Our Strategic Areas

For Afya Plus to be in a better position to achieve the strategic plan outcomes in the next five years; the organization will primarily focus its efforts on below four main strategic areas ventured around strengthening of service delivery systems, building of data-driven systems for quality health services, health service delivery, and institutional strengthening and growth.

Strategic Focus Area: Support the development and availability of skilled human resources for health to reduce the shortage of health workers and accelerate progress towards achieving universal health coverage in Tanzania.

Context and Gaps:
The country has made significant improvement on human resources for health including increasing the number of health workers from29,063 in 2006/07 to 102,919 in 2019; where the currently shortage stood at 52 percent of the actual needs. Also, the number of health professionals per 10,000 people has increased from 15.7 in 2010 to 17.2 in 2020. However, a resilient and responsive health system that address health needs of the population is mainly depending on the availability and equitable distribution of skilled health care workers. Evidence has shown a significant number of facility deaths and poor patient outcomes are associated with inadequate quality of health services due to numerous reasons, including shortage of human resources for health, presence of health workers with inadequate capacity and lack of continuing professional development (CPD) opportunities. The observed shortage of human resources for health and absence continuing professional development plans are partly attributed to the ineffective human resources for health planning and management at all levels of the health system coupled with unavailability of quality data on human resources for health that could guide decision-making process and planning.  Therefore, Afya Plus in next five years focus to work with the Government and other stakeholders in promoting data-driven and evidence-based human resources for health planning and management at all levels of the health system, as well as enhancing skills and productivity of available health care workers for quality services. Similarly, facilitating an enabling environment for the adequate engagement of the community health workers and other community-based platforms to curb the current shortage of human resources for health.

Strategic objective 1: Improve the skills of health workers through in-service training to meet current and future needs of knowledge and skills for prevention and management of common disease conditions.

Priority intervention 1.1: In-service training of health care workers through on-job trainings, targeted mentorship, and coaching; distance learning using virtual platforms, and continuing education.

Afya Plus will leverage its experience to support HIV prevention and health systems strengthening at the Local Government Authorities (LGAs) level through trainings, mentorship, coaching, and supportive supervision to prioritize and support the capacity development of relevant health care workers. To achieve that, Afya Plus will build on the following approaches: –

  • Use diverse methods, including on-job-training, clinical mentorship, and digital platforms, to provide relevant training to health workers at their workplace.
  • Collaborate with PORALG, MOH, LGAs and other key stakeholders to carry out targeted capacity development needs assessment through active engagement of health workers and other key actors to identify existing gaps and develop health provider’s centered capacity building plan.
  • Provide tailored technical assistance based on the existing national and international standards, which will focus on the disease conditions that are the top causes of the country’s burden of disease, such as Non-communicable Diseases, communicable diseases, and maternal, newborn, and child health conditions.

Priority Intervention 1.2: Training and mentorship program for community health workers.  

Afya Plus will leverage its experience of engaging and working with community-based structures in creating demand and expanding equitable access, to optimize the use of essential health services by the community. Afya Plus, in collaboration with PORALG, MOH and other key stakeholders, will:

  • Use various platforms such as in-class training, digital virtual models, supervision, and mentorship to develop the skills and abilities of community health workers (CHWs) and other community voluntary agents in delivering essential primary health services and other relevant tasks.
  • Develop capacity building plan for CHWs and other community voluntary agents to implement community-based interventions mainly to complement facility-based services on health education, social, behavioral change communication, disease screening, and facilitation of linkage and referral to essential health services.
  • Also, support the active participation of CHWs in tracing treatment defaulters, especially those enrolled in chronic care services across health facilities, by improving their acceptability and care-seeking practices while addressing their specific barriers and needs.

 

Strategic objective 2: Strengthen Human Resources for Health planning and management capacity at the national and sub-national level.

To achieve that, Afya Plus will focus on the two priority interventional areas.

Priority intervention 2.1: Enhance leadership and management capacity of human resources for health at all levels of the health system.

Afya Plus, through strong collaboration with PORALG, POPSM, MOH, LGAs, and other key players, will:

  • Support regional and council health management teams towards building of resilient and effective health systems with an emphasis on the use of evidence-based and inclusive planning and management of human resources for health.
  • Promote community engagement and social accountability to improve the efficient use of both financial resources and human resources for health.
  • Support implementation of innovative approaches to foster development and strengthening of sustainable and interoperable human resources for health information systems that will improve autonomy, planning, and management practices, efficiency, transparency, and accountability at all levels.

Priority intervention 2.2: Community involvement in planning, implementation and reviewing of health service delivery to improve social accountability in service provision.

Afya Plus will build on its experience of working with the community to support community engagement in healthcare delivery processes through:

  • Collaborating with PORALG, LGAs and other key stakeholders to support institutionalization of the community-led monitoring systems and practices at LGA level to increase community engagement, participation and accountability in planning and monitoring of health services using the community scorecard (CSC) tool.
  • Working with PORALG and LGAs to strengthen existing innovative strategies including Direct Health Facility Financing (DHFF) and develop new interventions which will further increase community engagement, transparency at facility level, and social accountability.
  • Strengthening systems that support the well-being of women, youth, adolescents, and children and improve their access to high-quality health services within their communities.

Strategic objective 3: Support community health workers and community participation in expanding access to integrated basic promotive and preventive health services.

Priority intervention 3.1: Availability and operationalization of quality policies, guidelines, and strategies to support community-based health service delivery initiatives.

Afya Plus will work in close partnership with PORALG, MOH, Ministry of Community Development, Gender, Women and Special Groups, PORALG, LGAs, and other stakeholders to:

  • Implement locally appropriate and acceptable legal framework and approaches for engaging community health workers and other community-based platforms to curb the current shortage of health workers.
  • Organize consultations with various key players, conduct need assessment, ensure alignment with national priorities on community-based health service delivery. Also, support the presence of enabling policy environment to implement efficient and sustainable community health service delivery model.
  • Support operationalization of quality assurance systems, standardized training and certification of community health workers, together with supportive supervision and continuous assessment mechanisms at LGA level.
  • Support institutionalization of the locally led monitoring, motivation and incentive mechanism of community health workers and other community voluntary agents at LGA level.

This strategy will promote the locally evidence-based rational distribution of tasks among health workers based on the local demographics, epidemiology, and available resources.

Strategic Focus Area: Develop and support the delivery of quality integrated and affordable health services.

Context and Gaps:
Tanzanian has made good progress on changing the burden of HIV/AIDS in the country in the last one decade. The country is committed to attain UNAIDS 95-95-95 targets by 2023 and be on track towards ending the epidemic by 2030. It is approximated that 1.6 million people were infected with HIV in Tanzania by the end of 2019. However, new HIV infections has decreased from 65,000 in 2017 to 53,000 in 2019 along with decreasing of AIDS-related deaths from 30,000 annually in 2017 to 24,000. Equally, a total of 1.28 million (79 percent) knew their HIV status and had been enrolled into care and treatment services as of December 2019.  Among them 1.27 million (99 percent) were already on antiretroviral therapy (ART) while 91 percent had attained viral suppression. However, still there are priority groups including adolescents and young girls that have limited access to comprehensive HIV services and are contributing large proportion of HIV new infections in the country.  In that context, the strategic plan will priorities its interventions towards improving access of the underserved and high-risk groups including children, adolescents, young girls and women to HIV prevention, treatment, and care services. Also, on supporting the country to reach the 2025 target of below 2 percent mother to child transmission of HIV among exposed infants and be on track to achieve elimination of mother to child transmission of HIV goal.

Currently, Tanzania is experiencing low reported malaria incidence. Although, still 96 percent of the country is within high transmission risk areas with reported malaria incidence at more than one per 1000 populations. In view of that, it is important to sustain ongoing vector control efforts to reduce transmission, improve diagnosis and treatment services, and enhance surveillance systems. Therefore, the strategic plan will stratify malaria interventions in line with transmission burden to strategically adjust available investments for achieving reduction of malaria burden in high transmission settings and to advance towards malaria elimination in very low transmission areas.

For the case of Tuberculosis (TB); Tanzania has experienced a steady fall in percent of total deaths attributable to TB over the past five years. TB treatment coverage has increased from 36 percent in 2014 to 59 percent in 2019 alongside with an increase of the TB treatment success rate which has reached 92 percent in 2018. Similarly, case notification rate has increased from 128 per 100,000 population in 2015 to 144 per 100,000 population in 2019, with declining of TB related deaths from 40 to 38 deaths per 100,000 between 2015 and 2017 respectively. In order to achieve both national and Sustainable Development Goals (SDGs) targets of ending the TB epidemic by 2030, the country is committed to expanding the TB treatment coverage and improving access to prevention, case finding, and treatment services countrywide.  Therefore, the strategic plan is going to priorities TB inventions in order contribute to the ongoing efforts in line with the national and global TB related goals.

Tanzania is among the country with the highest burden of maternal, newborn and child health problems. The country is ranked 18th for the highest maternal mortality rate (MMR) globally. The leading causes of maternal mortality are Post-Partum Hemorrhage (PPH), infections, unsafe abortions, and obstructed labor which requires concerted efforts to change the tide. Similarly, still access to quality emergency obstetric and neonatal care is limited in certain geographical settings which eventually affect the outcome.  In view of that, the strategic plan will align its maternal, newborn and child health interventions with the national RMNCAH priorities for a greater impact on reducing maternal and neonatal mortalities as well as increasing access of adolescents and youth to user-friendly reproductive health services. Also, the strategic plan will put more efforts on addressing cross-cutting issues pertaining to newborn, children, adolescents, and women health including nutrition and gender-based violence for better health outcomes.

 Tanzania has not spared with an upward trend of Non-communicable Diseases, which have become the leading cause of morbidity and mortality in the country. In 2017, Non-communicable Diseases accounted for 262.4 deaths per 100,000 in the country.  The rise in the magnitude of Non-communicable Diseases is primarily due to a sharp increase in immediate and intermediate modifiable risk factors for Non-communicable Diseases. This includes hypertension, diabetes mellitus, and total high cholesterol. The prevalence of these risk factors has been inclining over time. The prevalence of hypertension is 26 percent, diabetes mellitus is 9 percent, and hyperlipidemia is 33.8 percent. About 16 percent of Tanzanians are tobacco users, a third of the population is alcohol drinkers, and 35 percent are overweight and obese. This poses the country towards the “Double-Burden of Disease “following emerging epidemics of Non-communicable Diseases. For that reason, the strategic plan in next five years will invest on health promotion interventions that target to reduce the skyrocketing prevalence of modifiable risk factors of Non-communicable Diseases in the country.

Similarly, Afya Plus in next five-years will build on the experience gained and lesson learned from recently COVID-19 pandemic to support to the country to create an enabling policy environment and building of resilient and sustainable health systems for responding to the emerging infectious diseases and disease outbreaks using available evidence-based interventions with adequate engagement of the community.

Strategic objective 1: Support the national efforts towards improving access to quality integrated and client-centered preventive and curative services for Infectious diseases, primarily HIV/AIDS, TB, and Malaria.

Priority intervention 1.1: Scale up the delivery of quality Integrated and client-centered HIV, TB and Malaria prevention interventions complimented with focused social and behavioral change (SBC) initiatives targeting high-risk populations and most vulnerable groups, including women, young girls, adolescents, and children.

Afya Plus aims to support country efforts towards eliminating the HIV epidemic by 2030 and reducing HIV, TB and Malaria morbidity and mortality by improving equal access to preventive, and curative health services.

Afya Plus will also support the Government to curb emerging infectious disease and disease outbreaks using available evidence-based interventions.

In view of that, Afya Plus will collaborate with PORALG, MOH, NACP, NTLP, NMCP and other partners to:

  • Develop and scale up evidence-based and cost-effective diagnosis, treatment, and preventive strategies to further reduce transmission of HIV, TB, and malaria diseases.
  • Support presence of an enabling policy environment, community engagement mechanisms and effective implementation of available evidence-based interventions to control and prevent spread of emerging infections disease and disease outbreaks.
  • Use participatory core-behavioral approaches of both supply and demand-side to deliver client-centered and integrated HIV, TB and Malaria diagnosis, treatment and prevention services while improving ability of the served community to practice positive healthy behaviors.
  • Maximize the role of Innovation and Technology in improving access and uptake HIV /AIDS, TB, and Malaria services to the priority populations across the country.

Strategic objective 2: Scale up the integration of priority Non-communicable Diseases interventions in other health care services to increase both access and uptake of Non-communicable Diseases interventions and reduce the prevalence of modifiable risk factors.

Priority intervention 2.1:  Develop, adopt, and integrate into other health services, client-centered interventions that aim to prevent and reduce the prevalence of Non-communicable Diseases risk factors.

Afya Plus will collaborate with the national Non-communicable Diseases section at the MOH, PORALG, LGAs, and other relevant stakeholders to:

  • Advance national efforts towards prevention and control of morbidity and mortality caused by the rising prevalence of Non-communicable Diseases in the country.
  • Find ways of integrating proven Non-communicable Diseases interventions and health promotion into existing projects in ways that will complement the expected health and economic benefits of the projects, including the well-being of the served population.
  • Develop Non-communicable Diseases prevention and health promotion interventions that target to reduce the skyrocketing prevalence of modifiable risk factors in the country, including tobacco use, physical inactivity, obesity, intake of salt, and harmful alcohol use.
  • Leveraging role of Innovation and Technology in Non-communicable Diseases prevention and health promotion.

Strategic objective 3: Develop and support the delivery of evidence-based interventions for improved Reproductive, Maternal, Newborn, Child, and Adolescent Health, GBV & VAC & Nutrition outcomes.

Priority intervention 3.1: Design and implement effective strategies that will generate demand for and increase uptake of maternal, newborn, and child health services through innovative and client-centered approaches.

Afya Plus in collaboration with RCH section at MOH, Ministry of Community Development, Gender, Women and Special Groups, PORALG, and other key actors to:

  • Develop, adopt, and integrate strategies to raise community awareness and demand for maternal, newborn, and child health care services including FP, GBV & VAC, and nutrition services.
  • Support scaling up evidence-based strategies that aim to improve newborn, neonatal, and infant care according to national priorities at the facility and community level.
  • Promote effective use of available data and Maternal and Perinatal Death Surveillance and Response (MPDSR) findings to identify existing gaps and distribution; socio-cultural determinants; and locally led solutions to improve health services and prevent future occurrence of maternal and perinatal deaths.
  • Improve coordination, resource optimization, and social accountability in planning, managing, and delivering Maternal, Newborn and Child Health services including FP, GBV & VAC, and nutrition services.
  • Venture, and adopt promising Innovation and Technology solutions that have positive impact on maternal, newborn, children, and adolescent health outcome.

Priority intervention 3.2: Develop, adopt, and implement adolescent and youth-centered strategies to increase awareness, access to, and demand for integrated age-specific sexual and reproductive health services.

Afya Plus, in collaboration with MOH, PORALG, and other key partners, will:

  • Develop and implement adolescent and youth-centered strategies that will promote the integration of adolescent and youth-friendly sexual and reproductive health services to improve their access to such services and social well-being.
  • Support engagement and participation of adolescents and youth to better understand their health issues and develop an effective adolescent and youth-led mechanisms to advocate for increased availability and utilization of relevant sexual and reproductive health services including FP and nutrition.
  • Support ongoing country efforts to improve both in-school and out-of-school adolescent and youth centered interventions and work with the community and existing local structures to address their specific needs while promoting adolescent and youth health and social well-being.
  • Venture, and adopt promising adolescent and youth-led digital health innovations and social media solutions to improve their access to health education and sexual and reproductive health information that promote healthy lifestyle.

Strategic objective 4: Support country efforts to reduce malnutrition and its impact on women of reproductive age, adolescents, and under-five children.

Priority intervention 4.1: Develop, adopt, and implement strategies that promote good household nutritional practices for improved maternal, adolescents and under-five nutrition outcomes.

Afya Plus will work in partnership with the Government, Non-Governmental Organizations, and other stakeholders to:

  • Design and implement tailored interventions that promote optimal maternal, infant, and young child nutrition behaviors and practices.

These will be done using evidence-based strategies, including tailored and culturally appropriate social behaviors change approaches and meaningful community engagement.

Strategic Focus Area: Strengthen the capacity of the service delivery systems in the country to make data-driven planning, and management of health services based on the evidence-based information generated from quality data collected through existing routine health information systems.

Context and Gap:
Robust health information systems are the foundation of data-driven decision-making pertaining to the delivery of health services. The health system requires reliable data for evidence-based planning and management of health services as well as monitoring of progress towards attaining both national and global health goals including universal health coverage. Health data is obtained from various sources, including population-based surveys, civil registration systems, health facility surveys, and routine facility data systems. Despite substantial investments, Tanzania faces multiple challenges related to routine health facility data, including low data quality, fragmented data management systems, and inadequate standard operating procedures. Additionally, there is limited capacity to analyze and use data at district and facility levels for planning and quality improvement.  Despite ongoing efforts, there is an apparent lack of integrated systems for data collection, analysis, and visualization. Most of the data is sitting in the reports, on shelves, or in databases and is not sufficiently used either in strategic planning or program development and quality improvement, as well as in policy development. Therefore, Afya Plus in next five years will put concerted efforts to establish and strengthen data-driven systems at all levels of the health sector to promote the use of evidence-based decisions on planning, quality improvement and transformation of health services.

Strategic objective 1:  Support strengthening of data-driven systems for quality health services.

Priority intervention 1.1: Improve the capacity of the health system to manage, analyze, and make appropriate interpretations of data for improving health service delivery.

Afya Plus aims to support the strengthening of the data management and use within LGAs for better planning and management of health services. Afya Plus will collaborate with PORALG, MOH, LGAs, Non-Governmental Organizations, and other key stakeholders to:

  • Enhance leadership and managerial capacity of regional, council and facility management teams on evidence-based and inclusive planning and management of health services.
  • Assess and enhance the context for data visualization and use in decision making processes, identifying, and engaging data users and producers using available data dissemination platforms.
  • Improve data quality and availability, identifying information needs, and building overall capacity in data use core competencies.
  • Forge relevant partnerships to strengthen the organization of data and data infrastructure at LGAs level for high quality health service delivery.
  • Promote availability, integration into use of evidence-based knowledge, proven interventions and practices generated by research and implementation science on improving health services.

Priority intervention 1.2: Strengthen cross-sectoral human resources information systems to generate reliable human resources for health information and evidence for planning, implementing, and monitoring workforce policies towards UHC and SDGs.

Afya Plus will work in collaboration with PORALG, POPSM, MOH, and other relevant stakeholders to:

  • Expand access to health services through promoting the culture of using data for decision making; improve data-driven management for efficient distribution and use of the available human resources for health.
  • Develop efforts to support the strengthening of the available systems and skills, focusing on interoperable information systems for human resources management. The tailored interventions will also empower local communities and LGAs to have real-time data on the need and gaps for human resources and be instrumental for equitable distribution of and improved access to the health workforce.
  • Optimize the impact of the available data, which will emphasize setting up systems and processes that are multi-sectoral, interlinked, and interoperable to create a comprehensive database that will guide the management of the health workforce and their operations in the country.

Strategic objective 2: Strengthen facility and community-based surveillance and reporting systems to effectively monitor early warning indicators for prompt prevention and control of disease outbreaks and public health emergencies.

Priority intervention 2.1: Event-based and indicator-based surveillance of public emergencies and disease outbreaks for effective prevention and timely detection.

Afya Plus will collaborate with national coordination mechanisms for disease outbreaks and public health emergencies to:

  • Strengthen community involvement and LGAs capacity to monitor and timely report on disease outbreaks.
  • Support Government efforts to strengthen systems for detection, communication, and collaboration across sectors and between subnational and national by enhancing competent data management, analytics, and sharing across and within relevant sectors.

 Strategic Focus Area: Strengthen organizational management systems, recruit, develop and retain a high-performing and competent workforce and effectively mobilize funds for a successful implementation of this strategy.

Context and Gap:
Health is interlinked to many aspects of a country, and changes to any aspect directly affect the health status of the country. Re cognition of these changes is essential in developing effective and functional strategies. Furthermore, with inevitable changes and shifting priorities in the Tanzanian societies, Afya Plus needs to be flexible, agile, and better equipped to meet the market dynamics. Afya Plus in next five years will focus both on sustaining and developing organizational effectiveness for better service delivery and performance. Also, on strengthening its organizational capacities by enhancing the effectiveness of its organizational systems and the ability of Afya Plus staff to meet business needs and expectations. Moreover, the organization will invest on resilient, competent, and qualified workforce, efficiency systems, and strategic partnerships to meet the priorities of the country and ensure positive outcomes. In view of that, Afya Plus will focus on specific areas that intend to strengthen its organizational capacities and strategically positioning the organization for growth during the lifespan of this strategic plan.

Strategic objective 1: Develop a high-performing workforce through effective management practices and organizational systems, enabling a working environment and continuous improvement framework for effective implementation of this strategy.

Priority intervention 1.1: Improve organizational management practices and systems.

In the next five years, Afya Plus will strive to sustain and grow its organizational capacity. It will do so by enhancing the effectiveness of the organizational systems and the capacity of Afya Plus staff to support the organization to fulfill its vision and mission. Afya Plus will focus specifically on the following areas:

  • Strengthening the organizational capacity to maintain high standard management practices in compliance with relevant donor policies and regulations.
  • Develop the resource mobilization strategy that will guide solicitation of funding opportunities from various sources to guarantee diversification and sustainability of the organization.
  • Develop a communication and visibility strategy that will increase public awareness of the organization’s activities and its contribution to public health and the well-being of people.
  • Develop a strategic information system that will timely monitor, evaluate both organizational systems and programs’ processes and critical performance indicators to inform the management and other key stakeholders on the progress made and areas that need improvement.

Priority intervention 1.2:  Recruit, develop and retain competent and skilled human resources to utilize their full potential.

Recruit and develop organization employees to meet the demands of the organization and ensure continuous improvement in the organizational effectiveness. Afya Plus will:

  • Establish human resource development and a motivational plan to maximize staff performance, accountability, creativity, and retention.
  • Develop an integrated electronic, human resource system that will be used to manage payroll, timesheet, leave, performance, and staff development.
  • Create a strategy to promote the use of innovative digital technologies such as DHIS2 Touch mobile Application and Geospatial programming for improving organization efficiency, skill transfer, and quality of services.
  • Establish continuous collaborative learning and adaptation applications/platforms for internal improvement.

Strategic objective 2: Expand organizational financial base by retaining the existing grants and securing new funding for revenue growth.

Priority intervention 2.1: Strengthening the organizational capacity to maintain high standards of compliance to sustain and expand USG/PEPFAR and other donors’ funding.

Afya Plus will:

  • Develop a mechanism to ensure proper management of all organization costs and expenses.
  • Develop an organization’s communication and visibility strategy to increase public awareness of the Afya Plus activities and their contribution to public health and the well-being of people.
  • Strengthen the organizational capacity to maintain high standards of compliance with relevant donor policies and regulations.
  • Strengthening organizational data management systems for institutionalizing data-driven programming that meet high-frequency reporting (HFR) requirements.

Priority intervention 2.2: Develop a mechanism to diversify sources of organization revenue through solicitation of potential funding opportunities.

Financial stability will be a primary focus for Afya Plus during the implementation of this strategic plan.  In view of that, Afya Plus will focus on: –

  • Pursuing additional funding for its services by nurturing a diverse network of partnerships with potential funders including from the private sector that are willing and able to support local organizations.
  • Developing a system for a continuous identification and application of potential funding opportunities that are in alignment with local and donor’s environment and interests.
  • Adopting a strong communication strategy that will showcase Afya Plus technical capacity and support the organization to maintain trust and securing strategic partnerships from the potential donor community.