From Youth Action Volunteers (YAV) to report 2009-high res.pdf · i from youth action volunteers (yav) to table of contents abbreviations ii from youth action volunteers (yav) to

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From Youth Action Volunteers (YAV) to

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A N N U A L R E P O R T F O R T H E Y E A R 2 0 0 9

2009 ANNUAL REPORT

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TABLE OF CONTENTS

ABBREVIATIONS ii

FROM YOUTH ACTION VOLUNTEERS (YAV) TO SIKIKA 1

EXECUTIVE SUMMARY 2

SIKIKA’S GOALS 3

1: CENTRAL GOVERNMENT POLICY AND ADVOCACY 4

2: CITIZEN ENGAGEMENT WITH HEALTH SERVICE PROVIDERS 11

3: CITIZENS AS HEALTH SERVICE USERS 17

4: PROGRAMME DEVELOPMENT 21

4.1. Programme Development and Implementation 21

4.2. Documentation of Programme Monitoring and Evaluation 22

4.3. Building Staff Capacity 23

4.4. Media Engagement 23

5: FINANCIAL MANAGEMENT 26

6: ACHIEVEMENTS, CHALLENGES AND RESOLUTIONS 27

6.1. Achievements 27

6.2. Challenges and Resolutions 28

SUCCESS STORIES

CCHP Shows Improvements 13

Hafidhi: He Made It! 24

Ester: Sikika Training Changed My Life 30

ANNEX A: LIST OF BOARD OF DIRECTORS, STAFF AND VOLUNTEERS 32

ANNEX B: 2009 ORGANISATION STRUCTURE 35

ANNEX C: AUDITED FINANCIAL REPORTS 2009 36

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ABBREVIATIONSAIDS Acquired Immune Deficiency Syndrome

BWG Budget Working Group

CAG Controller and Auditor General

CCHP Council Comprehensive Health Plan

CSO Civil Society Organisation

DNA Deoxyribonucleic acid

FAO Financial Administrative Officer

FemAct Feminist Activism Coalition

HEqG Health Equity Group

HIV Human Immunodeficiency Virus

HSSP Health Sector Strategic Plan

JAHSR Joint Annual Health Sector Review

M & E Monitoring and Evaluation

MDG Millennium Development Goals

MKUKUTA Mkakati wa Kukuza Uchumi na Kupunguza Umaskini Tanzania

MoHSW Ministry of Health and Social Welfare

MP Member of Parliament

NACP National AIDS Control Programme

NGO Non Governmental Organisation

NSGRP National Strategy for Growth and Reduction of Poverty

OBI Open Budget Index

PC Programme Coordinator

PEPFAR US President’s Emergency Plan for AIDS Relief

PMO-RALG Prime Minister’s Office - Regional Administration and Local Government

PO Programme Officer

PPP Public Private Partnership

REPOA Research on Poverty Alleviation

SAT Southern African Aids Trust

SWAP Sector Wide Approach

TACAIDS Tanzania Commission for AIDS

TAF Tanzania AIDS Forum

TANGO Tanzania Association of Non Governmental Organisations

TGNP Tanzania Gender Networking Programme

YAV Youth Action Volunteers

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FROM YOUTH ACTION VOLUNTEERS (YAV) TO SIKIKAWe are pleased to introduce you to our Annual Narrative Report for the year 2009. This 2009 annual report marks an important transition from Youth Action Volunteers (YAV) to Sikika (be heard). YAV operated from 2000 to October 2009, and was initially registered as a small community based group of youth volunteers aiming to raise awareness amongst youth regarding the prevention of sexually transmitted infections, HIV being among them.

Success in carrying out its objectives resulted into growth beyond health awareness and development into policy and accountability monitoring and advocacy. This was a gradual process which started in 2004, marked with its first strategic plan on health sector governance and accountability between 2006 and 2010. This thrust was prompted by the weak accountability of public funds for healthcare delivery both at central and district government level as documented over the years by the Controller and Auditor General.

With the new strategic plan on governance and accountability monitoring and advocacy for the health sector, the name Youth Action Volunteers was no longer suitable for the new mission and vision. We are no longer community based, but rather our work involves interventions and policy dialogue with local government authorities, central government, parliament and donors. The name has therefore been changed following a review of YAV’s organisational capacity in 2008, extensive consultation of stakeholders and a decision by the Board in 2009.

Sikika will carry over the current vision and mission of Youth Action Volunteers, including on-going contracts already signed under YAV. This 2009 annual report, therefore, marks this transition and it is the penultimate for our strategic plans for 2006 and 2010.

Karibu!

Irenei KiriaExecutive Director, Sikika

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EXECUTIVE SUMMARY

On 28 July 2009, while presenting and defending the budget for his ministry in the Parliament, the Minister for Health and Social Welfare was unable to answer questions relating to the past financial management performance of his ministry. A question was asked by one Member of Parliament (MP) based on the report of the Controller and Auditor General for the ministry and as a result of Sikika’s intervention with the Parliamentary Social Services Committee. The question was unexpected because it had never happened in the past that MPs would ask questions relating to past budget performance during the current year budget debate. This report will provide further detail about Sikika’s budget analysis and its work to strengthen the oversight of public funds for the health sector.

The Executive Director of Sikika, Mr. Irenei Kiria, was summoned by the Municipal Health Management Team of Temeke Municipal Council on 25th May 2009. Although it was not stated earlier in the invitation, it transpired during the meeting that the Health Management Team was displeased with Sikika’s publications which aimed at empowering citizens to demand information about, and advocate for the good governance of, public resources at health facility level. It was clear that members of this team had limited knowledge of policies and legislation guiding delivery of public services at district level. This report will give detailed information about Sikika’s district level social accountability work.

When Jackson Yusi, a student of Mbagala Kuu primary school, through the health governance club organised by Sikika, questioned the decision of the School Committee to plan construction of more classrooms with no additional toilets, teachers in that school thought that was wrong to question decisions by his parents. The school had 3,354 students with only 24 pit-latrine against the requirement of 125 such latrines. We see a bigger demand to engage citizens, regardless of age, in making decisions for their health services. Access to public information is key in this regard, but continued to pose a major challenge to our work in 2009.

At the central level, Sikika continues to advocate for improvement in health budgeting and effective management of public funds. Budget and policy issues were raised through joint statements or participation in various high level meetings such as the Technical Committee for Sector Wide Approach and Joint Annual Health Sector Review. In addition to our engagement with Parliament, we carried out activities in four districts namely, Kinondoni, Temeke, Ilala and Kibaha.

Despite limited funding in 2009 compared to annual targets, we were able to achieve substantial progress in our planned activities. This challenge is expected to be overcome in 2010 as we are in negotiation with key funding partners. Sikika’s achievements in 2009 were possible under the co-funding of Irish Aid, Swiss Development Cooperation, The Foundation for Civil Society, and HIVOS.

This report summarises Sikika’s achievements, performance and progress as per planned activities and budget for 2009 and as part of the implementation of our Programme Strategy (2006-2010). The Programme activities are divided into four sections presenting our work for health service users, service providers, central government policy and advocacy, and monitoring and evaluation including financial audit report.

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SIKIKA’S GOALS

Mission

Sikika works to empower citizens to actively engage with health service providers and policymakers to realise good governance and accountability of public resources at all levels of the health sector.

Vision

A Tanzania where healthy and responsible citizens enjoy quality health services as their basic right.

Outcome 1

Central government is transparent and accountable to the public on health matters by providing timely and accessible information and ensuring participatory health planning, implementation, monitoring and evaluation, including the district and local level.

Outcome 2

Local government authorities and health service providers are transparent and accountable to the public by providing timely and accessible information on health, implementing participatory district health planning and delivering quality health services.

Outcome 3

Citizens are capable of demanding accountability from all levels of government officials as a result of undergoing capacity building by Sikika.

Outcome 4

The Health sector in Tanzania recognises the inherent right of all Tanzanian citizens, to monitor all five processes in the social accountability cycle1 and to obtain justification and explanations for any decisions, actions or omissions that could potentially affect these processes or their outcomes.

1 Planning and resource allocation, expenditure management, performance management, public integrity and oversight

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1: CENTRAL GOVERNMENT POLICY AND ADVOCACY1.1. Health Budget analysis and engagement with the Parliament

Health budget analysis was conducted in the second and third quarters to increase the budgetary literacy of Members of Parliament and encourage them to raise questions and issues of public interest to improve effective allocation of resources at the health sector budget discussion in Parliament. Primarily, the analysis was designed to assess how the government allocated its resources and whether the allocations matched policy priorities. It further was to enrich the general public to systematically follow up on discussions around health budget issues.

Firstly, Sikika conducted total government budget analysis and pertinent issues such as unnecessary expenditures on hospitality, allowances, seminars, acquisition of new vehicles, travels, and fuel2 were shared with some Members of Parliament through mail. These issues were raised in the National Assembly by MPs from both the ruling and opposition parties. Unfortunately, responses from the Executive were not direct or adequate. Until the end of 2009, debate continued regarding unnecessary expenditures by the government based mostly on figures from our analysis.

Second, we conducted a health budget analysis, where findings showed that the overall budget for the sector increased from Tshs 794 billion to Tshs 963 billion, which is about 11% of the total national budget, well short of Abuja target of 15%. An interesting finding was the allocation of Tshs 17.6 billion for the reduction of maternal mortality following a call by Sikika and other partners for the government to allocate specific budget for the reduction of maternal mortality, which is currently 578 per 100,000 births in Tanzania.

However, our analysis also revealed that allocation for unnecessary expenditure items2 for the Ministry of Health increased in the financial year 2009/ 2010 amounting to Tshs 14.7 billion. Sikika argued that it is unfair to spend substantial amounts of public funds on items which benefit very few individuals while critical problems like shortage of human resources for health and poor infrastructure of health facilities, as well as medical supplies and equipment, are receiving inadequate funding.

Following the budget analysis, we met with Members of Parliament to share the findings on 18th July 2009 in Dodoma before the actual health budget speech was tabled for discussion on July 28, 2009. The aim was to provide MPs with subjects for discussion that they would use during the budget session. As a result of this session, a good number of MPs raised issues regarding persistent challenges on human resources for health, pharmaceuticals, maternal health, and health infrastructure during the debate for the Ministry of Health budget. They could not however relate their contributions to specific sub-votes of the budget given how complicated the budget books are and given the varying capacities of individual MPs.

1.2. HIV and AIDS Budget Analysis

HIV and AIDS is an area of budget interest since it receives a lot of foreign funding through on budget and off budget arrangements. It is also an area of potential abuse and misuse of funds while the problem of HIV and AIDS remains significant. Unlike previous years, where Sikika concentrated mainly on the health sector budget, we planned to do analysis for the HIV and AIDS budget in 2009.

The aim of the analysis was to track the allocation of funds for HIV and AIDS in Tanzania and activities for such funds. Access to Medium Term Expenditure Framework (MTEF) for TACAIDS

2 Please visit http://www.sikika.or.tz/analytical_works.html

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was delayed until August 2009 when the budget was already debated in the National Assembly. Internal capacity at Sikika was another barrier since we only had one person responsible for HIV and AIDS. However, we did produce analysis despite the fact that it could not influence the debate. It was nevertheless useful for learning and will advance our analysis in 2010 in case information is accessed on time.

An abstract on this analysis was prepared in Kiswahili and shared with respective stakeholders through local Kiswahili newspapers and at the Annual Joint Stakeholders Meeting in October 2009. Electronic copies were also shared with government officials, some MPs, and members of civil society through the Foundation mailing list. The findings were also shared with members of other networks like the Health Equity Group and Tanzania Aids Forum and Policy Forum.

To improve this area of our budget analysis, Sikika has hired a Programme Officer who will work together with a Junior Officer starting in January 2010. She will attend training on social accountability and become active in national HIV and AIDS dialogue structure since some information is easily obtained if one is a member of high level decision making committees. All necessary preparations are already done and Sikika is committed to report on more outputs in this area in 2010.

1.3. Effectiveness of Oversight Bodies

Budget allocation and how funds are spent are not necessary parallel. Problems with mismanagement, misuse and abuse are widely reported by the Controller and Auditor General each year. Sikika intended to highlight and emphasise this reality to all organs and individuals responsible for playing the oversight role of public health funds and expect to see improved effectiveness of the oversight bodies. The approach was to reveal amounts of health funds queried, reasons for queries, and whether or not any remedial action was taken.

Data was drawn from Controller Auditor General (CAG) reports for the Ministry of Health for the period from 1999 to 2008. It was then analysed and presented as a briefing paper. While CAG’s opinion of the financial management of the Ministry of Health has improved over years, substantial expenditures continue to be questioned. Major queries are with regard to payments being made with no supporting documents and also salaries made to retired, absconded and deceased employees. Adherence to procurement regulations is still a problem which was noted and it needs to be addressed.

When Sikika met with the Parliamentary Social Services Committee on 18th July 2009, the analytical report from CAG formed part of presentations and discussions, and was shared with other stakeholders. As a result, during the budget debate for the Ministry of Health on 28 July, MPs asked four specific questions regarding the 2007/08 CAG report to the Minister who has not been asked questions regarding past expenditure during the debate of current year budget. None of these questions, therefore, were addressed by the Minister and no further follow up by respective MPs was recorded in the official Hansard.

It was not possible to establish any corrective actions planned and implemented to improve financial management in the Ministry of Health, as it is hard to access information and officials are very sensitive regarding the monitoring of past expenditures and financial management. We have mixed experiences regarding the effectiveness of oversight bodies such as the Parliament and National Audit Office (NAO). While NAO carries out audit for all public institutions and presents reports as per legislation guiding their work, Parliament has not been so effective.

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The CAG reports are reviewed by Parliament’s three finance committees. They are the Public Accounts Committee, the Local Authorities Accounts Committee, and the Public Corporations Accounts Committee. It is the Social Services Committee that is responsible for overseeing the Ministry of Health and CAG reports are not on the agenda when they meet with the minister.

In 2010, Sikika will step up work on the effectiveness of oversight to the Ministry of Health and that of local governments. The major aim will be to convince the Social Services Committee to include audit in their agenda during statutory meetings with the Minister of Health. A further aim is to encourage individual MPs to take interest in CAG reports and use them to hold the Executive to account. Misuse and abuse of substantial public funds contradicts the perennial claims that the health budget is not enough.

1.4. Assessment of Performance Management of TACAIDS and NACP

We intended to conduct an Annual HIV/AIDS Performance Assessment for Tanzania Commission for AIDS (TACAIDS) and National AIDS Control Programme (NACP) between the years 2006/07 and 2008/09 to assess the trends in terms of performance and the effectiveness and efficiency of resources to achieve their intended objectives. However, there have been difficulties in accessing documents from these institutions to conduct this study. Formal letters of request and other actions were taken to access these documents but these have not been successful. This activity could not be accomplished but will be attempted again in 2010 if documents can be accessed.

1.5. Expenditure Management of HIV/AIDS Sector

Sikika planned to assess the expenditure management of the HIV/AIDS sector to see how effectively and efficiently funds released by the Global Fund have been spent. The Global Fund, together with the US government, is the largest contributor to the health budget. Between December 2002 and February 2009, the Global Fund itself has allocated a total of $820 million for HIV/AIDS, tuberculosis and malaria programmes in Tanzania.

The aim of this analysis was to get a clear explanation of how work that is supported by the Global Fund is identified, funded and monitored. Major issues of poor financial management in the area of HIV and AIDS in Tanzania have been raised in the past by the CAG and in 2009 by the Office of the Inspector General of Global Fund. This assignment is currently with a consultant and is expected to be finalised in 2010. We will use this information as a platform from which to advocate for better financial management of HIV and AIDS in Tanzania.

1.6. Legislative processes for health

Given its longstanding working relationship with the Parliamentary Social Services Committee, Sikika is usually invited to provide inputs to all Bills submitted to Parliament by the Ministry of Health and Social Welfare. During the first quarter, we had the privilege of providing inputs into the 2008 Human DNA Regulation Act. The objective of the Bill was to enact a legislation that makes provisions for the management and the use of human DNA technology such as transportation, storage, analysis and disposal of samples for human DNA, disclosure of private genetic information, and research. The use of human DNA needs to be regulated so as to protect private genetic information that can be misused.

Sikika’s inputs proposed to address the deficiencies that were seen in the DNA Bill and suggested alternative statements to improve specific clauses. The President approved the Bill on 12th May

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2009. One of the issues that we advocated for in our recommendations has been taken. This is on the offenses and penalties. It now reads that ‘’any person who commits an offence under subsection (I) shall on conviction be liable to a fine of five million shillings or to imprisonment for a term of three years or to both Offences and penalties’’. Previously the term was six months and a fine of not less than one million shillings.

1.7. Public Policy Dialogue

The aim of this activity was for Sikika to participate in different public policy dialogue processes to influence changes and improvements through different policy setting agenda.

For the year 2009, we had the opportunity to attend the SWAP (Sector Wide Approach) Technical Committee meetings. These are high level meetings in the health sector where progress and challenges facing the health sector are discussed. This committee discussed a number of policy and progress reports such as: Monitoring & Evaluation of Health Management Information System Operational Plan; Newborn Situation Analysis Summary; Regional Referral Health Management Progress Report (Aug ’08 – ‘09); progress implementation of annual milestones; preparation of Joint Annual Health Sector Review; progress reports from various technical working groups, and the development of Terms of Reference for Health Sector Dialogue Structure.

Sikika also participated in the development of the Health Sector Strategic Plan III (2009-15), which was launched by the President on 30th June 2009. Sikika had the privilege of engaging with the different thematic working groups (Human Resources, Public Private Partnership, Pharmaceuticals and Financing) towards the development of this strategy. Such participation increased Sikika’s collaboration with the Ministry of Health and Social Welfare to improve plans and strategies that will strengthen the health sector performance so that quality health services are delivered to citizens.

The Joint Annual Health Sector Review (JAHSR) in October 2009 was another activity in which Sikika participated to improve policies and health service delivery. This is a meeting that convenes annually, assesses the annual performance of the health sector and sets new strategies for the coming year. Sikika had the opportunity to attend the task force meetings for preparation of the JAHSR. The annual review was preceded by the Technical Review Meeting to discuss the health sector performance for the year 2008.

In the JAHSR, Sikika prepared an opening speech which was presented through the Policy Forum, a network of 96 non-governmental organisations in Tanzania. In this statement, Sikika called for effective and efficient use of public funds, especially the Tshs 17 billion allocated for the reduction of maternal mortality. The speech also called for effective implementation of the policy for free services for various groups such as children and pregnant women. Other issues covered in the speech include human resources, pharmaceuticals, district planning and service delivery, HIV and

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AIDS and access to budget information. In 2010, Sikika will monitor the implementation status of these demands by the Ministry of Health and Prime Minister’s Office-Regional Administration and Local Government.

Sikika also had the chance to participate in the review of the National Strategy for Growth and Reduction of Poverty (known in Kiswahili as MKUKUTA) in September. The first phase of MKUKUTA will end in 2010, and therefore stakeholders including CSOs are in the process of reviewing the implementation of the current MKUKUTA and providing inputs for the next stage. These will be processed and status reported in 2010.

1.8. Participation in activities initiated by NGO Networks and other partnerships

Sikika is a member of NGO networks such as the Policy Forum’s Budget Working Group FEMACT, Tanzania AIDS Forum, and Health Equity Group. The aim of our participation in collective activities by networks is to influence broader policies and defend human rights for poverty reduction. Through networks we share our experiences, information, and learn different advocacy strategies. We also develop relationships with other organisations and networks to support our works.

Policy Forum

Policy Forum is a network of 96 NGOs working to influence policy processes and improve the quality of living for people in Tanzania. Sikika is involved in Policy Forum’s Budget Working Group. The purpose of our partnership is to discuss the budgets and individual member findings from budget analysis work. This year, Sikika attended monthly meetings by Policy Forum specifically for the Budget Working Group. These meetings serve as avenues for planning and sharing budget works including preparation of joint papers. In addition, Sikika attended the Policy Forum’s Annual General Meeting that took place from 2nd to 3rd April 2009 and also the monthly breakfast debates organised by the Policy Forum to share research and analytical discussions on various policy and budget works.

Constituency Development Catalyst Fund

The process for the establishment of the Constituency Development Catalyst Fund (CDCF) started in 2007 and ended with the passing of the law by the National Assembly in July 2009. This Fund allows MPs to access and manage public funds for development projects in their respective constituencies. This is in direct contravention of MPs Constitution

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role of playing oversight to the government; it also undermines the mandate of local government authorities. Sikika wrote three articles which were published in local newspapers in protest at the passing of CDCF. Sikika also sought signatures for petition and participated in preparation for a failed demonstration in Dodoma by Policy Forum as well as attended a public hearing for the same in July in Dodoma. Despite these efforts, the law to implement CDCF was passed. The assumption is that CDCF funds would facilitate political activities in the coming general elections in 2010.

Loliondo Case

A foreign company called Otterlo Business Corporation has confiscated a large area of land in Loliondo in Northen Tanzania, which was previously used for grazing livestock by Maasai communities. In a process to free the land to this Corporation, residents were evicted from their homes, their properties destroyed, houses burnt down, their livestock killed and some of the residents brutally harmed. This issue was raised at a coalition called FemAct which Sikika is part of. Sikika through FemAct, produced a statement on the Loliondo Eviction on 27 August 2009, urging the government to protect the rights of those residents. Some members of FemAct made a field visit to see the situation and wrote a report which was covered by media and prompted the Parliament to form a commission of inquiry. Sikika will follow up with the report of the committee in 2010 and the implementation of its recommendations.

Gender Festival

Through Health Equity Group, Sikika participated in Gender Festival in September. Gender Festival is usually organised by the Tanzania Gender Networking Programme (TGNP), which is an open forum for policy, budget and gender discussions. Sikika presented a paper regarding its health sector budget analysis.

CSOs Exhibition

Sikika was invited by the Foundation for Civil Society to share its experience of working with Parliament during the CSOs Exhibition in Zanzibar. In this exhibition, Sikika presented its experience in engaging with Parliamentarians to the Women Development and Social Services Committee of the House of Representatives. Other NGOs and especially those based in Zanzibar were advised to learn from Sikika’s experience if they want to affect public policies and budgets.

Another CSOs Exhibition was organised by the Foundation for Civil society in Dodoma from 26 to 30 June 2009, which was attended by Sikika. The aim of this event was to bring together CSOs from different parts of the country and share their experiences with Members of Parliament. It therefore helped Sikika to share and publicise its work and knowledge with Members of Parliament and other CSOs.

An annual CSO forum in Dar es Salaam, which was aimed at contributing different works and experiences among CSOs, was organised by the Foundation for Civil Society. Sikika attended this forum in Ubungo plaza in October. In this meeting, Sikika presented information on the budget process in Tanzania and the extent to which budget documents are publicly available, using the Open Budget Index (OBI) findings of 2008.

1.9. Human Resource for Health Deployment Tracking Study

For many years now, human resource levels for the health sector in Tanzania has been said to be in crisis, due to the fact that the total staffing in the health sector stands at 35% of the actual need. In the past two years, the Ministry of Health and Social Welfare has been deploying new workers to all 133

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local government authorities. The challenge has been to track those who are deployed and generate a database that will inform further interventions and decisions at central government level.

In response to this, Sikika decided to seek collaboration with the MoHSW to conduct a deployment tracking study in all local government authorities in Tanzania. The study examined the status of deployed health workers to the approved posts in the councils by cadre and the total available workers present at their duty stations. It also sought to investigate the reasons for the poor attraction and retention of health workers in each council.

Data collection started in June after obtaining a letter from the MoHSW to introduce Sikika to all 133 local government authorities in Tanzania. A one page questionnaire was used to collect information via telephone calls, email and fax. Sikika collected information from 104 out of the intended 133 local government authorities. Data was later entered into a computer programme (SPSS) for analysis.

A report of this tracking study will be finalised in 2010 and be shared with the respective Ministry and other stakeholders. It will show the status of human resources in the country and suggest ways to improve the situation. It is hoped that the findings of this study will provide clear and realistic

data for the implementation of the Human Resource for Health Strategic Plan (2008-2013).

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2: CITIZEN ENGAGEMENT WITH HEALTH SERVICE PROVIDERS2.1. Citizen participation in health planning through street/village level meetings

Due to delegation of authority from the central to local levels through the Decentralisation by Devolution, community dispensaries, health centres and district hospitals should be key actors in health planning and implementation processes. It also gives an opportunity for community members to be directly involved in district health planning called ‘Comprehensive Council Health Plan’ (CCHP), by attending street/village assemblies where they can identify their health priorities. According to Local Government, laws the street assemblies should occur once every two months (six per year) while the village assemblies should occur every three months (four per year).

The objective of this activity was to facilitate citizen participation in street/village assemblies with the aim of making them active in their residential areas.

First, Sikika assessed the frequency of the assemblies through the volunteers who monitored the assembly timetables in their residential area. Only volunteers from four out of 35 wards managed to participate in such assemblies. During the follow up process, our volunteers concluded that one of the main reasons for lack of participation is because such assemblies do not occur as indicated in the Local Government Law.

To address this challenge, Sikika monitored the frequency of such meetings. A checklist was developed in the third quarter by Sikika staff and volunteers. Volunteers were required to collect the information from the streets/village Secretaries or Chairpersons of all (99) streets from 30 wards in Kinondoni, Ilala and Temeke district and six villages from five wards in Kibaha district. The main aim of the monitoring was to examine frequency and the agenda for such assemblies. The report revealed that the majority of the street/village leaders (80 out of 115) were not aware of how often these assemblies should occur during the year. Only 16% of statuary meetings occurred, in which attendance was reported to be very low.

Sikika is expecting to use the results from the monitoring report to call for increased occurrence of the street/village assemblies in 2010 (from 16% to at least 30%), as well as to sensitise citizens on the importance of such assemblies in community decision making (see Activity 2.3 below). This will be an important activity for the 2011/12 CCHP formulation that will be delivered in December 2010. Campaigning will include the preparation of posters, brochures and media contribution to advocate for the correct implementation of street/village assemblies as given in the Law.

2.2. Citizen engagement through facility governing committees

In 2008, Sikika prepared an information booklet with the names and contacts of members of various health Boards and Committees in Dar es Salaam and Coast region. The information booklet contains a summary of roles and responsibilities of each level of healthcare governing committee. The intention for this information is to facilitate communication and feedback amongst healthcare governing structures and service users. The expectation is for citizens to monitor the health providers’ roles, register complaints regarding any poor quality of healthcare, and to demand accountability whenever necessary.

The plan was to print 10,000 copies of information booklet and distribute to citizens at street/village level. Unfortunately, the booklet could not be published because the names and contacts of

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members of boards and committees change frequently. However, computer printouts were made and distributed to the community members through volunteers in the 35 wards.

As a result of widely sharing roles and responsibilities of various governing boards and committees including contacts for its members, many citizens used the opportunity to telephone members of committees of their respective health facilities. Most citizens demanded meeting schedules for particular committees, asked for information regarding facility plans, income and expenditure, or inquired about progress regarding certain registered complaints against some health provider’s attitude. There were some complaints that Sikika’s activities have “exposed” citizens to be too demanding.

2.3. Citizen engagement in 2010/11 CCHP formulation

According to the Comprehensive Council Health Plan (CCHP) Guideline of 2007, districts should implement participatory health planning whereby, every December, community priorities are to be collected and incorporated in the coming year’s CCHP. The prospect of implementing participatory planning is for the improvement of their wellbeing since community needs and priorities would be addressed.

Our initial idea was to advocate for citizens to select their health priorities that would be put in district health plans. However, following the report from the monitoring exercise described in Activity 2.1, it was clear that there is a need to increase the frequency of street/village assemblies before citizens are able to contribute to the formulation of CCHP. In December, the approach was changed and we agreed to first advocate for increased citizen attendance of street/village assemblies before we promote citizen engagement in CCHP formulation. As a result, Sikika prepared a campaign strategy which will be implemented in 2010 to increase citizen participation in street/village assemblies.

2.4. Monitor the implementation of 2008/09 CCHPs

The activity’s objective was to monitor the implementation of 2008/09 CCHPs in 35 wards (in Kinondoni, Temeke, Ilala and Kibaha districts). The aim of the monitoring was to assess if the allocated funds have been used effectively, and if the planned activities have been accomplished accordingly.

Taking into consideration our last year’s experience,3 a new plan was developed which included the

3 In the last year there was no report produced from CCHP monitoring. This was because most volunteers did not managed to get the required data. On the other hand, much of the data collected was not valid so the process of data analysis was made impossible.

CCHP Shows Improvements!Council Comprehensive Health Plans (CCHPs) are planning and budgeti ng tools for health interventi ons at the local Council level. CCHPs combine all the acti viti es that need to achieve the goals and objecti ves at the council on annual basis.

Since 1999, a number of guidelines have been developed to direct councils in preparing these CCHPs with the aim of ensuring cost eff ecti ve uti lisati on of funds. Moreover, these guidelines are aimed at bridging the performance gap among the councils in the management of district health services and to enhance the decentralisati on process. These plans emphasise the involvement and ownership of all stakeholders including the private sector, faith based organisati ons, non-governmental organizati ons and health service providers that operate in a parti cular district. Through the pre-planning meeti ngs, they identi fy resources and acti viti es of which are included in the CCHPs. This is very important in ensuring eff ecti ve coordinati on of acti viti es and thus avoiding duplicati on.

Sikika is operati ng in four districts of Kinondoni, Ilala, Temeke and Kibaha. We have been monitoring the implementati on of CCHPs in health faciliti es as well as reviewing these plans. The aim of CCHP Review is to provide informati on on the management of public resources in the district health departments and highlight achievements on the implementati on of health interventi ons. The review also serves to identi fy strengths and weaknesses observed in the CCHPs documents and generate recommendati ons and inputs for CCHP guidelines.

The fi rst review was conducted in 2008 and involved the evaluati on of the CCHP for the government year of 2005/06, 2006/07 and 2007/08. These reviews, among other weaknesses, revealed gross arithmeti c errors in all the districts in which we operate, though worst cases were more prominent in Kinondoni Municipal Council.

The occurrence of such errors suggested that the budget offi cers were compiling budgets and reports manually. From our report, Sikika recommended capacity building trainings for planning/budgeti ng offi cers on the use of Microsoft Excel Spreadsheet. In additi on, these weaknesses were discussed at length during a consultati ve meeti ng organised by Sikika on 22nd January 2008. The council/district offi cials responsible for CCHP, parti cipated in the meeti ng and acknowledged these weaknesses. They were determined to take correcti ve measures to address them.

In 2009, the CCHP review for 2008/09 was done. The aim was to update the previous year’s review and fi nd how much of the recommendati ons were put forward in 2008. Findings obtained from this review revealed that arithmeti c errors had been minimized signifi cantly compared to the situati on in last review. In the consultati ve meeti ng held in 12th May 2009, parti cipants appreciated Sikika’s contributi on especially in reviewing these plans. They were delighted and expressed that these reviews gave them an opportunity to learn from each other and support the preparati on of the following council/district health plans. We believe that through these reviews and shared informati on, district health planning and budgeti ng will further be improved.

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improvement of the monitoring tool to simplify the data analysis process. This included the revision of a checklist which was later developed into a questionnaire by a consultant. The questionnaire was first pre-tested in eight facilities before the data collection process began. The monitoring was done by Sikika staff and field assistants.

Approval letters were obtained from DMOs in Kinondoni and Ilala districts (with the exception of Kibaha where there was no such demand) while at Temeke Municipal, the management team was reluctant to share information regarding the implementation of their annual plans. This was purely due to limited understanding of reforms and our consultation meetings did not improve this situation. Overall, the monitoring was done in a total of 73 (18 facilities at Ilala, 9 at Temeke, 31 Kinondoni district, 15 at Kibaha) out of 103 health facilities.

Data analysis and report writing will be done in 2010. A draft report will be shared with the health providers in the respective districts before it is widely distributed. Results and observations from this monitoring exercise are expected to inform future interventions to improve effectiveness and efficiency of district health plans and implementation.

2.5. Engagement with Councilors and Districts Authorities

Sikika planned to conduct consultative sessions with councilors in each of the four districts since they play oversight to the department of health in their respective districts. The aim was to strengthen their capacity in terms of their roles and responsibilities and share analytical information about planning and budgets for the department of health in their respective districts. This activity was not done because of limited funding, but will be carried over to 2010.

However, during the course of the year, Sikika was requested by the Kibaha District Council to conduct training to the HIV/AIDS Committee members in five wards regarding their roles and responsibilities to improve their performance. The training was successfully conducted on 11 and 12 June.

2.6. Analysis on social accountability monitoring in the four districts

Sikika planned to continue a number of social accountability analyses in the four districts of Kinondoni, Kibaha, Temeke and Ilala. These are the Review of the Controller and Auditors General (CAG Report 2007/08), the CCHP 2008/2009 Review and the Assessment of the Effectiveness of Oversight Bodies.

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Assessment of Expenditure Management (CAG Review)

The analysis of the expenditure management involved the review of the Controller’s Auditor General Reports for the financial year that ended on 30 June 2008 for Ilala, Kinondoni, Temeke and Kibaha districts. The aim of this analysis was to assess how effectively public funds in the four districts are being spent or have been spent. Areas indicating good and/or poor expenditure management were identified.

According to the written report4, all the districts were issued with a clean audit report although there were a number of expenditure inquiries and questions which were discovered in most districts. These included a payment made without supporting documents, a payment made in advance of delivery of goods, and unpaid salaries not surrendered to the Treasury. In all the CAG reports, there were neither mechanisms to oversee the use of public resources nor the capacity to respond to cases of misuse and/or abuse of public resources. We will use this information to increase awareness to citizens on the management of resources in respective districts so that they can hold their leaders accountable. This information will also be used for public officials to understand the magnitude of problems facing the management of public resources and set the ground on how to address them.

Assessment of Performance Management (CCHP 2008/09 Review)

The aim of the CCHP 2008/09 Review is to look at how each health department in the four districts is implementing their annual and medium term plans (strategic plans). It is also an opportunity to establish a trend in the performance of health budgets in District Councils over time and find how much of the recommendations from Sikika’s 2008 Review have been addressed in the 2008/09 planning, budgeting and budget execution processes. The assessment included the review of CCHP reports for 2008/09 and District Health Implementation reports for 2007/08. Improvements have been made comparing to previous years review, however there continues to be issues of: copying and pasting syndrome, arithmetic errors, lack of information on the unspent balance, no indication of budget ceiling per cost centre, and no explanation of why allocations sometimes deviate from the allowed ceiling.

A consultative meeting to discuss the findings of the draft report was conducted on 12 May. The meeting was attended by various district officials and their representatives including the advisor for Ministry of Health and Social Welfare. Attendants were grateful to Sikika for facilitating such discussions and for sharing our findings and lessons with those in charge.

Briefs were produced from the above mentioned studies. Advocacy action will be taken to continue influencing the improvement in policy, governance and health planning decisions as well as set the base for future citizen monitoring of health service delivery.

Findings from these reports will be reviewed and cross-checked in the following year with new information. We will use the recommendations stated in the 2009 reports to track improvements in 2010.

Assessment of Oversight Effectiveness

The aim of this activity was to find out if officials are called to account by oversight bodies for their

4 Review of Audit Reports for Temeke, Kinondoni and Ilala Municipal Councils and Kibaha District Council for the year 2003/04, 2004/05, 2005/06, 2006/07, 2007/08

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performance, and if the role of oversight bodies makes any difference. The activity was not done because of inaccessibility of documents especially at Ilala Municipal. As a result, a letter was sent to the Regional Administrative Secretary to challenge the lack of access to documents that should be publicly available. We are expecting to carry forward this activity to the next year.

Corruption Book

From research conducted in 2007, we decided to develop a book on the state of corruption in health service provision in Dar es Salaam and Coast region of Kibaha. The research findings from this study revealed that the majority of the service users (82%) in all the four districts are aware of the existence of corruption and participate in it one way or another. It was also revealed that all the cadres in the health facilities including nurses, midwives and doctors in charge, assistant medical officers and so forth are participating in corrupt behaviours. Moreover, it was observed in the report that there are many reasons which lead to corruption. Among them are the lack of human resources in the health sector, poor living conditions of the service providers, poor quality of health services and poor ethics. A total of 2000 copies of the corruption book (1000 copies in both Swahili and English language) will be printed and distributed to citizens and interested stakeholders. Through sharing these findings, we expect that health managers, policy makers, civil society organisations, service users and service providers will use this information effectively to prevent and combat corruption.

2.7. Monthly volunteers’ meetings

Sikika’s focal point of engagement with citizens is through 70 volunteers. They share our findings from analytical work and advocacy initiatives and collect stories of change and success from citizens. It is in the monthly volunteer meetings where they discuss achievements, raise issues and share information from the engagement with citizens. A total of 11 out of 12 volunteer meetings were carried out this year. The November and December meetings were joined together because of a holiday season.

In the second quarter, two Field Assistants started to train volunteers in their respective wards. A total of 12 capacity building sessions were organised is such way. Volunteers improved their skills on topics such as the structure of the health system, the level of health service provision and the

importance of good governance in the health sector. From such focused capacity building sessions, we expect the volunteers to be good ambassadors in their community and promote transparency and accountability for improved quality of

health services.

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3: CITIZENS AS HEALTH SERVICE USERS 3.1. Dissemination of Sikika’s publications

Sikika builds the capacity of citizens by disseminating information that increases levels of knowledge and results in active participation in health sector planning, implementation and tracking of health resources. Publications such as newsletters, fliers, policy briefs, booklets and posters were produced and distributed along with those from our partner FEMA. The publications were distributed to school health governance clubs, events such as the HIV/AIDS meeting in Mlandizi and Magindu, JAHSR, budget training in South Africa( 6 February, 2009), ward offices, health facilities and special occasions such as the Women’s Day, Gender Festival and the CSO exhibitions.

In 2009, a total of 12,049 publications were disseminated in the four districts where Sikika works. Questions and discussions from Sikika’s school health governance clubs show that the materials boosted recipient’s knowledge of social accountability issues in the health and HIV/AIDS sector. Concerns were raised about tracking the distribution of publications to the intended target group. A monitoring tool was developed and adopted by volunteers and staff who disseminated these publications. From the tracking tool, it was found that there is a serious problem with removing our posters in public places. In 2010, we plan to improve our approach so that our posters will not be removed easily from the display.

3.2. Training of trainer sessions for community members

The aim of this activity was to train trainers on district health sector reforms, policies, planning, budgeting, performance and monitoring of health resources. A total of 200 Swahili training kits (which included the training manual) were planned to be produced and used as a teaching tool during training sessions in the 35 wards. Sikika made efforts to prepare

citizens from 23 wards to participate in these trainings. Citizens would then share the information with community members so they can use knowledge and demand better health services through participation in their district health planning and monitoring.

A one day workshop was conducted on 30 May 2009 with participants from four district offices. Members of civil societies, schools and field assistants reviewed the training manual to improve the kits. Due to limited funding, there was no training conducted this year.

3.3. Participation in Radio and Television Programmes

Radio and television programmes are a good way to stimulate citizens to participate in the governance and accountability of healthcare delivery. This year, we planned to air a weekly radio programme, however were unable to buy air time due to financial constraints.

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For this reason, the organisation exploited opportunities to participate in free radio programmes. In this regard, three programmes were aired on two different stations, TBC FM and Radio Mlimani. Both episodes stimulated a discussion among citizens, this was revealed by the number of SMS and call-ins during the programmes. Since Sikika didn’t pay for production or air time, it was not possible to get recorded CDs from the stations. However, the topics for the radio programme were documented.

In order to reach wider audiences, Sikika also contributed to free pre-paid TV programmes offered by various TV stations. A total of four TV programmes on different topics were aired: this included discussions on citizen participation in the district annual health planning, budgeting and implementation. Other topics included the abuse and misuse of public funds for the delivery of healthcare. The TV programmes also gave an opportunity for Sikika’s volunteers to share what they learned not only from the organisation but also from the communities they represent. It was also an opportunity for citizens to view a real life experience from volunteers who are also affected by the weak health service delivery.

3.4. Production of Sikika’s Newsletter

Sikika’s newsletters are produced on a quarterly basis to communicate and disseminate findings and information regarding health governance and policy. The newsletters also explain the progress and challenges experienced by Sikika through monitoring of health service delivery, policy processes, planning and governance of health resources.

During this period, several issues of the newsletter were developed and 2000 copies of each were printed in Kiswahili. Of these, two issues were for quarter three and four for the year 2008 whose production was carried over to this year. Copies of our newsletters are available on our website: www.sikika.or.tz.

In order to improve our readership for the newsletter, we developed a survey which brought up a number of recommendations on how to improve the content and format of the newsletter. The majority of respondents preferred more articles on experience from the health service users in healthcare access. It was also recommended that the articles should be more entertaining and educational (by using cartoons, puzzles, and case studies). As for change in appearance, several respondents suggested increasing the number of pages to accommodate the suggested content. In addition, it was proposed to have a newsletter that appears in different colours per issue in order to differentiate the quarterly issues. In 2010, we expect to use the recommendations from our readers and improve our newsletter.

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3.5. Translation and popularisation of policy documents

Many of the policy documents are written in English and use technical language which ordinary citizens cannot understand. For this reason, Sikika decided to make policy documents accessible to citizens by popularising them in simplified language and content.

Two documents were to be popularised: these were the National Health Policy 2007 and HIV/AIDS (Prevention and Control) Act, 2008. The National Health Policy 2007 was selected to inform citizens about government health plans and policies in service delivery. It was to be used as a guide for planning, monitoring and evaluation of government commitments in health service delivery. The HIV/AIDS Act was selected to meet the demands of the Tanzanian citizens who are fighting the pandemic and also to complement the government’s efforts in the war against HIV/AIDS. The draft popular version of the National Health Policy was submitted to the Ministry of Health and Social Welfare, whereas the draft of the HIV/AIDS Act was sent to Ilala, Kinondoni and Temeke Municipals for pre-testing and improving the contents before they reach the end user. One of the major challenges we faced was the delay from government officials to give feedback on the popularised books. To avoid delays in the future, Sikika plans to reduce government involvement as this process sometimes undermines our autonomy and freedom of expression. It also delays implementation of Sikika’s activities since the government’s route can cause delays. We expect both books to be printed in 2010.

3.6. Management of School Health Governance Clubs

Through School Health Governance Clubs, Sikika is building a cadre of citizens who are responsible and able to participate in demanding for accountability in health and HIV/AIDS sectors. Students are engaged in discussions which are intended to enable them to monitor planning, implementation and tracking of resources at all levels in the district councils.

This year, Sikika’s volunteers conducted 304 discussions in 61 school health governance clubs in 35 wards in Dar es Salaam and coastal region of Kibaha. The students who participate in these clubs have verbally informed us that they have actively engaged themselves in various activities and decision making meetings in their wards. Some requested for information from health service providers, while others questioned some items in the plans for delivery of healthcare services. In the future, students will be asked to follow up on various social accountability

issues in their districts. They will report on their feedback to Sikika and also write stories from their experience of engaging with local leaders and service providers.

One of the challenges was the unreliable school timetables which led to some instability in our school sessions. In addition, there were issues of competition from other organisations’ clubs in

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the same schools, mobility of labour in education sector which caused the club teachers to be changed frequently and demand for out of pocket payments for teachers as motivation allowance. In the future, we plan to work closely with the schools while partnering with other organisations doing similar work.

Another challenge is the weak documentation strategy by Sikika which was to capture results and success stories from this activity. To address this, Sikika plans to engage members of the clubs in capturing and documenting all social changes that may result from their active involvement in governance and accountability of health service delivery.

3.7. Newspaper analysis and article writing

This activity is aimed at stimulating discussions on various health related issues that come from articles that are submitted by Sikika and also those that are analysed from the health governance perspective.

This year, a total of four articles on different topics were published by Sikika in three news papers; The Citizen, The Guardian and Tanzania Daima. These articles were prepared in response to sensitive issues that prevailed during this period in the health sector and overall social welfare. Out of the four articles, two were based on reactions against the establishment of the Constituency Development Catalyst Fund, a new type of funding which goes against the Constitution of Tanzania. One article was on the Mental Health Bill, explaining the importance of protecting the rights of mentally ill individuals, and one article was on the mismanagement of expectant mothers in Amana hospital maternal unit.

Sikika could have written more articles had it not been the limited capacity of staff in terms of analytical writing skills. In 2009, Sikika did not clearly define the responsibility of each department for writing such articles. For 2010, we plan to recruit more staff, improve the coordination and identify targets to make sure that each department participates in article writing to respond to prevailing issues in health and HIV/AIDS sectors.

Sikika intends to conduct a “one-stop-centre” for health related news by cutting and analysing news articles specific to health service delivery issues such as equity, affordability and quality, as well as professional conduct and overall challenges in the health sector. This year, a total of 1,676 articles on health and HIV/AIDS were cut and analysed on a quarterly basis. The most frequently reported health governance priorities in the newspapers included the lack of accountability in the use of health funds, especially on HIV/AIDS, problems of corruption, issues of human resources for health, health infrastructures and medical supplies. Quarterly analysis reports were prepared and shared with our stakeholders through Sikika’s website.

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4: PROGRAMME DEVELOPMENT4.1. Programme Development and Implementation

The aim of the Monitoring and Evaluation Department is to review and improve programme work as guided in the strategic plan and the logical framework. Feedback about the programme has been reviewed with decision making bodies such as the Board of Directors and the Management Team.

In 2009, Sikika’s strategic plan of 2006-2010 and the logical framework were analysed by a hired consultant. Based on the recommendations, the outcomes and measurable outputs were clearly defined with a realistic focus on the organisation’s five-year strategy and the National Strategies and Plans (MKUKUTA, HSSP II and III and the Vision 2025). During the review, it was recommended that the organisation should

change its name from Youth Action Volunteers to something that better represents the work with the target population and also in policy and advocacy. For this reason, a name ‘Sikika’ was chosen which better defines our work and promotes our overall aim for improved quality of health services and status in Tanzania.

Decisions on the programme, financial situation and the overall organisational policies and guidelines are made by the Board of Directors. This year, two Board of Directors meetings were held. Many important issues were discussed including the registration of the new name, recruitment of staff and the approval of the Annual Narrative and Audited Financial Reports for 2008. Detailed information about the topics of discussion and actions taken, have been documented.

In addition, during management meetings, the team reviewed and monitored progress, discussed and approved programme matters that affected the implementation of the work by each department. A total of seven management meetings were held in 2009. Major topics of discussion included the recruitment of staff, administrative issues, funding opportunities and 2009 activity reports.

To close the end of the year, a three-day staff retreat was held in Bagamoyo town in November. Each department shared their achievements and challenges, reviewed the 2010 work plans

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and participated in team building exercise. The retreat was successful and highly effective for preparing staff for the next year’s work. It was agreed that in 2010, Sikika staff will concentrate on results and changes that occur from our activities, and will identify ways of documenting such achievements. One way of documentation will be by collecting stories from health service users that describe the situation and action they have taken to improve health governance in their communities. Information from the stories will be shared on our website, in the media and used for our advocacy purposes.

Sikika expects to organise an Annual Stakeholder meeting where the 2008 and 2009 activities, achievements and challenges will be discussed. The primary stakeholders invited to the meeting will include: service users; donors; service providers; policy makers; NGO members and the media.

To meet the demands of Sikika’s activities, several positions were advertised which included: Part-time Financial Administrative Officer (FAO), Programme Coordinator (PC as replacement), Programme Officer of Social Accountability- Health (replacement) and Programme Officer of Social Accountability-HIV/AIDS. The recruitment of FAO and PC are in place but the recruitment for PO Social Accountability for Health and HIV/AIDS will take place in early 2010. Sikika decided to recruit the PO Social Accountability on HIV/AIDS in response to the expansion that the organisation is planning for 2010. It was agreed that there is an increasing pressure to improve

the HIV/AIDS sector demands and this will also require Sikika to actively participate in policy and advocacy work in the HIV/AIDS sector. Due to the current limited capacity of human resources in the Policy and Advocacy Department, it was agreed by the Board of Directors and the management that the department will break into HIV/AIDs and Health and will require new staff to administer the work.

4.2. Documentation of Programme Monitoring and Evaluation

This year, a monitoring tool was developed to track visits on Sikika’s website. The tool records the origin of the visitor, search engines used and the links visited on the website. This has become an effective instrument for following the popularity of Sikika’s publications after they

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are announced. In 2010 using this monitoring tool, Sikika anticipates an increased level of engagement with the online users.

Progress made on our activities is reported in the quarterly and interim-annual reports. In addition, staff are requested to attend Monday morning meetings to discuss their previous and coming weeks’ work. A special weekly report form was designed to record the short term tasks of staff. Documents are stored both electronically and in hard copy in Sikika’s office. Those of interest to the public are also available on Sikika’s website.

4.3. Building Staff Capacity

In 2008 when Sikika reached a mid-term of its strategic plan, a consultant was recruited to conduct a capacity assessment of the organisation. He identified several capacity building needs which included: health sector reforms and outcomes, budgeting processes and analysis, resource tracking, new research methods and Monitoring and Evaluation. Based on the recommendations, several staff participated in a Budget Analysis training which was facilitated by REPOA. The objective was to build the capacity of CSOs in National Budget and Government processes that leads to the allocation and utilisation of public resources. Several trainings were also organised by the Policy Forum which included Tax Justice and the Government Budget analysis. Sikika staff received essential tools to review the transparency and accountability of government systems. In addition, a member of the Policy and Advocacy Department participated in a workshop for Training of Trainers on HIV/AIDS and Human Rights which was organised by the Southern African Aids Trust (SAT) in South Africa. This workshop was designed to share experience and identify opportunities on how HIV/AIDS and Human Rights can be integrated into operational activities.

4.4. Media Engagement

The Media Coordinator is responsible for facilitating Sikika’s engagement in the media and documenting progress, achievements, challenges and future opportunities. This year, the Media Coordinator contributed ideas to an ITV programme known as Ulimwengu wa Vijana. In addition, several newspaper articles were recommended to be written by the Media Coordinator. One included an article on the quality of health services in Amana Hospital and one on the Mental Health Act.

Media engagement was limited this year mainly due to funding, and also undefined roles and responsibilities for each department. A facilitator from HIVOS-STAR Programme has organised a three-day training in December to clearly define the objectives, targets and messages for Sikika’s media activities. In 2010, we will use such information to improve our media work.

He made it!You won’t stop talking to him when you meet him! He is a charming, acti ve and talkati ve young man. This descripti on fi ts none other than a 19 year old Hafi dhi Ally who is a peer educator for the Ishi campaign which is HIV/AIDS behavior change communicati on campaign for Tanzanian youth. This is his story.

“One day I had a bad experience when I took my friend to a nearby dispensary called Gwazo in Kigamboni in Dar es Salaam. He was suff ering from stomach ache and needed emergency treatment right away. At the dispensary, there were only two nurses and one doctor available. However, they were busy with other pati ents and recommended me to call another nurse who was to be on duty that evening but did not show up. Because of my friend’s conditi on, I decided to go to the nurse’s house since I knew her from my previous hospital visits. She told me that we should have come early in the morning when she was on her fi rst shift so she could have treated my friend. Without her assistance, I went back to the dispensary. We did not receive any help aft er waiti ng long hours at the dispensary. I decided to take my friend to another dispensary in Kigamboni where he got treatment aft er he had progressively worse stomach ache.

I never had such a painful experience in my life. Nurses are here to help us. It is their responsibility to take good care of pati ents, treat them nicely and provide them with medicati on. This incident made me sad and I decided not to keep quiet and do something about it so that it will never happen to another person again.

The next day I went to see the doctor in charge of the Gwazo dispensary. I explained to him what happened and how the nurses both in the dispensary and the one who left early, did not take good care of the pati ent. I was happy because the doctor listened to me and promised to take acti on about it.”

Hafi dhi asked himself, where he got the courage to talk to the doctor? The answer turned out to be from a training conducted by Sikika. “It was a fi ve-day workshop, which was very useful as it explained diff erent themes such as basic rights of citi zens to questi on doctor in charge in a dispensary about the income and expenditure. In additi on, we were informed

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about our rights to questi on our health service providers when we see something wrong in our health faciliti es. We were also told about health sector reforms, health hierarchy in health faciliti es, dispensaries and hospitals and many other things that built my confi dence to stand up for my health rights.”

This workshop helped him to be courageous and confi dent to confront the doctor in charge of Gwazo dispensary.

Hafi dhi said, aft er few weeks, he visited the dispensary to fi nd out if the doctor had kept his promise. He spent few hours at the dispensary assessing the treatment of pati ents and the behavior of nurses. At last he saw that nurses started to handle pati ents with more care by listening to pati ent problems.

He followed up with the doctor in charge regarding the remarkable changes and was informed that a meeti ng was organized with all the nurses to discuss the matt er in details. They all agreed to make changes in the dispensary. The doctor thanked Hafi dhi for his eff ort and congratulated him for his bravery in that matt er.

Hafi dhi went back home sati sfi ed that he has seen some improvements aft er he succeeded to convince the service providers in Gwazo dispensary to improve provision of service in their dispensary.

Overall, Hafi dhi is a perfect example of a citi zen who does not sit back on informati on but raises his head high and exercises his rights when coming across problems in health service delivery. Sikika supports such bravery and urges other citi zens not to hesitate and do the same.

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5: FINANCIAL MANAGEMENTSikika’s financial accounts were audited by HORWATH Tanzania: a reputable audit firm which is a member of Horwath International, one of the top ten Accounting and British Advisory firms in the world. This company was selected after a competitive bidding by the Board of Directors. In May 7, 2009 the draft audited report was discussed and approved by the Board. Sikika’s audited accounts are shown in Annex C of this report.

The full copy of the audited financial report is available on our website at www.sikika.or.tz. The management letter is also available upon request.

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6: ACHIEVEMENTS, CHALLENGES AND RESOLUTIONS6.1. ACHIEVEMENTS

Budget Analysis

Mismanagement of public funds has been a major concern of Sikika for many years. The connection that Sikika has with the government authorities is important when it comes to sharing our findings and for advocating for equitable and efficient allocation of public resources. In addition, Sikika has developed strong relationships with Members of Parliament, many of whom participate in the Parliamentary Social Services Committee and influence policy change to ensure that available resources for health sector are wisely spent.

Feedback from our 2008-2009 budget and our findings on unnecessary expenditures have shown positive results. It has been noted that senior officials have been concerned about the allocation of funds for such spending and actions have been taken to reduce these expenditures. The situation will be monitored in 2010 however, we are pleased that our findings from budget analysis are shared and acted upon by senior officials.

Health Sector Review

As one of the key organisations working on health budgets in Tanzania, Sikika has the privilege to represent CSO voices at working groups and technical committee meetings organised by the government and NGO networks. In 2009, Sikika took a leading role in developing a CSO statement which was presented at the opening session in the Joint Annual Health Sector Review held in October, 2009. The statement comprised a summary of the CSO’s perspective of the progress and challenges of the health sector and proposed solutions to some of them. The CSO statement recognised the inclusion of various actors in developing health plans, strategies and formulating laws. However, it also asked the government to meet the commitments that were made in the policies such as free healthcare to vulnerable groups. The event also gave Sikika an opportunity to present findings from the joint collaboration with MoHSW on the human resource health tracking study.

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Street/village assemblies

To engage citizens in district health planning, they must attend the street or village assemblies. These assemblies are one of the best methods for citizens to present ideas and identify their health priorities for the coming year. Sikika built the capacity of 70 young volunteers and students from 61 primary and secondary schools to understand health governance for the improved quality of health services. Through such capacity building, citizens acquire increased knowledge on district health reforms, policies, planning, performance and citizens’ rights in decision making processes. Following the capacity building, Sikika volunteers have been participating in the assemblies however early in 2009, they discovered that these assemblies did not occur as indicated by the law. As a result, a monitoring questionnaire was developed and a total of 72 out of 115 assemblies in the 35 wards were examined. The outcomes of this monitoring tool will be used to facilitate a campaign in 2010 to raise awareness about the importance of such assemblies and to increase their frequency and citizen participation in formulating the district health plans.

Engagement with Councilors and District Authorities

Sikika sees an increased level of cooperation from the District Authorities regarding their involvement in governance issues. This can be observed through requests from the Kibaha district council to collaborate with Sikika in building the capacity of the HIV/AIDS committees in five wards: Magindu; Kwala; Mlandizi; Soga and Ruvu. In addition, Sikika facilitated a consultative meeting in May to discuss a draft report from our CCHP Review. Participants in the meeting showed appreciation of Sikika’s work and our dedication to strengthening the health system. These types of initiatives indicated excellent public relations as the councils recognise Sikika’s contribution in improving health service delivery in Tanzania.

6.2. CHALLENGES AND RESOLUTIONS

Economic Crisis

The global economic crisis has affected the implementation of our activities. In addition, the decision on funding in 2009 has been delayed because many donors who fund Sikika also fund the Government of Tanzania under the basket funding scheme. This year, the Ministry of Health and Social Welfare was in transition between the Health Sector Strategic Plan II (HSSP 2001-2008) and the Health Sector Strategic Plan III (HSSP 2009-2015). The HSSP sets the direction of the health sector in Tanzania and adheres to the objectives stated in MKUKUTA and the MDG. Funding problem has made us to postpone printing of our publications and our engagement with the media.

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Timely Availability of Information

Sikika has enjoyed access to some information as a result of our relationship with Members of Parliament and our memberships at national health sector committees. However, access to information remains a problem and several times is denied at both the central and district level. This delays the implementation of Sikika’s activities and interventions. In the near future, Sikika will monitor and document the efforts made to access information especially related to budgets, plans and reports to explain the challenges we face in delivering our analytical works.

School Health Governance Clubs

In school health governance clubs, one of the major challenges is the request for awards such as t-shirts, caps, pens and notebooks which Sikika could not fund in 2009. In addition, some school teachers expect allowances due to the increased workload to help facilitate such clubs. However, this goes against our core principles. On many occasions, school timetables clash with Sikika’s health governance clubs, making it difficult to plan in advance and therefore achieve all the necessary objectives. In 2010, Sikika anticipates to introduce school competitions to reward students for their accomplishments. Sikika also plans to partner with school clubs that are managed by other organisations to avoid conflict with school schedules and reduce workload of the teachers.

Human Resource CapacityWriting about analytical work, remains a challenge in Tanzania. One of the problems is the nature of public education system which does not produce enough critical thinkers and good writers, as well as the fact that few citizens are fluent in English language. Sikika is therefore at times facing difficulties in analysis and delivery of quality reports. This has delayed the production some of Sikika’s publications. In the future, Sikika will seek partnerships with organisations that can provide trainees and assist the organisation in such aspect.

Ester: Sikika training changed my life!“I have been working as a volunteer for many years in various organisati ons doing diff erent acti viti es. Sikika in parti cular has given me a new perspecti ve in health and especially governance sector. During Sikika’s volunteer training in 2005, I had the privilege to learn about the district health system and the role of Health Committ ees where many changes in health sector can be made. On many occasions, I saw announcements for openings in the committ ee but I did not understand the roles and importance of such work to the public. This training from Sikika has moti vated me to look for opportuniti es to be a member of a health committ ee.”

Ester Jackson is 27 years old. She is married and has one child. She lives at Kimara Kilungule in Kinondoni district. Ester was selected and has been a member of a Health Committ ee at Kimara dispensary since May 2006. She has successfully fi nished her four- year term and in 2010, her membership was extended for another four years.

She explains how she became a member of this Committ ee. Q. How did you know that there was a positi on open in your dispensary committ ee?A. At fi rst, I did not know anything about the positi on in health committ ee. I came

to know that aft er I att ended training conducted by Sikika. The training was about health committ ees in dispensary. During the training we were told that there was an opportunity for any citi zen to be member of health committ ee. These opportuniti es were available from ward to district level. We were also told about the responsibiliti es of the committ ee. In the coming months, I saw an adverti sement in the newspaper and the District Medical Offi ce, and was inspired to apply. This was an opportunity for me to apply and use the knowledge from Sikika’s training to help my community.

Q. How did you become a health committ ee member in your dispensary?A. I took my own initi ati ve to ask local leaders in our street about the applicati on

procedures. Aft er I submitt ed my applicati on, it took only few days before I received a lett er from the ward offi ce stati ng that I was selected for an interview. I was not sure whether I was going to be selected or not because there were many people vying for the same post. Among all the people called in the interview, I was the youngest. I waited for a long ti me without getti ng an answer from ward offi ce. One day I

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unexpectedly received a lett er stati ng that I had been selected to be a member of health committ ee in Kimara dispensary.

Q. What was your fi rst impression aft er receiving the news?A. I was very happy to receive this news! I told myself that now is the ti me for me to

work and make changes in this committ ee. I was looking forward to the call for my fi rst meeti ng.

Q. Since you were selected to be a member of health committ ee, what contributi on did you make?

A. Services were poor and members of the health committ ee were not taking full responsibility for their duti es. During the fi rst meeti ng, I suggested the division of responsibiliti es to each member so that they know what to do each day. The reason for this propositi on was to make them responsible and accountable for their work. Division of responsibiliti es has improved the quality of our administrati on through bett er ti me management and reporti ng.

Another contributi on I made was for our dispensary to have a suggesti on box where pati ents can post opinions and also fi le complaints about the quality of health services. The complaints had to include a day and date of the occurrence so it could have been easily followed up. This was successfully implemented and citi zens started to post complaints which helped the committ ee to work and improve the issues.

Through the team work, the committ ee members organized a meeti ng to discuss overti me payments for doctors and nurses at the dispensary. Meeti ng minutes were sent to the District Medical Offi cer and promise was made that this situati on will be improved in the 2010/11 Council Comprehensive Health Plan. This is also one of the committ ee’s achievements which I have contributed to.

Ester is proud of her role in the health committ ee. She was able to use her knowledge from Sikika’s training to justi fy the commitments and responsibiliti es committ ee members make to improve the quality of health services at Kimara dispensary. Since she joined in 2006, Ester conti nues to work closely with Sikika’s staff s and volunteers and encourages other citi zens to parti cipate in initi ati ves set up by the organisati on.

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ANNEX A: LIST OF BOARD OF DIRECTORS, STAFF AND VOLUNTEERS Board of Directors Title1. Pili Mtambalike Chairperson2. Sakina Datoo Vice Chair 3. Irenei Kiria Executive Director4. Abel Minja Member5. Usu Malya Member6. Dr. Eva Matiko Member7. Redemptus Ceasar Member

Staff Members Title 1. Aisha Hamis Programme Assistant 2. Barbara Dockalova Programme Coordinator (from July 2009) 3. Deogratias Mruah Programme Officer 4. Donath Lasway Office Support Staff 5. Edward Furaha Senior Programme Officer (until November 2009)6. Frank Brown Maguta Intern 7. Hope Lyimo Programme Assistant 8. Irene John Accountant 9. Irenei Kiria Executive Director10. Jackson Sikahanga Intern11. Lydia Peter Kamwaga Intern12. Mariam Rangi Programme Officer 13. Moses Mahundi Intern 14. Nicholas Lekule Junior Programme Officer 15. Renatus Kisendi Senior Programme Officer (from October 2009)16. Sara Godfrey Programme Coordinator (until May 2009) 17. Scholastica Lucas Programme Assistant 18. Stella Munisi Administrative Assistant19. Victoria Amandus Programme Assistant

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Volunteers Ward 1. Sylvia P. Salanga Azimio

2. Mussa Mziray Azimio

3. Alana Mbawala Charambe

4. Peter Alfred Charambe

5. Emanuel Josephat Kigamboni

6. Nelis Kamuhabwa Kigamboni

7. Dorothea Paul Mbagala

8. Musa Juma Mbagala

9. Japhat M. Kazi Mbagala Kuu

10. Bahati Shabani Mbagala Kuu

11. Husna Abdul Mji Mwema

12. Mohamed Kabesha Mji Mwema

13. Felista Kipangula Mtoni

14. Abdul H. Pazi Mtoni

15. Zuhura Masoudy Temeke

16. Nurdini A. Mamba Temeke

17. Bimkubwa Abdallah Toa Ngoma

18. Ally Salehe Toa Ngoma

19. Saidi Mnana Yombo Vituka

20. Samira Twalib Yombo Vituka

21. Steven Gumbo Ilala

22. Fatuma Seif Ilala

23. Zulpha Abdul Mchikichini

24. Alex Msale Mchikichini

25. Abiudi Malanga Buguruni

26. Gorate Mlwale Buguruni

27. Amina Mohamed Vingunguti

28. Ramadhani Khalfani Vingunguti

29. Leticia Fredy Kiwalani

30. Mustapha Hery Kiwalani

31. Vumilia Ally Chanika

32. Mwalami Saidi Chanika

33. Anitha Vicent Kitunda

34. Ezekia William Kitunda

35. Paschal Jao Tabata

36. Hafidha Ally Omary Tabata

37. Ansila Aloyce Segerea

38. Mathias Budodi Segerea

39. Theresia Mboma Ukonga

40. Anderson Denis Ukonga

41. Pius Nyamaka Goba

42. Prisca E. Maseke Goba

43. Emmanuel Peter Kawe

44. Alice Mathias Yombwe Kawe

45. Paskazia Robert Kijitonyama

46. Redemptus Caesar Kijitonyama

47. Isaack F. Kisamo Kimara

48. Ashura Kibwana Kimara

49. Kisuwa Mshenga Magomeni

50. Diana Masawe Magomeni

51. Samson S. Lugongo Mbezi

52. Revina Manyika Mbezi

53. Emmanuel Augustine Msasani

54. Cecilia Michael Msasani

55. Habiba Ramadhani Mwananyamala

56. Shabani Kibarati Mwananyamala

57. Barnabas Wandwi Sinza

58. Zulfa Chuma Sinza

59. Khalidi Ally Tandale

60. Arafa A. Salumu Tandale

61. Mustafa Vulu Mlandizi

62. Moza Mambo Mlandizi

63. Latifa R. Mhando Kwala

64. Siali S. Mateki Kwala

65. Lilian Walter Magindu

66. Yona Yohana Magindu

67. Fatuma Shabani Ruvu

68. Mohamed Said Ruvu

69. Batuli Omari Soga

70. Mussa Jummanne Soga

Volunteers Ward

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Consultants

Dr. Ahmed HiugonAlli MasoboAmos MtambalaAnne M. MtuyDr. Azaveli Feza LwaitamaCharles MkudeDaniel MvellaDr. Faustine NjauDr. Flora KessyGerald KibiraJudica TarimoMaro NyameteNathan MpangalaPeter BofinRemidius RuhindukaRuta G. Mutakyahwa

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70 V

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ANNEX C: AUDITED FINANCIAL REPORTS 2009

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P.O. Box 12183

Dar es Salaam, Tanzania

Tel: +255 222 666355/7

Email: [email protected]

Web: www.sikika.or.tz