<> The Policy Unit is responsible for advocating a conducive environment for the provision of health services, and to promote effective engagement of Church health facilities in health service delivery. Main interventions areas include:

• Advocating for the development of- and adherence to appropriate National and Church policies and legal frameworks;
• Supporting the government to develop and review national (government) standards, guidelines, strategies and plans;
• Advocating for public private partnerships between the government and Church facilities;
• Promoting public private health partnerships at district and regional levels (through district and regional PPP forums);
• Representing Church positions, interests and needs in dialogue with relevant government ministries / offices.

During the past 25 years, a number of prominent achievements could be noted:

• CSSC actively participated in the development of the national Public Private Partnership (PPP) Policy and the Health PPP Guidelines, providing a conducive framework for PPP.
• CSSC supported the Government to develop/review the Primary Health Care Development Plan, and standards for the provision of health care services in Church owned health facilities. Were we actively involved in other key policy documents of the government? If so, include them here.
• CSSC helped broker and develop Service Agreement (SA) contracts that enable Church facilities to access Government resources – in terms of finances, materials and personnel. Three types of SAs were developed:
  1. for Church hospitals elected as council designated hospitals (CDH)
  2. for hospitals/lower-level health facilities selected to provide specific health services, supplementing those of public health facilities (Service Level Agreement or SLA); and
  3. for hospitals elected to provide regional hospital referral (specialised) services (RHRL). By the end of 2016, 85 out of 103 Church hospitals had SAs with their respective district/ regional authority.
• In 2016/17, CSSC played a pivotal role in reviewing and improving the SA contract templates. The revised CDH and SLA contracts were officially released in July 2017, and all Church health facilities were required to re-negotiate and sign these new SAs as pre-condition for continued Government support. With active backing from CSSC, 63 out of 91 Church hospitals have managed to re-negotiate new SAs by the end of June 2018.
• Despite regular prompting by CSSC, the new RHRL templates have not yet been officially released by the Government. We will continue to put pressure on the Government to release this template, so that the 10 Church regional offices can also access support for regional referral services.
• CSSC supported the establishment of PPP health forums in more than 20 district councils. Is the number correct? What about regional health forums? Forum meetings were facilitated to discuss issues related to PPP, including progress and challenges in implementation of service agreements.

The Department represented church interests and successfully advocated for the need to develop RHRL SA contracts, to review the CDH and SLA SA contracts, and to develop a Health Financing Strategy.

For 2018, the following main results areas have been prioritised for the Policy Unit:

• Negotiating & signing of revised SAs at council level (CDH & SLA);
Negotiating & signing of SAs at regional level (RHRL);
• Negotiating & signing of SAs at zonal level (ZHRL);
• Supporting health facilities to monitor adherence to Service Agreements, as input to bilateral consultative meetings with government partners;
• Facilitating functional PPP forums at district level;
• Supporting the Ministry of Health to improve functionality of regional PPP coordination meetings;
• Promoting PPP at national level;
• Reviewing and updating the health database (for advocacy and promotion purposes);
• Advocating for pro-poor health financing;
• Advocating for recognition and inclusion of key and vulnerable populations (KVP) in health service delivery;
• Conducting quarterly consultative meetings with PO-RALG and MoHCDEG The Department is supported by a Health Technical Advisory Committee (TAC-health), representing relevant stakeholders (Church, Government and development partners), who meet at least twice a year to advise the Department on (emerging) advocacy issues and best ways to address them.

The Department has also forged close relationships with other partners for joint advocacy, e.g. the Association of Private Hospitals in Tanzania (APHTA) and SIKIKA.

The Technical Unit is responsible for strengthening health systems of Church health facilities, covering all 6 system building blocks: leadership & governance, human resources, service delivery, financing, technology and health information. Some of the notable achievements are highlighted below.

• CSSC supported the construction and rehabilitation of 83 first-line health units (health centers and dispensaries), 14 hospitals and 26 houses for doctors countrywide. Facilities benefited were both owned by the Government and Churches.
• CSSC contributed to the ongoing initiative of increasing production and retention of qualified Human Resources for Health in the country.
• CSSC constructed, rehabilitated and expanded buildings of St. Bhakita and Mvumi Health Training Institutions in Rukwa and Dodoma Regions, respectively. This has allowed these training institutions to increase their enrolment capability to at least 1000 middle-cadre students.
• CSSC improved the capacity of health training institutions (HTIs), by (i) developing and propagating a competence-based education and training curriculum guide (to standardize teaching across HTIs), (ii) introducing / improving skills labs, and (iii) training of tutors. The skill labs has improved the performance of student in practical examinations by 77%; while more than 750 tutors were trained / upgraded (including tailor-made trainings, upgrading courses, BSC and MSC diploma courses). In addition, CSSC supported 5 HTIs to develop gender strategies, to mainstream gender and institute gender sensitive management systems.
• The hospital governing committees of ?? hospitals were strengthened; while hospital management teams of 63 hospitals received training in planning (developing Comprehensive Hospital Operational Plans, or CHOP) and human resource management (OPRAS).
• Capacity building support was provided to senior and middle management of 35 Church hospitals in the fields of general management & operations, human resources management, financial management and safety & quality of healthcare. Trainings combined plenary presentations/discussions with real-life case studies and individual/ group assignments. Moreover, participants were required to identify capstone projects that would allow them to put obtained competencies/skills into practice, i.e. projects that address actual areas for improvement in the hospital.
• With respect to strengthening of health management information systems (HMIS), CSSC supported the development and deployment of ICT solutions to Church hospitals i.e. Afya Pro and the web-based QI2 benchmarking tool. A total of 45 hospitals have installed the Afya Pro software, and 9 are using the benchmarking tool; tis has considerably improved transparency, accountability and informed decision-making.
• Health facilities have also been supported to upgrade and strengthen the quality of their health service delivery. Through the Business of Quality (BoQ) project, which started implementation in October 2014, CSSC has assisted (and is still assisting) 250 Church health facilities (73 hospitals and 177 lower-level facilities) to improve the quality of their service delivery. By the end of 2017, 59 facilities had attained SafeCare level 3 or above; 1 hospital (Mugana) attained the maximum rating of 5, and others are expected to follow (after re-assessments planned in the 2nd half of 2018). SafeCare, with levels ranging from 1 – 5, is an accredited system to objectively measure the quality strengths of health care facilities; a level of 3 denotes medium quality strengths. More details on the BoQ project can be found under the menu Projects – Health Department.
• CSSC helped establish and equip health care technical service centers in each of the five zones, providing maintenance services for health care equipment. A total of 60 technicians were trained in maintenance and repairs.
• CSSC also contributed towards improvement of the medical supply chain. CSSC supported the establishment of a Revolving Drug Fund (RDF) to improve availability of medicines. In addition, CSSC continues to support MEMS, a medical supply company established by CCT and TEC in 2013, as alternative medical supply chain in the country.

The following main results areas have been prioritised by the Department since 2018:

• Capacitating hospitals to develop and utilize CHOP & OPRAS
• Strengthening Hospital Governing Committees
• Strengthening HMIS
• Supporting HTIs to strengthen quality of educational services
• Improving the capacity of pharmaceutical cadres in Tanzania (MAP project – more details can be found under menu Project – Health Department)
• Improving the quality of health service delivery (BoQ project)
• Institutionalising a CSSC Quality Assurance Unit
• Supporting MEMS to improve its services
• Professional upgrading (clinical, focussing on doctors-in-charge)