ZIM-809-G14-S HEALTH SYSTEMS STRENGTHENING CROSS- CUTTING INTERVENTIONS Annual Report 2013 15 April 2014 TABLE CONTENTS 1 INTRODUCTION .................................................................................................................................... 2 OVERVIEW OF THE GRANT ........................................................................................................................... 2 2.1 BACKGROUND .................................................................................................................................................................................... 2 2.2 COMPONENTS OF THE GRANT ........................................................................................................................................................... 3 2.2.1 Health Retention Scheme ................................................................................................................................................ 3 2.2.2 Community Systems Strengthening (CSS) ................................................................................................................ 4 2.2.3 Health information Systems (HIS) ................................................................................................................................. 4 2.3 COORDINATION OF THE GRANT ........................................................................................................................................................ 5 ACTIVITIES IMPLEMENTED ........................................................................................................................... 7 3.1 RETENTION SCHEME ................................................................................................................................................................. 7 3.1.1 Payment of Retention Scheme Allowances ................................................................................................... 7 3.1.2 Human Resource Database ....................................................................................................................................... 8 3.1.3 HSB Oversight over implementation of HWRS ................................................................................................. 8 3.1.4 UNDP Oversight over the Retention Scheme ................................................................................................... 10 3.1.5 Achievements ............................................................................................................................................................... 11 3.1.6 Challenges in 2013 ...................................................................................................................................................... 12 3.2 COMMUNITY SYSTEMS STRENGTHENING ....................................................................................................................................... 12 3.2.1 Distribution of Cell Phones ...................................................................................................................................... 12 3.2.2 Community Health Workers .................................................................................................................................... 13 3.2.3 Change in Payment Mechanism of VHWs.......................................................................................................... 13 3.2.4 Evaluation of the CSS Component of the Grant .............................................................................................. 13 3.3 HEALTH INFORMATION SYSTEMS .......................................................................................................................................... 14 3.3.1 Roll out of District Health Information System 2 (DHIS2) ....................................................................... 14 3.3.2 Improving Internet Connectivity ........................................................................................................................... 16 3.3.3 Strengthening Collaboration with CDC/RTI ...................................................................................................... 17 MONITORING AND EVALUATION ............................................................................................................... 17 4.1 ON-SITE DATA VERIFICATION ................................................................................................................................................ 17 4.2 GRANT PERFORMANCE .................................................................................................................................................................. 17 4.3 GRANT RATINGS ............................................................................................................................................................................... 19 5 FINANCIAL SUMMARY ........................................................................................................................ 20 5.1. DISBURSEMENTS OF FUNDS IN 2013 ............................................................................................................................................ 20 5.2. DISBURSEMENT IN 2013 BY SUB -RECIPIENT ................................................................................................................................. 20 5.3 DISBURSEMENT BY COMPONENT I .E. HWR S, CSS & HIS ............................................................................................................. 21 CAPACITY DEVELOPMENT PLAN................................................................................................................ 21 SUCCESS STORIES ....................................................................................................................................... 25 7.1 SUCCESS STORIES .................................................................................................................................................................... 25 7.2 CHALLENGES ........................................................................................................................................................................... 25 CONCLUSIONS ............................................................................................................................................ 26 1 1 INTRODUCTION In 2013, the year 2 of the Round 8 Phase ll of the Health Systems Strengthening (HSS) grant, the activities implemented covered 3 broad components, namely: (i) the Health Worker Retention Scheme (HWRS), (ii) the Community System Strengthening (CSS) and (iii) the Health Information System (HIS). This report presents the summary of activities implemented under the grant during that period, the overall performance, the Capacity Development (CD) activities, and the successes and challenges encountered in the implementation of the grant. During the period under review, the grant recorded impressive performances and these are reflected in the A1 ratings it achieved in the semester 1 and semester 2. Noticeable improvements were observed in two of the HWRS and HIS components, especially the indicators on completeness and timeliness of reports to the national level. During the year, the CCM continued to provide its oversight leadership and guidance to the implementation of the grant. The PR also provided timely updates on grant implementation and progress to the CCM as well as data to populate the CCM dashboard. The PR worked collaboratively with the SRs and SSR in devising strategies for implementation of the grant, coordination of capacity building, and monitoring and evaluation, which ensured the basis for good performance. In 2013 the GFATM approved additional $2.7 million dollars to support the national rollout of the DHIS-2. The piloting of the system was completed in the first quarter of 2013 and the national rollout to provinces, districts and 166 hospitals was successfully completed with technical support from Oslo University (UiO). OVERVIEW OF THE GRANT 2.1 BACKGROUND Zimbabwe has experienced an unprecedented decline in health service delivery due to the high inflation, severe economic decline and rising poverty, which led to mass exodus of skilled workforce in particular from the health public sector. This adversely affected the country’s health delivery system and consequently health outcomes of the population. This situation seriously compromised efforts by the government of Zimbabwe and its international partners to provide universal access to basic health services and combat HIV, Tuberculosis (TB) and Malaria. The deterioration of the health sector has had a negative bearing on the Government of Zimbabwe in its quest to achieve the Millennium Development Goals (MDGs), which among others, include having halted by 2015 and reversing the spread of HIV/AIDS and reversing the incidence of Malaria, TB and other major diseases. In response, the Ministry of Health and Child Care (MOHCC) and some funding partners instituted the “Public Health Retention Scheme” in 2007/2008. The goal of the retention scheme was to reverse the outward migration of health staff from the country; and to ensure that the numbers of new trainees entering the health system from the clinical training schools exceed those leaving the sector. In 2008, a Harmonized Health Worker Retention Scheme (HHWRS) was set up as a joint initiative between the MOHCC, Health Services Board (HSB), College for Health Science, Harare