calls. It may be time to establish a routine process by which all users receive

regular updates on changes that have been made and PS3 will discuss with PORALG ICT Help

Desk the possibility of adding alerts or notification into the systems whenever changes are made.

The main point is that finding and fixing operational issues and bugs is a critical aspect of actual

system implementation but also creates ownership, more efficient system operation, and

institutionalization for sustainability.

Next Quarter Activities:

▪ Highest priority for quarter is development of communication products

▪ Support RS, LGAs and service providers to implement FY2018/19 plans and budgets

▪ Support PORALG and MOFP to approve and export FY2019/20 plans and budgets to financial systems, and continue to integrate PlanRep and CBMIS

▪ Support PORALG on PlanRep, LGRCIS, Epicor, and FFARS integration improvements

▪ Collaborate with PFMRP V to support PORALG on asset management implementation

1.2 Sector-Specific Information Systems

1.2.1 Extend Health Information Systems to Facility Level and Link to

Strengthening Health Financing and Management

In Y4Q2, GOT and PS3 supported increasing interoperability of GoTHOMIS, eLMIS, HMIS, and

NHIF claims management. As shown in the text box below, GoTHOMIS is already reaping

benefits from increased efficiency. This quarter, PORALG, Global Health Supply Chain (GHSC),

and PS3 progressed in making GoTHOMIS and eLMIS interoperable. Technical experts

programmed and configured GoTHOMIS/Muungano Gateway and eLMIS/Health Information

Mediator (HIM) interoperability allowing the systems to exchange data. Both systems were

equipped to send drug request and requisition (R&R) data to each other. End-to-end or between

system testing for GoTHOMIS and eLMIS was conducted during Y4Q2. As a result of the system

development and testing, both GoTHOMIS and eLMIS successfully sent data to each other via

Muungano Gateway and HIM.

Accountant Agnes Bitina Kabuje entering payment Voucher

into the Epicor 10.2 system in Kongwa District Council,

Dodoma.

17

In addition, work continued to complete interoperability development and testing for both

GoTHOMIS and HMIS, and GoTHOMIS and NHIF, specifically, system testing to verify system

function, and user acceptance testing to verify programmatic performance. Additionally,

GoTHOMIS and HMIS facility level testing was successfully conducted at Ilemela. Dialogue led by

the MOHCDGEC to move Tanzania to International Classification of Diseases (ICD)-10 to ICD-

11 continued but it appears the transition will not occur in the short-term. PS3 also conducted a

technical meeting with UNICEF and PATH to discuss how to move forward in integration of

GoTHOMIS and vertical health program systems. As a first step, the teams developed a technical

specification document on how GoTHOMIS and Tanzania Immunization Registry (TImR) will be

integrated. PS3 also supported LGAs and facilities to extend LANs and install GoTHOMIS (see

LAN section). Progress to date in national installation of GoTHOMIS in health facilities is shown

in Figure 5. Chart includes all facilities under PORALG (public dispensaries, health centers,

district hospitals), all regional referral hospitals under MOHCDGEC, a few Faith-Based

Organizations (FBOs) but not tertiary hospitals under MOHCDGEC

Figure 2: Percent of regions’ total health facilities with GoTHOMIS installed

1.2.2 Support Strengthening other Sector Information Systems

In Y4Q2, PS3 supported Teacher’s Service

Commission (TSC) to solidify use of e-Office at

TSC headquarters in Dodoma and begin to

develop plans to extend to regional and district

level. The e-Office system aims to automate the

process of receiving and dispatching files and

letters within and outside government

institutions Also in Y4Q2, TSC and PS3

developed plans and technical mechanisms to use

e-Office for storage and maintenance of teacher

confidential files, including personnel records,

and TSC began to decongest and enter these

confidential files into e-Office.

Box 2: E-Office shapes TSC functionalities

“As a new institution we requested support from

PS3 to establish e-Office to improve performance of

our functions because we had a big burden to deal

with all teachers nationwide. Normally it took us

more than two hours for file transfer within TSC,

with assistance from PS3 and capacity building, we

now transfer files in only five minutes. We reduced

costs, improved record keeping, safety of

information and easy monitoring. Indeed e-Office

is a solution providing real time access to reliable

and up to date information”. -Devota Gabriel, TSC

Head of ICT

18

Next Quarter Activities:

▪ Highest priority for quarter is development of communication products

▪ Continue installing GoTHOMIS, enabling productive PORALG and MOHCDGEC dialogue on steps to refine the system based on both policies and user feedback in the

context of the broader GoTHOMIS roadmap for improvement, increasing interoperability

with eLMIS, HMIS, and NHIF, and moving forward step-by-step to integrate vertical

program information systems

▪ Implement TSC e-Office to increase correspondence and records management efficiency

1.3 Management of Strengthened Information Systems

1.3.1 Central Help Desk Supports Management, Use, Refinement and

Maintenance of Strengthened National Systems

In Y4Q2, PORALG and PS3 continued to implement the Help Desk system that uses a customized web-based system that creates tickets allowing technicians to enter, support, track and document

RS and LGA user requests and responses. There are currently 20 GOT staff assigned to the Help

Desk, RS and LGAs are reporting systems issues, and the Help Desk is supporting resolution.

Help Desk management and capacity requires further strengthening including extension to the

regional level.

1.3.2 Establish and Maintain LGA Local Area Networks

In Y4Q2, PS3 supported further institutionalization of Local Area Networks (LANs) in PS3 13

regions and 93 LGAs, and began preparation for LAN procurement in non-PS3 13 regions and

92 LGAs. In PS3 regions, PORALG/ICT, RS ICT officers, LGA ICT officers, and PS3 improved

operation and maintenance of LGA LANs, and provided expertise upon request for LAN

extension to facilities to enable use of interoperable systems (e.g. GoTHOMIS, PlanRep, and

FFARS). PS3 supported extending LAN and installing GoTHOMIS in 15 health facilities. This

activity was a cost-share between facilities, LGAs and PS3, with facilities paying for the small

equipment required, LGAs paying labor costs for the LGA ICT officer, and PS3 providing training

for facility staff who will be using the system.

In non-PS3 regions, Global Fund Resilient Systems Strengthening for Health (RSSH) grant is

planning to fund LANs, so PS3 continued to engage with the RSSH grant coordination team on

ICT assessment, LAN specification, and development of procurement documentation. Global

Fund has approved LAN procurement in non-PS3 regions, MOHCDGEC is working on

procurement process, and PS3 is providing technical assistance as necessary.

Next Quarter Activities:

▪ Highest priority for quarter is development of communication products

▪ Support PORALG ICT Department to operate Help Desk, particularly related to its

PlanRep user support for FY2019/20 planning and budgeting

▪ Support PORALG ICT Department to further develop management structure and staffing

plans to operate the Help Desk including integration of national expert team functions,

and develop plans to extend Help Desk to regional level

▪ Improve operation and maintenance of LGA LANs

19

▪ Support LGA ICT officers and facilities to implement LAN extension to facilities for

system use (e.g. GoTHOMIS, PlanRep, FFARS) conditioned on infrastructure investment

▪ As GF RSSH approved procurement of LANs for non-PS3 regions progresses, provide technical assistance to actual procurement process and LAN installation

1.4 Strengthen System Interoperability, Improve Data Access and Use

1.4.1 Strengthen System Interoperability

In Y4Q2, PORALG and PS3 improved the information mediator - Muungano Gateway by adding

a mediator to enable data to be transformed from one protocol to another. Previously, the

gateway was only used to support message queueing through message brokers, but it has now

been equipped with the ability to queue data obtained from Hypertext Transfer Protocol (HTTP)

requests. PORALG and PS3 also improved Muungano Gateway management console to enable

users to view transaction logs; configure Application Programming Interface (API); configure

notifications; set-up authentication and authorization to improve system security.

1.4.2 Improve Data Access and Use

Muungano Gateway and its IT aspects of inter-system communication or interoperability is the

start, not the end, of strengthening access and use of both cross-sectoral and sector-specific

information to improve efficiency, equity, transparency, management and service delivery.

In Y4Q2, PORALG, PS3 and other stakeholders embarked on the development of Integrated

Monitoring and Evaluation System (iMES) which is a cross sectoral system or database being built

on DHIS2 platform which will act as a data warehouse for PORALG. It is a modular web-based

software package built with free and open source Java frameworks. The application is released

under the BSD license and can be obtained at no cost. It runs on any platform with a Java Runtime

Environment (JRE) 7 or higher installed. The platform is used in more than 40 countries in Africa,

Asia, and Latin America, and countries that have adopted DHIS2 as their nation-wide HIS

software include Kenya, Tanzania, Uganda, Rwanda, Ghana, Liberia, and Bangladesh. A rapidly increasing number of countries and organizations are starting up new deployment using the

platform.

In theory, all cross-sectoral interoperable system information flowing through Muungano

Gateway data mediator can be exported and stored in iMES. In practice, selected information

will be extracted including data elements, indicators and specific user requests. As M&E

frameworks evolve, the data exported from Muungano Gateway to iMES will be adjusted to

enable continuous, robust, relevant and flexible monitoring of public services. Health information

will flow through both Muungano Gateway (e.g. PlanRep, Epicor, FFARS, GoTHOMIS) and Health

Information Mediator (HIM) including HMIS (both iMES and HMIS are on DHIS2 platform). When

GoTHOMIS and HMIS interoperability goes live, there could be some overlap in selected HMIS

and iMES data elements or indicators. However, iMES data will be broader and more

comprehensive than HMIS data as it includes planning, budgeting, accounting and other finance

and HR management data in addition to clinical data. GOT dialogue is ongoing across sectors and

institutions on how to increase efficiency, and the early conclusion is that iMES will drive reduced

fragmentation of information systems/sources by either replacing them or exporting data to them.

20

Two teams contributed to the process: a team of developers and a team of analysts and business

process owners. The Tanzanian terminology of “business process owner” means any GOT

ministry, department, agency or other entity responsible for a function (e.g. planning, finance,

HR), program, product or sector service (e.g. health, education, agriculture, water). Business

owners are primarily or ultimately responsible entities while service providers are end users of

systems. Business process owner representatives are included at every step in the process

including user requirements gathering, design, development, user testing, deployment, mentoring,

feedback, continuous refinement and access and use of information. The developers dealt with

matters related to the programming part of the application, while analysts and business process

owners dealt with issues related to configuration of datasets, indicators and data validation, and

program use. The teams consist of representatives from PORALG including ICT Department

programmers and analysts, Statistics Unit under ICT Department, other functional or sectoral

departments (e.g. Department of Policy and Planning, Department of Regional Administration,

Department of Local Government, Health Department, Education Department, agriculture),

National Bureau of Statistics, and PS3 Information, Finance and OR teams. The table below shows

the status of iMES development as of 27th March 2019.

Table 1: Status of iMES Development

# Main Activity Status

1 Review DHIS2 platform, including data elements, indicators and overall design document Complete

2 Design organization units for iMES Complete

3 Design iMES categories, category option combos, data elements, data sets Complete

4 Configure iMES web and database server Complete

5 Design data quality tools and indicators Complete

6 Import organizational units to iMES Complete

7 Organize data elements into categories in line with existing data elements (PFM and Health) Complete

8 Configure iMES data elements, categories, category option combos, indicators, forms and

data set (PFM and Health)

Complete

9 iMES Api review In Progress

10 iMES public dashboard design and development In Progress

11 Import data elements into iMES In Progress

12 Configure iMES PFM and health indicators In Progress

Next Quarter Activities

▪ Highest priority for quarter is development of communication products

▪ Support PORALG to refine Muungano Gateway based on operational experience

▪ Further develop iMES to begin to access and use the enormous amount of higher quality

Muungano Gateway data to improve management and service delivery

21

2. FINANCE

The foundation for extending systems and shifting funding to facilities is creation of a new

intersection of PFM and sector service purchasing and payment. The new PFM and sector service

payment intersection supports both good financial controls and “buying the right thing” to better

match payment to priority services, improve management, increase efficiency and extend

coverage. PFM and sector service payment dynamics extend throughout all GOT and PS3’s

finance interventions. The two sections entitled “Strategic Purchasing and Shift to Output-Based

Payment”, and “Strengthen Service Provider Financial Management” are the core of the PS3

Finance Component and the relationship between systems strengthening and service delivery.

Strategic purchasing, including DFF, increases facility transparency, autonomy and accountability,

reduces fragmentation across revenue sources and funds flows, increases interoperability and

efficiency of management and operating systems, and also realigns roles and relationships to

improve governance and management at all levels of public sector systems and services. Through

DFF and corresponding facility autonomy, health facilities and schools are able to determine the

best mix of inputs to produce desired outputs and better plan, budget, procure, perform internal

controls, account and report expenditures for services delivered to citizens. The new intersection enables the health sector to establish single national health insurance (NHI)

sequencing for movement towards universal health coverage, including reducing funds flow

fragmentation, and harmonizing provider payment and information systems.

2.1 Support Development of National Health Insurance Architecture GOT is implementing major health financing reform to ensure that every citizen has equal access

to needed health care services. Tanzania aims to achieve this ambitious endeavor through the

introduction of single NHI with a standard Minimum Benefit Package (MBP) entitlement for every

citizen. The process started with development of the Health Financing Strategy (HFS) which

clearly states the intention to establish single NHI and standard MBP. GOT approval of HFS and

single NHI has been a long process, facing multiple delays and shifting deadlines but to date it has

only minimally detracted from overall implementation as the steps in process including direct facility financing, shift to output-based payment, reduction of funds flow fragmentation, and health

facility level systems and capacity take the longest time and establish the foundation for success.

During the process of engagement with cabinet secretariat and Inter-ministerial Technical

Committee (IMTC) to review the single NHI concept paper, a suggestion was put forward to

MOHCDGEC and technical team that instead of just proposing single NHI, the team should

develop a comprehensive proposal to merge the proposed single NHI with Workman

Compensation Fund (WCF). From February 26th to March 1st, GOT and PS3 held a workshop

in Morogoro to discuss in great detail this high level suggestion and comprehensive proposal. In

the workshop, technical representatives across ministries agreed it will not be possible to start

with a full merger of single NHI and WCF, but rather follow a step-by-step approach, starting

with establishing single NHI and then determining the feasibility of incorporating WCF. It was

clear that further exploration and assessment is needed to understand the nature of WCF and

other country experiences before making a final decision on merger. A concept paper was

developed to continue with single NHI while sequencing a single NHI and WCF merger. A follow-

up meeting was convened in Dodoma on March 13th to discuss this approach with the PS Ministry

22

of Labor, Youth, Employment and Persons with Disability; PS PORALG; and PS MOHCDGEC.

Further improvements are ongoing to address comments that came out of these meetings,

including defining MBP and assessing the feasibility of proposed single NHI premium to finance

MBP.

Also in Y4Q2, PS3 met in Dodoma with directors of agencies under MOHCDGEC to support

the ministry in increasing awareness of single NHI and support and obtain approval of the single

NHI cabinet paper. Participants included Medical Store Department (MSD), Kilimanjaro Christian

Medical Centre (KCMC), Muhimbili Orthopedic Institute (MOI), Muhimbili University of Health

and Allied Sciences (MUHAS), Tanzania Food and Drug Authority (TFDA), National Institute of

Medical Research (NIMR), National Health Insurance Fund (NHIF) and vertical programs. During

this session participants had the opportunity to comment on the proposed single NHI design.

The meeting was chaired by the Permanent Secretary (PS) and the Chief Medical Officer.

Next Quarter Activities: ▪ Highest priority for quarter is development of communication products

▪ Support GOT to continue improving single NHI concept paper, including clearly defining SNHI MBP together with premium contributions for submission to the Cabinet

Secretariat, IMTC and the Cabinet

▪ Support GOT to draft single NHI bill for submission to Parliament

2.2 Strategic Purchasing and Shift to Output-Based Payment

2.2.1 Direct Health Facility Financing and Unified Purchasing Framework

GOT and PS3 have worked to develop SNHI on two tracks: 1) architecture, including legal

foundation, revenue and pooling of funds (see above); and 2) health purchasing foundation,

including direct health facility financing (DHFF), shift to output-based payment, unifying payment

systems and their incentives to reduce funds flow fragmentation, harmonizing health operating

and information systems, strengthening and extending to facility level cross-sectoral public finance

management (PFM) systems (e.g. PlanRep, FFARS), and increasing provider autonomy, capacity,

and accountability to improve management of service delivery.

Health purchasing has been sequenced as shown in the chart below. Phase I is the green boxes,

consisting of establishing core Primary Health Care (PHC) capitated rate payment system for public funds, including Health Basket Fund (HBF), private funds such as Community Health Fund

(CHF), and Results-Based Financing (RBF) with its direct fee-for-service incentives. Phase 1

leverages all funds in stimulating performance improvement. In Year 3, MOHCDGEC, PORALG,

DPs, and PS3 developed and implemented direct health facility financing (DHFF) and shifted to

output-based payment for 5,459 health centers and dispensaries in all 185 LGAs in Tanzania. In

Y4Q2, NHIF and PS3 began Phase II of health purchasing for DHFF and preparation for SNHI.

As shown in the yellow box in the chart below, Phase II focuses on NHIF and includes refining

payment systems, harmonizing information systems, and organizational development in

preparation for future role as SNHI purchaser.

23

Figure 3: Steps to improve purchasing and provider payment to prepare for SNHI

In Y4Q2, NHIF and PS3 held a three-day technical workshop (8 NHIF technical staff including

payment, information and quality assurance experts) for the purpose of moving forward in Phase

II to refine NHIF payment systems, harmonize information systems, and prepare NHIF to become

SNHI purchaser. Results of the workshop included:

▪ Development of a detailed plan to further improve and automate the PHC capitated rate payment system and integrate it into NHIF

▪ Agreement to shift hospital and outpatient specialty payment from fee-for-service to a formula-based budget neutral payment system

▪ Development of a detailed plan to refine NHIF hospital payment system, including six steps encompassing both financial/cost and clinical sides of the process (some steps will be

implemented in parallel): 1) conduct hospital cost accounting; 2) compile clinical information

including international classification of diseases (ICD) codes; 3) combine cost and clinical

information by attaching cost data to clinical cases and creating a database; 4) create

preliminary hierarchy for patient classification into hospital case groups; 5) calculate and

iterate relative payment weights and payment adjustors; and 6) simulate impact and further

refine patient classification into hospital case groups and relative payment weights.

▪ Development of a new hierarchy to classify hospital cases for payment and preliminary specification of new hospital payment groups

▪ Plans to link payment and information system development including harmonization of

information systems

▪ Beginning the process of further specifying NHIF institutional and staff roles and relationships in the context of both DHFF and SNHI

2.2.2 Support Unique Aspects of Results-Based Financing and Integrate into

Direct Health Facility Financing

RBF is a key block in the unified DHFF purchasing framework as it provides direct and powerful

fee-for-service incentives on top of the core output-based payment systems to stimulate service

24

delivery improvements in the large public sector health delivery system. RBF serves as a trigger

for a variety of systems strengthening interventions, including shifting to DHFF and output-based

payment, and making providers more visible by extending systems to service provider level.

The RBF program is currently undergoing significant restructuring and transformation focused on

realigning it with the broad DHFF framework and health priorities. The intent is to save cost and

increase efficiency and sustainability by making sure that RBF is well aligned with other key

government priorities and reforms. In Y4Q2, PS3 engaged with MOHCDGEC and PORALG to

develop a plan that will help to transform RBF. Areas that were identified for PS3 support include

analysis of data from DHIS2 and FFARS to assess implementation progress and correlations

between DHFF, RBF and service delivery. PS3 will also support better defining roles and

relationships between MOCDGEC and PORALG (see DHFF management section). An aspect of

roles and relationships is staffing, especially related to reduction in MOHCDGEC RBF team

capacity due to re-assignment of three RBF staff. RBF coordinator has been appointed to be a

District Executive Director, RBF MSD focal person has been assigned as a Regional Pharmacist,

and the RBF ICT data officer has been appointed as Acting ICT Director. It will be important to

address this human resource gap by looking at the big picture of DHFF implementation and RBF integration into it. MOHCDGEC and PORALG teams are currently working on the

proposal/concept note for RBF restructuring which will be shared to PS3 for inputs.

During Y4Q2, PS3 continued to follow the process of RBF disbursement to health facilities.

Facilities continued to face delays in fund disbursements and have not received payment for five

cycles. This delay is due to both high level dialogue promoting redirection of funds to

infrastructure investment and MOFP requirements, including the need to provide financial reports

on how RBF funds have been used to date. RBF coordinators from MOHCDGEC and PORALG

have already responded to this MOFP directive. It is hoped that disbursement of RBF to health

facilities will resume soon although the picture is not yet clear and promoting RBF and further

integration into DHFF may be vital to program continuation (see Challenges section).

2.2.3 Strengthen Other Public Sector Output-Based Payment Systems

In Year 3, Ministry of Education, Science and Technology (MOEST), PORALG, education sector

P4R, and PS3 analyzed and refined education capitation grant payment to schools. The refinement

shifted from a flat fee per student to a payment formula that adjusts payment to schools based

on education policy objectives (similar to DHFF). The payment formula has been approved by

MOEST and PORALG and submitted to MOFP. In Y4Q2, PS3 continued to coordinate with

education sector P4R, but implementation is still delayed due to ongoing negotiations between

MOEST and MOFP for an increase of total budget allocated for education capitation.

Next Quarter Activities: ▪ Highest priority is development of communication products

▪ Support NHIF to begin implementation of workshop plans to refine payment systems,

harmonize information systems, and organizational development as single NHI purchaser

▪ Promote RBF results and support RBF restructuring and realignment to DHFF

25

2.3 Strengthen Service Provider Financial Management

2.3.1 Support Use of Facility Financing Accounting and Reporting System

DFF and its shift to output-based payment require strengthened financial management at facility

level. An element of financial management is accounting and financial reporting. Facility Financial

Accounting and Reporting System (FFARS) meets the growing demand for financial management

systems and capacity at the service provider level and empowers facilities and schools to be more

autonomous and accountable. By March 2019, the use of FFARS across all health facilities and

schools had jumped to 99.6% (24,898 facilities). As shown in the text boxes, FFARS has resulted

in efficiency and productivity gains, saving time and administrative costs including reduced time

and travel costs for requesting funds, and reduced time to produce better quality reports. The

cost savings allow the education sector and schools to use resources for other priorities.

In Y4Q2, PORALG and PS3 FFARS analysts and programmers continued to refine FFARS based

on day-to-day user experience. Improvements are listed below with changes documented and

user guidance shared across regions, LGAs and facilities:

▪ Review performance in automatic transfer of plans and budgets from PlanRep to FFARS

▪ Enhance bank reconciliations window by allowing selection of months and not dates to address challenges that were previous observed when conducting banking

▪ Enhance adjustment window to give users the right to remove negative balances that were appearing in the system due to wrongly budgeted ‘fund sources’ for carry over funds

▪ Pagination of the reconciled transactions to fit into the reconciliation window

▪ Add facility fund source status report for easy tracking of each fund source

▪ Add feature to track all the outstanding transactions especially old cheques

▪ Add approval control when facility wants to reverse paid Payment Voucher (PV). The rights to approve are set by Council Treasurer

Box 4: Gairo Primary School benefits

from FFARS

“Previously when LGA demanded a report,

both the Accounts Teacher and the Head

Teacher would cancel all their classes and

other duties so as to dedicate their whole day

to prepare the report. Despite the time it

would take and hassle they would go

through, the report still came out full of

mistakes and computational errors. Since

the introduction of FFARS, now it takes just

a click to produce a perfect report. Angelus

Mlahagwa, Head Teacher at Gairo Primary

School in Gairo DC

Box 3: FFARS saves time and money for Bukililo Primary

School by reducing trips to LGA Headquarters

Bukililo Primary School is among 59 primary schools in

Kakonko DC in Kigoma region, situated 40 km from LGA

headquarters (HQ) with limited public transport. The Head

Teacher is very happy with introduction of FFARS as it

relieves him of many tedious trips to the headquarters to

request funds for school activities. “I have more time to teach,

attend to other school matters and it saves transport costs.

Previously I used to travel to LGA HQ 4-5 times per month to

request funds for recurrent expenditure for various activities,

and most times would return only with promises and should

come back next week.” - Jonathan Buzobona (Bukililo

Primary School Head Teacher)

26

In Y4Q2, PORALG and PS3 continued

development of FFARS mobile

application, focusing on testing

performance. Testing was conducted in

Dodoma CC, Kondoa TC, Iringa DC

and Iringa MC. The application behaved

well during testing and the few issues

observed were addressed by the

technical team. The plan is to deploy the

FFARS mobile app to all facilities in April

2019, and it will be accessed through

android mobile phones and tablets.

In Y4Q2, ICT and business process experts from PORALG, MOHCDGEC, Medical Stores

Department (MSD), GHSC and PS3 worked on integration between FFARS, MSD Epicor

accounting system and eLMIS. The purpose of the activity is to: 1) increase transparency of

national budget funds disbursed directly to MSD by allowing facilities to see their fund balances in FFARS; and 2) improve facility level drug procurement by enabling facilities to use DHFF to

plan, budget, and procure drugs to serve their patients. The result of the workshop was end-to-

end exchanges of data whereby MSD Epicor managed to send actual central budget allocation

information to FFARS, and FFARS sent fund source balance information to eLMIS for facility drug

procurement. This interoperability is shown in Figure 7 and will use Muungano Gateway and

Health Information Mediator.

Figure 4: FFARS, MSD Epicor and eLMIS Interoperability

2.3.2 Strengthen Direct Health Facility Financing Management

DHFF is a micro-version of single NHI that helps meet pre-conditions, harmonize the payment

systems to reduce funds flow fragmentation, and establish sequencing including getting ahead of

the game in empowering facilities to manage which is the step that takes the longest.

FFARS Mobile App Dashboard:Nyakato Disp. Ilemela MC

27

In Y4Q2, PORALG, MOHCDGEC, PS3 and other

stakeholders continued dialogue on a draft DHFF

management framework intended to establish clear and

consistent rules across revenue sources and funds

flows for how health facilities can and should operate

to expend DHFF funds to procure inputs to produce

service delivery outputs. As described in the text box,

health facilities are ready and able to manage their

DHFF funds. PORALG and PS3 discussed a number of

steps to move forward in DHFF including finalizing

DHFF management framework, refining and automating

DHFF payment formula, capacity building, and analyzing

progress (e.g. FFARS and link to service delivery).

MOHCDGEC is currently reviewing and revising the Comprehensive Council Health Plan

(CCHP) guide. On 22nd February, UNICEF and PS3 were jointly invited by MOHCDGEC to

provide comments on revised CCHP, including its alignment to DHFF. Getting the CCHP guide right is very important as it impacts DHFF implementation as well as cross-sectoral efficiency and

consistency between general PlanRep system guidelines and CCHP (that will be enhanced when

Muungano Gateway/PlanRep and HIM/HMIS are fully interoperable). CCHP guidelines provide

criteria for allocation of funds to councils and cost centers, hence having direct impact on DHFF

payments. The CCHP also provide guidance on development of facility plans and budgets, hence

determining how DHFF funds are used by service providers.

Next Quarter Activities: ▪ Highest priority for quarter is development of communication products

▪ Deploy FFARS Mobile to service providers in health and education sectors, further refine FFARS based on user experience

▪ Test integration of FFARS, MSD Epicor and eLMIS

▪ Further develop DHFF management framework and CCHP guideline revision

2.4 Strengthen Resource Allocation and Tracking

2.4.1 Better Define Public Sector Service Outputs

In Y4Q2, PS3 continued to support all levels of

government and multiple sectors, programs

and objectives to better define their public

sector service outputs as core to

strengthening planning, budgeting,

management and delivery of public services.

Recognition of the potential for well-defined

service outputs to improve resource allocation is growing, as reflected in the text box.

In Y4Q2, a major GOT and PS3 gender activity was supporting the refinement of gender service

outputs and gender disaggregation of resource allocation. Specifically, gender activities in Y4Q2

Box 5: Kidabaga Health Center in Iringa

DC uses DHFF to move from struggling

to improved performance

“The situation here at Kidabaga Health

Center was struggling rather than

performing, but following arrival of DHFF,

there has been great changes to improve

service provision” says Albert Daud, the

Accountant Assistant. He added “DHFF has

proved to be a very effective approach for

rapid response of services to targeted

population, and it has also improved timely

availability and access of drugs and improve

Health Center infrastructure.

Box 6: Service outputs help Kigoma DC plan

ahead

“Inclusion of PlanRep service outputs for every

objective helps me to ensure every available resource

is efficiently allocated to achieve the Council service

delivery goals. They help me plan ahead including

seeking other stakeholders to provide delivery of basic

services that we cannot include in our 2019/20 plan and

budget.” -Peniel Titus DPLO in Kigoma DC

28

focused on deepening integration of gender, social welfare, and nutrition activities and objectives

in the planning and budgeting process by supporting LGA CDOs, SWOs, and district nutritionists

to budget based on the defined service outputs and generic activities included in PlanRep. To

ensure gender mainstreaming in all sectors, four cross-cutting gender related service outputs

have been defined: enhanced gender mainstreaming across sectors; improved women’s access to

labor saving technologies; improved women participation in decision making; and improved

gender based violence services. Other gender related service outputs budgeted under various

sectors include:

community income

increased, community

participation and

community ownership

enhanced, and youth

employment opportunities

increased.

Redesigned PlanRep enables analysis of LGA

alignment to national

priority gender policies.

An analysis of LGA budget

allocations to gender

based violence service

outputs shows a

tremendous increase in

the budget from 340 million TZS in FY2018/19 to 3.3 billion TZS in FY2019/20. This type of

analysis produces evidence for dialogue between GOT, NGOs and other stakeholders. In

addition, the Government can provide a convincing argument of its commitment to the National

Plan of Action to End Violence against Women and Children (NPA-VAWC) 2017/18-2021/22

based on this analysis. MoHCDGEC has commended the ability of improved PlanRep in

strengthening its analytical capabilities. “With this kind of information, it will be easy for

MoHCDGEC to develop an evidence-based report to Convention on Elimination of All Forms of

Discrimination Against Women (CEDAW) reporting in March 2020,” said Dorah Neema, Gender

Officer in MoHCDGEC.

Redesigned PlanRep has the ability to track the gender budget at each district by service outputs.

The refinement of gender service outputs in PlanRep has enabled analysis of GOT progress in

implementing Gender Responsive Planning and Budgeting. For instance, the gender team

extracted the budget of all gender service outputs in PlanRep for FYs 2018/19 and 2019/20.

Analysis of the budget shows a decline of 32% in total allocation for gender related interventions

through these seven service outputs, from TZS 136 billion in FY2018/19 to 103 billion in

FY2019/20.

Redesigned PlanRep also enables analysis of gender equity in budget allocation. PS3 tested the

strength of PlanRep in highlighting variations in the amounts allocated for gender activities across

LGAs. The findings show big variations in amounts including between fiscal years. In 34 councils,

amounts increased by more than 50 percent, including some areas with upwards of a 6-fold

Nanyumbu District Nutrution Officer Salvatory Chinguile presenting the status

of Nutrition at Nanyumbu District Council in Mtwara during the Nutrition in

PlanRep and service output implementation training.

29

increase and several extreme cases (e.g. Temeke MC, which had an increase of 3734 percent in

its budget). In areas that declined, the average decrease was 46 percent. This includes Babati DC

and Nyasa DC, which made no allocation to gender related activities in FY2019/20.

Additional analyses show that the allocation to activities to increase youth employment

opportunities increased by 16 percent while promotion of women’s participation in decision

making decreased by 16 percent. A total of 13 councils allocated funds to gender mainstreaming

across sector service outputs. The allocations were not only done under the LGA CDD, but also

in other departments/units or sector such as general administrative, M&E, and health. Only two

councils allocated funds to facilitate access by women to labor saving technologies.

2.4.2 Strengthen National Budget Formation, Intergovernmental Fiscal Transfers

(IGFT) and Resource Tracking

In Year 3, PS3 created synergies between IGFT OR study and technical assistance by supporting

PORALG to begin to address system gaps in aggregation of the Council Financial Report (CFRs)

to increase efficiency and improve quality and analysis of data. In Y4Q2, PORALG and PS3 refined

PlanRep to improve performance production of automated CFR and Council Development

Report (CDR). Initially, users were experiencing challenges in producing CDR automatically from

PlanRep largely because they were not updating activity implementation status required to

produce the reports. Therefore, the technical team added a PlanRep control to force users to

update activity implementation status enabling generation of automated CDR. With this feature,

council users, especially district planning officer, heads of departments, and council health

secretary will be able to enter and report activity implementation status and produce CDR on

time to improve LGA compliance. Following a request from PORALG Directorate of Local

Government, PORALG and PS3 technical team began development of a template to automatically

consolidate CFR at regional and national levels. Currently, PlanRep produces CFR automatically

at LGA level but does not yet consolidate to regional and national level.

During Y4Q2, PS3 worked with the MOHCDGEC to finalize a combined NHA report for FYs

2013/14, 2014/15 and 2015/16. This report has been submitted to MOHCDGEC and will be validated by the National Bureau of Statistics, as required by government procedures, before it

is made public. Further, PS3 continued with activities to institutionalize a FFARS and resource

tracking module into Muhimbili University of Allied Health Services (MUHAS), Kilimanjaro

Christian Medical University College (KCMC) and Mzumbe University. PS3 and these institutions

have agreed that PS3 will train them on FFARS and NHA methodology in April, to prepare for

initiating the modules in the coming semester.

Next Quarter Activities: ▪ Highest priority for quarter is development of communication products

▪ Initiate nutrition activities including link to capturing impact of nutrition service outputs

and improvement in multi-sectoral planning and budgeting, and also working with

PORALG Nutrition Section to address important capacity building needs that have

emerged after the inclusion of Nutrition Objective in PlanRep.

▪ Continue dialogue with LGA CDDs on their role guiding planning departments to budget more funds for important gender related service outputs and gender related activities

▪ Inspire the PORALG sector coordinators and MoHCDGEC on performing different gender analyses using information from PlanRep and FFARS.

30

▪ Automate regional and national level consolidation of CFR and CDR in PlanRep

▪ Build capacity on FFARS and NHA resource tracking methodology at MUHAS, KCMC

and Mzumbe University, and support MOHCDGEC to analyze NHA for FY2016/17

3. HUMAN RESOURCES

The strength of the public sector lies within its human resources, which are required to deliver

essential services. In order to act upon its mission, GOT must be able to attract, develop, engage

and retain staff with the right skills in the right positions and at the right time. Human resource

management is therefore a key strategic function, extending far beyond payroll administration

into systematically managing human talent to meet GOT’s objectives. GOT and PS3 are

collaborating to place staff where they are most needed, and ensure they are prepared and

incentivized to deliver high quality services.

3.1 HR Planning and Distribution

3.1.1 Implement WISN Plus POA in the Health Sector

In Y4Q2, MOHCDGEC, PORALG, Touch Foundation and PS3 supported integration of WISN

plus POA into GOT systems so it can be used to continually inform human resource allocation

and distribution in real time. A meeting between PORALG, PS3 and Touch Foundation resulted

in agreement to integrate WISN plus POA into GOT systems consistent with both MOHCDGEC

and PORALG roles and relationships, and interoperability or integration with other GOT

systems. It was agreed that WISN plus POA will be commissioned to PORALG accompanied by a transfer of knowledge and skills to PORALG and other GOT IT and program staff (see Table 2

for detailed plans). MOHCDGEC, University of Dar es Salaam (UDSM), and Touch Foundation

are leading on developing WISN plus POA on DHIS2 platform. PORALG’s IT department is very

interested in harmonizing and integrating WISN plus POA with PlanRep, and integration with

DHIS2, HCMIS, and the PORALG HR recruiting system. PS3 will further invest in building capacity

within PORALG for use of POA to distribute LGA level health staff thus increasing ownership

and sustainability. Also this quarter, PS3 continued to collaborate with Touch Foundation to

program WISN plus POA on DHIS2 and preparing the system for testing.

Table 2: Installation of WISN plus POA at PORALG

# Main Activity Sub-activities Timeline Status

1 Formation of national team of

experts (multidisciplinary business

and technical aspects)

Identify IT experts from PORALG and

MOH to join the national team.

February, 2019 Complete

2 Move system to PORALG (for

ownership and sustainability)

Host the system at GOT/PORALG April 2019 In process

(after testing)

3 Build technical competencies for

the PORALG Technical Team

Build capacity of the national team of

experts on automated WISN + POA

(both IT and business owners)

April-May

2019

In process

4 Add a recruitment module into

WISN+POA system to link-up with

the HR Recruiting System (HRRS)

Initial assessment on how to link the

systems with HRRS and develop

requirements document

April 2019 In process

31

5 Integrate WISN+POA system with

other GOT systems via Muungano

Identify the Information Systems that

will be linked (HCMIS, HMIS,

PlanRep)

April 2019 In process

6 Involve all key stakeholders in

implementation of WISN+POA

(awareness and dissemination)

Stakeholder forums (high level and technical)

to showcase WISN+ POA staff

distribution achievements

Continuously,

as system

evolves

Ongoing

7 Develop WISN+POA User and

Technical Manuals

Develop manuals April-May

2019

First draft

In Y4Q2, PS3 also continued to mentor LGAs on the use of WISN plus POA for staff distribution

and redistribution. GOT and PS3 continued to document the 6,180 health workers distribution.

About 15% of the initially allocated, recruited, deployed and distributed staff did not report to

their assigned post. So PORALG and MOHCDGEC have continued the recruitment and posting

process, and PS3 has continued to mentor LGAs on distribution of these replacement workers

consistent with WISN plus POA. PS3 also supported PORALG in national level review of personal

emolument (PE) requests in PlanRep. Specifically, the review looked at WISN plus POA standard

packages for PS3 LGAs by:

1) Extracting data from PlanRep Form 8e (aggregated summary of number of employees to

be recruited) and Form 9 (detailed list of cadres currently employed and to be recruited);

2) Comparing the aggregated number from Form 8e with the individual total counted from

the list of cadres listed as recruitment in Form 9;

3) Advising if forms were not well-completed such that detail and aggregated didn’t match;

4) Using the LGAs’ priority ranking (PRI) list, filtering match of cadre priorities with total

staff requests. For example, if LGAs requested 50 dispensary staff, then the top 50 in the

PRI list should be consistent for that facility category;

5) Comparing and analyzing PE/staff requests and PRI list and identifying discrepancies.

These review and analysis steps resulted in PORALG advising LGAs on how to revise PE requests.

The resubmitted PE requests from LGAs were more consistent with WISN plus POA PRI.

3.1.2 Strengthen Staff Allocation and Distribution in Other Sectors

POPSM has a long-standing requirement that better allocation of staff permits should be done

across sectors such that cross-sectoral strengthening of staff allocation and distribution may

contribute to institutionalization and sustainability. This quarter, the meeting with PORALG on

integration of WISN plus POA (described in 3.1.1) resulted in PORALG reiterating the

importance of cross-sectoral tools that can facilitate distribution and redistribution in other

sectors. PS3 recommended a strategy of integrating LGAs’ HR planning into PlanRep, HCMIS and

the Human Resource Recruiting System through Muungano Gateway. In addition, HCMIS

inclusion of mechanism and data for cross-sectoral staff allocation and distribution was also proposed by PS3. POPSM is open to incorporating it into redesigned HCMIS but at a later phase

in the process. TSC under PORALG has had discussions with POPSM, and the envisaged redesign

of HCMIS, which will make staff visible at facility levels, provides the foundation for establishment

of staff distribution particularly for teachers.

32

Next Quarter Activities: ▪ Highest priority for quarter is development of communication products

▪ Document analysis of 6,180 health workers recruitment and distribution as well as results

of PlanRep HR PE/staff planning review

▪ Support GOT and IS team to conduct user testing of automated WISN plus POA in a few

PS3 LGAs, and develop WISN plus POA User and Technical Manuals

▪ Build national expert team capacity on automated WISN plus POA integrated into GOT systems. National expert team includes PORALG ICT Department, Health Department,

and Department of Local Government/HR section, MOHCDGEC ICT Department, HR

Development Department including WISN experts, UDSM, Touch Foundation and PS3.

3.2 HR Retention PS3’s HR retention activities, new LGA staff orientation and customized LGA retention strategies

work in conjunction with information systems, finance and governance component activities to

create lasting change in the retention of LGA staff. In an environment of limited financial and

human resources, HR management must go beyond allocating and distributing staff to help ensure that new staff are supported to perform well in their positions. By the end of Year 3, new staff

orientation was being implemented nationwide or in all 26 regions and 185 LGAs of Mainland

Tanzania. In Y4Q2, PS3 mentored LGAs to orient new staff on an as needed basis. In addition to

mentoring, PS3 supports the following steps to help ensure that LGAs have established processes

to perform this function with minimal external support:

● LGA and facility level: LGAs are encouraging lower local government and facilities to

establish a “buddy” system of experienced and new staff to continue the orientation

process at work sites. Based on observations to date, it appears to help new staff to

have a designated person to help them understand the rules, working environment and culture.

● LGA level: Advocacy to ensure that LGA leadership including District Executive

Director (DED) and District HR Officer promote and support new staff orientation

together with responsible functional and sectoral departments. Also, build on

acceptance of staff orientation demonstrated by cross-cutting administrative

departments.

● Regional level: increasing role in promotion and oversight of new staff orientation.

● National level: HCMIS redesign dialogue confirmed that current plans include documenting whether new staff are oriented or not thus increasing transparency and

hopefully commitment to orient new staff. In addition, a legal and regulatory framework

is in place as new staff orientation is mandatory according to Orientation Manual, other

circulars, regulations, and standing orders (summarized in the Manual).

In addition to engraining new staff orientation as an anchor of the posting process at LGA and

lower local government levels, PORALG, LGTI and PS3 are also institutionalizing new staff

orientation through adapting it into a cost-effective distance learning format (see Governance

Component). The distance learning content includes roles and responsibilities of employees,

information about LGA management and environment, and basic information related to the

sector. It is expected that the distance learning component will be combined with a face-to-face

33

orientation at the LGA and duty station levels, as human contact and interactions are a well-

known and accepted approach that cushions new employees and increases commitment and

motivation. Through discussions with POPSM on redesigned HCMIS, staff orientation will be

considered to be required before new employees can be confirmed to the job.

In Year 3, PS3 supported 32 LGAs to develop and implement customized retention strategies

based on the needs of the staff in their LGAs. In Y4Q2, PS3 awaited approval and endorsement

from PORALG management for a document that describes the LGAs’ approaches to customizing

incentive strategies. For rural and hard-to-reach areas, developing a package of incentives can be

a powerful method of proactively retaining staff. In designing retention packages, as in all other

aspects of human resource management, it is important to tailor the package and approach to

the staff. The documentation that PS3 submitted to PORALG, once approved, will support

expansion and institutionalization of the LGA retention strategy customization process.

Next Quarter Activities: ▪ Highest priority for quarter is development of communication products ▪ Support the LGAs and RS to continue providing new employee staff orientation

▪ Support building capacity of stakeholders on distance learning staff orientation

▪ Follow-up on status of LGA customized retention strategy documents and next steps

3.3 Improve HR Performance Management and Efficiency In Year 3, GOT and PS3 began to develop linkages between the three HR performance

management and efficiency interventions of strengthening HCMIS/Lawson system, OPRAS and

personnel records management. These linkages and synergies within HR performance

management and efficiency interventions, together with HR planning and distribution linkages (e.g.

WISN plus POA), contribute to realizing PS3’s strategy of taking a comprehensive approach to

HR management.

3.3.1 Strengthen Human Capital Management Information System (HCMIS) and

Open Performance Review and Appraisal System (OPRAS)

HCMIS (often called the Lawson system) is the centralized POPSM HR management system

currently used largely as the payroll system for all public servants. In Year 3, POPSM, PORALG,

and PS3 dialogue resulted in general consensus on how the system should function. In Y4Q1,

POPSM submitted to PS3 an OPRAS digitalization project concept note (e-OPRAS). The objective

of the project is to develop a system that will computerize the OPRAS form and automate the

performance management business process without a complete re-engineering. The concept note

highlighted linkages between e-OPRAS and HCMIS including a performance management module

which will facilitate keeping electronic records of annual appraisals and evidence-based HR

decisions related to promotions, rewards, staff development, and discipline.

In Y4Q2, the extensive dialogue and initial strengthening of HCMIS and OPRAS systems

converged and began to bear fruit. A meeting with POPSM Head of Planning and Coordination,

Head of IT, Head of Performance Contracting, POPSM technical staff and PS3 staff in Dodoma

on 19 February 2019 resulted in: 1) POPSM acknowledging the importance of a broader approach

to HR management (extending beyond only payroll management), and communicating their vision

of redesigned HCMIS incorporating additional HR functions and extending to facility level; and 2)

34

POPSM acknowledging and making plans to

address challenges related to completing

OPRAS particularly for service delivery front

line staff such as nurses and teachers. The

selected mechanism for strengthening

OPRAS system and its management is

automation of the OPRAS form. POPSM

envisions automation to be an extensive

process which will result in simplifying

OPRAS for all civil servants. During the

meeting, POPSM committed to creating a

separate e-OPRAS system that is

interoperable with the redesigned HCMIS.

Therefore, POPSM and PS3 agreed to fully

integrate HCMIS and OPRAS activities, with

PS3 focusing on e-OPRAS but contributing to broader framing of HR management

functions and interoperability of HCMIS.

Two initial tasks were agreed upon at the Dodoma meeting:

▪ Task 1: review more than 4,200 replies from public servants to questionnaires sent out by

POPSM to OPRAS stakeholders (ministries, LGAs, public institutions, agencies) on challenges

and obstacles that have rendered the existing OPRAS ineffective, analyze data, and write a

report. In parallel, Task I will refine OPRAS forms. The Task 1 team members include POPSM

Department of Performance Contracting, National Bureau of Statistics analysts, appointed staff from other POPSM departments to do data entry and analysis, and PS3. By the end of

Y4Q2, Task 1 team had developed a draft OPRAS report and refined three OPRAS forms.

▪ Task 2: Use the refined OPRAS forms to program e-OPRAS system. Steps in this process

include: 1) conduct requirements analysis and prepare architecture, data models design, and

user interface and database design; 2) develop and program/code system; and 3) perform

system and user acceptance tests. E-OPRAS will be interoperable with other core HR

information systems such as HCMIS and e-Office. The Task 2 team is composed of members

from POPSM IT Department and the Department of Performance Contracting. Task 2 team

will start working in Y4Q3 upon hand-off of the refined OPRAS form(s). The detailed e-OPRAS implementation schedule is shown in Table 3.

Table 3: e-OPRAS Implementation Schedule (February-June 2019)

# Main Activity Sub-activities Timeline Status

1 Analyze questionnaires,

produce report and OPRAS

forms refinement

● Preparation for data entry and analysis (SPSS).

● Data entry, cleaning, analysis and reporting

● New OPRAS forms design and structure

22nd Feb 2019 –

31st March 2019

Complete

2 Logistics and preparation for

users’ requirements ● Finalize Analysis Report & OPRAS forms

redesign

1st – 13th April

2019

In

Progress

Government of Tanzania Officials together with PS3 in

a discussion during the user requirement for e-OPRAS

meeting in Iringa

35

● Prepare list of participants, including sending

invitation letters to stakeholders

● Timetable and schedule for the activity

3 Conduct requirement

analysis & prepare

requirement report

● Review the existing requirement document

● Validate and approve requirement documents

● Finalize requirement document reports

15th – 27th April

2019

On

Schedule

4 System architecture, data

models design, user interface

and database design

● System architecture design, data models

● User interface mockups, database design

(tables, relationships, etc.)

29th April – 10th

May 2019

On

Schedule

5 System development

(programming/coding) ● Start programming sprints

● Team responsibilities assigned based on

identified modules and functionalities

● Agile methodology for better results

13th May – 15th

June 2019

On

Schedule

6 System testing and user

acceptance test ● Technical team stress testing

● User acceptance test

● Administrative initial training

17th June – 29th

June 2019

On

Schedule

Also in Y4Q2, POPSM, PORALG/RS/LGAs and PS3 continued to support implementation of the

improved teacher’s OPRAS form. TSC, PORALG/RS/LGA, POPSM, and PS3 completed training

all head of schools in all LGAs, and the schools had begun teachers training and completion of

OPRAS forms for 2019 calendar year.

3.3.2 Improve and Automate HR Personnel Records Management

PORALG and PORAMD have consistently requested PS3 support to improve and automate LGA

records management, including HR personnel records management. Records management is a

significant problem in Tanzania, negatively impacting service delivery and performance on a

number of other objectives, including efficiency. In Year 3, PORALG, PORAMD, LGAs and PS3

worked together in 30 LGAs to implement incremental bottom-up strengthening of records

management. In Y4Q2, PS3 continued to mentor LGAs on personnel records management and

engaged in dialogue on how to expand the role of the regional level in institutionalization of

improved records management. It is expected that the enhanced RS and LGA knowledge and

skills will be utilized to further support personnel records improvement mainstreaming and

institutionalization processes.

In Y4Q2, TSC and PS3 worked to decongest files in TSC HQ for the purposes of preparing for

records automation and enabling TSC to easily access the information necessary to make

recommendations on promotions, rewards, discipline, and transfers. The teacher files

decongestion process supported TSC to harmonize teachers’ information, remove all closed files,

and create linkages with e-Office and redesigned HCMIS. An example was President’s Office

Records and Archive Management and TSC resolving challenges arising due to some teachers

having more than one personnel file. A total of 1,106 teachers’ files were merged in Y4Q2.

36

Next Quarter Activities: ▪ Highest priority for quarter is development of communication products

▪ Support Task 2 of e-OPRAS development

▪ Mentor Phase I LGAs on teachers’ OPRAS, and support mid-year review processes

▪ Mentor TSC on teachers’ records decongestion and support creation of linkages with e-Office automated correspondence and records management and redesigned HCMIS

4. GOVERNANCE AND CITIZEN ENGAGEMENT

Strengthening governance at all levels underpins all of PS3’s interventions. GOT and PS3 are

realigning institutional structure, roles and relationships, with a focus on transparency, facility

autonomy and accountability, committee functioning, and fostering a better relationship between

the political and executive arms at the LGA, ward and village/mtaa levels. PS3 is supporting LGAs

to increase information sharing with citizens, and to strengthen obtaining citizen feedback and

complaints management. Strengthening LGA PFM systems contributes to increasing clean audit

reports and the new intersection of PFM and sector service purchasing.

4.1 Improve Sharing of Information with Citizens In Year 3, PORALG, eGA and PS3 refined the RS/LGA websites. Y4Q1 dialogue with LGA

councilors, committee members, and staff revealed that most stakeholders, including citizens,

would be much more likely to use the LGA website if it is accessible through their mobile (smart)

phones. In Y4Q2, PORALG/ICT, Open University of Tanzania, and PS3 conducted a needs

assessment which confirmed the need to make the website more accessible. PS3 developed an

Android web-based application which underwent testing from PORALG and PS3 staff. Feedback

is currently being addressed before the app is rolled out.

Also in Y4Q2, PS3 governance mentors continued to advise LGA council management teams,

information officers and ICT officers on uploading to websites and posting information in public

places to increase transparency and share information with citizens. As shown in the text box,

the websites are making access to information easier, particularly for those in remote locations.

GWF Guidelines and related reference materials, training and mentoring continue to have a

positive impact. Sharing of information at facility level has significantly improved.

Mentors’ reports show a positive change

in facilities sharing information with

citizens: by the end of Year 3 only 15.4%

of dispensaries and 23.1% of primary

schools (amongst sampled facilities) were

sharing information with citizens. By

Y4Q2, this improved to 62.5% for

dispensaries and 70.8% for primary

schools.

Box 7: Easy access to information through LGA website

“As citizen’s representatives we work in very remote areas

where the people are. Therefore it may not be easy to travel

daily or weekly to our LGA Headquarters to get information

on development activities and follow-up on our council

meetings. Nanyumbu DC website gives us access to

information on implementation of development projects in

our council” -Benjamin Masime, Councilor of Masuguru

Ward and Assistant Council Chairperson in Nanyumbu DC

37

Next Quarter Activities: ▪ Highest priority for quarter is development of communication products

▪ Launch Mobile Website Android application

▪ Continue to mentor and monitor LGA website use

4.2 Strengthen Citizen Feedback and Complaint Management Strengthening complaints management is a high POPSM and PORALG priority, reflected in

repeated requests for PS3 support. A PS3 governance premise is that GOT receiving and acting

on citizen feedback, including complaints, is key to engaging citizens, promoting more responsive

systems and improving service delivery. Complaints Officers are encouraging responsiveness of

LGA officials, staff and service providers to citizen’s needs and adding a gender perspective to

the existing complaints system. In Year 3, POPSM, PORALG, and PS3 strengthened citizen

feedback and complaints management in four regions/LGAs, and forty (40) service delivery points.

The regions/LGAs are Kishapu DC, Shinyanga; Kigoma-Ujiji MC, Kigoma; Mtwara-Mikindani MC,

Mtwara; and Bahi DC, Dodoma.

In Y4Q2, POPSM, PORALG, and PS3

supported the four LGAs to further

improve citizen feedback and

complaint management by mentoring

LGAs and their complaint handling

officers on implementing POPSM

guidelines, use of complaint registers,

developing reports for management

and council committees, publishing citizen rights and client service

charters in health facilities and

schools, and increasing RS and LGA

leadership in governance and management of the system., PORALG, LGAs, and PS3 continued to

advise 26 Phase I LGAs on improving complaints management in the context of benchmarking to

improve LGA performance, including strengthening committee functioning.

In parallel to strengthening citizen feedback and complaints management in the four

regions/LGAs, POPSM, PORALG and PS3 engaged in dialogue to find creative ways to disseminate

experiences and leverage expansion of strengthened complaints management. PS3 received a

request from POPSM to cost-share preparation of an educational video on complaints

management (subsequently approved by USAID). A POPSM/Ethics Department, PORALG and

PS3 meeting in Morogoro resulted in an implementation plan and agreement to produce and air

TV programs and video clips as a means to expand and promote the complaint handling system

in public offices and sensitize citizens to utilize the system.

Next Quarter Activities: ▪ Highest priority for quarter is development of communication products

▪ Collaborate with POPSM and PORALG to develop the TV programs and video clips

▪ Continue to mentor and monitor citizens’ complaints in the four regions/LGAs

Box 8: Effectiveness of complaints handling training and

addressing citizens’ complaints in Mtwara MC

“My participation at the PORALG and PS3 complaint handling

training in July 2017 increased my knowledge on the use of

multiple approaches to address citizens’ complaints. I admit that,

before the training, I was not aware of the use of a referral system

and the need to strategize and communicate on how to address the

problems/complaints. I now realize that the training has enabled

me to effectively use the strategies. So far I have been able to

address 28 complaints out of 34 and 6 are still in the hearing

process.” -Francis Mkuti, a Complaints Officer at Mikindani

District Commisioner’s Office in Mtwara region.

38

4.3 Strengthen Committee Functioning, and Realign Roles and

Relationships

4.3.1 Strengthen Committee Functioning

All GOT and PS3 interventions encompass productive realignment of roles and relationships

between national, regional, LGA and facility levels to implement and institutionalize systems

strengthening; drive public sector transformation, including facility autonomy and accountability;

increase efficiency; and improve management and service delivery. In Y4Q1, PS3 governance

mentors continued to support Phase I LGAs to strengthen the basic processes and functioning

of HLG and LLG committees to ensure that committees are properly constituted, meet according

to approved schedules, prepare and act on meeting minutes, and execute their mandated

functions according to guidelines, standing orders, and bylaws.

In Y4Q2, PS3 governance mentors continued to support committee functioning benchmarking activity to consolidate achievements and mentor LGAs to address identified gaps. For lower local

government (LLG) committees, the mentors used the benchmarking tool to monitor

performance of sampled Facility

Governing Committees/Boards

(FGCs/Bs) from Phase 1 LGAs with a

focus on compliance to guidelines and

DFF and FFARS systems and processes.

Mentors found improvement in the

functioning of FGCs/Bs in terms of

compliance to guidelines, as illustrated in

the text box. The only reported

challenge was limited execution of

mandated functions, specifically the

requirement to submit copies of minutes

to both LLG and HLG levels. Apart from

the WDCs that recorded minimal

improvements (in terms of holding meeting according to schedules), Reports on village/mtaa

level committees and ward development committees (WDCs) indicated a number of gaps, such

as meetings not being held according to schedules, poorly written minutes and inadequate

execution of mandated functions. These aspects of committee functioning will continue to be a

PS3 priority in benchmarking and mentoring Phase I LGAs.

Phase 1 LGAs recorded achievements in strengthening the functioning of higher local government

(HLG) committees. Reports indicate that in all Phase 1 LGAs the HLG committees (i.e. the full

councils and standing committees) were meeting according to the standing orders. However,

LGAs have not yet succeeded in addressing the issue of poor citizen attendance at the full council

meetings, or in sensitizing citizens to submit questions/concerns to the council. The HLG main

thrust was on mentoring LGAs to sensitize citizens to attend the full council meetings. All Phase

1 LGAs introduced citizens’ attendance registers to register citizens attending the full council

meetings. PS3 also mentored LGAs on how to support LLGs to prepare meeting schedules,

follow-up to ensure meetings are held, and copies of meeting minutes are submitted to the

Box 9: Strengthened committee functioning in Bahi DC

“Not having alive and functioning Council Health Services

Board (CHSB) and Health Facility Governing Committees

(HFGCs) not only jeopardizes the provision of health services

in the council but deprives the community of involvement in

decision making. As a result of PS3 mentoring our council

now has a well-functioning CHSB and HFGCs which have

meeting schedules, adherence to the meeting schedules,

meetings are chaired by the right person, minutes are properly

written, and submitted at the council level. Before we were

having trouble passing our annual plans and budgets and

better functioning CHSB and HFGCs helps us.” -Angela

Godfrey Health Secretary Bahi DC, Dodoma Region

39

Councils. Consequently, in 20 out of 26 Phase 1 LGAs, files were opened for every village and an

officer was appointed to coordinate, follow-up, acknowledge receipt and file submitted minutes.

Year 3 mentoring led to the observation that committee minutes are inadequate at both LLG and

facility level, and the conclusion that a simple standardized template should be developed to

record meeting minutes. In Y4Q2, PORALG technical staff and PS3 engaged in dialogue and

drafted a standard automated committee minutes template for review and approval. PORALG

and PS3 also discussed modalities for automation and linking with other existing systems, such as

the LGA website, and agreed to address the limited functioning of LLG committees holistically

including sharing and comparing mentors experiences from Phase 1 LGAs with that of PORALG

(PORALG also has a system of following up the functioning of LLG committees).

4.3.2 Gender Sensitivity and Integration

Gender sensitivity, integration and equity in service access and quality is crucial to building human

capital of men and women in Tanzania and increasing their economic productivity. PS3 takes an

integrated or horizontal approach to gender sensitivity and integration and tries to incorporate

it into all interventions to realize delivery of gender sensitive services and benefits. The majority

of PS3 gender activities for Y4Q2 related to better definition of public service outputs (see

Finance Component).

During Y4Q2, PS3 also completed several governance gender activities. The team followed up

on the use of gender checklist by LGA CDDs to support multi-sectoral gender planning at LGAs.

The gender checklist, a guideline to assist CDDs in coordinating gender mainstreaming across all LGA public sectors, was completed last quarter. In Y4Q2 the gender team worked with the

gender focal person in Iringa DC CDD to identify how to enhance the use of the gender checklist

to support integration of gender service outputs across priority sectors at the LGA level including

agriculture/forestry, livestock and water. In addition, PS3 sensitized Phase I LGAs on using the

gender checklist in planning and budgeting in order to enhance policy dialogue on improving

gender planning and budgeting in the context of the Gender Responsive Planning and Budgeting

Initiative supported by UN Women. MOHCDGEC has expressed interest in including the gender

checklist as an attachment in their Gender Responsive Planning and Budgeting Manual which is

currently being reviewed by the MOFP Gender Macro Working Group.

In Y4Q2, PS3 participated in a public consultation on the PEFA Gender Module. PS3 provided

inputs on the proposed overall approach to collecting information on gender responsive public

financial management practices using PEFA and suggested additional questions, specifically those

likely to inspire country progress in collecting and producing sex and gender disaggregated data.

Next Quarter Activities:

▪ Highest priority for quarter is development of communication products

▪ Benchmarking and mentoring Phase 1 LGAs HLG and LLG committee functioning

▪ Finalize automated standard committee minutes template ▪ Follow-up on strengthening functioning of FGCs/Bs including support mechanisms and

including women and youth on the committee/board membership

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4.4 Strengthen Public Finance Management As described in the Finance Component, PS3 is supporting GOT to create a new PFM and sector

purchasing intersection to both improve financial control and enable a shift to output-based

payment to buy the right product or service, increase efficiency, extend coverage, and improve

management and service delivery. In Year 3, PORALG, MOFP, PFMRP V, and PS3 mentored LGA

treasurers and accountants on strengthening LGA PFM systems to reduce qualified audit opinions.

Also in Year 3, MOFP/IAG, PORALG, and PS3 strengthened internal auditing by introduction of

Teammate automated internal audit system and process management.

In Y4Q2, substantial progress was made in strengthening LGA internal audit system as

MOFP/Internal Auditor General (IAG), PORALG, and PS3 embarked on the development of a

web-based internal audit document management system for use by both Ministries, Departments

and Agencies (MDAs) and LGAs. The process of dialogue produced a substantial improvement

in roles and relationships by involving PORALG Financial Tracking Unit as the process owner of

internal LGA audits (in the past LGA internal audit functions were performed solely by

MOFP/IAG without involvement of PORALG). Dialogue also resulted in a substantial and positive

evolution from the initial strengthening LGA internal audit system strategy. In 2017, PS3 assisted

in the LGA internal audit automation by adaptation, deployment and implementation of

Teammate package in Morogoro region. The aim was to enhance efficiency, effectiveness and

quality provision of internal audit services in LGAs. However, over the last year, it has become

increasingly clear that scale-up to other LGAs is complicated due to the following:

▪ Teammate is an “off-the-shelf” software which requires purchasing licenses. Licenses are very expensive to cover 185 LGAs and approximately three Internal Auditors per LGA

▪ Teammate has been configured as a “standalone system” meaning it is hard to manage and aggregate data and analysis for all LGAs.

The combination of the high cost of Teammate licenses and better functionality of a web-based

rather than standalone system led MOFP/IAG, PORALG and PS3 to the conclusion that

developing a web-based system through a centralized server would be more efficient, effective

and timely. It is important to note that this strategy refinement and resulting commitment to

national development and implementation of strengthened LGA internal audit system is inherent

in sequencing and closely related to both the positive Teammate experience in Morogoro and

successful GOT and PS3 implementation of other cross-sectoral web-based public management

systems. Thus, MOFP/IAG, PORALG and PS3 are developing a secure web-based system that will

be integrated or made interoperable with other financial management systems. It was agreed with

MOFP/IAGD to use PFMRP V funds initially budgeted for Teammate training to cover the cost of

requirements gathering which is Stage 1 of system development. Cost-sharing for other stages of

system development is planned including PS3 funding for system design, development and user

testing and PFMRP V funding for the cost of deployment which involves training internal auditors

(estimated at TZS 270 million).

Next Quarter Activities:

▪ Highest priority for quarter is development of communication products

▪ Continue development of web-based internal audit information management system

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4.5 Use of Distance e-Learning to Institutionalize Capacity Building

and Increase Sustainability In Year 3, PORALG, Local Government Training Institute (LGTI), Open University of Tanzania

(OUT), and PS3 developed a strategy to incorporate practical training on strengthened national

systems into LGTI curriculum and use distance e-learning (DeL) as a sustainability mechanism.

4.5.1 LGA Councilor DeL training

In Y4Q2, building on the user testing of LGA Councilor DeL conducted in Y4Q1, PS3 activities

included developing a plan for councilor training in six Phase I LGAs. This training is supposed to

provide LGTI with practical experience

in preparation for country-wide

training of newly elected councilors

after the next elections. The activity will take some time to accomplish

because it depends on the timing of the

full council meetings in the relevant

councils. PS3 is coordinating with these

meetings so that we do not incur the

extra expense of calling in the

councilors for the initial introduction

to the course, and can rather sponsor

a one-day addition to the Council

Director’s agenda.

4.5.2 LGA New Staff Orientation DeL

Staff orientation is a requirement for newly recruited staff, and GOT and PS3 have developed a

new staff orientation manual to perform this function. Newly recruited LGA staff are currently

being oriented using the new orientation manual but the time and financial resources required

will likely place an undue burden on LGAs in the future. Hence, the strategy of using DeL to

implement the same activity in a more cost effective way. Through this method (combined with

face-to-face meetings and mentoring) it will be possible to reach out to all newly recruited staff

in a timely and cost-effective manner. Development of New Staff Orientation DeL materials began

in Y4Q2. PORALG, LGTI, OUT, and PS3 governance and HR components worked to convert

new staff orientation manual and guideline to DeL style. Development of DeL courses is a long

process, and the status of New Staff Orientation course tasks is shown in Table 4 (current status

in yellow).

Table 4: Review and convert existing LGA staff orientation manual to DeL style

PHASE 1: Review and convert existing LGA staff orientation manual to DeL style Status

Review and harmonize existing staff orientation manual with newly launched induction guideline

Done

Convert staff orientation manual to DeL style

Staff orientation manual converted to DeL style submitted to PORALG Awaiting approval

Councilors from Iringa region following up practical training

during the launch of ODeL.

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PHASE 2: Online course development and multimedia integration

Pending

After approval then we will develop an

implementation timeline

Developing and uploading content and associated multimedia integration

PHASE 3: Review and document DeL-based system and new staff orientation/induction course

Review and enhance MUKI and supporting systems in line with DeL new staff orientation course

Update MUKI course user manual in line with DeL new staff orientation/induction course

Prepare MUKI self-updating materials (video/multimedia) and standard presentations for DeL new staff orientation course to enable support staffs at LGTI, RSs & LGAs to orient and facilitate trainees.

PHASE 4: Experts’ review, test, stakeholders appraisal and validation of DeL orientation course

Experts’ platform/content review and improvement

Stakeholders review workshop, test and refinement

PHASE 5: Implementation through use of DeL course for LGA new staff orientation

Next Quarter Activities: ▪ Highest priority for quarter is development of communication products

▪ Work with LGTI and OUT to start conducting LGA Councilor DeL in 6 Phase I LGAs, planned to occur in Y4Q3 and Y4Q4

▪ Support PORALG, LGTI, OUT to continue development of New Staff Orientation DeL

5. OPERATIONS RESEARCH

PS3 uses operational research (OR) as a tool to 1) Identify system barriers so that they can be

addressed, or find opportunities to refine implementation of system strengthening activities; 2)

Identify how facility management and governance is changing in relation to system strengthening

and reforms, particularly extension of systems to facility level, DFF and increased facility

autonomy; and 3) Produce flexible, timely and responsive analyses to determine the results of

the use of strengthened systems and related management improvements. In Y4Q2, the OR team

focused on data analysis and refining reports as well as institutionalizing gender-data

disaggregation. OR products are continuously being used to inform PS3’s technical activities.

Service Delivery Facility OR Study

The facility OR study is a deep qualitative study exploring the dynamics of change in health facility

and school management and governance processes. In Y4Q2, PS3 focused on three main activities

for the service delivery facility OR study: 1) cleaning and organizing field notes; 2) data coding

and analysis. Data cleaning activities included auditing notes to ensure consistency and quality

between the 243 field notes from individual and group interviews. Unfortunately, translation and

transcription was a very slow process and could not be completed on time to support data coding

43

and analysis; therefore the field notes were used as a replacement and audio tapes were used to

enrich field notes. The team matched information in the field notes with that on audio files so

that field notes could be trusted as the main source of data.

For the data coding exercise, the team created a master data set for all the 243 field notes

categorized by questions, types of respondents and facilities. A total of 141 (81 for facilities and

60 for LGAs) questions, and 6,372 responses were included in the master data set and then

coded. The first round of findings were presented to all the technical component team members

for feedback and for use in implementation. A second, shorter version was presented to USAID.

Key findings from preliminary analysis show that:

▪ LGAs recognize their role in supporting facilities to function better

▪ Facility governing committees (FGCs) are now playing their oversight and citizen feedback roles more effectively as compared to the pre-reform era

▪ DFF and strengthened systems, particularly PlanRep and FFARS, have improved facilities’ ability to meet the needs of their communities through improved management work

processes, availability of resources, and increased collaboration and transparency among

different stakeholders involved in facility service delivery

▪ DFF and strengthened systems have enhanced facility capacity to plan and budget

according to community needs, implement their plans on time, procure inputs to deliver

service outputs, and better account for public monies with less burdensome processes

▪ Timely and predictable transfer of funds by GOT to facilities have strengthened confidence, relationships and trust between facilities and communities, facility

management and governing committees, and facility management and staff.

▪ DFF and strengthened systems have raised facility awareness that improved quality of services attracts more service users and also increases facility funding

▪ Reforms and their implementation is not perfect, many challenges remain, especially related to low funding, continued need for capacity building due to staff turnover, and

maintaining momentum and political will to support the reforms.

In the coming quarter, the team will deepen the analysis to link research findings to research

questions and objectives. The responses will also be analyzed by facility performance and other

facility characteristics in line with study design. The team will finalize the analysis and produce the

first draft of the facility OR study report. Finally, the writing team will collaborate with component

team lead to identify themes for publication of journal articles and policy briefs.

Other OR Studies

Use of RS/LGA Websites to Share Information with Citizens

In Y4Q2 the OR team continued with analysis and report writing for OR study on use of websites

by RS/LGAs. This study aims to draw lessons from implementation of interventions using

technology to improve local governance, accountability, and transparency in Tanzania. The study

was conducted to find out whether LGAs were motivated to provide information to citizens and

to identify factors that facilitated or hindered the sharing of information. Specifically, the study

assessed the extent to which the websites were being used by the RS and LGAs to share

information with citizens as well as receive feedback from them, which could be helpful for further

44

improvement of services. Interviews were conducted in two high performing and two low

performing LGAs from PS3 regions of Mtwara and Lindi.

Overall, the study found that LGAs have embraced websites and are using them to share

information with citizens. Similarly, the study found that citizens are using information from the

websites for various reasons, including accessing services such as downloading application forms

or for knowledge purposes. We found that more than half of the LGAs supported by PS3 update

their websites at least every 20 days. The highest performing DC, Kilwa, had more than 10,000

website views from citizens and staff, while the other high performing LGAs averaged

approximately 600 views. Among the determinants of a strong performance in number of views

is the publication of administrative documents, including forms relevant to staff, particularly

OPRAS forms, leave forms, and sick sheets. Business owners and other citizens also accessed

services or forms online, particularly for business license which allows businesses to access,

complete and submit without having to visit the LGA. Another factor increasing use of the

websites was links to social media such as YouTube videos, Facebook, Twitter, or blogs. Factors

that hindered use of the websites was poor connectivity and seeming lack of readiness to embrace

the culture of sharing information for posting on websites among some of the LGA staff.

Special Seat Councilor Study

In Y4Q2 the OR team worked to continue dissemination of the Special Seat Councilors report

that was concluded and disseminated to gender equality advocacy NGOs and DPs during Y4Q1.

This quarter the report was shared with the GOT including PORALG and MOHCDGEC who

have both expressed interest in leveraging the ongoing review of the Local Government Election

Laws to promote dialogue to address some of the issues raised in the report. The OR team will

continue engaging with PORALG to monitor feedback on use of the report and to identify areas

for follow-up.

Next Quarter Activities:

▪ Highest priority for quarter is development of communication products

▪ Complete analysis and write the report for service delivery facility OR study

▪ Finalize IGTF and Revenue Enhancement OR studies as part of the larger project communications product push planned for May-July

6. COLLABORATIONS

In Y4Q2, PS3 continued to collaborate to its comparative advantages with USAID activities and

other DP projects. In addition, regional/LGA operations continued collaborating and leveraging

USAID funds as systems strengthening to improve service delivery refined implementation and

began deepening institutionalization at the LGA level. The status at the end of Y4Q2 and

expectations for Y4Q3 are described in Table 4 below.

45

Table 5: PS3 Collaborations with USAID and Development Partner Projects

PS3 Collaborations with USAID Activities and Other Development Partner (DP) Projects

Collaboration End of Y4Q2 Status Planned Y4Q3 Activities

USAID Activities

USAID Iringa

Hub

Implement PS3 activities in the context of Iringa

Hub plans and processes, and participate in Iringa

Hub meetings

Implement PS3 activities in the context of Iringa

Hub plans and processes, and participate in Iringa

Hub meetings

Touch

Foundation

Continue to integrate WISN+POA into GOT

systems by programming onto DHIS2 platform,

making PlanRep and DHIS2/HMIS interoperable

and engaging in dialogue with MOHCDGEC and

PORALG on roles and relationships

Develop communication products. Complete

WISN+POA programming in DHIS2 and begin

testing, continue to develop PlanRep and DHIS2

interoperability, further dialogue with PORALG

and MOH on roles and relationships, plan

deployment, continue deepen LGA use

GHSC, MCSP Continue three tasks: 1) interoperability

Muungano/GoHOMIS and HIM/eLMIS; 2)

automating MSD RBF invoices; and 3) creating

interoperability FFARS, MSD Epicor 9, and

eLMIS

Develop communication products. Continue

three tasks: 1) interoperability

Muungano/GoHOMIS and HIM/eLMIS; 2)

creating interoperability FFARS, MSD Epicor 9,

and eLMIS; and 3) DHFF management

Boreshya Afya,

other USAID and

CDC health

service projects

Communicate and collaborate on PlanRep, Epicor,

DFF, FFARS, HR management, and extending

health information system GoTHOMIS to facility

level including HMIS, eLMIS and NHIF

interoperability and link to improving DFF drug

procurement

Develop communication products. Communicate

and collaborate on PlanRep, Epicor, DFF,

FFARS, HR management, and extending

GoTHOMIS to facility level including HMIS,

eLMIS and NHIF interoperability and link to

improving DFF drug procurement

CHSSP and

Kizazi Kipya

Continue link with MOHCDGEC and PORALG

on social welfare service outputs and PlanRep

Continue link with MOHCDGEC and PORALG

on social welfare service outputs and PlanRep

HP+ Minimal follow-up dialogue on HFS/SNHI Continue dialogue on HFS/SNHI

USAID

Governance

Activities

Participating in USAID Governance “Integration

Baraza” meetings, and collaboration meetings with

governance activities with a focus on facility

autonomy, more proactive facility governing

committees, “civic space” and links to community

and other program topics

Participating in USAID Governance “Integration

Baraza” meetings possibly including site visit,

and governance activity collaboration with a

focus on public service delivery, facility

autonomy, more proactive facility governing

committees, “civic space” and links to

community involvement

Education

Activity

Only indirect collaboration activities this quarter Follow-up on Facility OR study, school

governing boards and performance management

strategy

Agriculture

Activities

Dialogue with PORALG and agriculture

stakeholders on better defining public sector

agriculture outputs (linked to ASDP-2)

Dialogue on better defining public sector

agriculture outputs (linked to ASDP-2) and link

to expanding nutrition activities

Other Activities Meetings upon request, and continue to identify

potential collaborations

Meetings upon request, and continue to identify

potential collaborations

Development Partner Projects

World Bank,

SDC/HPSS, GIZ,

Danida, WHO,

other HBF

Continue work to develop DHFF management

framework (e.g. how to spend DHFF to improve

service delivery) systems, guidelines, and

mentoring to deepen implementation

Begin programming to integrate PHC capitated

rate payment into NHIF, begin refine NHIF

hospital payment system, harmonize IS, and

DHFF management framework (e.g. how to

46

spend DHFF) systems, guidelines, monitoring.

Basically Phase II of movement towards SNHI.

DFID, Norway,

World Bank,

Danida, EU

Deepen PFMRP V collaboration related to Epicor,

internal audit, accounting and CAG reports,

PlanRep, FFARS, other PFM systems, and DHFF.

Deepen PFMRP V collaboration prioritizing

internal audit and including Epicor, accounting

and CAG reports, PlanRep, FFARS, other PFM

systems, and DHFF.

World Bank Support DHFF, RBF and productive dialogue with

Public Service Management project.

Support DHFF, RBF and productive dialogue on

Public Service Management project (HR)

P4H, WHO, all

HF DPs

Provide TA and coordinate SNHI policy dialogue

with WB, P4H and WHO.

Coordinate all steps on ongoing policy dialogue,

SNHI Act, and SNHI architecture.

SDC/HPSS, GIZ,

KfW, P4H

Harmonize DHFF purchasing and information

systems, implement iCHF, link to NHIF

development as purchaser and SNHI

Harmonize DHFF purchasing and information

systems, implement iCHF, link to NHIF

development as purchaser and SNHI

UNICEF Strong linkage on PlanRep implementation,

revising CCHP guideline, health information

systems, and PFM

Strong linkage on PlanRep implementation,

revising CCHP guideline, health information

systems, and PFM

GF RSSH Confirmed that GF RSSH grant has received

approval to extend LANs to LGAs in non-PS3

regions.

Provide TA as needed to enable GF RSSH grant

to procure equipment to extend LANs to LGAs in

non-PS3 regions, collaborate on other IS, finance,

and HR activities

GIZ Collaborate with Good Financial Governance

(GFG) project on PFMRP V, revenue collection,

LGA accounting, and internal audit.

Collaborate with Good Financial Governance

(GFG) project on PFMRPV, revenue collection,

LGA accounting, and internal audit.

JICA/internal

audit

Minimal direct collaboration due to JICA staff

turnover and incorporating internal audit into

PFMRP V collaboration

Envision integrating collaboration into broader

PFMRP V collaboration especially internal audit.

Education

projects

Only indirect collaboration activities this quarter Follow-up with P4R on education capitation grant

payment formula and staff allocation and

distribution. Region/LGA collaboration other

education activities with P4R, LANES, EQUIP-T

7. COMMUNICATIONS AND KNOWLEDGE MANAGEMENT

In Y4Q2, the communications team submitted all contractual deliverables, including the Y4Q1

Quarterly Report and monthly events calendar. The team also continued to support all PS3

interventions requiring communication expertise, including photographing key activities. The

team also continued to manage the design and interface of Jamvi internal website for

communication, management, and storage of final contractual deliverables and products which

will serve as legacy documents as the project comes to an end.

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Joint Quarterly Newsletter

In Y4Q2, PORALG and PS3 produced the Eighth

Edition of the quarterly joint newsletter known as

Mifumo Yetu (Our Systems). Mifumo Yetu reflects

the collaboration of GOT and PS3 in implementing

systems strengthening in Tanzania, and is

disseminated nationwide through PORALG,

RS/LGA and other sectoral ministries websites.

This quarter’s newsletter highlights how the

redesigned PlanRep system has been further

refined with additional features, and has been used

for the FY2019/20 planning and budgeting cycle.

PlanRep Video Manual

In Y4Q2, PORALG and PS3 teams further developed the PlanRep video manual that started

production in Y4Q1. Completion of this task will be a major achievement for PORALG as the

RS, LGAs, and facilities who are the main users of the system will be able to reference the video

manual to more easily work in the system. The video manual shows the step-by-step process that

regional, LGA and facility officers should follow to access and work in the PlanRep system.

Next Quarter Activities:

▪ Lead the communication products push

▪ Finalize PlanRep video and support development of POPSM complaints management video

8. MONITORING AND EVALUATION (M&E)

The PS3 results framework was described in detail in the Year 1 workplan. Consistent with the

PS3 implementation strategy, this results framework is intended to portray a direct link between

systems strengthening and service delivery improvements. It prioritizes the policy objectives of

efficiency or better use of existing resources, and responsiveness of public services to the needs

of citizens.

During Y4Q2, the M&E team completed several activities intended to strengthen project

monitoring, including:

▪ Completed revisions of PIRS to solidify PS3’s integration into USAID Implementing Partners Reporting System (IPRS) and submitted to USAID. Examples of revisions include adjusting the

data collection methodology for data that can now be accessed directly from national systems,

and updating terminology consistent with program implementation.

▪ Established indicators and targets for four nutrition activities assigned to PS3 by USAID.

▪ Finalized the development of data visualization maps or charts and corresponding narratives

for all 93 LGAs. In addition, RPMs and mentors, with the support of LGA and Regional Focal

Persons, have continued presenting indicator data to LGA Council Management Teams. During this quarter, indicator data was presented in 5 LGAs.

8th edition of the joint ‘Mifumo Yetu’ newsletter

48

In addition, the M&E team continued working with component teams to follow-up on indicator

results to inform and refine system strengthening interventions, and to tighten up indicator data

collection and management. For example, the M&E team worked with the HR team to follow-up

with LGAs on the indicator “Use of new orientation manual” which was reported for the first

time in Year 3. During the initial data collection exercise, the team noted good progress but also

identified challenges with regard to district HR officers (DHROs) keeping proper records of staff

that received orientation using the new staff orientation manual. The M&E and HR team agreed

to work together to support DHROs to set up simple mechanisms for reporting.

In Y4Q2, the M&E, OR and the Gender teams engaged MOHCDGEC, PORALG and LGAs to

assess GOT progress related to LGA performance in collecting and reporting on gender

disaggregated data. The discussion opened up avenues for MOHCDGEC and PS3 to work

together to identify information needs, and use PlanRep for tracking progress on gender equality

across levels of government. In these discussions, MOHCDGEC committed to finalize the Gender

Profile outlining national level gender indicators for monitoring LGA progress in addressing

barriers to gender equality through improved service delivery. PORALG has also committed to

explore the possibility of supporting MOHCDGEC through identifying and generating a National Annual Gender Report. This report will aggregate all LGA transfers and expenditure to service

outputs that directly impact gender indicators as outlined in the MOHCDGEC Gender Profile.

This initiative is also supported by UN Women and the Gender Macro Working Group through

the Gender Budget Initiative coordinated by MOFP.

9. CHALLENGES

During the last quarter, changes in the implementation and rigidity of PEPFAR applied pipeline

rules created a PS3 PEPFAR funding timing problem. PS3 is working closely with USAID/Tanzania

to address this challenge on both revenue and expenditure sides. One strategy to help make the

problem an opportunity is that next quarter PS3 will keep most staff at their work stations to

prioritize organizing and developing three types of communication products: 1) technical

communication packages for each strengthened system to deepen institutionalization across

levels of government, increase routine use by responsible public workers, and enable efficient and

effective user support for all systems; 2) results analyses papers based on intensive study of new

data in strengthened systems; and 3) developing PS3 communication messages, Road-to-Results

success stories, and a framework for development of legacy products. It is planned that technical

communication packages will be utilized by GOT and PS3 in a late Year 4 and early Year 5 final

implementation and user support push to increase awareness, ownership, technical

knowledge/skills, use and institutionalization of strengthened systems for sustainability.

Challenges are also arising due to RBF program delays instigated by the MOFP. While not good

news, there are also opportunities to further integrate and harmonize DHFF and RBF for

purchasing payment, information and quality assurance systems, and also for improving provider

management of funds to deliver better health services to the population. RBF has been a trigger

for many system and management improvements, but it can benefit from integration into the

broader health financing systems to increase efficiency and sustainability and support development

of single NHI moving towards universal health coverage. To take advantage of this opportunity,

PS3 will collaborate with the World Bank to support MOHCDGEC and PORALG to document

49

DHFF results in general and RBF results in particular, engage in dialogue with MOFP on deepening

health financing reform including DHFF and single NHI, and provide technical assistance to NHIF

to refine its provider payment systems, encompass DHFF including RBF, and prepare for its

further role as single NHI purchaser.

In Y4Q2, GOT, other DPs, other USAID projects, and PS3 made progress in resolving technical

challenges to interoperability between PORALG information mediator (Muungano Gateway) and

MOHCDGEC HIM, related interoperability between GoTHOMIS, PlanRep, HMIS, eLMIS, and

NHIF claims management, and harmonization of remaining inconsistencies between LGA general

planning and budgeting guidelines (PlanRep) and the Council Comprehensive Health Plan (CCHP)

guideline. Finally, operational program implementation challenges are constantly being identified,

managed, and resolved by PS3, and they are expected to continue to arise until the end of the

project due to its size, complexity, collaborations, and multi-sectoral work across all levels of

government.

10. PROGRAM MANAGEMENT

In Year 3, PS3 reached its program implementation peak intensity level, and towards the end of Year 3 began a program management evolution. In Y4Q2, program management began the long

process of gradually reducing implementation program costs which is hard to do as GOT

commitment and ownership is creating demand for even more activities. In the process of

managing a tight budget and engaging in dialogue with GOT this quarter, PS3 discovered an

additional phase of Year 4 implementation dynamics consisting of increased technical assistance

and maintenance of high project activity levels due to GOT and other DP project cost-share and

leveraging funds. PS3 program management will maintain this new implementation dynamic as

long as possible in the context of project close-out phases and PEPFAR applied pipeline rules (see

Challenges), while in parallel GOT and PS3 will intensify development of communication products

and solidify institutionalization.

In Y4Q2, PS3 managed complex operational issues and continuously increased efficiency of

management systems and processes. As PS3 transitions from peak level of implementation

intensity into institutionalization, the strong foundation built for program management and

regional/LGA operations will be crucial to the transition, especially strong communication and

collaborations across national and regional/LGA teams.

50

PUBLIC SECTOR SYSTEMS STRENGTHENING

(PS3) IN TANZANIA