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Tanzania National Voucher Scheme: Hati Punguzo

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Tanzania National Voucher Scheme: Hati Punguzo Tanzania National Voucher Scheme: Hati Punguzo Quarterly Report for January – March 2007 Prepared for The Ministry of Health and Social Welfare, Tanzania and United States Agency for International Development by Mennonite Economic Development Associates Mennonite Economic Development (MEDA) Plot 261 Msonge Street at Old Bagamoyo Rd Mikocheni A PO Box 10817 Dar es Salaam Tanzania Phone +255 (22) 270-1333, -1313, -1334 Fax +255 (22) 270-1297 TABLE OF CONTENTS EXECUTIVE SUMMARY ............................................................................................................ 1 PERFORMANCE INDICATORS.................................................................................................. 2 1.0 Strategy: Design and implement systems to ensure effective and efficient transfer of vouchers to pregnant women via the RCH clinics.............................................................. 2 1.1 Vouchers Procured ..............................................................................................................2 1.2 Regional Logistics Teams Identified and Trained...............................................................2 1.3 Vouchers Issued to the District Medical Officers ...............................................................3 2.0 Strategy: Set up systems of free distribution of IRKs to mothers of infants at vaccination milestones at three and nine months ................................................................................... 5 2.1 Insecticide Re-treatment Kits Secured and Stored:.............................................................5 2.2 Number of RCH Clinics Distributing IRKS to Mothers: ....................................................5 2.3 Number of IRKS Distributed ..............................................................................................5 3.0 Strategy: Identify, train, & monitor selected retail outlets eligible to receive vouchers.... 5 3.1 Retail Outlets Identified and Trained In All Regions by Regional Teams..........................5 4.0 Strategy: Design and Manage Voucher Redemption Scheme ........................................... 6 4.1 System Design and Upkeep.................................................................................................6 4.2 Redemption Rates ...............................................................................................................6 4.3 Vouchers Redeemed and Coverage Rates...........................................................................7 5.0 Strategy: Design & implement risk management systems to minimize misuse & fraud... 8 6.0 Additional comments.......................................................................................................... 9 6.1 Zanzibar ITN Voucher Programme.....................................................................................9 6.2 PLAN Project Voucher (PPV) ............................................................................................9 6.3 GPS Mapping ......................................................................................................................9 6.4 Special Events and Visitors.................................................................................................9 7.0 Challenges for the January-March 2007, Q11 .................................................................. 10 7.1 Misuse ...............................................................................................................................10 7.2 Early Stages of Equity Voucher Operation .......................................................................10 7.3 Scanning machine .............................................................................................................10 7.3 MEDA’s Contract Addendum...........................................................................................10 7.4 New MEDA Country Manager .........................................................................................10 LIST OF ACRONYMS CHMT Council Health Management Team DPS Director of Preventive Services DED District Executive Director DMO District Medical Officer DVP District Voucher Provider EV Equity Voucher GPS Global Positioning System HPFP Hati Punguzo Focal Person IHRDC Ifakara Health Research and Development Center IV Infant Voucher IRKs Insecticide Re-treatment Kits MIS Management Information System MEDA Mennonite Economic Development Associates MoHSW Ministry of Health and Social Welfare MEC Monitoring and Evaluation Contractor MU Monitoring Unit MVC Most Vulnerable Children NMCP National Malaria Control Programme PS Permanent Secretary PPV PLAN Project Voucher PWV Pregnant Woman Voucher PMI President’s Malaria Initiative PCB Prevention Corruption Bureau RCH Reproductive and Child Health (RCH) Clinic RM Regional Manager RMO Regional Medical Officer(s) TNVS Tanzania National Voucher Scheme TPRI Tanzania Pesticide Research Institute TPC Training and Promotion Contractor USAID United States Agency for International Development VEO Village Executive Officer VTS Voucher Tracking System WEO Ward Executive Officer WV World Vision ZM Zonal Manager EXECUTIVE SUMMARY Infant Voucher Launched. Hati Punguzo entered a new phase with the launch of the Infant Voucher (IV). Funded by the President’s Malaria Initiative (PMI) through USAID, the IV was introduced in 15 regions (89 districts) during this quarter. With World Vision, MEDA trained District Medical Officers (DMOs), Council Health Management Teams (CHMTs), clinic staff, wholesalers and retailers in the remaining 31 districts by the first week of March. Infant Vouchers are now operational and flowing in all 89 IV districts. Vouchers distributed hits 4 million. During the quarter 630,025 vouchers were distributed to DMOs: 358,025 Pregnant Woman Voucher (PWV) and 272,000 IV. Since the Tanzania National Voucher Scheme (TNVS) started in August 2004, a total of 3,357,475 PWVs and 654,900 IVs have been distributed to RCH clinics and DMOs. Equity Voucher Prepares to Launch. The Equity Voucher (EV) made progress toward launch. Agreements were signed with the selected NGOs and Ministry of Health and Social Welfare (MoHSW) and community-based Most Vulnerable Children (MVC) committees. MEDA regional teams and district level partners were trained on EV procedures. 26,040 vouchers were distributed to DMOs. Of the six districts, Dodoma Rural successfully launched and vouchers were being issued by March 31 st . The other five districts are expected to launch during April. Distribution Network Grows, New Target Set. The number of retailers and wholesalers involved in the program grew by 237, or 5.5 percent, over the three month period, from 4,280 to 4,517 and the number of wholesalers increased from 206 to 226. At the MEDA retreat held in December, MEDA’s regional teams committed to the ambitious goal of doubling the number of retailers in their region over the coming 12 months. Voucher Redemption Nears 2 million. By the end of the program’s 11th quarter the number of vouchers redeemed was 1,985,988, comprised of 1,901,947 pregnant woman vouchers and 84,014 infant vouchers. PWV redemption averaged 117,470 monthly, up 41% from the previous quarter. To date, 66,736 PWV stub books have been returned to MEDA from the DMOs, representing a total number of 1,668,400 vouchers. Of this voucher sub-set, 1,368,073 have been redeemed by MEDA, making the effective redemption rate 82%. This represents a drop by 1% in the redemption rate and was caused by a surge in stub books being returned this quarter. It is too early to calculate redemption rates for IVs as very few IV stub books have been returned. Database improves with addition of GPS mapping coordinates. Global Positioning System mapping has also begun in 14 regions this quarter with the provision of GPS units from USAID. Insecticide issues from the field. Without registration of KO tab 123, most of the regions have exhausted supplies of traditional Insecticide Retreatment Kits (IRKs). Risk Management a Primary Concern. The Monitoring Unit (MU) has engaged in a revision of weekly and monthly report templates for Regional Managers to include data on follow-ups regarding statistical irregularities and voucher analysis reports. MU also created a clinic tracking database to record findings of visits. TNVS Program Visibility. The Canadian Minister of Health, the Honorable Tony Clement, visited MEDA’s office. The MEDA board visited Tanzania for their annual board meeting and made several TNVS site visits to clinics and retailers in Morogoro region. PERFORMANCE INDICATORS Performance indicators for TNVS and MEDA appear in Table 2 appended to this document. They correspond to the Key Performance Indicators table developed by the MoHSW and USAID. MEDA is working with MoHSW and USAID to update the program indicators. Until then, the existing targets will be used in these quarterly reports. 1.0 Strategy: Design and implement systems to ensure effective and efficient transfer of vouchers to pregnant women via the RCH clinics 1.1 Vouchers Procured The TNVS vouchers are currently printed by a security printer in Johannesburg following a tender process undertaken in June 2006. Pregnant Women Vouchers (PWV): Last quarter we received 400,000 PWVs. In February, this quarter, 650,000 PWVs were received from the printer in South Africa. Next quarter we expect 450,000 PWVs to complete the order of 1,500,000 that was placed in August 2006. These new PWVs have a subsidy value of 3,250 TSh, as opposed to the previous 2,750 TSh. They
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