Document(s) 3 of 10

Component A focusses on health systems at both the District Health Management Team (DHMT) level and also the facility level. It observes and records what actually happens over time with respect to stakeholder influences, planning, prioritization, resource allocation and control, management, etc at the DHMT level and at the Facility level, implementation, quality, compliance, satisfaction and coverage.

Component B is concerned with health behaviours at the household level. This includes items such as health seeking decision making, health facility/traditional healer utilisation, expenditure, compliance, satisfaction, perceived quality, access, equity, etc.

TEHIP, through its collaboration with the Ministry of Health, uses the existing frameworks and structures. It is not the goal of TEHIP to produce the two best districts for health planning and health service delivery but to use the two districts' experiences as pilots to develop sustainable and practical tools which will permit the process to be potentially "rolled out" to the remaining 115 Tanzanian districts.

Thus far, TEHIP has been able to address the first two of TEHIP's Core Questions namely:

1. How and to what extent can DHMTs do planning which is more evidence-based?

2. How and to what extent can DHMTs implement evidence-based plans?
   
   To-date, there is good evidence that DHMTs can bring about important process changes in both evidence based planning and implementation. TEHIP is therefore pushing ahead with the search for the answer to the 3^rd question which is....

3. How, to what extent and at what cost, does this reduce the burden of disease? It is only through Component C undertaking the demographic surveillance that this answer will be revealed.

Tanzania at the moment has two districts that are using an evidence-based approach and piloting tools which TEHIP has developed. The two districts that TEHIP works in are considered representative of classical rural districts and contain typical district council personnel.

Component C tracks the health impacts through continuous demographic surveillance of around 85,000 people at the household level in each district. Every mortality event is followed up by a verbal autopsy and assigned to a specific cause of death.

Component D Planning Tools (Research and Development ) will be the subject of a future issue of TEHIP News.

Document(s) 3 of 10