United Republic of Tanzania Ministry of Health, Community Development, Gender, Elderly and Children Health Sector Strategic Plan July 2021 – June 2026 (HSSP V) Leaving No One Behind Foreword On 1stJuly, 2020, the World Bank declared that Tanzania has been categorised Tanzania as a lower middle-income country (LMIC) after achieving economic and human development consistent with a middle-income status. This goal was achieved five years ahead of the country's schedule of 2025 as indicated in the Tanzania Development Vision 2025. The government’s investment in the health sector has contributed to attainment of the LMIC status by improving the health and the health status of Tanzanians. The key attributes contributing to this achievement include the discipline in financial expenditure, the prevailing peace and tranquillity, reinforcement of leadership ethics, implementation of flagship projects and investment in human development which are the hallmarks of the Sixth phase Government under Her Excellency Samia Suluhu Hassan, the President of the United Republic of Tanzania. The report of the Mid-Term Review (MTR) of Health Sector Strategic Plan Four and the Annual Health Sector Performance Report of July 2020 highlight the achievements made in the health sector during the first five years of implementing Sustainable Development Goals (SDG). The gaps identified have informed the development of the fifth Health Sector Strategic Plan 2021-2026 (HSSP V) which aims to achieve the targets for the last five years of TDV2025 and the second five years of SDGs. The health sector interventions in the HSSP V are also guided by the ruling party election manifesto and the third Five Year Development Plan 2021/22 – 2025/26. In implementing the HSSP V, Tanzania will continue strengthening health systems in order to sustain achievements made in improving reproductive, maternal, newborn, children and adolescent health as well as results attained in control of communicable and non-communicable diseases. Government will improve the response to epidemics and disasters. Also, the government will strengthen leadership, governance and accountability in the sector in order to safeguard these achievements. Local Government Authorities (LGAs) have a critical role to play in order to reach all communities, all people, providing services and solutions to the health needs of the population. The health sector commits itself to apply community- and facility-based interventions inspired and guided by locally generated evidence and globally proven best practices. Increased capacity of the President’s Office Regional Administration and Local Government (PO-RALG) will continue to play a major role of coordination and support to LGAs in implementation of health sector policies and guidelines towards achieving the goals of HSSP V. Achievements in the health sector cannot be reached and sustained without participation of central ministries, Ministry of Finance and Planning (MOFP) and President’s Office – Public Service Management and Good Governance (PO-PSMGG) and other sectoral ministries including but not limited to those responsible for water, agriculture, livestock, fisheries, infrastructure, ICT and others that have impact in the health sector. Cross-sector collaboration will be enhanced under the guidance of the Prime Minister’s Office to ensure that the Health in All Policies (HiAP) approach is effectively implemented. The Government will establish systems and mechanisms to ensure increased accountability of all health sector stakeholders at all levels towards achieving the goals of HSSP V. The Ministry of Health Community Development, Gender, Elderly and Children (MOHCDGEC) will develop an accountability ii framework for all health sector stakeholders to be included in the Common Management Arrangements for implemen�ng HSSP V. Tanzania con�nues to have a strong Sector-Wide Approach (SWAp) providing an avenue for policy and technical dialogue among all key stakeholders of the health sector. The SWAp structure will be further decentralised to regional and council levels to ensure that inputs from local council and regional stakeholders are always recognised and taken on board during the Joint Annual Health Sector Review (JAHSR) –Technical Review and Policy Mee�ngs. It is my expecta�on that HSSP V will guide all players in the health sector including all departments and agencies of the health sector, all councils and departments at PO-RALG, MOFP, POPSMGG and all ministries, departments and agencies in alloca�ng financial, material and human resources for the health sector and inter-sectoral roles that have a health impact. I believe that the HSSP V will also guide health sector Development Partners and other stakeholders including non-state actors as they support and complement the Government’s role to bring health and development to people and communi�es, Leaving No one Behind. Dr Dorothy O. Gwajima (MP), Minister of Health, Community Development, Gender, Elderly and Children iii Acknowledgement The development of the HSSP V was a par�cipatory process that began with the comple�on of the MTR of HSSP IV that was presented to the 20th Joint Annual Health Sector Review (JAHSR 2019). The process was led and guided by the Senior Management of MOHCDGEC chaired by the Permanent Secretary. The role of my predecessors Dr Zainab Chaula and Prof Mabula Mchembe in kick-star�ng the process is underscored and appreciated. Most of all, I would like to recognize and applaud the excellent coordina�on by Mr Edward Mbanga, the Director of Policy and Planning whose performance was that of the conductor of an orchestra involving diverse players across the spectrum of the mul�ple internal and external stakeholders of the sector. While each of the stakeholders had their vested interest at heart, he ensured that all contributed to the vision of the country and mission of the sector. In the same breath, I would like to recognise and thank the en�re senior management team of the MOHCDGEC for their ac�ve engagement throughout the formula�on of HSSP V. Par�cipa�on of representa�ves of health facili�es, Council and Regional Health Management Teams (CHMTs and RHMTs), PO-RALG, POPSMGG, MOFP, other ministries, departments and agencies and non-state actors (including civil society and private sector) enhances ownership of this document by ensuring that it contains strategies and interven�ons that are adequate and relevant to the prevailing situa�on and actual needs of people and communi�es. The Development Partners suppor�ng the health sector (DPG-H) led by the DPG-H Troika and the Health Basket Fund (HBF) partners con�nues to provide technical and financial support to the sector including the support for conduc�ng the mid-term review of HSSP IV and the development of this strategic guidance document. The MOHCDGEC established a core team involving development partners and lead consultants under the leadership of the Head of the Health Sector Resource Secretariat (HSRS). The Core team acted as cement holding together all pieces contribu�ng to the development and finaliza�on of HSSP V. I would like to recognise and acknowledge efforts made in this regard by Dr Catherine Joachim, (Head of HSRS), Dr Jaap Koot (Lead consultant HSSP V), Dr. Yahya Ipuge (Na�onal Consultant HSSP V), Dr Ties Boerma (M&E Lead), Prof Daudi Simba (M&E Na�onal Consultant), Harun Mahundi (M&E Na�onal Consultant), Rachel Sanders (Cos�ng Lead), Prof Sia Msuya (Consultant RMNCAH), Dr Mary Mayige (Consultant NCD), Prof Henry Mollel (Consultant HRH), Sally Lake (Advisor, PO-RALG and Cos�ng Team), Dr Rutasha Dadi (Canada DFATD), Maximillian Mapunda (WHO) and Dr Thomas Fedjo Tefoyet (WHO). I extend my sincere thanks to technical experts from all Technical Working Groups listed in Annex 1 for their valuable inputs to the formula�on of this strategy. I would like to thank the Health Sector Basket Partners, WHO, UNAIDS and USAID for their financial support that has been instrumental in facilita�ng the en�re development process. The en�re leadership of the Ministry of Health, Community Development, Gender, Elderly and Children will ensure that this HSSP V is used at all levels to guide the sector in planning, monitoring and evalua�on of the progress towards universal health coverage, leaving no one behind. Prof Abel N. Makubi, Permanent Secretary iv Table of content Foreword ................................................................................................................................................. ii Acknowledgement ................................................................................................................................. iv Table of content ...................................................................................................................................... v Acronyms/Abbreviations ..................................................................................................................... viii Key messages ......................................................................................................................................... xi 1 Chapter 1: Introduction .................................................................................................................. 1 1.1 The formulation process of HSSP V ............................................................................................. 1 1.2 Health in Tanzania’s national development agenda ................................................................... 2 1.2.1 Tanzania Development Vision