Academic journal article Bulletin of the World Health Organization

Midterm Review of National Health Plans: An Example from the United Republic of Tanzania/Examen a Mi-Parcours Des Plans Nationaux De Sante: L'exemple De la Republique-Unie De Tanzanie/Revision Intermedio De Los Planes De Salud Nacionales: Un Ejemplo De la Republica Unidad De Tanzania

Academic journal article Bulletin of the World Health Organization

Midterm Review of National Health Plans: An Example from the United Republic of Tanzania/Examen a Mi-Parcours Des Plans Nationaux De Sante: L'exemple De la Republique-Unie De Tanzanie/Revision Intermedio De Los Planes De Salud Nacionales: Un Ejemplo De la Republica Unidad De Tanzania

Article excerpt

Introduction

In the health sector, regular reviews of progress and performance are critical for good planning and resource allocation. Most countries have a national strategic plan for the health sector that outlines major strategies and sets targets. Such plans often cover a period of five years and usually include regular monitoring of core indicators and the progress being made towards set targets. The results of progress reviews are typically published in annual progress reports (1-5) and discussed at annual meetings of the relevant stakeholders. The stakeholders may then decide how--and if--the implementation of the strategic plan needs to be adjusted. In a recent investigation of 75 countries, it was found that 58 (77%) countries were conducting annual reviews of their health sectors. (6) During the implementation of a strategic plan, such annual reviews are often supplemented with more extensive midterm and--sometimes --final reviews. The World Health Organization (WHO) has specified the key characteristics of a monitoring and evaluation platform for supporting regular reviews of health sector strategy. (7)

Compared with annual reviews, midterm reviews are usually broader in process and scope. They may be conducted in conjunction with a regular annual review or they may replace it. (6,7) They take a multi-year perspective and pull together all of the available relevant data to assess the progress and performance of the health sector as a whole. Ideally, they should pay special attention to data quality, long-term trends, contextual changes and equity, and compare performance at national level with that in other similar countries. They should also form the basis for the situation analysis for the next strategic plan.

At present, most midterm reviews are conducted by teams of international and local consultants and the analysis and synthesis of evidence are usually quite rapid. (6) Ideally, any midterm review should begin with a thorough and systematic analysis and synthesis of all of the relevant data, to provide a comprehensive picture of progress and performance. It should be conducted by national research and public health institutions, in close collaboration with the national health ministry, the national statistical authority and international partners.

As an example, we present a midterm review done for the United Republic of Tanzania in 2013. A systematic approach was used to analyse and synthesize data from multiple sources.

Context of the review

The Ministry of Health and Social Welfare of the United Republic of Tanzania is currently implementing its third national plan, which covers the period 2009-2015.8 This plan represents the key government document that provides specific guidance to the health sector. The main aim of the plan is improving access to those health services that are relevant to the Millennium Development Goals--at community, facility and district levels. The plan pays special attention to equity and gender issues and the general improvement of service quality. There are baseline values available--for 2008-2009 or earlier--for most of the 42 indicators used to track progress with the plans implementation and corresponding target values for 2015.

The results of household surveys and longitudinal community studies have indicated that the United Republic of Tanzania has made major progress towards the achievement of its health goals since the mid-1990s. (9) In particular, the child mortality rate declined substantially between 1995 and 2005. Since 1999, health sector reviews have been conducted on an annual basis and a health sector performance profile has been produced. (3) Our review--done in the context of general midterm policy review--included several sessions to report midterm progress to the Ministry of Health and Social Welfare and relevant development partners.

Box 1 Key components of an analytical midterm review of the United
Republic of Tanzania's strategic plan for health in 2009-2015

Core indicators and targets

* Map the core indicators of the health sector's strategic plan on
to the logical results framework. … 
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