Zanzibar Human Resource For Health 5 Year Development Plan Final Version1

REVOLUTIONARY GOVERNMENT OF
ZANZIBAR
MINISTRY OF HEALTH AND

SOCIAL WELFARE
HUMAN RESOURCE FOR HEALTH

5 -YEAR DEVELOPMENT PLAN
2004/05 – 2008/09
WHO Emblem (Subject to WR’s Approval)
October, 2004
TABLE OF CONTENTS
CONTENTS PAGE
The Technical Working Group on HRH i

Foreword ii
Acknowledgment iii
Abbreviations iv
Executive Summary 1
CHAPTER ONE: INTRODUCTION 3
1.0 Country Profile 3

1.1 Demography 3
1.2 Health Services Infrastructure 3
1.3 Health Status 3
1.4 Burden of Disease 3
1.5 HRH Statement in Health Policy 4
1.6 Plan Purpose 4
1.7 Human Resource Planning Concepts 5
1.7.1 Human Resource demands 5
1.7.2 Supply 5
1.7.3 Human Resource Stocktaking 5
1.7.4 Career development 6
CHAPTER TWO: HUMAN RESOURCES FOR HEALTH POLICY 7
2.0 General Aim of the Policy 7

2.1 Policy Goals 7
2.2 Policy Objectives 7
2.3 The HRH Policy Priority Areas 7
2.3.1 Organisation of the Human Resource Division 7
2.3.2 Planning 7
2.3.3 Training 8
2.3.4 Recruitment, Deployment and Management 8
2.3.5 Human Resource Quality maintenance 8
2.3.6 Human Resource Financing 8
2.3.7 Ethics, Discipline and Human Rights 8
2.3.8 Plan Implementation and Evaluation 8
CHAPTER THREE: HRH SITUATION ANALYSIS 9
3.0 Government Initiatives 9

3.1 Successes 10
3.2 Identified Problems 10
3.2.1 HRH Planning 10
3.2.2 Management 10
3.2.3 HRH Development 11
3.2.4 HRH Quality in relation to Performance 11
3.2.5 Gender issues in HRH 11
3.2.6 HRH Financing 12
3.3 HRH Challenges 12
CHAPTER FOUR: HRH PLAN AIM, OBJECTIVES AND STRATEGIES 14
4.0 Aim 14
4.1 Objectives 14
4.2 Priority Areas 14
4.2.1 HRH Medium Term Plan Advocacy and Promotion 15
4.2.2 HRH Development 15
4.2.3 Retention 15
4.2.4 Quality Care at all Levels 15
4.2.5 HRH Data Base 16
4.2.6 Capacity Building for the College of Health Sciences 16
4.2.7 Mnazi Mmoja as a Referral Hospital 17

4.2.8 Monitoring and Evaluation 18
CHAPTER FIVE: HRH PROJECTIONS 19
5.0 Essential Health Package (Service at each level) 19

5.0.1 1st line PHCU 19
5.0.2 2nd line PHCU 19
5.0.3 Primary Health Care Centre (PHCC) 19
5.0.4 District Hospitals 20
5.1 Staffing Level 20
5.2 Demand and Supply 26
5.3 Gap filling Strategies 27
5.4 Dealing with Surplus staff 28
5.5 Establishment of HRH Data Base for HRH Projections 28
CHAPTER SIX: HUMAN RESOURCE DEVELOPMENT 24
6.0 Quality of training 24

6.1 Selection of Students 24
6.2 College Accreditation 24
6.3 Career Development 25
6.4 Pay and Rewards 25
6.5 Training Plan 25
6.6 Continuing Education 26
CHAPTER SEVEN: HUMAN RESOURCE MANAGEMENT 27
7.0 Deployment and Redeployment 27

7.1 Proper Utilisation 27
7.2 Performance Appraisal 27
7.3 Focal Person 27
7.4 Motivation 27
CHAPTER EIGHT: HRH FINANCING 29
8.0 Budget for implementing the Medium Term Plan 29

8.1 Sources of Financing. 29
8.2 Sustainability. 29
CHAPTER NINE: MONITORING AND EVALUATION 35
9.0 Why Monitoring and Evaluation 30

9.1 Coordination of HRH Activity 30
9.2 Research 31
CHAPTER TEN: ASSUMPTIONS AND RISKS 32
10.0 Assumptions 32
10.0.1 Existence of training facilities 32
10.0.2 Availability of staff 32
10.0.3 Recruitment, transfer and retrenchment procedures 32
10.0.4 Support from senior management, development partners
and politicians 32
10.0.5 Strengthening of Department of Policy and Planning 32
10.1 Risks 33
10.1.1 Constrained resource base of the government 33
10.1.2 Political environment 33
10.1.3 Competitive labour market 33
10.1.4 Slow progress in the implementation of Public Sector Reforms 33
ANNEXES
ANNEX I: Activities, Output, Indicators, Time frame and Financial 35

Requirement for each Priority Area
ANNEX II(a): HRH Situation as at June, 2003: Core Medical

Occupations at Primary Level (PHCUs and PHCCs) 81
ANNEX II(b): Core Medical Occupations at the Secondary Level

(District Hospitals) 83
ANNEX II(c): Core Medical Occupations at the Tertiary Level

(Mnazi Mmoja Hospital) 85
ANNEX II (d): Core Occupations at the Government Central Laboratory 88
ANNEX II (e): Core Occupations at the College of Health Sciences 90
ANNEX II (f):Core Occupations at the MOHSW 92

ANNEX III: Expected Number of Graduates from the College 94
of Health Sciences, 2004/05 – 2008/09
ANNEX IV (a): Summary of Deficit and Surplus 1st Line PHCU

Unguja and Pemba 95
ANNEX IV (b): Summary of Deficit and Surplus 2ND Line PHCC

Unguja and Pemba 96
ANNEX IV (c): Summary of Deficit and Surplus for PHCCs Level

Unguja and Pemba 97
ANNEX IV (d): Summary of Deficit and Surplus for Secondary Level

(District Hospital) 99
ANNEX V: Immediate and intermediate gap Filling Plan and the

Criteria used to determine the immediate and intermediate
gaps to be filled 103
ANNEX VI: Redeployment of Staff at Primary, Secondary and Tertiary

level of Health Care 107
ANNEX VII: Non Citizen Workers 113
ANNEX VIII: HRH Career Development by Cadre: PHCU/PHCC and

District Hospitals 114
ANNEX IX: Current Organogram for the MOHSW 116
ANNEX X: Proposed Organogram for the MOHSW 117
ANNEX XI: Proposed Organogram for the HRH Division 118
ANNEX XII: Justification for the New Proposed Organogram 119
ANNEX XIII: Consultant’s Assessment Report 123

THE TECHNICAL WORKING GROUP ON HUMAN RESOURCES FOR HEALTH
NAME DESIGNATION INSTITUTION

Ms. Mwaka A. Said Director /Planning MOHSW
Mr. Fadhil Abass Planning Officer MOHSW
Mr. Khamis Hussein Training Coordinator MOHSW
Ms. Sharifa Awadh CE. Officer CEU MOHSW
Dr. Mkasha H. Mkasha H/Coordinator MOHSW Pemba
Ms. Jokha Khamis Academic Officer CHS
Mr. Waziri Juma Adm. Officer CHS
Mr. Abdalla Rashid CHS. Tutor CHS
Dr. Ali Salim Med Superintendent Mnazi Mmoja Hosp
Dr. Mohamed Dahoma ZACP I/C MOHSW
Ms. Fatma Juma Matron Mental Hospital
Ms. Asha M. Seha Adm Officer ZACP, MOH
Mr. Othman Mussa CNO MOHSW
Mr. Kai Bashir Administrator DPP Office
Mr. Suleiman M. Juma Adm Officer Z’bar State University
Mr. Issa A. Mussa Hd/HDP&L MOHSW
Mr. Ali Hassan Rajab Adm. Officer C.S. Commission
Ms. Khadija Khamis Planning Officer MOHSW
Ms. Salama Thabit M. PHNO “U” MOHSW
Mr Ali H. Suleiman Planning Officer MOHSW
Ms. Mwakalukwa HRH Officer MOH Dar es Salaam
Ms. B. Tillya HRH Officer MOH Dar-es-salaam
Mr. John B. Mwinuka Assistant Director PO-PP
Dr. Nangawe MPN WHO – Dar es Salaam
Max Mapunda HSD WHO – Dar es Salaam
Mr. Shaibu Khamis Hd. H. Resource Div. MOHSW
Mr Abdalla M. Ali Zonal Administrative Pemba
Mr. Shaib Khamis Head Personnel Unit MOH&SW
Ms. Tausi Yusuf Secretary WHO – Dar es Salaam
Ms. Maryam Ali Secretary MOHSW
Ms. Tatu S. Abeid Secretary MOHSW
Mr. Hamad Ali Driver MOHSW
Mr. Abdalla Sharia Driver MOHSW
FOREWORD
The Revolutionary Government of Zanzibar continues with the implementation of ZPRP, whose
overall objective is to eradicate poverty and promote the well - being of her people.
All developing countries emphasize the poverty reduction policy and strategies in different
sectors (through chosen productive employment and the provision of basic social services
including quality health care delivery through knowledge, skills and right attitude of their human
resource as a basis for increasing productivity and overall human development).
The status of health in any country is a useful indicator of human development and therefore the
poverty levels. The implication of this fact is that health care services must be made accessible
(on an equitable basis) to all Zanzibar. In addition, it must respond or be relevant to the needs of
all persons in Zanzibar on other words the Health system must be seen to function optimally: for
this to happen Human Resource for Health Development is a critical element.
The Human Resource for Health Development Plan emphasizes on improving quality of health
care by providing the right number of health worker in the right place, at the right time, with the
right skills and motivation in line with Zanzibar Health Sector Reform guidelines.
The aim of the plan is to build HRH management capacity at district and higher-level
institutions/organizations and to strengthen the mechanism for productivity and proper utilization
of available HRH plan through integration of HMIS database with the MOH&SW.
However, the success of implementation of the HRH Plan depends on the cooperation and or
collaboration with all stakeholders including other government ministries and departments,
partners/donors and more critically, the community, which is the ultimate consumer of the health
services.
It is on this note that I invite wide participation and commitment to make this plan successful in
contributing to strengthening Zanzibar’s health system. I encourage every one to take this
document seriously as it has the full backing of the Ministry of Health and Social Welfare and
the Revolutionary Government of Zanzibar in general.
It is a homegrown initiative based on our problems and needs with interventions that will have
far reaching implications for the health of our people and the development of Zanzibar as a
whole. Together we can make a difference.
Hon. Salum Juma Othman

MINISTRY OF HEALTH AND SOCIAL WELFARE
ZANZIBAR.
ii
ACKNOWLEDGEMENT
This HRH Medium Term Plan is a result of a collaborative activity between local experts of the
Ministry of Health and Social Welfare and Consultants, Advisor and Officials from WHO,
CEDHA, Ministry of Health Tanzania Mainland and the President’s Office, Planning and
Privatisation Dar-es-Salaam.
On behalf of the Ministry of Health and Social Welfare, I would like to thank all people who
played a vital role in preparing this HRH Plan.
Their contributions were extremely valuable in helping us develop the features and content of the
document.
Last but not least, I would like to thank all Zanzibar Human Resource for Health team members
who spared their time to ensure the completion of this document.
Cooperating partners’ ideas that enriched our policy documents, strategic plans and frameworks
have greatly influenced the concepts and outlined strategies in this plan. It is our hope that
partners’ contributions in terms of ideas to improve the document and commitment to move it
forward shall be forthcoming to enable achievement of our common goals in health
development.
Dr. Omar M. Shauri

PRINCIPAL SECRETARY,
MINISTRY OF HEALTH AND SOCIAL WELFARE,
ZANZIBAR.
iii
ABBREVIATIONS
ADO - Assistant Dental Officer
AMO - Assistant Medical Officer
BSc - Bachelor of Science
CEU - Continuing Education Unit.
CHN - Community Health Nurses
CHS - College of Health Science
CO - Clinical Officer.
CSO - Civil Society Organization
CT - Computerised Tomography
DCO - Diploma in Clinical officer
DDS - Doctor of Dental Surgery
DDT - Diploma in Dental Therapist.
DEHS - Diploma in Environmental Health Sciences.
DGNM - Diploma in General Nursing and Midwifery
DGNP - Diploma in General Nursing and Psychiatry
DHMT - District Health Management Team
DMU - Drugs Management Unit
DNA - Diploma in Nursing Anesthetist
DPT - Diploma in Pharmaceutical Technician.
HMIS - Health Management Information System
HPMS - Health Personnel Management System
HRH - Human Resources for Health
HS - Hospital Secretary
MD - Doctor of Medicine
MMED - Master of medicine
MMH - Mnazi Mmoja Hospital
MO - Medical Officer
MOH&SW - Ministry of Health and Social Welfare
MSc - Master of Science
MTEF - Medium Term Expenditure Framework
NACTE - National Council for Technical Education
NCD - Non-Communicable Diseases
iv
OPD - Out Patient Department
PHC - Primary Health Care Centre
PHCU - Primary Health Care Unit
PhD - Doctor of Philosophy
PHNB - Public Health Nurse B
SASE - Selective Accelerated Salary Enhancement
SWOT - Strengths, Weaknesses, Opportunities and Threats
TB - Tuberculosis
ZHMT - Zonal Health Management Team
ZHSR - Zanzibar Health Sector Reform
ZPRP - Zanzibar Poverty Reduction plan.
v
EXECUTIVE SUMMARY
The Situation Analysis Study identified problems in a number of areas including HRH planning,
management, HRH development, HRH quality in relation to performance and HRH financing.
The HRH Policy was formulated to address the issues raised in the Situation Analysis Study and
the previous study conducted by the African Development Bank.
This five year HRH Plan has tried to translate some of the concerns addressed in the HRH Policy
and the Situation Analysis Study into implementable activities in eight priority areas, namely:
HRH Medium Term Plan, HRH Development, Retention, Quality Care at all levels, HRH Data
Base, Capacity Building for the College of Health Sciences (CHS), Mnazi Mmoja as a Referral
Hospital and Monitoring and Evaluation. The main aim of the plan is to develop the HRH by
improving their skills and management capacity that will ensure provision of quality health
services.
Interventions are proposed to:
• Disseminate and promote the HRH Medium Term Plan to stakeholders,

• Restructure the HRH Division within the Department,
• Ensure effective and efficient running of the Personnel Unit,
• Have adequate number of skilled personnel in the health sector,
• Create a conducive working environment to MOHSW staff,
• Build management and organization capacity in line with HSR/ZPRP,
• Strengthen the HRH Information System (Data Bank),
• Upgrade the knowledge and skills of CHS staff,
• Make the College of Health Sciences (CHS) recognized by NACTE and other learning
institutions,
• Ensure access to essential equipments and supplies to meet the demand of the CHS,
• Increase the CHS income,
• Increase the quality and standard of work performance at the CHS,
• Introduce incentive packages in the CHS,
• Establish an integrated Health Management Information System (HMIS) for CHS,
• Develop and transform Mnazi Mmoja Hospital (MMH) into a functional semi-
autonomous Referral Hospital,
• Increase the quality and standard of work performance at MMH,
• Build the capacity of health care workers at MMH to deliver quality health care, and
• Monitor and evaluate the HRH Medium Term Plan implementation process
The Five-year HRH Plan is estimated to cost US $ 6,438,220, and its breakdown per Priority
Area is as follows:
• HRH Medium Term Plan US $ 33,500

• HRH Development US $ 4,653,720
• Retention US $ 40,000
HRH 5-Year Plan – Ministry of Health & Social Welfare Zanzibar 1

• Quality Care at all Levels US $ 75,000
• HRH Data Base US $ 70,000
• Capacity Building for the College of Health Sciences US $ 878,000
• Mnazi Mmoja as a Referral Hospital US $ 653,000
• Monitoring and Evaluation US $ 35,000
HRH Development has taken the lion’s share of the total estimate (72.3 per cent). This is
justifiable because this priority area deals with the development of staff of the primary and
secondary levels of health care, which constitute the majority of workforce in health care
delivery.
The Medium Term Plan will require an annual average budget of US $ 1,287,644.

CHAPTER ONE
INTRODUCTION
1.0 Country Profile
Zanzibar comprise of two main Islands, Unguja and Pemba. Unguja Island covers an
area of about 1464 square kilometers and Pemba Island covers an area of about 864
square kilometers. There are five administrative regions, three in Unguja and two in
Pemba island which are subdivided into 10 districts and more than 230 Shehias, the
lowest administrative level of the government structure.
After the 1964 revolution, Zanzibar joined with the then Tanganyika to form the United
Republic of Tanzania. Zanzibar maintains its own government and is directly responsible
for all non-union affairs, including health services.
1.1 Demography
According to the 2002 Population and Housing Census, Zanzibar has a total population of
984,625 people with an annual growth rate of 3.1%1. Unguja has a population of
622,459 and Pemba has 362,166. Viewed from a gender perspective, the female
population is 502,006 while the male population is 482,610. Zanzibar is one among the
highest densely populated areas in Africa with about 370 people per square kilometre.
However, urban centres such as Zanzibar town, which is the capital of the country, have
higher density rates.
1.2 Health Service Infrastructures
Health service in Zanzibar is organized through 118 Primary Health Care Unit
(PHCU’s), 4 Primary Health Care Centre (PHCC), 3 district hospitals, Mental,
Mwembeladu Maternity home, and Mnazi Mmoja Referral Hospital.
1.3 Health Status
The life expectancy at birth for Zanzibar was estimated to be 48 years by 2002. The
infant mortality rate for Zanzibar is estimated at 83 per 1000 and for children below five
years mortality is 114.3 per 10002. Maternal mortality rate is estimated at 377 per
100,0003 live births, and continues to be high despite the numerous health service
delivery interventions.
1.4 Burden of disease

Zanzibar has documented marked increases of both communicable and non-
communicable diseases. Cardiovascular diseases and Neoplasms account for a greater
proportion of the NCD while Malaria (which accounts for more than 40% of both the
admitted as well as OPD cases) is the leading cause of morbidity and mortality in
Zanzibar.
Periodic cholera outbreaks with marked fatalities have also been documented. Like many
of the Sub-Saharan African countries, Zanzibar has also experienced slight rise of the
cumulative HIV/AIDS cases, with a general population seroprevalence of 0.6% among
the sexually active adults (MOHSW 2002) with a significant presence of predisposing
risk factors.
1.5 HRH statement in Health Policy:
The Zanzibar Health Policy, which was endorsed by the 19th session of the 5th Zanzibar
House of Representatives on the 17th day of April 2000, underscores the importance of
human resources. One of its objectives is to ensure the availability of adequate number of
skilled personnel at all levels of health care delivery. This is to be achieved through the
following strategies:
• Developing a human resource plan that meets the health services delivery plans;
• Abiding by the advice on personnel policy and regulations as set by the Government
of Zanzibar;
• Developing a training policy and plan that includes basic, post-basic training,
continuing education and induction.
1.6 Plan Purpose:
Human resources in the health sector take long periods to train and after being trained
they are characterized by high mobility. This makes it necessary to develop a human
resource plan to contribute to effective stabilization of the labour force in the sector. The
plan is more important now when the Ministry is seeking to improve the quantity and
quality of health service delivery.
In the process of implementing the Health Sector Reform, priority will be given to human
resources for health by ensuring that qualified and skilled personnel provide the services
needed at all levels.
The HRH study conducted in May/June 2003 revealed the following:
• There is improper balance, distribution and utilization of HRH at all levels of health
care delivery both in the rural and urban areas.
• There is no clearly stipulated essential health care package at all levels of care.
• There is no staffing level document (Staff Establishment) for all levels of health care
in Zanzibar.

To address the above concerns, there was justification to develop a HRH Medium Term
Plan that will ensure the availability of the right number of human resources at the right
place, with the right skills at the right time and at affordable cost.
1.7 Human Resource planning concepts:
In developing a Human Resource Plan, there are various elements that need to be
addressed in order to develop an implementable Plan. These include:
1.7.1 Human Resource Demand:Demand:

This is a requirement for specified types of staff with particular skills to carry out the
work of an organization based on its objectives. It is usually expressed as a number of
posts (staff) required at a particular time. Demand forecasting is an essential feature of
managerial decision-making. The basic questions that need to be answered include:
- Does the work need to be done?
- Are the correct numbers of employees doing it?
- Have the employees the requisite skills?
There are different ways of estimating demand. Hall T. and Mejia A. (1978) outline four
ways of estimating demand within the health sector based on:
- Health needs
- Service targets
- Health (or economic) demand
- Human resource/ population ratio
In any Human Resource Planning activity in the health sector, a mixture of these four
methods will be used. In preparing the HRH Medium Term Plan for Zanzibar, the first,
third and fourth methods were used to determine the staffing levels for the primary,
secondary and tertiary levels of health care.
1.7.2 Supply:
Supply represents the availability of the organisation’s workforce, i.e. the numbers of
people categorized by occupation, grade, level, skill etc. that are available for work now
and in the future. The basis for this is provided by human resource stock taking.
1.7.3 Human Resource Stock taking:

It involves carrying out of personnel inventory to determine the existing numbers and
deployment by level of care, cadre, grade and sex. It also involves estimating the attrition
rates for the major cadres of staff and reviewing the levels of productivity, including
coverage and anticipated expansion of health facilities.
Supply forecasting is part of Human Resource Planning. Essentially, it is about

generating predictions of the future. It is a necessary guide to the decision makers. It
enables them to influence future events by adjusting Human Resource strategies and
policies to ensure a match between human resource demand and supply that shifts the
organization forward to achieving optimum performance.

Human Resource Supply forecasting requires an understanding of how staffs move into
and out of service. The basic variables involved are:
- Recruitment
1. Direct from training
2. Transfers in
- Wastage (losses) from the organization through:
1. Emigration
2. Transfers out
3. Retirement
4. Death
Stocktaking for Zanzibar HRH was done in 2003 by conducting the Situation Analysis
Study and head count of all staff that were in post by occupation, level of education and
health facility. Supply forecasting was done by estimating the number of students who are
taking medical and health programmes at various training institutions who will be
graduating in the coming five years. These will be recruited by the various health
facilities. Other staff will be transferred in the health facilities from other organizations.
Forecasting for wastage was not done because currently, there are no ratios for the four
components for Zanzibar. A separate study is needed that will come out with such ratios.
1.7.4 Career Development:

This is an organized, planned effort consisting of structured activities or processes that
align organizational and individual goals. There are two aspects involved in this process,
namely, career planning and career management.
In career planning a deliberate effort is made to determine opportunities, choices,

consequences and constraints; to identify career related goals and programme work,
education and training to reach those goals. Career management is a process of preparing,
implementing and monitoring career plans undertaken by the individual alone or in
conjunction with the organisation’s career system. These two aspects need to be
integrated in an organisation’s development plan.
Career development is an important concept in Human Resource Planning in the sense

that it addresses individual needs as well as organizational pressures. The individual has
motivational needs, wants pay and job security and also an opportunity to grow and
develop. In terms of organizational pressure, career development can be a means of
solving certain human resource problems such as high labour turnover among
professionals and low productivity among middle level workers.
In the case of Zanzibar, a career development of the core medical cadres has been
suggested (See Annex VI). It shows the scope of the career ladder from the time of
recruitment of a worker to the time of his/her retirement.

CHAPTER TWO
HUMAN RESOURCE FOR HEALTH POLICY
2.0 General Aim of the Policy
The Ministry has developed a HRH policy which aims at addressing the HRH challenges
and issues such that a framework to achieve a balanced multi disciplinary health work
force, well trained, motivated and equitably distributed according to the health needs and
health facilities shall be developed, managed and sustained.
2.1 Policy Goals
• To contribute to poverty reduction through ensuring universal and equitable

access to primary health services,
• To align health sector human resource development plans with the health needs,
• To establish transparent human resource management functions and procedures in
accordance with the existing and future civil service procedures and regulations,
• To establish reliable financial resources mobilization mechanisms to support
training programmes for individual, community, government and collaborating
agencies.
2.2 Policy Objectives
• Provide the human resource planning mechanism and guidelines,

• Institutionalise and practice the recruitment, deployment management procedures for
HRH,
• Institutionalise the HRH quality maintenance methods,
• Create alternative mechanisms for human resource financing,
• Re-activate Professional Councils to monitor standards, ethical and discipline issues.
• Manage HRH development including career development.
2.3 The HRH Policy Priority Areas
2.3.1 Organization of the Human Resource Division

Human resource for health Division (HRD) will be established and will be responsible
for Human Resource for Health at MOHSW under the directorate of Planning and
Administration. The division will coordinate and control Human Resources for Health
policy compliance through monitoring its existing units, planning, development and
management. The division shall be headed by a duly qualified officer, and shall be
assisted by a competent team.

2.3.2 Planning
The Division of Human Resource for Health at MOHSW will be responsible for
coordinating and controlling Human Resources for Health planning and management
practices in the country. The plan shall indicate skills mix based on demand and needs,
workload, turn over and costs. The plan shall be reviewed at the end of but not later than
the 4th year in the current plan period.
2.3.3 Training
Training will ensure that human resource for Health is qualified and prepared to meet the
disease pattern and health care needs of the country.
2.3.4 Recruitment, Deployment and Management

All employees will be served with induction/orientation training upon their recruitment to
understand better job content and context. In this regard, a health personnel management
system (HPMS) shall be established and the function assigned to dully trained and
qualified staff.
The HRH management will ensure that the Personnel Information System (PIS) is used to
assist in planning for retirees’ replacement particularly for professionals and management
cadres. Other causes of attrition shall also be monitored through the PIS and replacement
action decisions taken.
2.3.5 Human Resource Quality Maintenance

The Human Resource division will coordinate the review of supervision guidelines for
each level of health facility personnel based on their competencies and working
environment.
In liaison with the Civil Service Department, the HRD will develop a transparent
performance appraisal scheme based on job objectives and develop a performance
appraisal audit mechanism to monitor the processes and their outcome.
2.3.6 Human Resource Financing

The human resource financing will attract a consortium of actors, including government,
individual, donor community and other collaborating agencies.
2.3.7 Ethics, Discipline, and Human Rights

The Professional bodies will be entrusted to compliment Civil Service regulations in the
monitoring of adherence to professional ethics, discipline, and human rights at work
places in line with the provisions of respective governing councils/boards.
2.3.8 Plan Implementation and Evaluation

The Human Resource Division will on medium term basis convene the stakeholders to
review the outcomes of plan implementation and relevance of the plan contents in line
with HRH policy.

CHAPTER THREE
HRH SITUATION ANALYSIS
3.0 Government initiatives
The Revolutionary Government of Zanzibar in her endeavor to control diseases and

manage effectively the protection of her people’s health and alleviate suffering,
developed a policy that included provision of free, accessible and equitable health
services to both urban and rural population.
Human Resource for Health has been an issue that has received significant attention in
the health care delivery system in Zanzibar in almost all post independence health policy
documents. The familiar Vision 2020 and the Zanzibar Poverty Reduction Plan (ZPRP)
have both highlighted the need to improve HR for Zanzibar and the recently approved
Health Sector Reform Strategy has specifically stressed the need for a sound HRH system
for efficient and effective delivery of health services in Zanzibar.
3.1 Successes
There have been remarkable successes as briefly outlined below:

• The primary health care facilities are in place and they fall under two categories:
PHCUs and PHCCs: There are 118 PHCUs and 4 PHCCs, (2 in Unguja and 2 in
Pemba) offering PHC services. The PHCCs act as referral centers for PHCUs. These
together form the PHC infrastructure at the lowest level. This expanded PHC
infrastructure called for expanded production of health cadres. The first line primary
Health care Units provide out patient and community health services to the population
ranging from 3,000 to 5,000 peoples. They have two beds for observation. The second
line Primary health care units are the same as first line PHCUs, but in addition they
provide laboratory and dental services. They have four beds for observation and two
beds for delivery. The primary health care centres provide health services to the
population of about 50,000 peoples. They provide in-patient and out patient services
and they are referral facilities for the first and second line PHCUs. They have 30
beds.
• The Ministry has managed to establish the College of Health Sciences (CHS) that
generates paramedical staff for the PHC levels.
• Opportunities exist for training undergraduate and post graduate Doctors,
Pharmacists, Dentists and other health cadres in Tanzania mainland and overseas
Universities. Training of Health workers to work at different levels of the health care
system started in the late 1930’s.
• The Continuing Education programme is well organized and managed, and integrates
training of all cadres in the front line. The creation of Continuing Education
Committees, Resource Centers near PHCUs and PHCCs is an example of this.
• The Personnel Information System is in place with software, which will assist the
human resource for health planning and management.

• Schemes of service for health personnel have been reviewed and implemented in
2001.
3.2 Identified Problems
3.2.1 HRH Planning

Zanzibar lacks a HRH plan drawing from a clear HRH policy. Specifically, the following
shortfalls exist:
There is no elaborate HRH Plan,

Staffing levels are not available (Staff Establishment)
Frontline health facilities still face shortages of staff in the right skills mix due to
misdistribution
HRH Personnel Information System is not regularly up-dated and the reporting system
is not in place.
3.2.2 Management
The Ministry’s organizational structure follows the traditional models of having so many
hierarchical points of authority with overlapping roles, characterized by poor
coordination.
Government rules and procedures that are in place are not well implemented. Such rules
and procedures include:
- Recruitment and selection of personnel,
- Induction/on the-job-training,
- Succession planning
- Performance management and career development,
- Codes of conduct,
- Disciplinary and grievances procedures,
- Structure and administration of remuneration and other benefits.
There is misallocation of the available HRH.
- The majority of front-line workers targeted to work at PHCUs and PHCCs are
inappropriately placed at the Referral Hospital and PHCUs that are located in
urban areas, thus negating their planned deployment.
- The human resources are deployed into specific vertical programs rather than
placed in health facilities where they can provide the services cost effectively and
in an integrated manner.
Performance appraisal guidelines are not in place and most heads of departments do not
understand the appraisal system.
Unqualified personnel fill some technical and managerial posts. This is particularly so at
PHCC, ZHMT, DHMT, and District Hospitals and even in some vertical programs. The
same situation applies at the central level.
It is not clear as to who has the final responsibilities for the HRH management function.
The socialization function is inadequately performed and seems to be unfamiliar to most
of the supervisors and their subordinates.
The political environment sometimes makes the allocation of HRH difficult.

The proposed HRH policy needs legal machinery that can compel and bind decision
makers on the issue of restructuring the Ministry.
3.2.3 HRH Development

The study has revealed that the human resource development effort is facing the following
constraints:
• The undergraduate candidates training programme for Doctors and Pharmacists is

constrained by lack of qualified candidates with proper combinations in science
subjects.
• Funds for sponsoring health personnel for undergraduate and postgraduate programs
are not disbursed as required or regularly.
• The formula for opportunity for post basic training for some cadres doesn't exist.
• The College of Health Sciences has a shortage of full time tutors in some courses and
even full time tutors are inadequately specialized. For example, Diploma holders
teach diploma students of the same discipline.
• There is delay in reviewing the curriculum for College disciplines to cope with the
advancement of Technology taking place globally.
• The College of Health Sciences has no basic academic rules in the form of College
handbook (prospectus).
• The College is lacking modern equipment such as Computer and Internet services;
telefax machine, overhead and slide projectors, and a well-equipped resource centre.
• Inadequate resources for the students at clinical areas lead to improper
implementation of the curriculum in practical sessions.
• The College is not yet registered by National Council for Technical Education
(NACTE).
• Physical infrastructure at the College of Health Sciences is inadequate.
3.2.4 HRH Quality in relation to Performance

General staff performance is sub-standard and is mainly attributed to shortage of materials
and erratic supplies and services. In addition, there is no standard guideline for staffing
levels at all work places. Staff training is on ad-hoc basis, hence leaving the majority of staff
with minimal training opportunities or uncertain as to when they will receive additional
training or retraining within the specialties they serve. Generally, the education level for staff
in most of the departments is low. The majority of the paramedical staffs have attained the
minimum basic qualification for that particular cadre i.e. certificate, with very few having
been awarded a diploma or advanced diploma.
3.2.5 Gender issues

Gender differences explain the current staff disposition in which males dominate most of the
posts in health service provision. There is increased recognition among health care providers
and researchers of the need to consider gender issues in health policy, planning, and practice.
This helps to reduce both health inequalities and to increase the efficiency and effectiveness
of health care services. The aspect of gender is important to health for a number of reasons.
These include:

• Vulnerability and illness.
• Burden of Diseases
• Health status
• Quality of care.
• Access to promotion
• Prevention and curative measures
The other factors are: health information and research, and priority for funding health
services.
The current situation in the MOH&SW is that the majority of females join the nursing
profession while males join environmental health, medical and other professions. Although
there are no specific gender disaggregated data by profession, the PIS recorded the total
number of workforce in relation to gender as shown in the table below:
MALE FEMALE TOTAL

UNGUJA 1116 1369 2485
PEMBA 594 407 1001
TOTAL 1710 1776 3486
Source MOH&SW- PIS at MOH&SW August 2004.
In the Five year HRH Plan it is proposed to consider gender balance among the professions.
There is a need to recruit more male nurses and more females in other specialties and clinical
graduate courses. These will help to bring about fairness in health care provision in the
system. There should be accurate data records in relation to gender perspective among the
professions and services provision.
3.2.6 HRH Financing

• Gross under-funding of the health service as a whole affects HRH performance.
• Low remuneration for the HRH staff, which is below minimum living standards, has
negative effect on staff performance and retention.
3.3 HRH Challenges

The problems outlined in the Human Resources for Health situation analysis that was conducted
before preparing the HRH policy and this plan pose the following challenges:
• The Zanzibar Health Sector Reform initiative requires decentralization of

management functions to the districts level that will demand a properly balanced
DHMT with the right professional skills and maturity in leadership and management.
The challenge is to develop district health management capacity at an accelerated
pace.
• This also will be applicable to the College of Health Sciences and Mnazi Mmoja
Hospital when they become semi autonomous.
• The prevailing burden of Diseases (BoD) calls for a sustained availability of duly
trained health workers at all levels of care with sufficient working tools, equipment,

and drugs. Similarly, the emerging diseases and chronic conditions such as HIV/AIDS
call for extra compliment of skills and services to keep the health system running.
• Attrition of qualified health personnel due to competitive market conditions poses the
risk of depriving the people of the badly needed health service, thereby causing
inequity, as the poor may not be guaranteed access.
• Development of HRH to the required skills is needed to comply with the HSR
Requirements. Quality of training and capacity of CHS within a resource constrain
environment is a key challenge.
• HRH Studies and Research need to be conducted to improve HRH performance.
• Establishment of comprehensive HRH Data Base is needed to facilitate accurate
management decisions.
• The urban attraction tendency for some of the PHC cadre and the difficulties
experienced in redeployment attempts affect effective functioning of Mnazi Mmoja
hospital as a tertiary referral facility.

CHAPTER FOUR
HUMAN RESOURCE FOR HEALTH PLAN AIM, OBJECTIVES AND STRATEGIES
4.0 Aim
The main aim of the plan is to develop the HRH by improving their skills and
management capacity that will ensure provision of quality health services.
4.1 Objectives
The specific objectives of the Plan are:

• To improve the quality of health care by providing the right number of health workers
in the right place, at the right time, with the right skills and motivation,
• To build HRH management capacity at district and higher level institutions/
organization for quality health care provision.
• To provide basic and post basic training program equipping HRH with knowledge,
skills and the right attitude for the implementation of the Health Sector Reform
(HSR).
• To strengthen the mechanism for equitable and proper utilization of the available
HRH.
The plan objectives address the concerns raised in the Situation Analysis. They also
translate some of the statements contained in the HRH policy into implementable
activities without losing sight of the Health Sector Reform requirements.
4.2 Priority areas
The HRH Plan has singled out 8 areas among those addressed in the HRH Policy and
Situation Analysis, and these shall be given special attention during the coming five
years. These areas include:
• HRH Medium Term Plan advocacy and promotion,
• HRH Development
• Retention
• Quality care at all levels
• HRH Data Base
• Capacity Development for the College of Health Sciences
• Mnazi Mmoja as Referral Hospital
• Monitoring and Evaluation
In each priority area, a number of interventions and strategies have been proposed that
will be applied to bring about the intended changes. According to the HSR, the College of
Health Sciences and Mnazi Mmoja Referral Hospital are expected to become semi-
autonomous. To reflect this, these two priority areas have been treated as separate
entities.

A detailed description of the activities, outputs, indicators, time frame for carrying out the
various activities and financial resources requirement, is contained in the matrix in Annex
I.
4.2.1 HRH Medium Term Plan advocacy and promotion
Intervention: 4.2.1.1 To disseminate the HRH Medium Term Plan to

stakeholders
Strategy: 4.2.1.1.1 Develop advocacy mechanisms for
sensitization of the HRH Medium Term Plan
The total cost will be US $ 33,500.
4.2.2 HRH Development
Intervention: 4.2.2.1 To restructure HRH Division within the department

(The proposed Organisational Structure of the Directorate of
Planning and Administration is shown in Annex XI).
Strategy: 4.2.2.1.1 Review the organizational structure of the
Ministry. (The current and the proposed
Organisational Structures of the MOHSW are
shown in Annex IX and X respectively).The
justification for a re-organised Ministry is given in
Annex 12.
Intervention: 4.2.2.2 To ensure effective and efficient running of the

Personnel Unit
Strategy: 4.2.2.2.1 Strengthen the Personnel Unit
Intervention: 4.2.2.3 To have adequate number of skilled personnel in the

Health sector
Strategies: 4.2.2.3.1 Strengthen the Training Unit and its
functions
4.2.2.3.2 Strengthen the Continuing Education Unit and its
functions
4.2.2.3.3 Develop the training plan for HRH. The
proposed Five Year Training Plan for PHCU,
PHCC, District Hospitals, DHMT and ZHMT is
shown in Annex 1.
4.2.2.3.4 Develop socialization system
The total cost will be US $ 4,653,720.

4.2.3 Retention
Intervention: 4.2.3.1 To create a conducive working environment to

MOHSW staff
Strategy: 4.2.3.1.1 Develop a system for job satisfaction
4.2.4 Quality care at all levels
Intervention: 4.2.4.1 To build management and organization capacity in line

with HSR/ZPRP
Strategies: 4.2.4.1.1 Ensure provision of minimum standard of
health services at all levels
4.2.4.1.2 Develop and implement comprehensive
participatory performance and evaluation system
4.2.5 HRH Data Base
Intervention: 4.2.5.1 To strengthen the HRH Information System

(Data Bank)
Strategy: 4.2.5.1.1 Update and integrate PIS into HMIS to meet
the planning, management and development needs
of HRH
4.2.6 Capacity Building for the College of Health Sciences
The College of Health Sciences is the only institution in Zanzibar that provides training
in the health sector and was officially opened in November 1989. It has a capacity of
accommodating 200 students on campus and takes 80 more students who stay off
campus. So far, 783 students have graduated from the college since its inception 14 years
ago. As a result of the Situation Analysis Study of the college, the following interventions
are being proposed to address the identified problems:
Intervention 4.2.6.1: To upgrade the knowledge and skills of the college staff
Strategy: 4.2.6.1.1 Provide short and long courses for college
staff
Intervention 4.2.6.2: To make the college recognized by NACTE and other

learning Institutions (Accreditation)
Strategies: 4.2.6.2.1 Comply with the conditions set by NACTE

4.2.6.2.2 Improve curriculum
Intervention 4.2.6.3: To ensure access to essential equipments and supplies to

meet the demand of the college
Strategy: 4.2.6.3.1 Purchase the required supplies
Intervention 4.2.6.4: To increase the College income

Strategy: 4.2.6.4.1 Introduce short courses on commercial basis
4.2.6.4.2 Introduce cost sharing
Intervention 4.2.6.5: To increase the quality and standard of work

performance
Strategy: 4.2.6.5.1 Develop and implement Participatory

Performance Approach and Performance appraisal
system
4.2.6.5.2 Adapt current schemes of services
Intervention 4.2.6.6: To introduce incentive packages

Strategies: 4.2.6.6.1 Consolidate salary and allowances
4.2.6.6.2. Develop a system of job satisfaction
Intervention 4.2.6.7: To establish an integrated HMIS

Strategy: 4.2.6.7.1 Purchase the necessary equipment and train
staff
4.2.7 Mnazi Mmoja as a Referral Hospital
Mnazi Mmoja is the main referral hospital in Zanzibar, with 400-bed capacity and 18
functional departments. The hospital also serves as a training center for the College of
Health Sciences. After conducting a head count staffing assessment and a complementary
rapid departmental analysis, three main interventions are being proposed for Mnazi
Mmoja Hospital:
Intervention 4.2.7.1 To develop and transform MMH into a functional semi-

autonomous referral institution
Strategies: 4.2.7.1.1 Formulate policy to transform MMH into a
semi-autonomous referral Hospital
4.2.7.1.2 Strengthen managerial and technical capacity of
MMH
4.2.7.1.3 Establish effective HMIS
Intervention 4.2.7.2 To increase the quality and standards of the working

environment for better staff performance and service delivery
Strategies: 4.2.7.2.1 Formulate employee performance evaluation

guideline and staff promotion schemes
4.2.7.2.2 Develop career path HR and career advancement
plans
Intervention 4.2.7.3: To build capacity of health care workers to deliver

quality health care
Strategies: 4.2.7.3.1 Develop a special training programme for
staffs on different specialties
4.2.7.3.2 Design a special workplace education
programme [continuing education]
4.2.8 Monitoring and Evaluation
The aim of Monitoring and Evaluation is to ensure that there is an effective

translation of HRH Policy and institutionalization in all sub-sectors. M &E is also
intended to assist in assessing the HRH Medium Term Plan contribution in
improving the quality of delivered services. Based on this, the MOHSW will
develop a standardized tool for monitoring and evaluation.
Intervention: 4.2.8.1To monitor and evaluate the HRH Medium Term Plan
implementation process
Strategy: 4.2.8.1.1 Develop a standardized tool for monitoring
and evaluation of the HRH Medium Term Plan
implementation
The total cost for all the priority areas is US $ 6,438,220

CHAPTER FIVE
HUMAN RESOURCE FOR HEALTH PROJECTIONS
5.0 Essential Health Care Package: Services at Each Level
The following health care services are obtained at different levels of health care facilities:
5.0.1 1st Line PHCU
• Outpatient services, which include management of STI, IMCI and other common
diseases and injuries.
• Maternal and child health services, which include growth monitoring,
immunization, antenatal, intra-natal and post-natal services
• Family planning and youth friendly services
• Health education and counselling
• Environmental health services
• Outreach services/community based health care services (including home-based
and aging health care)
The Technical Working Group has proposed that 7 workers of 6 skill mixes should man
this level of facility.
5.0.2 2nd Line PHCU
• Outpatient services, which include management of STI, IMCI and other

common diseases and injuries,
• Maternal and child health services, which include growth-monitoring,
immunization, antenatal, intranatal and postnatal services.
• Family planning and youth friendly services
• Laboratory services
• Dental services
• Health education and counselling
• Environmental health services
• Outreach services/community based health care services (including home
based and aging health care)
The Technical Working Group has recommended that this level of facility should have 11
workers mixed in 9 skills.
5.0.3 Primary Health Care Centres (PHCC)
• Outpatient services
• Inpatient services (30 beds)
• Laboratory services including blood transfusion services
• Antenatal, intranatal and postnatal services,

• Consultation of special conditions/illness e.g. surgical, medical, pediatric and
gynecological care
• Dental services
• Community health services including community based home care
• Health education
• Family planning and counselling
• Rehabilitation services
• Mental health services
• Minor surgery
For this level of facility, it has been proposed to have 53 workers with a mix of 26 skills.
5.0.4 District Hospital (Secondary Level)
• Bed capacity ranging from 80 – 120

• Outpatient services (Receiving out-patient 80 – 200 daily)
• Reproductive services 20 – 40 clients daily
• Maternal and child health complicated services from the lower facility level
• Mental health services
• Rehabilitative Health Services including physiotherapy, occupational therapy
and orthopaedic services
• Special consultation clinics i.e. obstetric and gynaecology, surgical services,
pediatric and ophthalmology
• Health education and counseling
• Outreach/community health (including home based and aging health care)
• Operational Research
• Coaching students from health training institutions, during practical and field
work attachment
The Technical Working Group has proposed that this level of facility should have 137
workers mixed in 35 skills.
5.1 Staffing Level
A staffing level guideline will be adjusted based on proposals in this plan and early
government approval shall be sought. The staffing level for the different levels of service
delivery will be reviewed regularly to reflect the prevailing circumstances. The staffing
level guideline will clearly indicate the skill mix required at all levels of health care and
the number of staff required.
The staffing level will consider criteria which are in line with the workload/ WHO
standards and working environment. The staffing level guideline will indicate the
qualification of the in charge or management team of the respective services level.

5.2 Demand and Supply
Annex 2 shows the staff position of core medical staff by cadre and by level of facility as
at June 2003 based on the Situation Analysis and head count of all staff that were in post
on that date and the staffing level proposals prepared by the Technical Working Group
(Team A, B, C, and D) formed by the Ministry of Health and Social Welfare.
The situation analysis has revealed that the skills gap is very wide for the first and second
levels of medical facilities. At the primary health care level, (see Annex II(a)) it is
observed that there are 700 employees in the core medical posts against the required 1128
employees. It is also observed that 428 posts are vacant, which is equivalent to 38 per
cent of the required posts. Although there are staff shortages in some occupations, there is
an excess of 388 employees in occupations like MCHA (147), Health Assistant (75),
Health Orderly (59), General Nurse (30), Nurse/ Midwife (18) and Public Health Nurse A
(7) occupations. Shortages of staff are significant for the Public Health Nurse B (212),
Public Health Assistant (119), Clinical Officer (101), Pharmaceutical Technician (117)
and Community Health Nurse (77) occupations.
At the secondary health care level, (see Annex II(b)), 244 core medical posts have been
filled against the 411 required posts. Some 167 posts are vacant (equivalent to 40 per cent
of the required posts), but there is also an excess of 27 workers. Occupations which have
significant shortages include the Medical Specialist (12), AMO (11), Medical Recorder
(12), Pediatric Nurse (12), PHNA (9), Theatre Nurse (10), Physiotherapist (6) and
Pharmaceutical Technician (6). Surplus workers are in the following occupations:
Laboratory technician (11), Nursing Officer (11), Radiographer (4), and Ophthalmic
Nurse (1).
A more elaborate disposition of surplus staff and staff shortage from First line PHCUs to
District Hospitals for Unguja and Pemba is shown in Annex IV(a) – IV(d).
At the tertiary health care level, Annex II(c) shows that there are 494 core medical
workers against the required 566; 72 posts are vacant (equivalent to 13 per cent) and
there is an excess of 158 workers. Significant shortages of staff are in the following
occupations: Medical Officer (18), Medical Specialist (5), Assistant Medical Officer (5),
Laboratory Technologist (9), Nursing Officer (32), Nurse A (7), Nurse/Midwife (13),
Ophthalmic Nurse (8), Orthopaedic Nurse (12) and Pharmaceutical Technician (13).
Excess staffs have been observed in the following occupations: Hospital Orderly (56),
Laboratory Technician (16), Laboratory Assistant 16), Clinical Officer (14),
Pharmaceutical auxiliary 21) etc.
The staffing position for the Government Central Laboratory, the College of Health
Sciences and the Ministry of Health and Social Welfare is shown in Annex II(d) – (f). At
the Government Central Laboratory, 30 posts, equivalent to 75 per cent of the required
core medical posts are vacant. Similarly, 34 posts or 67 per cent of the required core

academic posts at the College of Health Sciences are vacant while in the Ministry of
Health and Social Welfare, 87 posts representing 87 per cent of the required posts are
vacant.
In addition to the vacancies shown above, there are 39 posts that are held by non-citizens
in both Unguja and Pemba on contract terms (See Annex VII). These posts constitute an
additional HRH requirement because they will have to be filled by citizens when the
contracts of the non-citizens expire. There will also be gaps that will be caused by
wastage through transfers-out, retirements and deaths. Furthermore, there may be
expansion programmes of the medical facilities during the plan period that will require
additional medical staff.
In this plan, no estimate has been made for the additional staff requirement due to
expansion and wastage because data was not available. As such, this plan is basically
concerned with filling the gaps that were determined by the staffing level proposals
prepared in 2003 and the gaps that will be come when the contracts of non citizens
expire. Although the plan has confined itself to the public sector, the government will
create conducive environment for the private sector to participate fully in the provision of
health care and in the training of health personnel.
5.3 Gap filling Strategies
The projection of manpower supply to fill the identified gaps is based on the traditional
estimation of annual output from the College of Health Sciences that caters for primary
health care facilities. Annex 4 shows that from 2004/5 to 2008/9, annual output from the
College will range between 73 and 81, making a total supply of 400 graduates by 2009.
This output will not be enough to fill the skill gaps shown in Annex II(a) and II2(b).
In order to meet the great HRH demand, students from Zanzibar will be enrolled at
Medical Schools in Tanzania mainland for undergraduate and post-graduate courses.
Tanzania mainland has several health schools and Universities that offer medical courses,
while Zanzibar has only one Health School (College of Health Sciences) that offers pre-
service and in-service courses in the following disciplines:
• Diploma in General Nursing with Midwifery/Psychiatry (DGNM/DGNP),
• Diploma in Environmental Health Sciences (DEHS),
• Diploma in Clinical Medicine (DCM),
• Diploma in Community Health Nursing (DCHN),
• Diploma in Medical Laboratory Technology (DMLT), and
• Certificate in Public Health Nursing “B” (CPHN “B”)
The College is in the initial stages of introducing other courses like Diploma for
Pharmaceutical Technicians, Diploma for Dental Therapists and Diploma for Nurse
Anesthetists.
For scholarships, candidates directly apply through the Ministry of Education, Culture
and Sports in Zanzibar and the Ministry of Science, Technology and Higher Education in
Dar es Salaam for training and funding fellowships. Zanzibar graduates from institutions

of higher learning in the medical field from Tanzania Mainland and abroad come to fill
the skill gaps in the secondary and tertiary levels of health care. Since the training of
medical personnel for the secondary and tertiary level takes a longer gestation period, it
may be necessary to recruit non-citizens to fill the current gaps while the local staffs are
being trained.
Annex V gives a detailed description of the immediate and intermediate gap filling plan
and the criteria that has been used to determine the gaps to be filled.
5.4 Dealing with the Surplus Staff
The Situation Analysis Study has revealed that there is improper balance, distribution and
utilization of HRH at all levels of health care delivery, both in the rural and urban areas.
To address this problem, a coordinated mechanism to re-deploy excess personnel in the
identified areas to the understaffed health delivery points has been suggested, basing on
the manning level proposals that were prepared by Team A, B, C and D. The details of the
redeployment proposals are shown in Annex VI.
5.5 Establishment of HRH Data Base for HRH Projections
The MOHSW has established a comprehensive HRH Unit to ensure proper utilization of
up to-date information in planning and management. However, experience shows that
there is need to strengthen the existing unit to ensure proper data collection, processing,
analysis, interpretation and utilization. The HRH database will be regularly updated to
determine demand and supply and turnover of HRH. Districts, Zones, Programs and
departments/institutions shall provide quarterly and annual HRH reports to HRH
information unit to update the HRH Data Base, and in that way facilitate planning.
There will also be a need to solicit user-friendly software for forecasting HRH demand,
supply, attrition and productivity. Websites like www.workforce-logistics.com can be
contacted to solicit such software.

CHAPTER SIX
HUMAN RESOURCES DEVELOPMENT
6.0 Quality of Training
The Ministry of Health and Social Welfare (MOHSW) and the National Council for
Technical Education (NACTE) control quality at middle level technical training
institutions. These organizations set conditions for establishing learning institutions in
terms of quality and adequacy of physical infrastructure, teaching and learning materials,
equipment quality and quality of teachers, students entry qualifications, standard of
examinations and marking procedures, including curriculum for the programmes that are
offered. The other areas that are considered include courses duration and grading of
students awards.
The quality of training in the College of Health Sciences as indicated in the ZHSR has
not yet fully been met due to teaching methods, transport problems, inadequate resources
such as lack of equipment during practical sessions in hospitals or other teaching
premises. What students learn and experience in those areas does not relate with what
they are taught in the class.
The quality of examination is assured through the use of internal and external examiners
whose assessment is considered in the evaluation of students. The whole process of
marking and grading the candidates is done by examiners and then approved by the
council through the academic board of CHS.
6.1 Student selection
Selection of students is conducted by evaluation of the applicant’s basic qualification

against the entry requirements set by the College’s Academic Board. Students have to
pass the oral matriculation interview to verify their academic capabilities. In order to
undertake the programmes, the College Council approves applicants.
6.2 College accreditation
The College of Health Sciences is recognized by the MOHSW. The Ministry through
College Councils and professional bodies approves all curricula and examinations done.
The college is I the initial process of registration by NACTE. Some of the conditions to
be fulfilled for accreditation include: -
• To ensure that there are enough tutors and supporting staff with good
qualifications.
• To ensure there are adequate teaching materials and teaching aids.

• Availability of regular transport.
• Ownership of Physical infrastructures.
• Availability of Internet and other communication sources.
A training board for vetting and certification of all paramedical/allied health science
courses shall be established. For future academic development and scholarship, the
recognition of CHS by the Department of Higher Education shall be vital.
6.3 Career Development
This is an organized and planned effort to align individual and organization goals. The
individual has motivational needs, wants good pay and job security. For the organization,
career development is one of the means of solving certain HRH problems like high labour
turn over.
In this plan a career structure of the core medical cadres for PHCU, PHCC and district
hospital has been suggested, (see Annex VIII). It shows the career ladder from the time of
recruitment of a worker to the time of his/her retirement.
6.4 Pay and Rewards
The Ministry of Health and Social Welfare instituted an incentive package to its
employees. It provides the consolidated health allowance, which is paid at the rate of
30% of the salary, and professional allowances ranging from Tshs 5,000/= – 9,000/= for
Certificate and Diploma holders, 15,000 and 100,000 for Advanced Diploma and Degree
holders respectively. However, the basic salaries remain low in comparison with Tanzania
Mainland and neighboring countries.
The Ministry of Health and Social Welfare shall review the existing salary scales for all
health professions so that workers are remunerated appropriately. Incentive packages
such as:
• Professional allowance,
• House allowance,
• Leave allowances,
• Promotion, and
• Retirement benefits.
• Transport allowance
• Annual increment
should also be reviewed with the intention of improving performance.
6.5 Training Plan
The Situation Analysis Study revealed that staff training in the health sector is on ad hoc
basis and it leaves the majority of staff with minimal training opportunities. To address
this problem, a Five Year Training Plan has been developed for PHCU, PHCC, District
Hospitals, DHMTs, ZHMTs, Mnazi Mnazi Mmoja Referral and the College of Health
Sciences. The Plan has two types of Programmes, one is for short courses and the other is

for long courses (Annex I). However, before implementing the Plan there will be a need
to conduct a thorough training needs assessment because the needs may have changed.
6.6 Continuing Education
The MoHSW established the Continuing Education Programme in 1991 “to improve
educational opportunities for health workers in order to improve health care services
they provide and contribute to personal and professional growth. . .”
The present CE activities do not reach the majority of health workers of whom over 60%
are fluent in Kiswahili only, less that 50% have Form IV qualifications and 100% have
not been oriented or received training for present job responsibilities. Establishing new
approaches and programmes for self-learning, upgrading and performance evaluation are
a major focus of the MoHSW’s reform process for the Continuing Education Unit and
Human Resource Department to meet these challenges.
The main aim of the reformed CE programme is to enable the motivated health workers
to access programmes and information that can improve health care service and
performance and can create opportunities for upgrading professional roles or status.
Achieving this aim will be done in stages over a period of 3-5 years through developing
MoHSW human resource and training priorities, strengthening CEU in distance
education, establishing a learning materials production unit under the CEU and
expanding resource center educational facilities.

CHAPTER SEVEN
HUMAN RESOURCE MANAGEMENT
7.0 Deployment and Redeployment
The management of HRH in Zanzibar shall ensure that effective and efficient human
resource utilization targeting quality care provision is institutionalized. The situation
analysis revealed that performance of the human resources management and development
system is inadequate. The study also found a very heavy hierarchical system that
antagonizes effective utilization. To rectify this, clearly defined job descriptions and a
guideline on appraisal systems for delivery of quality service will be put in place.
7.1 Proper Utilization
Clear job descriptions and guidelines shall be developed for each cadre in order to
achieve quality health care and to ensure availability of the right number of human
resource with the right skills at the right place. Schemes of Services shall be prepared for
cadres that do not have by adapting the schemes used by the health sector Tanzania
Mainland to suit the prevailing situation in Zanzibar.
The HRH Division shall be responsible for analyzing inter-institutional balance and
equity of staff distribution. The Division shall also take measures to adjust imbalances
and mal-distribution by implementing the deployment and redeployment proposals
prepared by Teams A, B, C and D. (See Annex VI).
7.2 Performance Appraisal
The current performance appraisal system is not objective and task oriented. The Human
Resource Division in liaison with all Directorates and the Civil Service Department shall
put in place proper performance appraisal guidelines that are geared to productivity. The
performance appraisal shall be transparent so that employees become motivated to
measure their own achievement and satisfaction on the job.
7.3 Focal Person
In order to be successfully managed, there will be a responsible focal person (Health

Secretary) at every level (Central, Zonal, Hospital, District) to monitor and implement
HRH activities. The focal persons will be given special training in phases on how to
manage HRH issues.
7.4 Motivation
At the moment, staff motivation is not based on productivity. Future plans for improving
health staff motivation will include the following:

• Consolidation of salary and allowances to raise employees’ basic salary. This will
have a positive effect when calculating the terminal benefits.
• Identification of training needs and designing a sound training program. This will
ensure that the prioritized needs are met and are resulting from objective
performance appraisal.
• Putting in place a system of reward and promotion based on competence and
performance rather than seniority and other non-job criteria. This will motivate
people to work hard and diligently. It will also enhance employees’ morale and
commitment as there will be a clear link or relationship between the reward or
promotion and competence or performance.
• Establishment of special and attractive responsibility allowance to be paid to all
people who are given responsibility of manning key positions and difficult
stations.
• Tying promotion and training opportunities to the period of service in ‘difficult’
(remote) stations.
• Creating an advantageous proportionate salary package that assures meeting basic
needs the more peripheral (remote) one gets from the center.
• Putting in place a participatory decision-making that creates a sense of belonging.
• Introducing a system of recognition of employees’ outstanding performance,
whether individual or group innovations or contribution to the success of any
initiatives. This creates a sense of one’s discrete effort being valued.
• Introducing career development by cadre whereby each worker knows his/her
career ladder from the time he/she is recruited until retirement. The career
development for various cadres is shown in Annex VIII.

CHAPTER EIGHT
HRH FINANCING
8.0 Budget for implementing the Medium Term Plan
The proposed budget for implementing the Medium Term Plan is as a follows:
• Activities for priority Area 1……………………………US $ 33,500
• Activities for priority Area 2……………………………US $ 4,653,720
Total …………………………………………………US $ 6,438,220
The detailed budget for all the priority areas is presented in Annex I.
8.1 Source of financing
The proposed budget for implementing the plan is beyond government allocation to the
health sector. The government allocation to the health sector on an annual basis has been
ranging from sh 2,957.9 million or 5.8% of total government expenditure (1999/2000) to
sh 2,581.3 million or 8% (1997/98) while the HRH plan requires an average sum of sh
1.3 billion per annum. The current Health sector budget will therefore not be enough to
meet the total financing requirement of this plan.
In order to enhance the government’s ownership and leadership of the plan, the
government will allocate 10 percent of the HRH financing requirement annually. The
remaining financing requirement will be met through private sources by individuals
contributing to fees for their training and upgrading programmes in the local training
institutions. The government will also welcome other actors, including the private sector,
the donor community and other development partners to finance HRH.
8.2 Sustainability
Human resources development is a costly exercise. To ensure that financing of the Plan is
sustainable, the following shall be done:
• Cost-sharing activities shall be expanded and strengthened to assist in the training;
• HRH Plan shall be implemented according to the budget;
• Staff Retention Scheme shall be implemented. This will involve taking a holistic view
of reducing staff turnover by introducing a variety of initiatives to improve internal
career opportunities, supporting work-life balance and creating an attractive and
interesting working environment.

CHAPTER NINE
MONITORING AND EVALUATION
9.0 Why Monitoring and Evaluation
Monitoring and evaluation constitute the hub for governing and ensuring efficient and
effective implementation of a unified HRH Plan. It is the systematic observation and
recording of specific targets, strategies, measures, lines of actions and immediate outputs.
It is dynamic, and hence needs to be continuous. It is linked with implementation and the
data and information generated is used continuously to make adjustments to the
implementation processes.
The purpose of HRH - ME is to ensure that there is an effective HRH policy translation
and institutionalisation in all sub-sectors within the Health sector. In addition, a sound
ME will be responsive to HRH demand and supply, development and management.
Monitoring and Evaluation of HRH is also intended to assist in assessing the HRH plan
contribution to improving the quality of delivered services. Furthermore, the ME will
provide vital information that will be used to track HRH accountability and its equitable
distribution as determined by the manning level.
Based on the above, the MOHSW will develop standardised ME tools. An integrated
form of ME for Activity Reporting System for HRH interventions [with indicators and
data sources] will also be institutionalised. This plan contains output indicators and
process indicators. A rolling HRH Annual Plan will be drawn from the HRH Medium
Term Plan, and this will be fed into the Medium Term Expenditure Framework (MTEF).
The plan will be evaluated annually. However, at national level, mid-plan and end of plan
implementation evaluation will be conducted to assess outcome indicators.
9.1 Coordination of HRH activity
Given the fact that HRH activities are conducted at various levels and in different
sections within the health sector, intra-departmental coordination for HRH activities will
be vital. The internal coordination mechanism will have the following features:
a. MOHSW Technical Committee meetings quarterly and annually.
b. Consultative stakeholders meeting that involve various sectors both public and non-
public.
c. A technical platform between various stakeholders for information sharing.
In order to ensure smooth institutional performance, there is need to appoint sectoral HRH
focal persons who shall ensure that HRH issues receive appropriate attention. This will also
facilitate institutional memory and provide secretarial services to HRH activities that will
take place in each department. The focal person shall:
a. Promote networking, linkages and partnerships with other players in areas relating to
HRH,

b. Engage in resource mobilization activities for HRH in the institution,
c. Document HRH issues within the sector/sub-sector, and
d. Monitor the function of PIS and HRH management, namely: allocation, performance
appraisal and HRH financing.
9.2 Research
Research is one of the tools that are used to provide additional information on HRH
issues. Effective identification of HRH research priority areas and utilisation of research
findings will strengthen the ME and will contribute to HRH development. Research on
HRH will enable the system to identify gaps and deviation or misinterpretation of HRH
policy, documenting best practices and innovative intervention, retention and motivation,
to mention just a few. Furthermore, HRH research will assist in mapping up HRH factors
that contribute to the quality of delivered services.
The department of planning in collaboration with various research institutions [local and
international] shall ensure that researches that address functions and system performance
are promoted and institutionalized.

CHAPTER TEN
ASSUMPTIONS AND RISKS
10.0 Assumptions
The success and failure of the implementation of the Human Resource for Health
depends on the assumptions and risks on which the plan is based. The assumptions
provide the strength on which the plan is built while the risks are the threats, which the
plan tries to mitigate in order to minimize and overcome. This plan is expected to be
successfully implemented because of the existing assumptions within the Human
resource for Health area in Zanzibar.
10.0.1. Existence of Training facilities
Zanzibar has one College for Health Sciences, which trains six categories of health
disciplines. Moreover, training institutions in Tanzania Mainland provide more
opportunities for the training of all cadres that are required to fill the most important
posts in the Health system.
10.0.2 Availability of staff
All health facilities are staffed with personnel, some who can be upgraded through
training. The proposal for upgrading staff will therefore not face any problems to find
appropriated staff.
10.0.3 Recruitment, transfer and retrenchment procedures
In a process of right sizing the workforce, the implementation of the plan will be using
the existing procedures for recruitment and reattachment. The plan will only need to
support the procedures in order to expedite and make them more effective. More over the
existing process of transferring staff will be used to shift staff from areas with surplus to
those with deficits.
10.0.4 Support from Senior Management, Development partners and politicians
Their expectation is that improvement in Human Resource for Health management will
lead to improvements in health services performance as such they are determined to see
that developments is taking place in the area of Human Resource for Health. Work that
has been supported by ADB and WHO in this area is one of the evidences of
development partners’ interest.
10.0.5 Strengthening of the Department of Policy and Planning
Creation of a Human Resource for health Division through strengthening the Department
of Policy and Planning in MOHSW not only calls for shift action but requisite

competencies have to be in place within this organ. In particular, programme
management competency shall be vital to ensure the plan components are fully
operationalised.
10.1 Risks
Although there is optimism in the success of the plan, there are also some risks that need
to be addressed as the plan is being implemented. These include:
10.1.1 Constrained resource base of the Government
Government allocation to the health sector is not adequate to finance the plan. The plan
shall rely on the support of other financiers. The Advocacy and promotion element of the
plan needs to play a vital role in this area.
10.1.2 Political environment
Involvement of development partners has very often depended on the political

environment, which has varied frequently after the 1995 general elections. The support
from the development partners will depend on the continuation and consolidation of the
current political consensus.
10.1.3 Competitive Labour market
Differences in the remuneration and benefit package to health professionals in Zanzibar

vis a vis their colleagues in Tanzania Mainland may retard the pace of professionalisation
of Zanzibar health services. It is assumed that government shall put policy measures in
place to establish an adequate motivation package to address attraction, equitable
deployment and retention of health workers.
10.1.4 Slow progress in the implementation of Public Sector Reforms
Decentralisation may facilitate improvement in management of Human resource because

the workforce will be managed at the district level. Since this process is going slowly, it
is threatening the speed of implementation of the plan. The Ministry of Health will
collaborate with the Public Service Department to accelerate the on-going public sector
reforms.

BIBLIOGRAPHY
1. Zanzibar Health Sector Reforms – Strategic Plan 2002/3 -2006/7

Ministry of Health and Social Welfare, 2002
2. Zanzibar Health Sector Reforms Priority areas Action Plan 2002-03

3. Zanzibar Health Policy

4. ADB Health Development Requirement Study Phase III Report: Addendum I:

Human Resources Supply Requirements Forecast
Zanzibar, 2002
5. Situation Analysis for Human Resource for Health Zanzibar

6. Human Resource for Health Policy

7. Human Resources for Health Sector in Tanzania, A Five Year Plan

Ministry of Health, Dar es Salaam, 1996
8. Staffing levels for Health Facilities/Institutions

Ministry of Health/Civil Service Department, Dar es Salaam, 1999
9. 2002 Population and Housing Census: General Report

National Bureau of Statistics, Dar es Salaam, 2003
10. Zanzibar Poverty Reduction Plan, 2002

www.tzdoc.ortz/znz/health.doc

ANNEX I
ACTIVITIES, OUTPUT, INDICATORS, TIME FRAME AND FINANCIAL REQUIREMENT FOR EACH PRIORITY
AREA
PRIORITY AREA 4.2.1: HRH Medium Term Plan Advocacy and Promotion
OBJECTIVE 4.2.1.1: To disseminate the HRH Medium Term Plan to stakeholders

STRATEGY 4.2.1.1.1: Develop Advocacy mechanisms for sensitization of the HRH Medium Term Plan.
Activities Main Output Indicator Time Frame Financial Resources

Actor Y1 Y2 Y3 Y4 Y5 USD
Translate and print 1000 DPF& Swahili version of Number of copies translated X 2,500
copies of HRH Medium A the document in and printed
Term Plan @ 2500/= place
Conduct 6 Increased Number of meetings and X X 30,000

workshops/meetings for awareness to workshops
120 stakeholders decision makers.
(Decision makers,
technical staff,
development partners
and community) to
advocate HRH Plan
Total for 4.2.1 32,500

PRIORITY AREA 4.2.2: HRH DEVELOPMENT
OBJECTIVE 4.2.2.1: To restructure HRH Division within the department

STRATEGY 4.2.2.1.1: Review organization structure of the Ministry
Activities Main Output Indicator Time Frame Financial

Actor Y1 Y2 Y3 Y4 Y5 Resources –USD
Develop roles and DPF&A Roles and Job descriptions of staff X -
responsibilities of HRH responsibilities
division. developed
Recruit Head of HRH Head of the HRH Report of filled Vacancy X 3,000
Division division recruited
Sub Total 3,000

OBJECTIVE 4.2.2.2: To ensure effective and efficient running of personnel unit
STRATEGY 4.2.2.2.1: Strengthen the Personnel Unit
Actor Y1 Y2 Y3 Y4 Y5 Resources -USD
1. Recruit two DPF&A Qualified Number of personnel X -

qualified personnel officers recruited
personnel recruited.
officers.
2. Train one Personnel officer Number of staff trained X 10,500

personnel officer trained
at Master Degree
level.
3. Procurement of Equipment and Number of equipment and X 16,000

equipment and supplies in place supplies procured.
supplies (2 filing
cabinets, 3
computers with
accessories) for
the division
26,500
Sub Total

OBJECTIVE 4.2.2.3: To have adequate number of skilled personnel within health sector.
STRATEGY 4.2.2.3.1: Strengthen the Training Unit and its functions.
Activities Main Actor Output Indicator Time Frame Financial

Resources –USD
. Y1 Y2 Y3 Y4 Y5
Conduct 14 day DPF&A Policy and Numbers of Workshop X 8,000
workshops to guidelines updated conducted
update training
policy and
guidelines
Liaise with local DPF&A Fellowships/scholar Number of X X -
and international ships secured fellowships/scholarship
institutions to s secured.
secure
fellowships/
scholarships
Train 2 Unit DPF&A Staff trained Number of staff trained 1 1 16,000

Staff at Master
Degree level
Procure DPF&A Equipment and Number and types of X 15,000
equipment and supplies procured equipment and supplies
supplies (2 purchased
computers, 2
filing cabinet )
for the unit
Introduce Health DPF&A Health information Number of centers X 15,000
information resource center operating.
resource centers introduced
(data bank) at all
levels

Conduct 2 weeks DPF&A Training manual Numbers of Modules X 15,000
workshop to and modules and Manuals
develop training developed. documents produced
modules and
manuals for Unit
Staff.
Conduct 5 days DPF&A Marketing Numbers of strategies X 3,000

meeting to strategies documents produced
develop developed
strategies to
attract A Level
students to join
health sector
Sub Total 72,000

Strategy 4.2.2.3.2: Strengthen the Continuing Education Unit and its functions

1. Develop and DPF&A Guidelines and Guidelines and regulations X 10,000

ensure CE guidelines regulations documents
and regulations are developed
in line with human
resource policies and
plans
2. Resource CE with Qualified CE Unit strengthened X X 10,000

qualified personnel personnel
in areas of CE recruited
management,
distance education,
net-based CE and
learning materials
development
3. Establish and Central data base Central Data base X X X 5,000

maintain a central established operating
data base for
compiling, analyzing
CE information from
districts and zones
Sub Total 25,000

Strategy 4.2.2.3.2: Develop the Training Plan for HRH. The proposed Five Year Training Plan for PHCUs, PHCCs, District
Hospitals, DHMTs and ZHMTs is shown below.
SHORT COURSE FOR PHCU AND PHCC

Resources -USD
Y1 Y2 Y3 Y4 Y5
Train 130 PHC In charge for 4 ZMO Trained PHC Number of 26 26 26 26 26 26,000
weeks on Management and Unit in-charges Staff trained
Computer skills
Train 270 PHC staff for 4 weeks on ZMO Trained PHC Number of 54 54 54 54 54 54,000
information management ( Data Staff PHC Staff
Collection processing and analysis, trained
storage interpretation and utilization
Train 275 PHC staff for 2 week son ZMO Trained PHC Number of 55 55 55 55 55 50,000
community participation, to enable Staff PHC Staff
them to integrate with community trained
involvement
Train 150 staff for 3 month on DPS Trained PHC Number of 30 30 30 30 30 30,000
computer skill to manage the Staff PHC staff
development of modern technology trained
Provide on job training ( Continuing DPA Trained PHC Number of 90 90 90 90 90 10,000
Education) for 450 PHC Staff in staff PHC staff
charge on new technology, emerging trained
new health problem and medical
procedure
Conduct 4 weeks training to 300 DPA Trained Number of 120 120 120 120 120 100,000
community leaders and 200 workers community community
on Health Sector Reform and their leaders and leaders and
role in the implementation of HSR workers health
workers
trained
SUB TOTAL 270,000

LONG COURSES FOR PHCU AND PHCC

DPA AMO trained Numbers of AMO trained 2 2 2 2 64,000
Up grade ( through
training ) 8 Clinical
officer to AMO to serve
in PHCC
DPA Dental Therapist Numbers of ADO 2 2 2 1 1 64,000
Upgrade 8 Dental upgraded
Therapist to ADO
DPA Medical Doctor Numbers of Medical 2 2 160,000
Train 5 Medical trained Doctor
Doctors to Serve PHCC
(5years )
DPA Trained Clinical Numbers of Clinical 20 20 20 20 20 600,000
Train 100 clinical Officer Officers trained
officers to serve PHC
Units ( 3 years training )
DPA Health Numbers of Health 2 2 2 2 2 60,000
Train 10 Health Secretaries Secretary trained
Secretaries at Certificate trained
level ( 2 years )

DPA Specialized 3 3 3 3 3 90,000
Train 15 Nursing officer Nursing Officers Number of Specialized
in specialized nursing Nursing Officers
skills at advanced
Diploma/ BSS Nursing
( 2 years )
DPA Trained Medical Number of Trained 2 2 2 2 2 20,000
Train 10 Medical Recorders Medical Recorders
Recorders on Diploma DPA PHNB trained Number of PHNB trained 40 40 40 40 40 40,000
Train 200 PHNB to
in Medical Records ( 2
serve PHC facilities ( 2
years )
years )
DPA
DPA Trained Secretary
Community Number
Number ofof Trained
Community 16 116 116 116 116 8,000
40,000
Train
Train 480Secretary
community on Secretaries
Health Nurses Health Nurses Trained
office Management
Health Nurses to work Trained
skills
in PHC and computer
facilities (2
(stage
years ) III ) 2 years
DPA
DPA Trained
Trained Librarian Number
Number ofof Trained
Pharmaceutical 16 16 16 16 6 8,000
90,000
Train
Train 304 Librarian at
Pharmaceutical Librarian
Pharmaceutical Technician Trained
Certificate level
Technicians for PHC to serve
Technician
in PHC library
facilities ( 3 years )
DPA
DPA Trained
Trained Social
Nurse Number of Social
Trained Nurse Workers
Officer 14 14 14 4 14 16,000
140,000
Train
Train 420Social workers
Nursing Officer Workers Trained
Officer
on social welfare
on Advanced and in
Diploma
counseling at Certificate
PHC skills to cope with
level
services , community
and sectoral integration DPA Health Officer Number of Health Officer 20 20 20 20 20 12,000
Train 100 Health Officer Trained Trained
DPA Trained Dental Number of Dental 2 2 2 2 2 30,000
at Diploma
Train level
10 dental Therapist Therapist Trained
Therapist at Diploma DPA Trained Number of Laboratory 10 10 10 10 120,000
Train 40 Lab Technician Laboratory Technologist Graduated
Level
at Advanced Diploma in Technologist
Laboratory Technology
(3 years )
DPA Pharmaceutical Number of Pharmaceutical 10 10 10 10 10 120,000
Train 40 Pharmaceutical Technician Technicians
HRH 5-Year Plan – Ministry oftrained
Health & Social Welfare Zanzibar 43
Technician trained
1,252,000
SUB TOTAL
ACTIVITIES MAIN OUT PUT INDICATOR TIME FRAME COST
ACTOR
Y1 Y2 Y3 Y4 Y5 120,000
Train 30 Hospital leaders DCs Trained Hospital Number of Hospital 6 6 6 6 6
for 10 weeks on planning, leaders leaders trained.
budgeting, marketing,
management and computer
skills.
Train 20 Hospital leaders DCs Trained Hospital Number of Hospital 4 4 4 4 4 20,000
for 6 weeks on community staff on leaders trained
participation to enable them community
integrate with community. participation
(Doctors, Nurses, PHO,
Pharmacist, Social worker,
Health secretary ).
Train 3 personal secretaries DCs Trained personal Number of personal 3 3 3 3 3 25,000
annually for 6 months in secretaries secretaries trained.
office management and
computer skills.
Conduct 2 days Advocacy DCs Trained Number of 30 30 30 30 30 15,000
training on HSR for 150 community community leaders
community leaders and leaders and Health and Health workers
health workers. workers trained.
Train 12 medical recorders DCs Trained medical Number of Medical 3 3 3 3 3 10,000
and 3 Health secretaries for recorders and recorders and health
1 month on data base Health secretaries secretaries trained
computer processing and
information technology.
Train 6 kitchen staff for 6 DCs Trained medical Number of kitchen 2 2 2 5,000
weeks to acquire catering recorders and staff trained
skills to provide quality health secretaries

food for the patients.
Train 9 staff from Nursing, DCs Trained Nurses, Number of staff 3 3 3 10,000
PHO and Social worker PHO and Social trained
cadres for 4 weeks on workers.
counseling skills
Train 6 Accounts and DCs Trained account Number of account 2 2 2 10,000
supplies staff for 4 weeks and supply staff and supply staff
on financial and materials trained
management.
Provide 3 weeks refresher DCs Library staff Number of library 2 2 2 5,000
course on resource centre attended refresher staff receive refresher
for 6 library staff. course course
Train 25 staff from various DCs Trained technical Number of Technical 5 5 5 5 5 50,000
Technical Health cadres for health cadres on staff trained.
10 weeks on research research
methodology methodology.
Provide 6 weeks training to DCs Trained health Number of staff 6 6 6 6 6 50,000
30 Medical offices, Nursing staff trained
officers in charge, Hospital
secretaries and Heads of
deportments/ Sections on
Human resource planning
and management for 10
weeks.
Provide on job training on DCs On job training Number of Health 20 20 20 20 20 10,000
new technology, procedures provided staff provided with
and emerging diseases for on job training
100 staff from all health
cadres.
Sub total 330,000
LONG COURSES: DISTRICT HOSPITALS

Resources –
USD
Y1 Y2 Y3 Y4 Y5
Provide Post Graduate DPA Trained Medical Number of Staff 1 1 1 36,000
Studies ( MMED) to 3 Officers in charge trained
medical Officer Incharge
of the District Hospitals
Provide 2 year training for DPA AMO Number of Staff 1 1 1 1 1 60,000

5 AMO in the fields of Trained trained
Anesthesiology,
Ophthalmology, Radiology
and Dermatology to work
in the District Hospitals
Up grade 12 Medical DPA Upgraded Numbers of 2 3 3 2 2 144,000
Doctors to become Medical Doctors Medical Doctors
specialist in pediatrician up graded
Obs/Gyne, Orthopedic,
Surgeon and general
surgeon
Train 3 Dental Officers at DPA Trained Dental Number of Dental 1 1 1 12,000
Degree level in Dental Officers Officers trained
Surgery for District
Hospitals
Train 2 ADO at Advanced DPA Trained ADO Numbers of ADOs 1 1 8,000
Diploma level in Dental trained
Services
Train 3 Dental Technician DPA Trained Dental Number of Dental 1 1 1 12,000
at Advanced Diploma level Technicians Technicians
in Dental Technician trained
Train 4 Dental Therapist at DPA Trained Dental Numbers of Dental 1 1 1 1 16,000

Diploma level Therapist Therapist trained
Train 4 Health Secretary at DPA Health Secretary Number of Health 1 1 1 1 36,000
Advanced Diploma level (3 trained Secretary trained
years )
Up grade through training DPA Personnel Numbers of 2 2 2 18,000
6 Typist to personnel Secretary Trained Personnel
Secretary position Secretary Trained
Train 12 Medical DPA Trained Medical Numbers of 3 3 3 3 36,000
Recorders in the Diploma Record Medical Record
in Medical Record Trained
Train 4 Social workers on DPA Trained Social Numbers of Social 2 2 16,000
Diploma in Social Welfare Workers Workers Trained
Train 3 librarian in DPA Trained Numbers of 1 1 1 8,000
Certificate in library Librarians Librarians Trained
services
Train 4 Pharmacist at 1st DPA Trained Numbers of 2 2 48,000
Degree level pharmacists Librarians Trained
Train 6 Pharmaceutical DPA Trained Numbers of 2 2 2 54,000
Technician at Advanced Pharmaceutical Pharmaceutical
Diploma Level Technician Technician Trained
Train 6 Hospital DPA Trained Hospital Numbers of 2 2 2 18,000
technician at Certificate Technician Technicians
level trained

D PA Trained Number of Physiotherapist 2 2 2 54,000
Train 6 Physiotherapists on Physiotherapist trained
Advanced Diploma in
physiotherapy
DPA Trained Number of Occupational 2 2 2 18,000
Train 6 occupational Occupational therapists trained.
therapists at certificate level in Therapist
occupational therapy
DPA Trained Number of Orthopedic 1 1 1 1 36,000
Train 4 Orthopedic Orthopedic Technicians Trained
Technicians at Advanced Technician
Diploma level in Orthopedic
Technician
DPA Trained Public Number of Public Health 5 5 30,000
Train 10 Public Health Nurses Health Nurses Nurses Trained
Grade A at Advanced Diploma
level in PHNA
DPA Nursing officer Number of nursing officers 2 2 2 2 24,000
Train 8 Nursing Officer on trained trained
Advanced Diploma /BSS in
specialized Nursing
Discipline
DPA PHNB Trained Number of PHNB Trained 2 2 2 6,000
Train 6 PHNB at certificate
level
DPA Pediatric Nurses Number of Pediatric 4 4 4 4 48,000
Train 16 Nurses to specialized trained Nurses trained
in pediatric Nursing at
Advanced Diploma level

DPA Theater Nurses 2 2 2 2 2 120,000
Train 10 Nurses to trained Number of theater Nurses
specialize in Theater trained
Nurses at Advanced
Diploma level
SUB TOTAL 858,000
SHORT COURSES FOR DHMTs
ACTIVITY MAIN OUT PUT INDICATOR TIME FRAME COST

ACTOR
1 2 3 4 5
Train DHMT members on Director Trained DHMT Number of DHMT 12 12 12 12 12 157,800
information management Preventive Members members trained
skills budgeting and budget Services
control, Human Resources
planning and management
(10 weeks).
Office management skills Director Trained DHMT Number of DHMT 12 13 12 13 12 52,150
(6weeks) Preventive Members Members Trained
Services
Research methodology Director Trained DHMT Number of DHMT 12 12 12 12 12 107,400
skills (6weeks) Preventive Members members trained
Services
Counseling skills (6weeks) Director Trained DHMT Number of DHMT 12 12 12 12 12 107,400
Preventive Members members trained
Services
Community participation Director Trained DHMT Number of DHMT 12 12 12 12 12 82,200
skills (4weeeks) Preventive Members members trained
Services

Up date courses related to Director Updated Course Number of courses 12 12 12 12 12 107,400
technical professional Preventive updated
matters Services
SUB TOTAL 614,350
LONG COURSES FOR - DHMTs
ACTIVITY MAIN OUTPUT INDICATOR TIME FRAME COST

ACTOR
1 2 3 4 5
Train 10 AMOs at degree Director, Trained DHMT Number of AMOs 2 2 2 2 2 420,000
level and MPH and Preventive members trained
promote them to DMO Services
(1) MD: 8000 x 3 x 10
(2) MPH: 9000 x 2 x 10
Upgrade 10 District Director, Upgraded Number of District 2 2 2 2 2 60,000
Nursing Officers with Preventive DHMT members Nursing Officers
Advanced Diploma/BSc Service upgraded
Nursing
2000 x 3 10
Train 10 District Health Director, Trained District Number of District 2 2 2 2 2 60,000
Secretaries at Advanced Preventive Health Health Secretaries
Diploma Level Service Secretaries trained
Train 10 District Director, Trained District Number of District 2 2 2 2 2 60,000
Environmental Health Preventive Environmental Environmental Health
Officers at Advanced Service Health Officers Officers trained
Diploma level
Sub-total 600,000

SHORT COURSES FOR ZONAL HEALTH MANAGEMENT TEAMS (ZHMT)
ACTIVITY MAIN ACTOR OUT PUT INDICATOR TIME FRAME COST

Y1 Y2 Y3 Y4 Y5
Train ZHMT members Director Trained ZHMT Number of ZHMT
on :- Preventive members members trained
 Human resources Services
planning and
management,
information
management
budgeting and 6 6
budget control and
computer skills (10
weeks) 31,560
 Research Director Trained ZHMT Number of ZHMT
methodology (6 Preventive members members trained 2 3 3 2 2 21,480
weeks) Services
 Community Director Trained ZHMT Number of ZHMT
participation (4 Preventive members members trained 3 2 2 3 2 16,440
weeks) Services
 Counseling (6 Director Trained ZHMT Number of ZHMT 2 3 2 2 3 21,480
weeks) Preventive members members trained
Services
Office management Director Trained ZHMT Number of ZHMT 3 3 3 3 3 10,430
(6weeks) Preventive members members trained
Services
Updated courses related Director Up dated Course Numbers of Courses 2 3 2 3 2 21,480
to technical processional Preventive updated
matters(6weeks) Services
SUB TOTAL 122,870

LONG COURSES FOR ZONAL HEALTH MANAGEMENT TEAMS (ZHMT)
ACTIVITY
Provide M.P.H. MAIN
DPA OUT PUT INDICATOR
Trained District Number of DistrictTIME
2 FRAME
2 2 2 COST
2 120,000
training to 10 ACTOR Medical Officers Medical officers
medical officer to trained Y1 Y2 Y3 Y4 Y5
Train 2 Zonal
works MDOs DPA Trained Zonal Number of 1 1 24,000
Medical officers Medical officers Medical officers
Train 10 Nursing DPA Trained District Number of District 2 2 2 2 2 80,000
on Masters in trained
officer at advanced Nursing Officers Nursing officers
Public Health
diploma/Bsc to trained
(MPH)
work as district
Train 2 Nursing DPA Trained Zonal Number of 1 1 24,000
nursing officers
officers on Msc in Nursing officers Nursing officers
Train
Nursing10 Health DPA Trained District
trained Number of District 2 2 2 2 2 80,000
officers at advanced
Train 2 Health DPA Environmental
Trained Health Number of Environmental 24,000
diploma /degree
Secretaries at in Officers
Secretaries Health Health officers 1 1
environmental
Masters level in Secretaries trained
health
Healthlevel to serve trained
as district
Administration
environmental
Train 2 DPA Trained Number of 1 1 48,000
health officer
Environmental Environmental Environmental
Health10officers
Train Healthat DPA officers Trained Health
officers trained
Number of Health 2 2 2 2 2 80,000
Advanced
Secretaries at Secretaries Secretaries trained
diploma/Degree to
Advanced
serve as Zonal
Diploma/Degree
Environmental
level in health
officers.
Administration to
serve the District
SUB TOTAL 480,000
TOTAL for 4.2.2 4,653,720

PRIORITY AREA 4.2.3: RETENTION
OBJECTIVE 4.2.3.1: To create conducive working environment to MOHSW staff

STRATEGY 4.2.3.1.1 Develop a system for job satisfaction

Introduce Credit DPF&A Credit schemes Type of credit schema X 10,000
Schemes. introduced
Review salary structure. “ Salary structure Salary Structure X 7,500

reviewed. document
Introduce rewards and “ Reward and Reward and X 10,000

recognition system recognition recognition system
based on performance. system document
“ introduced.
Introduce SASE. “ SASE introduced. SASE document X 7,500
Develop & advocate “ HRH career Types of HRH career X 5,000

career ladder & open ladder developed ladder in place.
system of promotion to
HRH.
TOTAL for 4.2.3 40,000

PRIORITY AREA 4.2.4: QUALITY CARE AT ALL LEVELS
OBJECTIVE 4.2.4.1: To build management and organization capacity in line with HSR/ZPRP
STRATEGY 4.2.4.1.1: Ensure provision of minimum standard of health services at all levels

Recruit consultant to DPF&A Consultant Consultant Report X 5,000
develop guidelines for recruited.
minimum service Guidelines
standard per level of developed.
health care
Train 50 Health Training Number and type of

Management Team conducted team members trained X X X X X 25,000
member on minimum
services standards
SUB TOTAL 30,000

STRATEGY 4.2.4.1.2: Develop and implement a comprehensive participatory performance approach and evaluation system

Conduct 10 days work DPF&A Performance Appraisal tool X 10,000
shop to develop appraisal tools document
performance appraisal developed.
tool based on Job
Description,
professional ethics and
civil services
regulations.
Conduct 5 training “ Training Report of the training X 15,000

sessions for appraisers conducted. sessions
and appraisees on the
tools, processes and
outcome of
performance appraisal.
Conduct 2 days meeting “ Responsibility Report of the meeting. X X X X X 10,000

assign responsibility and assigned.
schedule performance to
appraisal audit team.
Conduct 5 meetings to “ Advocacy Report of the meetings X 10,000

advocate the system to conducted. conducted.
the stakeholders.
SUB TOTAL 45,000

TOTAL for 4.2.4 75,000

PRIORITY AREA 4.2.5: HRH DATA BASE
OBJECTIVE 4.2.5.1: To strengthen the HRH information system (data bank)

STRATEGY 4.2.5.1.1: Update and integrate PIS into HMIS to meet the planning, management and development needs of HRH

Retrain 10 Unit staff to DPF&A Retrained Unit staff Number of skilled X X X X X 15,000
advanced level. personnel trained.
Procure equipment and Equipment and Equipment and X X 20,000

Supplies (Soft and Hard supplies procured supplies in place.
ware)
Establish net work Network established. Types of network X X X X 25,000

system on HRH data system established.
base (Intra net and inter
net)
Conduct 5 days Guidelines developed Document of the X X X 10,000

workshop to develop Guidelines
guidelines for collection
and usage of data.
Printing of Guidelines
TOTAL for 4.2.5 70,000

PRIORITY AREA 4.2.6: CAPACITY BUILDING FOR THE COLLEGE OF HEALTH SCIENCES
OBJECTIVE 4.2.6.1: To upgrade the knowledge and skills of college staff

STRATEGY 4.2.6.1.1: Provide short and long courses for college staff
Short courses
Activities Main Output Indicators Time Frame Financial
Actors Y1 Y2 Y3 Y4 Y5 Resources
–USD
Train 1 tutor for 4 weeks on human resources, planning CHS Tutors trained Number of 1 3,000
and Development tutors trained
Train 2 tutors in Management Information System CHS Tutors trained Number of 1 1 6,000
tutors trained
Train 16 tutors for 4 weeks in Computer Sciences CHS Tutors trained Number of 3 3 4 3 3 48,000
tutors trained
Train 1 tutor for 4 weeks in planning, budgeting and CHS Tutors trained Number of 1 3,000
budgetary control tutors trained
Train 8 tutors in planning, monitoring and evaluation CHS Tutors trained Number of 1 2 2 2 1 24,000
tutors trained
Train 3 tutors for 4 weeks in community participation CHS Tutors trained Number of 1 1 1 9,000
skills tutors trained
Train 5 tutors for 4 weeks in research methodology CHS Tutors trained Number of 1 1 1 1 1 15,000
tutors trained
Train 1 tutor for 4 weeks in health learning materials CHS Tutors trained Number of 1 3,000
tutors trained
Train 2 tutors for 4 weeks in Development of IEC CHS Tutors trained Number of 1 1 6,000
materials tutors trained
Train 2 supporting staff for 4 weeks in higher personnel CHS Staff trained Number of 1 1 4,000
staffs trained
Train 2 supporting staff for 4 weeks in Office CHS Secretaries Number of 1 1 4,000
Management trained staffs trained

Train 2 Managers on Health Management Institution cause CHS Manager Number of 1 1 6,000
3 month trained manager
trained
Train 1 tutor for 4 weeks in information and management CHS Tutors trained Number of 1 6,000
tutors trained
Train 1 tutor for 4 weeks in Health Economics CHS Tutors trained Number of 1 6,000
tutors trained
SUB TOTAL 143,000
Long courses
Actors Y1 Y2 Y3 Y4 Y5 Resources – USD
Train 10 tutors in Diploma in Health CHS Tutors trained Number of tutors 2 2 2 2 2 90,000
Personnel Education trained
Train at degree level, 8 Nurse tutors in CHS Tutors trained Number of tutors 2 2 2 1 1 96,000
nursing specialties trained
Train at degree level 2 Environmental CHS Tutors trained Number of tutors 1 1 24,000
Health tutors in Public Health trained
Train at degree level 2 Medical CHS Tutors trained Number of tutors 1 1 24,000
Laboratory tutor in med, lab. Sciences trained
Train at degree level 2 pharmaceutical CHS Tutors trained Number of tutors 1 1 24000
tutors trained
Train at degree level 1 dental tutor in CHS Tutors trained Number of tutors 1 12,000
dentistry trained
Train at degree level 2 CHN tutors in CHS Tutors trained Number of tutors 1 1 10,000
community health trained
Train at Masters level 1 Nurse tutor in CHS Tutors trained Number of tutors 1 7,000
Nursing trained
Train at Masters level 1 EHO tutors in CHS Tutors trained Number of tutors 1 7,000
Public Health trained

Train at Masters level 1 Medical CHS Tutors trained Number of tutors 1 7,000
Laboratory tutor in medical laboratory trained
science
Train at Masters level 1 pharmaceutical CHS Tutors trained Number of tutors 1 7,000
science tutor in Pharmacy trained
Train at Masters level 1 dental tutor in CHS Tutors trained Number of tutors 1 7,000
dentistry trained
Train at Masters level 1 CHN tutor in CHS Tutors trained Number of tutors 1 7,000
community participation skills trained
Train at Masters level 1 tutor in CHS Tutor trained Number of tutors 1 7,000
Medical Education trained
Train at Diploma level 1 supporting CHS Accountant Number of 1 9,000
staff in accountancy trained accountants
trained
Train at Diploma level 1 support staff CHS Store keeper Number of store 1 9,000
in stores management trained keepers trained
Train Manager at degree level in CHS Administrative Number of staffs 1 12,000
management/administrative officer Officer trained trained
Train at degree level 1 Librarian in CHS Librarian Number of 1 12,000
library services trained librarians trained
SUB TOTAL 281,000

OBJECTIVE 4.2.6.2: To make the College recognized by NACTE and other learning institutions
STRATEGY 4.2.6.2.1: Comply with the conditions set by NACTE
Actors Y1 Y2 Y3 Y4 Y5 Resources
Recruit 17 tutors with the required CHS Tutors recruited Number of tutors 1 X
qualifications recruited
Provide equipment necessary for CHS Equipment for Number of X 10,000
communication system communication communication
System provided equipments
Monitor and evaluate periodically CHS Evaluation & Monitoring and X X X X X 25,000
training provided evaluation done Evaluation
reports
SUB TOTAL 35,000
STRATEGY 4.2.6.2.2: Improve curriculum

Commission consultant to review CHS Consultant Consultant Report 1 5,000
current curriculum commissioned
Conduct 3 days workshop to CHS Workshop Workshop Reports 1 6,000
discuss consultancy report conducted
Prepare curriculum of 12 courses CHS Curriculum Curricula documents 1 5,000
prepared
SUB TOTAL 16,000

OBJECTIVE 4.2.6.3: To ensure access to essential equipment to meet the demands of the college
STRATEGY: 4.2.6.3.1: Purchase the required supplies
Actors Y1 Y2 Y3 Y4 Y5 Resources –USD
Purchase 10 computers with CHS Computers Number of computer 5 5 15,000
accessories purchased purchased
Purchase Stationeries ( Package ) CHS Stationeries Report of stationery 1 1 1 1 1 20,000
purchased purchased
Purchase learning equipments for CHS Equipment Number of purchased X X X X X 220,000
all cadres DDA DEHS DGNM purchased learning equipment
DGNP+CO DPT DCM
SUB TOTAL 255,000
OBJECTIVE 4.2.6.4: To increase college income

STRATEGY 4.2.6.4.1 Introduce short courses on commercial basis
Commission consultant to conduct CHS Market Survey Number of X 5,000
market survey on marketable conducted Market Survey
courses done
Conduct 3 days workshop to CHS Workshop Number of X 3,000
discuss the Consultant’s report conducted Workshop
conducted
Conduct 14 days workshop to CHS Curricula prepared Number of X 10,000
Prepare curricula for marketable Workshop
courses conducted
SUB TOTAL 18,000

STRATEGY 4.2.6.4.2: To introduce cost sharing

Actors Y1 Y2 Y3 Y4 Y5 Resources –USD
Conduct 10 days study to CHS Study conducted Numbers of X 10,000
determine peoples’ ability to share Studies Study
the cost conducted
Conduct 14 days workshop to CHS Number/types Number of X 10,000
Prepare the cost sharing guideline prepared Guideline
and disseminate it prepared
SUB TOTAL 20,000
OBJECTIVE 4.2.7.2: To increase the quality and standard of work performance

STRATEGY 4.2.7.2.1: Develop and implement participatory performance and performance appraisal system
Actors Y1 Y2 Y3 Y4 Y5 Resources-USD
Develop performance appraisal tool CHS Performance Types of X 5,000
based on Job Description, appraisal tool Appraisal
professional ethics and civil developed developed
services regulations
Train appraisers and those to be CHS Training conducted Number of staff X X X X 10,000
appraised on the tools, processes trained
and outcome of performance
appraisal.
Assign responsibility and schedule CHS Responsibilities Audit teams X X X X 4,000

performance to appraisal audit assigned schedule
team. assigned
responsibility

Advocate the system to the CHS Advocacy done System X X X X 5,000
college staff advocated
SUB TOTAL 24,000
STRATEGY 4.2.6.5.2: Adapt current schemes of service

Conduct 5 days meeting to Review CHS Review conducted Numbers of X 3,000
the current schemes of services meeting
Conduct 5 days workshop to CHS Schemes of Types of Schemes X 5,000
Prepare schemes of services for services reviewed prepared
cadres that do not have
SUB TOTAL 8,000
OBJECTIVE 4.2.6.6: To introduce incentive packages

STRATEGY 4.2.6.6.1: Consolidate salary and allowances
Actors Y1 Y2 Y3 Y4 Y5 Resources- USD
Conduct 5 days meeting to Analyze CHS Current salary Number of X 5,000
the current salary structure structure analysed meeting
Conduct 14 days workshop to CHS Salary scales Number of X 8,000
Review the salary scales reviewed workshop
SUB TOTAL 13,000

STRATEGY 4.2.6.6.2: Develop a system for job satisfaction

Introduce rewards and recognition CHS Reward and Number of staff X 5,000
system based on performance recognition Reward
system introduced
SUB TOTAL 5,000
OBJECTIVE 4.2.6.7: To establish an integrated HMIS

STRATEGY 4.2.6.7.1: Procure the necessary equipment and train staff

Conduct 2 weeks needs assessment CHS Survey conducted Survey Report X 5,000
survey
Purchase equipment needed 20,000
Train 2 staff to manage HMIS CHS Staff trained Number of staff 2 15,000
trained
Expand the current network system CHS Network expanded Number of rooms X X X X X 20,000
with network
SUB TOTAL 60,000

TOTAL for 4.2.6 878,000

PRIORITY AREA 5.8: MNAZI MMOJA AS A REFERRAL HOSPITAL
Objective 4.2.7.1: To transform MMH into a functional semi-autonomous Referral institution

Strategy 4.2.7.1.1: Formulate policy, laws and regulations for transforming MMH into a semi-autonomous hospital

Y1 Y2 Y3 Y4 Y5 Resources –USD
Conduct advocacy Conducted Number of X 2,000
campaigns for MMH Hospital advocacy advocacy
semi- autonomy director campaign campaigns
conducted
Conduct 10 days Hospital Workshops Numbers of X 15,000
policy formulation director conducted workshop
w/shop for MMH conducted
Conduct 3 days Hospital Endorsement Numbers of X 500
meeting to table director Meeting meeting conducted
policy document to conducted
relevant authority for
discussion and
endorsement
Formulate an act to Hospital MMH act enacted Numbers of Act X 1,500
translate and director formulated
reinforce the policy
SUB TOTAL 19,000

Strategy 4.2.7.1.2: Strengthen managerial and technical capacity of MMH.

Y1 Y2 Y3 Y4 Y5 Resources -USD
Conduct 7 days workshop to Hospital Management Type of Management tool X X 10,000
Formulate management Director tools formulated
tools [i.e. staffing guidelines; DHS formulated
administrative/management;
motivation schemes,
performance /monitoring and
evaluation guidelines,].
Train 10 departmental staff DHS Staff trained Number of trained staffs X 5,000
on formulated guidelines. on formulated
of guidelines
SUB TOTAL 15,000

Objective 4.2.7.2: To increase the quality and standards of working environments for better staff performance and service
delivery
Strategies 4.2.7.2.1: Formulate employee performance evaluation guideline and staff promotion schemes.
Activities Main actors Output Indicators Time Frame Financial
Resources -
USD
Y1 Y2 Y3 Y4 Y5
Conduct tripartite [labour DCS Consultative Report of the X X 10,000
commission, trade union, meetings Consultative
hospital administration] conducted Meetings
consultative meeting for the
formulation of staff
performance and promotion
guidelines
Conduct two days appraisal DCS Numbers of Workshop report X 5,000
workshops on performance workshop
and promotion guidelines. conducted
Train sectional head on DCS Trained Number of X X X X 8,000
performance and promotion sectional head sectional head
guidelines trained
Produce and distribute DCS Guideline Guidelines X X X X 2,000
performance and promotion distributed document
guidelines
SUB TOTAL 25,000

Strategy 4.2.7.2.2: Develop career path and career advancement plans

Resources -
Y1 Y2 Y3 Y4 Y5 USD
Conduct staff’s needs assessment Head Admin & Needs identified Assessment X X X X 5,000
finance report.
Design HR career path and Head Admin & Career path and HR career X X X X 5,000
advancement plans. finance advancement path/plans
plans developed document
Advocate for the developed Hospital Director Advocate on Advocacy Report X X X X 3,000
plans career
development
Plan done
Educate HCW on career path. Medical HC W educated Number of HCW X X X X 3,000
superintendent on career path educated
SUB TOTAL 16,000

OBJECTIVE 4.2.7.3.: To build capacity of health care workers to deliver quality health care.
STRATEGYS 4.2.7.3.1 Develop a special training programme for core medical staffs on different specialties

Resources -
Y1 Y2 Y3 Y4 Y5 USD
Review and update cadre DCS Training needs Types of training X X X X X 2,000
specific training needs updated needed
Prepare comprehensive DCS Comprehensive Training plan X X X X X 20,000
training plan plan in place
Prepare booklet [directory] DCS Training Training directory X X X X X 1,000
on training for cadre specific directory in use
priorities
Solicit funds for training DCS Funds solicited Number of types X X X X X 20,000
of advocacy
sessions
Affiliate with interested DCS MMH affiliated Number of X X X X X 5,000
training institutions to training training
institution affiliations.
Organise long term training DCS Health care Number of X X X X X 400,000
of care workers to various workers trained trained HCW
institutions (see below)
SUB TOTAL 448,000

INTERNAL MEDICINE
TIME FRAME
CADRE NO IN TRAINEE QUALIFICATION
1 2 3 4 5
Neurologist 1 MMED 1
Dermatologist 1 MMED 1
Endocronologist 1 MMED 1
Physician 1 MMED 1
Chest & TB Specialist 1 MMED 1
MO 16 Doctor of Medicine 4 3 3 3 3
Counselor 1 Counseling 1
Nursing Officer 4 Nursing and Management with 1 1 1 1

Computer Skills
Nurse Psychiatrist 4 Advanced Diploma in Psychiatric 2 2
Nursing

OBS/GYNAECOLOGY
TIME FRAME
1 2 3 4 5
Gynaecologist 2 MMED 1 1
AMO 6 Advance Diploma in clinical Medicine 1 2 1 1 1
Clinical Officers 3 Diploma in Clinical Medicine 1 1 1
Nursing Officer 4 Advanced Diploma in Midwifery 1 1 1 1
RADIOLOGY
TIME FRAME
1 2 3 4 5
Radiologist 1 MMED 1
MO 4 Doctor of Medicine 1 1 1 1
FSW GYNER
TIME FRAME
1 2 3 4 5
Nurse Midwife 2 Advanced Diploma in Midwife 1 1

PATHOLOGY
TIME FRAME
1 2 3 4 5
Pathologist 2 MMED in Pathology 1 1
Laboratory Technologist 2 Advance Diploma in Lab 1 1

Science
ORTHOPAEDIC
NO IN TIME FRAME
CADRE QUALIFICATION
TRAINEE 1 2 3 4 5
Orthopedic surgeon 2 MMED 1
MO 2 Doctor of Medicine 1
Orthopedic Nurse 4 Advanced Diploma in Orthopaedic 1 1 1 1 1

Nursing

DENTAL
NO IN TIME FRAME
CADRE QUALIFICATION
TRAINEE 1 2 3 4 5
Specialist Dental 2 MMED in Oral Surgery 1 1
surgeon
Specialist Dental 1 MMED in Paedontist 1 3
surgeon
Dental surgeon 4 Doctor in Dental surgery 1 1 1 1
Dental Technicians 2 Advanced Diploma in Posthodontics 1 1
Dental Attendant 3 Diploma/ Certificate 1 1 1
PHARMACY
TIME FRAME
1 2 3 4 5
Pharmacist 5 Bachelor of Pharmacy 1 1 1 1 1
Pharmaceutical 13 Diploma in Pharmaceutical 4 3 3 3

Technician Technician
Specialist Pharmacist 2 M Pharm. In Hospital pharmacy. 1 1

ENT DEPARTMENT
TIME FRAME
1 2 3 4 5
ENT Surgeon 2 Mmed 1 1
MO 2 Medical Doctor 1 1
OPTHTHALMIC
TIME FRAME
1 2 3 4 5
MD Ophthalmology 2 Mmed 1 1
MO 4 Medical Doctor 1 2
Ophthalmic Nurse 2 Advanced Diploma in Ophthalmic 1 1

Nursing
Optician 1 Optician Certificate 1

PHYSIOTHERAPY
TIME FRAME
1 2 3 4 5
Specialist 2 MMED 1
Physiotherapist
MD Occupation 2 Advance Diploma in Occupation 1 1
therapist Therapy
Physiotherapist 6 Advanced Diploma in Physiotherapy 1 2 3
Speech therapist 2 Advance Diploma in Speech Therapist 1 1
Orthopaedic Technician 7 Orthopaedic Technician 3 2 2

Nurse
ANAESTHESIA
TIME FRAME
1 2 3 4 5
Anaesthetist 2 Mmed in Anaesthezia 1 1
MO 2 Doctor of Medicine 1 1
Anaesthetic AMO 9 Advance Diploma/Diploma in 2 1 2 3 1

&Nurse Anaesthesia
THEATRE
NO IN TIME FRAME
CADRE QUALIFICATION
TRAINEE 1 2 3 4 5
Theatre Midwife 17 Advanced Diploma in Theatre Management 3 5 2 3 4

PAEDIATRIC
TIME FRAME
1 2 3 4 5
Paediatrician-MD 2 Mmed in Paediatrict 1 1
Neonatologist MD 1 Mmed in Neonatology 1
MO 2 Doctor of Medicine 1 1
Paediatric Nurse 24 Advanced Diploma in Paediatric 5 5 5 5 4

Nursing
SURGICAL DEPARTMENT
CADRE NO IN TRAINEE QUALIFICATION TIME FRAME
1 2 3 4 5
Urologist 2 Mmed in Urology 1 1
Paediatric Surgeon 1 Mmed in Paediatric Surgery 1
MO 4 Doctor of Medicine 1 1 1
Nurse Midwife 2 Advanced Diploma in Nursing 1 1

Strategy 4.2.7.3.2: Design a special workplace education programme

Resources -
Y1 Y2 Y3 Y4 Y5 USD
Design department-specific Medical Departmental Number of X X X X X 5,000
on job Continuing Education superintendent CEU departments with
[CEU] training programmes programmed CEU.
designed
Facilitate distance learning Medical Distance Number of HCW X X X X X 2,000
education superintendent learning in enrolled in
place distance
Create documentation center Medical Functional Number of HCW X X X X 100,000
superintendent documentation accessing
centre in use documentation
services.
Set up a newsletter editorial Hospital Director Newsletter Well functional X 3,000
board editorial board board in place
in place
Produce MMH newsletter Hospital Director Newsletter and Number of X X X X 20,000
and other learning materials other learning newsletters
materials produced
produced
Sub total 130,000
TOTAL FOR 4.2.7 653,000

PRIORITY AREA 4.2.8: MONITORING AND EVALUATION
OBJECTIVE 4.2.8.1 To monitor and evaluate the HRH Medium Term Plan implementation process
STRATEGY 4.2.8.1.1 Develop a standardized tool for monitoring and evaluation of the HRH Medium Term Plan
implementation

Conduct 5 days DPA M&E guidelines Types of guidelines X 5,000
workshop to develop developed. developed
monitoring and
evaluation guidelines.
Conduct 3 days meeting DPA HRH master plan Number of Meeting X X X X X 30,000
to review HRH Medium reviewed
Term plan annually and annually and
at mid-term. midterm.
TOTAL for 4.2.8 35,000
Grand Total 6,438,220

ANNEX II (a)
HRH SITUATION AS AT JUNE 2003
(a) CORE MEDICAL OCCUPATIONS AT PRIMARY LEVEL (PHCUs and PHCCs)
No OCCUPATION REQUIRED CURRENTLY IN POST DEFICIT/ SURPLUS
1 Medical Officer 4 0 4
2 Clinical Officer 126 25 101
3 Hospital Secretary 4 0 4
4 Public Health Officer 122 3 119
5 Nursing Officer 0 32 +32
6 General Nurse 0 30 +30
7 Nurse/Midwife 17 36 +18
8 Comm. H. Nurse 122 45 77
9 Public H. Nurse B 260 48 212
10 MCHA 0 147 +147
11 Psychiatric Nurse 0 22 +22
12 Pharm. Technician 130 13 117
13 Lab. Technician 130 16 114
14 Dental Therapist 21 1 20
15 Assist. Dental Officer 4 0 4
16 Health Assistant 0 73 +73
17 Ass. Medical Officer 4 0 4
18 Medical Recorder 12 0 12
19 Radiographer 4 0 4
20 Mortuary Attendant 16 0 16
21 Pub. Health Nurse A 0 7 +7
22 Health Orderly 143 202 +59
23 Social worker 3 0 3
TOTAL 1128 700 428

ANNEX II(b)
CORE MEDICAL OCCUPATIONS AT THE SECONDARY LEVEL

(DISTRICT HOSPITALS)
No OCCUPATION REQUIRED CURRENTLY IN DEFICIT/

POST SURPLUS
1 Medical Officer i/c 3 1 2
3 AMO 15 4 11
4 Medical Specialist 12 0 12
5 District Envir. Officer 10 8 2
6 Dental Officer 3 0 3
8 Dental Technician 3 0 3
9 Dental Therapist 3 2 1
10 Health Secretary 3 0 3
11 Medical Recorder 12 0 12
12 Pharmacist 3 1 2
14 Laboratory Technician 12 23 +11
15 Lab. Technologist 3 2 1
16 Health Technician 3 0 3
17 Health Orderly 57 0 57
18 Radiographer 3 7 +4
19 Radiographic Assistant 3 0 3
20 Physiotherapist 9 3 6
21 Occupational Therapist 3 0 3
22 Orthopaed. Technician 3 0 3
23 Nursing Officer 105 116 +11
24 Public H. Nurse A 12 3 9
25 Public H. Nurse B 6 2 4

26 Pediatric Nurse 12 0 12
27 Ophthalmic Nurse 6 7 +1
28 Theatre Nurse 12 2 10
29 Pub. Health Officer 3 0 3
30 Pharm. Auxiliary 6 0 6
31 Laboratory Attendant 6 0 6
32 Medical Attendant 9 0 9
33 Mortuary Attendant 6 6 0
34 Psychiatric Nurse 48 48 0
35 Social Worker 3 0 3
TOTAL 411 244 167

ANNEX II(c)
CORE MEDICAL OCCUPATIONS AT THE TERTIARY LEVEL

(MNAZI MMOJA HOSPITAL)
No OCCUPATION REQUIRED CURRENTLY DEFICIT/

IN POST SURPLUS
1 Medical Superintendent 1 1 0
2 Assist Medical Sup. 1 1 0
3 Hospital Secretary 1 1 0
4 Matron 1 1 0
5 Assist. Matron 1 2 +1
6 Med. Specialist (TB) 9 4 5
8 Therapt. Counselor 1 0 1
9 Nurse A 19 12 7
10 Nurse Assist 14 9 5
11 Radiologist 4 4 0
12 Radiographic Specialist 3 3 0
13 Radiographer 2 8 +6
14 Med. Ass (Accup) 2 2 0
16 ENT Specialist 2 1 1
17 Psychiatry Nurse 1 0 1
18 Pharmacist 5 2 3
20 Pharm. Auxiliary 3 24 +21
21 Pharm. Production 0 2 +2
22 Dental Surgeon 4 2 2
23 Dental Specialist 3 0 3
25 Dental Technician 4 2 2

26 Dental Attendant 4 1 3
27 Med. Dent. Recorder 2 2 0
28 Specialist (obs) 5 3 2
30 Assist. Med. Officer 12 7 5
31 MCHA 0 4 +4
32 Ophthalmologist 2 1 1
33 Ophth. Cat. Surgeon 6 3 3
34 Ophth. Clin. Surgeon 6 3 3
35 Ophth. Clin. Officer 0 4 +4
36 Ophth. Nurse 10 2 8
37 Optician 2 1 1
38 Production Assist 3 2 1
39 M.A Ophth. Orient 0 1 +1
40 Orthopedic Nurse 12 0 12
41 Gen. Pathologist 2 0 2
42 Microbiologist 1 0 1
43 Immunologist 1 0 1
44 Parasitologist 1 0 1
45 Hematologist 1 0 1
46 Lab. Technologist 18 9 9
47 Clinical Bioch. 1 0 1
48 Lab. Scientific. Off. 10 1 9
49 Lab. Technician 21 37 +16
50 Lab. Assistant 1 17 +16
51 Surgical Specialist 5 4 1
52 Clinical Officer 0 14 +14
53 Psychiatry Nurse 9 8 1
54 Nurse/Midwife 121 108 13
55 SN/MW 20 19 1
56 SN/PSY 6 3 3
57 Hosp Orderly 59 115 +56

58 Anesthetist 4 2 2
59 Nurse(Anesth.) 9 9 0
60 Theatre Nurse 8 2 6
61 Spec. Psychiatrist 2 1 1
62 Nursing Officer 49 17 32
63 Comm. Psy. Nurse 1 1 0
TOTAL 566 494 72

ANNEX II(d)
CORE OCCUPATIONS AT THE GOVERNMENT CENTRAL LABORATORY

IN POST SURPLUS
Chief Chemist Office

1 Chief Chemist 1 0 1
Food & Drugs Control
2 Food Scientist 3 2 1
3 Nutritionist 2 0 2
4 Microbiologist 1 0 1
5 Chemist 2 0 2
6 Chemical Lab. Tech 2 1 1
7 Pharmacist 1 0 1
8 Pharmaceut. Tech 1 0 1
9 Pharmaceut. Assist 1 0 1
10 Laboratory Assist 1 0 1
11 Food Technician 2 2 0
Chemical Management and Environmental Control
12 Chem.& Pr. Eng. Ch 1 1 0

13 Chemist 2 0 2
14 Chem. Lab Tech 2 1 1
15 Medical Lab Tech 1 0 1
Forensic Science Service
17 Forensic Chemist 2 0 2
18 Toxicologist 1 0 1
19 Chem. Lab. Techn 1 1 0
20 Medical Lab. Tech 1 0 1

Technical Services (Instrumental Analysis)
22 Chemist (Instr. Analysis) 1 0 1
23 Engineer (Electronic) 1 0 1
24 Engineer (Electric) 1 0 1
25 Technician (FTC) 1 0 1
26 Computer Technologist 1 0 1
27 Laboratory Techn 1 0 1
TOTAL 40 10 30

ANNEX II(e)
CORE OCCUPATIONS AT THE COLLEGE OF HEALTH SCIENCES

IN POST SURPLUS
1 Principal 1 0 1
2 Chief Academic Officer 1 1 0
3 Chief Admin. Officer 1 0 1
4 Librarian 2 0 2
6 Anesthetist 1 0 1
7 Pharmacist 2 0 2
8 Dental Officer 1 0 1
10 Assist Med. Officer 1 0 1
11 Med. Lab. Scientist 2 0 2
12 Env. Pub. H. Nurse 4 2 2
13 Nursing Officer Psych 3 1 2
14 Nursing Officer MW 8 8 0
15 Nursing Officer PHN 3 1 2
16 Comm. H. Nurse 2 0 2
Specialist
17 Medical Sociologist 1 0 1
18 Epidemiologist 1 0 1
19 Parasitologist 1 0 1
20 Health Officer 2 1 1
21 Nutritionist 1 0 1
22 Sanitary Engineer 1 0 1
23 Pub. H. Nurse Specialist 1 0 1
24 Theatre Man. Specialist 1 0 1
25 Emerg Med. Specialist 1 0 1

26 Med. Ethics Specialist 1 0 1
27 Warden 2 2 0
28 Accountant 1 0 1
29 Store-keeper 1 1 0
30 Secretary 2 0 2
TOTAL 51 17 34

ANNEX 2(f)
CORE OCCUPATIONS AT THE MOHSW
NO POSITION REQUIRED CURRENTLY DEFICIT

IN POST
1 PPF&A 1 1 0
2 HRH Officer 1 - 1
3 HRH Planning Officer 1 - 1
4 DAO 1 - 1
5 Training Officer 1 - 1
6 CEO 1 1 0
7 HMIS 1 1 0
8 Statistician 1 1 0
9 Epidemiologist 1 - 1
10 Research 1 - 1
11 HDPP 1 1 0
12 PBF 1 - 1
13 PAM 1 - 1
14 H & Acc 1 - 1
15 Accountant 2 - 2
16 Supplies Officer 1 - 1
17 Maintenance 1 1 0
18 Biomedical 1 - 1
19 Garage 1 - 1
20 Estate 1 - 1
21 DHS 1 - 1
22 Zonal Health Coordinator. 2 - 2
23 Zonal Public Health Off 2 - 2
24 Zonal Public Health N 2 - 2
25 Zonal Health Secretary 2 - 2
26 Zonal Health Manager. Off 2 - 2

27 Programme Manager 8 5 3
28 District Medical Officer 10 - 10
29 District Public H Officer 10 - 10
30 District Public H Nurse 10 - 10
31 District Health Secretary 10 - 10
32 DHMSO 10 - 10
33 DSWDA 1 - 1
34 SWO 4 2 2
35 DSAO 1 - 1
36 Counselor 2 0 2
37 Educator 2 0 2
TOTAL 100 13 87

ANNEX III
EXPECTED NUMBER OF GRADUATES FROM THE COLLEGE
OF HEALTH SCIENCES 2004/05 – 2008/09
Cadre 2005 2006 2007 2008 2009
GNM 23 13 13 16 12
GNP 10 8 9 11 10
MLT 30 0 0 0 0
EHO 0 16 15 17 16
CHN 0 0 0 0 0
CO 10 18 16 15 17
PHNB 0 20 16 17 18
DENTAL
ASSISTANT 0 8 10 8 8
Total 73 83 79 84 81
GNM = General Nurse/Midwife

GNP = General Nurse (Psychiatry)
MLT = Medical Laboratory Technician
EHO = Environmental Health Officer
CHN = Clinical Heath Nurse
CO = Clinical Officer
PHNB = Public Health Nurse B

ANNEX IV(a )
st
SUMMARY OF DEFICIT AND SURPLUS 1 LINE PHCU UNGUJA AND PEMBA
S/N CADRE UNGUJA PEMBA TOTAL
DEFICIT SURPLUS DEFICIT SURPLUS DEF SURP
1 Clinical Officer 8 0 44 0 52 0
2 Community Health Nursing (CHN) 5 1 30 0 35 1
3 General 1Nurse 1 5 0 5 1 10
4 Psychiatric Nurse 0 1 0 13 0 14
5 Nurse Midwife 8 0 0 5 8 5
6 Public Health Officer 11 0 45 0 56 0
7 Public Health Nurse ‘B’ 17 0 60 0 77 0
8 Maternal and Child Health Aider 0 17 0 39 0 56
9 Pharmaceutical Auxiliary 0 4 0 0 0 4
10 Pharmaceutical Technician 11 0 45 0 56 0
11 Health Assistant 1 5 0 22 1 27
12 Health Orderlies 0 4 0 17 0 21
13 Laboratory Assistant 0 1 0 1 0 2
14 Laboratory Technician 10 0 0 0 10 0
15 Dental Therapist 11 0 0 0 11 0
TOTAL 83 38 224 102 307 140
SUMMARY OF DEFICIT AND SURPLUS AT 2ND LINE PHCU UNGUJA AND PEMBA ANNEX IV(b)

DEFICIT SURPLUS DEFICIT SURPLUS DEF SURP
1 Clinical Officer 1 9 0 8 1 17
2 Community Health Nursing (CHN) 1 5 0 4 1 9
3 General 1 Nurse 4 0 2 0 6 0
4 Psychiatric Nurse 0 1 0 13 0 14
5 Nurse Midwife 3 7 0 8 3 15
6 Public Health Officer 0 12 0 7 0 19
7 Public Health Nurse ‘B’ 0 14 0 13 0 27
8 Maternal and Child Health Aider 21 0 12 0 33 0
9 Pharmaceutical Auxiliary 4 0 0 0 4 0
10 Pharmaceutical Technician 0 12 0 5 0 17
11 Health Assistant 9 0 3 0 12 0
12 Health Orderlies 0 12 0 8 0 20
13 Laboratory Assistant 3 0 0 0 3 0
14 Laboratory Technician 0 12 0 8 0 20
15 Dental Therapist 0 12 0 8 0 20
16 Watchman 1 0 0 0 1 0
17 Microscopist 9 0 3 0 12 0
18 Pharmaceutical Assistant 3 0 0 0 3 0
TOTAL 53 88 29 61 82 149

ANNEX IV (c)
SUMMARY OF DEFICIT AND SURPLUS FOR PHCCs LEVEL UNGUJA AND PEMBA

MAKUNDUCHI KIVUNGE MICHEWENI VITONGOJI
DEFICIT SURPLUS DEFICIT SURPLUS DEFICIT SURPLUS DEFICIT SURPLUS DEFICIT SURPLUS
1 MEDICAL OFFICER 1 0 1 0 1 0 1 0 4 0
2 A.M.O 1 0 1 0 1 0 1 0 4 0
3 CLINICAL OFFICER 0 0 0 2 0 0 1 0 1 2
4 A.D.O 1 0 1 0 1 0 1 0 4 0
5 HOSPITAL 1 0 1 0 1 0 1 0 4 0
SECRETARY
6 NURSING OFFICER 0 3 0 8 0 2 1 0 1 13
7 PHNB 3 0 4 0 5 0 4 0 16 0
8 HEALTH OFFICER 0 23 0 15 0 8 7 0 7 46
9 LAB TECHNICIAN 0 0 0 1 0 0 2 0 2 1
10 PHARM 2 0 2 0 2 0 2 0 8 0
TECHNICIAN
11 MEDICAL 3 0 3 0 3 0 3 0 12 0
RECORDER
12 DRIVER 0 2 1 0 0 0 1 0 2 2
13 TRAINED COOK 1 0 1 0 1 0 1 0 4 0
14 KITCHEN ATTEND 3 0 0 0 0 0 2 0 5 0
15 LABOURER 2 0 2 0 2 0 2 0 8 0
16 WATCHMAN 0 0 0 0 2 0 1 0 3 0
17 SECRETARY 0 0 1 0 1 0 1 0 3 1
18 ACCOUNTANT 1 1 1 0 1 0 1 0 4 0
19 CASHIER 1 1 1 0 1 0 1 0 4 0
20 MORTURY ATTEND 1 0 1 0 1 0 1 0 4 0
21 DHOBI 1 0 1 0 0 0 0 1 2 1
22 LIBRARIAN 1 0 1 0 1 0 1 0 4 0
23 SOCIAL WORKER 1 0 1 0 1 0 1 0 4 0
24 HEALTH OFFICER 1 0 1 0 1 0 1 0 4 0
25 RADIOGRAPHER 1 0 1 0 1 0 1 0 4 0
26 PHARM. ASSISTANT 0 0 0 0 0 1 0 1 0 2
27 DENTAL THERAPIST 0 0 0 0 0 0 0 0 0 0

28 PHARM. 0 2 0 0 0 0 0 1 0 3
AUXILLARY
29 HEALTH ASSITANT 0 0 0 0 0 0 0 1 0 1
30 MICROSCOPIST 0 0 0 0 0 0 0 1 0 1
31 TYPIST 0 0 0 0 0 1 0 1 0 2
32 CLERK 0 0 0 2 0 1 0 4 0 7
33 GARDENER 0 2 0 2 0 1 0 1 0 6
34 RMA 0 0 0 0 0 0 0 1 0 1
35 CHN 1 0 1 0 0 0 1 0 3 0
36 MCHA 0 1 0 2 0 3 0 0 1 5
37 LAB ASSITANT 0 0 0 0 0 1 0 2 0 3
TOTAL 27 34 27 32 27 18 40 14 122 97

SUMMARY OF DEFICIT AND SURPLUS FOR SECONDARY LEVEL(DISTRICT HOSPITAL) ANNEX IV (d)
NO CADRE MKOANI WETE CHAKE TOTAL

DEFICIT SURPLUS DEFICIT SURPLUS DEFICIT SURPLUS DEFICIT SURPLUS
1 DEFICIT SURPLUS DEFICIT SURPLUS DEFICIT SURPLUS DEFICIT SURPLUS
45 General
DRIVER Surgeon 10 00 10 02 10 03 30 05
24
246 Health Officer
Orthopedic Surgeon 11 00 11 00 11 00 33 00
25 Watchman
Physiotherapist 03 10 01 50 02 00 06 60
347 Obs/Gynae
Trained Cookspecialist 12 00 01 00 02 00 15 00
26
448 Occup. Therapist
Physician 11 00 11 00 10 00 32 00
27 Kitchen Attend
Orthopedic Technologic 01 00 01 30 01 40 03 70
549 M.O General
Supplies Asst. 11 00 01 00 01 10 13 10
28
650 Nurs.
Dental Off. General
Officer 13
11 00 41 00 71 00 24
33 00
29 Social
PHN Worker
‘A’ 30 00 13 00 13 00 91 00
751 AMO General
Librarian 12 00 01 00 11 00 34 00
30
852 PHN
AMO ‘B’
Anesthesia 00 00 21 00 01 00 24 00
31 Laborers
Peadric nurse 21 50 21 00 21 00 43 50
953 AMO Ophthalmic
Clinical Officer 00 02 10 011 10 05 02 018
32
10 Othalmic
AMO Nurse
Radiology 10 10 11 00 11 00 30 10
54
33 CHN
Theatre Nurse 21 00 01 00 01 00 43 00
11
55 AMO
Pharm. Dermatology
Asst. 01 03 10 03 10 00 03 06
34
12 Health
ADO Secretary 10 00 11 00 10 00 20 00
56
35 Pharm.
Account Auxillary 11 10 01 50 01 60 32 12
00
13
57 Dental
Pharm. Therapist
Attendt. 21 00 12 00 02 00 63 00
36
14 Account
Dental Asst.
Therapist 10 00 10 00 11 00 20 029
58
37 General
Personal Nurse
Secretary 11 15
00 01 10
00 01 40 32 00
15
59 Pharmacist
Cashier 01 01 00 00 10 00 04 01
38
16 Registry
PharmacistAsst.
Technology 30 01 23 01 21 00 70 03
60
39 Typist
Supplies Officer 11 00 01 01 01 10 31 01
17
61 Lab.
MCHA Technologist 04 30 00 10 00 03 012 70
40
18 Medical
Lab. Recorder
Technician 00 32 40 30 40 07 00 13
62
41 Clerk
General Tech 02 00 01 00 00 72 13 92
19
63 Lab. Assistant
Assistant Nurse 00 02 00 22 00 10 01 02
42
20 DHOBI
Radiographer 00 20 00 21 10 00 00 44
64
43 Ophthalmic Asst.
Mortuary Attend. 2 0 02 0 02 00 6 10
65
21
44 Microscopist
Lab. Attendant
Office Attend 00 10 01 10 01 010 02 230
66
23 Shoe market
Radiog. Attendant 01 0 01 0 01 10 03 10
ANNEX IV (d) continued
ANNEX IV (d) continued
Annex IV (d) continued

67 Tailor 0 0 0 1 0 0 0 1
68 Telephone Operator 0 0 0 0 0 1 0 1
69 Opth. Co 1 0 0 1 1 0 2 1
70 Co. Officer Anaeth. 0 0 0 1 0 1 0 2
71 ENT. Nurse 0 0 0 1 0 1 0 2
72 Anaethesia Nurse 0 0 0 1 0 1 0 2
73 Messenger 0 1 0 0 0 1 0 2
74 Gardener 0 3 0 2 0 0 0 5
Total 67 49 52 61 57 51 176 161

ANNEX V
IMMEDIATE AND INTERMEDIATE GAP FILLING PLAN AND CRITERIA USED TO DETERMINE IMMEDIATE AND
INTERMEDIATE GAPS TO BE FILLED
No. HRH GAP IMMEDIATE PLANS INTERMEDIATE PLANS

1. No equity in the distribution of human Re-deployment/re-allocation of the staff as  Posting of the newly employed
resources for the PHC and secondary level soon as possible staff should ensure equity in the
health services. There is a deficit in some distribution of staff
facilities and surplus in some facilities  Training bond should include
employment aspect
 Build staff houses in the rural
health facilities
2. Shortage of staff in the health facilities Recruit where there is extreme shortage of  Plan to annually recruit a certain
health workers percentage of staff for all
technical cadres and priority
should be for PHCU and PHCC.
3. Health Management workers are lacking Organize tailor made short courses in  Plan and budget for 2 – 3
qualifications in the primary and secondary collaboration with institutions, e.g. candidates to join University of
health care levels (both in the management University of Mzumbe that offers training in Mzumbe for the degree in health
team and at the facility level). Only acting Health Administration. The institute may services administration annually.
staff are doing the job without management offer a 2 – 3 months or even six weeks short  Plan and budget for 2 or more
skills courses to equip the acting staff with acting health secretaries to
management skills for better performance. attend certificate course in
health administration tenable at
the University of St. Augustine,
Mwanza
4. Lack of HRH information system, making Initiate steps to collect, process, analyse,  Plan and budget to establish a
HRH planning, management and decision interpret and store HRH data for better comprehensive computerized
making process difficult decision making on matters related to HRH data base system
planning, management and training of HRH  Prepare HRH monitoring
guidelines to ensure updating of
the data and sustainability

5. Lack of high-level manpower. Staff inventory Initiate process of filling the gaps. Prepare a  Plan and budget for training
compared to the agreed staffing level training plan that gives priority to the high high level manpower
indicates that high level manpower is lacking level manpower, otherwise quality will not  Solicit sponsors if the
e.g. pharmacists, dental officers, specialist be achieved government cannot fund.
doctors and health management staff
6. Patients’ medical records not well recorded or Initiate proper patient medical record system  Plan and budget for training at
not recorded at all at the primary health care least 3 – 5 medical recorders at
facility and therefore it becomes difficult to Recruit trained medical recorders from KCMC School of medical
assess workload or conduct operational KCMC School of Medical Records. records
research. The primary and secondary  Plan and budget for recruitment
facilities are lacking trained medical recorders Prepare tailor made courses for the current of at least 3 trained medical
who are well equipped with skills in patient staff keeping medical records as a temporary recorders annually.
records measure while preparing for recruitment
7. Most of the in charge of health facilities, Conduct or provide short courses in  Plan and budget for the training
hospital, district and zonal health management and computer skills to the on management and computer
management teams currently in the post are management team members for the management team
lacking management and computer skills members and in charge of the
health facilities
8. Majority of the surplus staff in the health Work out a retrenchment and reallocation  Retrench surplus untrained staff
facilities are untrained staff plan to allow the government save
money for recruiting qualified
trained staff. Reallocate
accordingly
9. Lack of identification of training needs Identify training needs for various cadre and  Conduct training needs
assessment and training plan for middle level prepare training plan for health workers assessment after every two years
technical staff  Ensure availability of training
plan. Training plan to ensure
equity in the opportunities of
training to the available staff
and therefore minimizing
complaints.
CRITERIA USED TO DETERMINE IMMEDIATE AND INTERMEDIATE HRH GAPS TO BE FILLED
• Situational analysis report and data, which indicated that there is extreme shortage of staff in some health facilities while in other facilities
there is overstaffing.
• Field report: Team C visited the following health facilities i.e. Gamba, Kivunge, Sebleni, Mahonda, Chumbuni and Mwembeladu to assess
the actual staff available and the workload. The report obtained reveals that in some facilities there is a shortage of staff in relation to the
workload.
• Equity Principle: Health is a basic need to a human being. Due to this fact, every community should enjoy equity in the distribution of
health services including other resources like human resource, drugs and supplies
• The concept of quality care provision as the major objective of the Health Sector Reforms: Quality health care cannot be achieved without
having the right number of human resource with right skills at the right place, time and at affordable cost.
• Basic and essential health care package at each level requires a well-organized team with all the necessary skill mix.
• The staff inventory, when compared with the prepared staffing level for primary and secondary levels indicates deficit and surplus to all
PHCU, PHCC and District Hospital.
ANNEX VI
REDEPLOYMENT OF STAFF AT PRIMARY, SECONDARY AND

TERTIARY LEVELS OF HEALTH CARE
(a) Reallocation of Existing Surplus at the
i. Primary Health Care Level
Cadres Total Number to be reallocated

Clinical Officer 3
Psy Nurse 7
Nurse Midwife 24
General Nurse 5
PHN A 3
Lab. Tech 1
Dental Therapist 1
Nursing Officer in charge/ Matron 13
ii. Secondary Health Care Level

Clinical Officer 18
Laboratory Technician 14
Radiographer 4
Radiographer Assistant 1
General Technician 2
iii. Tertiary Health Care Level

Radiographer 6
Clinical Officer 14
Laboratory Assistant 16
Pharmaceutical Auxiliary 10
(b) Retrenchment of Existing Surplus at the
Cadre Total Number to be retrenched
Health Orderly 100
Health Orderly 67
Health Orderly 56
(c) Upgrade Training of existing Staff at the
Cadre Total Number to be upgraded

General Nurse 29
MCHA 7
Pharm. Assist 3
Nurse Assistant 2
Ophtalmic Assistant 1
Pharm. Auxilliary 10
Microscopist 2
Ophtalmic Clinical Officer 1
Anaeth. Clinical officer 2
Anaethetic Nurse 2
ENT Nurse 1
Optician 2

General Nurse 29
MCHA 7
Pharm. Assist 3
Nurse Assistant 2
Ophtalmic Assistant 1
Pharm. Auxilliary 10
Microscopist 2
Ophtalmic Clinical Officer 1
Anaeth. Clinical officer 2
Anaethetic Nurse 2
ENT Nurse 1
Optician 2

Matron 1
Medical Recorder 2
MCHA 4
Ophthalmic Clin. Officer 4
Pharmaceutical Production 2
M.A Ophth. Orient 1
Nursing Officer 2
(d) New recruitment of Staff at the
Cadre Total Number to be recruited

Clinical Officer 96
CHN 76
PHN B 187
Pharm Technician 117
Health Officer 103
Lab Techn 25
Dental Therapist 25
Health orderly 7
Nurse midwife 1
Medical Recorder 10
Radiographer 4
Social worker 4

General Surgeon 2
Opth. Surgeon 3
Gynecologist 1
Physician 2
Dentist 3
AMO General 1
AMO Anesthesia 2
AMO Opthal 3
AMO Radiology 3
AMO Dermatology 3
AD Officer 2
Dental Tech 3
Dental Therapist 1
Pharmacist 2
Pharm Thechn 7
Health Officer 3
Physiotherapist 6
Occu. Therapist 3
Nursing Officer 24
PHN A 9
PHN B 4
Paed Nurse 4
Oph Nurse 1
Theater Nurse 4
Lab Attendant 6
Hospital Secretary 3
Mortuary Attendant 6
Medical Recorder 12
Social Worker 3
Hospital Secretary 1
Hospital Surveillance Officer 4
Cardiologist 1
Gastroenterologist 1
NB: Compiled from the recommendations on Redeployment made by Team B and C (Situation Analysis)
ANNEX VII
NON CITIZEN WORKERS
Pemba Zone
Abdalla Mzee Hospital 7 Chinese Dr.
Wete Hospital 4 Cuban Dr.
Chake Chake Hosp. 5 Russian Dr. & Rotary Dr.
TOTAL 16.
Unguja Zone
Mnazi Mmoja Hosp 10 Chinese Dr.
2 1 Pediatrician Egyptian
1 Physician
2 1 Neurologist
1 Radiologist Russian
1 Japanese Physiotherapist
1 Korean (Lab Tech).
3 Cuban Physicians
1 Nigeria(Microbiologist Md)
1 VSO U.K CHN Psy
21
Chinese ( Anesthesiologist 1, Radiologist 1, Obs/ Gyn 1, Endocrinology 1, Surgeon 1, Accupuncture moxibustion 1, ENT 2, Nursing 1,
Cardiologist 1).
Social Welfare Department 2

TOTAL 2
TOTAL UNGUJA AND PEMBA 39
ANNEX VIII
HUMAN RESOURCE FOR HEALTH CAREER DEVELOPMENT BY CADRE

PHCU/PHCC AND DISTRICT HOSPITAL
No. Cadre 1st Upgrading 2nd Upgrading 3rd Upgrading 4th Upgrading 5th Upgrading 6th Upgrading
1 Surgical Specialist PhD
2 Orthopedic Surgeon PhD
3 Obs/Gynae Specialist PhD
4 Medical Officer Masters PhD
5 Dentist Masters PhD
6 AMO- General MO Masters
7 AMO – Anesthetist MO Masters
8 AMO – Ophthalmology MO Masters
9 AMO – Radiology MO Masters
10 AMO – Dermatology MO Masters
11 ADO DO Dental Surgeon
12 Dental Assistant ADO DO
13 Clinical Officer AMO MO
14 CHN Adv. Diploma Bsc. Nursing
15 Dental Technician Degree Masters
16 Pharmacist Mpharmacist PhD
17 Pharmaceutical Technician Pharmacist MPharm
18 Pharmaceutical Assistant Pharm.Tech Pharmacist
19 Pharmaceutical Auxiliary Form IV Ph. Assistant Ph. Tech.
20 Laboratory Technician Advanced Dip Lab. Degree
21 Laboratory Assistant Lab Technician Adv. Diploma Lab.
22 Radiographer Masters PhD
23 Radiographic Assistant Diploma Radiology Adv. Diploma In

Radiology
24 Physiotherapist Advanced Diploma 1st degree
25 Orthopaedic Technician Advanced Diploma 1st degree
26 Social Worker Masters PhD
27 Health Officer Masters PhD
28 Health Assistant Diploma Advanced Diploma
29 Specialist Nurses (Paed, 1st degree Masters
Ophth, theatre)
30 Nursing Officer Advanced Diploma Bsc. Nursing
31 General Nurse Diploma Advanced Diploma
32 PHN "A" 1st degree Masters
33 PHN "B" Diploma Advanced Diploma
34 MCHA Certificate PHNB Diploma
35 Medical Recorder Assist Dip. Medical Records Advanced Diploma
36 Accountant Advanced Diploma CPA

37 Cashier NABOCE NAD
38 Secretary OMASEC Diploma
39 Librarian Diploma 1st Degree
ANNEX IX
MINISTRY OF HEALTH & SOCIAL WELFARE –ZANZIBAR
THE CURRENT ORGANIZATION CHART
MINISTER
BOARDS
LEADERSHIP DEPUTY
COMMITTEE
MINISTER
PHARMACY
MEDICAL
PRINCIPAL
SECRETARY
NURSING
DEPUTY PRINCIPAL
EXECUTIVE SECRETARY
COMMITTEE
PIU (ADB) PHL id C
CHIEF GOVT. DIRECTOR SOCIAL DIRECTOR DRUG DIRECTOR OF DIRECTOR OF DIRECTOR OF COORDINATING
CHEMIST WELFARE ABUSE CONTROL PLANNING & ADMIN PREVENTATIVE HOSPITAL OFFICER PEMBA
SERVICES SERVICES
ANNEX X
MINISTRY OF HEALTH & SOCIAL WELFARE –ZANZIBAR

PROPOSED ORGANIZATION CHART
MINISTER
LEGISLATIVE BOARDS
LEADERSHIP
COMMITTEE
MEDICAL PHARMACY NURSING CHS
DEPUTY
MINISTER
PRINCIPAL
SECRETARY
EXECUTIVE
COMMITTEE
DEPUTY PRINCIPAL
SECRETARY
HEALTH DIRECTOR HEALTH DIRECTOR POLICY, FINANCE DIRECTOR SOCIAL WELFARE CHIEF GOVERNMENT
COORDINATOR SERVICES & PLANNING & DRUGS ABUSE CHEMIST
PEMB

ANNEX XI
ROPOSED ORGANOGRAM FOR THE DIRECTORATE OF
PLANNING AND ADMINISTRATION
DIRECTOR PLANNING,
FINANCE & ADMIN
CHS
DMU
HUMAN RESOURCE HMIS& R HEALTH DEVELOPMENT FINANCE & MAINTENANCE FHRP

POLICY AND PLANNING ACCOUNT (ADB )
DIVISION
HR Planning
Epidemiology Planning
Policy & PIS Account &
Statistic budgeting & Biomedical
Monitoring Salaries
Personnel financy
Administration Research
Supplies Garage
Policy
Training &Store
Legislation
monitoring
C/Education Estate &

Health Building
Financing

ANNEX XII
JUSTIFICATION FOR A REORGANISED MINISTRY OF HEALTH
Introduction
The roles of each directorate which justify the posts and optimum number of personnel needed to perform for better results are
mentioned hereunder:
The role of the Ministry of Health and Social Welfare has been rationalized by determining the core functions which are promotive,
curative, preventive and Human Resource Development. These functions are considered to be the basis for having four directorates in
the Ministry. Each directorate has specific roles and responsibilities that contribute to the achievement of the Ministry’s goal.
Directorate of PFA
A critical core department responsible for the coordination of health activities across the Ministry, designing and formulating sound
health policies, programs and plans that direct the functioning of the Ministry for the efficient and effective delivery of quality health
services. Its roles include among others:
o Budgeting and soliciting funds from the public and development partners as well as ensuring proper use of the funds.
o Designing and coordinating policy and programme implementation.
o Ensuring the availability, development and effective utilization of quality and well balanced HR across the health system
o Maintaining and providing updated and accurate health information and HR information to facilitate timeliness of decision
making.
o Ensuring the availability of adequate physical infrastructure, furniture, equipment, materials and transport for the smooth
running health services.
o Cooperating with regional and international stakeholders in the health sector for the purpose of sharing and transferring
knowledge and experience.
o Ensuring availability of necessary material resources needed for rendering of services

These broad roles define the tasks and the type of HR required for the department. The department is structured into divisions and
sections to specify tasks and skills required to perform outlined those tasks. Both the workload and marginal productivity of labour
were considered to determine the number of posts and employees needed for each section.
Department of Social Welfare and drugs abuse
This department deals with the promotion of social development of the vulnerable sections of our society including orphans, disabled,
the aged people and drug addicts and children who are living under difficult circumstances. Its main roles include:
o Caring for the aged people, orphans and children living under difficult conditions.
o Ensuring availability of facilities, equipments and materials for caring of these groups.
o Compensating those employees who have sustained injuries or deaths at work places or during the course of work.
o Counseling and rehabilitating addicts and sensitizing the communities from dangers of using illicit drugs, thus reducing the
drug related harm and the number of persons involved in drug abuse.
o Liaising with other sections and NGOs concerned or interested in taking care of the disadvantaged and vulnerable groups
Directorate of Health Services
This directorate assumes the core activities of the Ministry, i.e preventive, promotive and curative services in a more integrated
approach.
Its main role is to coordinate the activities of the two zonal Health Management Teams – that is coordination of both curative and
preventive services rendered by the two zones – Pemba and Unguja Health Management Teams, together with the health facilities at
primary and secondary levels so as to ensure integrity of the entire health system. Major diseases prevention programmes shall be
coordinated with an emphasis towards integration under this directorate.

Government Chemist
This Office provides laboratory services to almost all sectors of our community. It carries out technical and scientific laboratory tests
for foods, chemicals, dangerous drugs and verifies their quality for human consumption and provides advice for the necessary policy
and legal actions to be taken.
Semi Autonomous Institutions
In the process of implementing HSR through decentralization, the Ministry has initially selected three (3) organisations that will
operate as semi autonomous institutions. These include Mnazi Mmoja Referral Hospital, the College of Health Sciences and the
Central Medical Stores. They will have their own Directors and communication with the Ministry will be done through the Principal
Secretary as shown in new proposed organogram.

ANNEX XIII
CONSULTANT’S ASSESSMENT REPORT
The terms of reference required the consultant to study the work that had already been undertaken in the areas of planning and training
and development programme/Strategies and to assess the extent of their accomplishment. The consultant’s observations are as follows:
PLANNING
Task Groups A, B, C and D that had been formed by the Ministry of Health and Social Welfare early in 2003 to prepare the Situation
Analysis had done a commendable job of taking stock of the existing HRH as at June 2003 by occupation, level of education and level
of facility. They had gone further to prepare the staffing level for the different levels of health facilities for the core medical staff and
peripheral staff using the health needs, service targets and human resource/population ratio approaches. Through this exercise it was
found that there was a significant deficit of staff in some occupations and a surplus in some others. The teams worked out a
redeployment proposal for the surplus staff and suggested ways of filling the identified gaps. The proposal for redeployment of excess
staff whose skills were still needed was to reallocate to facilities that had shortages of such skills and for those whose skills were no
longer needed, the recommendation was to retrench them. As for filling the gaps, the suggestion was to make new recruitments or
upgrade the existing staff through training.
While much was done to develop the staffing level, more needs to be done to refine the staffing level criteria, especially for specialised
occupations at the secondary and tertiary levels of health facilities and for the College of Heath Sciences. The staffing level proposals
could have been used to project the HRH additional requirements for the coming five years of the plan if information on the
anticipated health facility expansion, staff attrition rates and the current number of non-citizens working on contract terms was
available. Due to the shortage of this information, the plan has focused on filling the existing HRH gaps. Separate studies need to be
conducted to come up with the missing information, if not for the current plan then for the subsequent plans so that forecasts on
additional HRH requirements are made.
The proposals on the redeployment of excess staff through reallocation and retrenchment have financial implications. So far, no
estimates have been made to determine how much the exercise will cost financially. If the proposals will be implemented, there will be
a need to work out the cost.
TRAINING AND DEVELOPMENT PROGRAMME/STRATEGIES

In this area, each Work Group managed to prepare short and long term training plans for the relevant levels of health facility basing on
the Situation Analysis findings. Full time institutionalised training was the dominant approach that was suggested. Socialisation or
orientation programmes were proposed for those who will be newly recruited. Task Group C pointed out that staffs that do not have
the required qualifications were holding some posts. A training programme was proposed for them to upgrade their skills. In order to
retain those who are already in service, interventions have been proposed to have a career development plan, to create conducive
working environment and to develop a system of job satisfaction.
Before embarking on the proposed training plans, it will be necessary to carry out a thorough training needs assessment and to revisit
the cost of training because it appears that the cost of some programmes have been overestimated and some have been underestimated.
Succession planning is very important for organisations. But it can only be implemented if organisations have information about the
age structure of their work force, academic qualification and length of service. It will be necessary to create a data base of this
information and update it from time to time so that it can be used to introduce succession planning.

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Zanzibar Human Resource For Health 5 Year Development Plan Final Version1

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REVOLUTIONARY GOVERNMENT OF

MINISTRY OF HEALTH AND

HUMAN RESOURCE FOR HEALTH

The Technical Working Group on HRH i

CHAPTER ONE: INTRODUCTION 3

1.0 Country Profile 3

CHAPTER TWO: HUMAN RESOURCES FOR HEALTH POLICY 7

2.0 General Aim of the Policy 7

CHAPTER THREE: HRH SITUATION ANALYSIS 9

3.0 Government Initiatives 9

3.3 HRH Challenges 12

CHAPTER FOUR: HRH PLAN AIM, OBJECTIVES AND STRATEGIES 14

4.2.7 Mnazi Mmoja as a Referral Hospital 17

CHAPTER FIVE: HRH PROJECTIONS 19

5.0 Essential Health Package (Service at each level) 19

CHAPTER SIX: HUMAN RESOURCE DEVELOPMENT 24

6.0 Quality of training 24

CHAPTER SEVEN: HUMAN RESOURCE MANAGEMENT 27

7.0 Deployment and Redeployment 27

8.0 Budget for implementing the Medium Term Plan 29

CHAPTER NINE: MONITORING AND EVALUATION 35

9.0 Why Monitoring and Evaluation 30

CHAPTER TEN: ASSUMPTIONS AND RISKS 32

ANNEX I: Activities, Output, Indicators, Time frame and Financial 35

ANNEX II(a): HRH Situation as at June, 2003: Core Medical

ANNEX II(b): Core Medical Occupations at the Secondary Level

ANNEX II(c): Core Medical Occupations at the Tertiary Level

ANNEX II (d): Core Occupations at the Government Central Laboratory 88

ANNEX II (e): Core Occupations at the College of Health Sciences 90

ANNEX II (f):Core Occupations at the MOHSW 92

ANNEX IV (a): Summary of Deficit and Surplus 1st Line PHCU

ANNEX IV (b): Summary of Deficit and Surplus 2ND Line PHCC

ANNEX IV (c): Summary of Deficit and Surplus for PHCCs Level

ANNEX IV (d): Summary of Deficit and Surplus for Secondary Level

ANNEX V: Immediate and intermediate gap Filling Plan and the

ANNEX VI: Redeployment of Staff at Primary, Secondary and Tertiary

ANNEX VII: Non Citizen Workers 113

ANNEX VIII: HRH Career Development by Cadre: PHCU/PHCC and

ANNEX IX: Current Organogram for the MOHSW 116

ANNEX X: Proposed Organogram for the MOHSW 117

ANNEX XI: Proposed Organogram for the HRH Division 118

ANNEX XII: Justification for the New Proposed Organogram 119

ANNEX XIII: Consultant’s Assessment Report 123

NAME DESIGNATION INSTITUTION

Hon. Salum Juma Othman

Dr. Omar M. Shauri

Interventions are proposed to:

• Disseminate and promote the HRH Medium Term Plan to stakeholders,

• HRH Medium Term Plan US $ 33,500

HRH 5-Year Plan – Ministry of Health & Social Welfare Zanzibar 1

HRH 5-Year Plan – Ministry of Health & Social Welfare Zanzibar 2

1.0 Country Profile

1.2 Health Service Infrastructures

1.3 Health Status

1.4 Burden of disease

HRH 5-Year Plan – Ministry of Health & Social Welfare Zanzibar 3

1.5 HRH statement in Health Policy:

1.6 Plan Purpose:

The HRH study conducted in May/June 2003 revealed the following:

HRH 5-Year Plan – Ministry of Health & Social Welfare Zanzibar 4

1.7 Human Resource planning concepts:

1.7.1 Human Resource Demand:Demand: