Process of developing the National Health in All Policies Framework to address social determinants of health in Tanzania Mainland: lessons learned, 2018 - 2022.

Introduction: social determinants of health (SDH) are the non-medical factors that contribute to various infectious and non-infectious diseases in Tanzania. Studies suggest that SDH account for 30-55% of health outcomes globally. Most SDH are outside the mandate of the health sector; hence, multi-sectoral collaboration through Health in All Policies (HiAP) is critical. Health in All Policies looks at public policies across sectors that consider health implications of decisions, seek synergies, use resources and avoid harmful health impacts to improve population health and health equity. This paper demonstrates lessons learned from the process of developing National HiAP Framework in Tanzania Mainland to address SDH. It is expected that countries will be able to learn and adopt what deems fit in their context as they address SDH to improve population health. Methods: different methods were used to promote multi-sectoral collaboration in addressing SDH through HiAP. They included consultations with Prime Minister's Office (PMO) as the coordinator of Government business for their buy-in. High-level advocacy meetings of Directors of Policy and Planning and Permanent Secretaries from sectoral ministries were conducted to move forward the HiAP agenda. Capacity building was provided for sectoral Ministries to understand HiAP concept and SDH. Interministerial collaboration meetings were convened to bring sectors together to identify SDH issues and key areas for inter-sectoral collaboration and develop National HiAP Framework to address SDH. Health in All Policies Secretariat coordinates the HiAP activities. Results: it has been noted that almost every sectoral ministry has a health component in its policy which contributes to the Tanzanian population's health. In this regard, every sectoral ministry has a role to play in addressing SDH for sustainable development. Political will is key in moving forward the HiAP agenda. The role of PMO is significant to ensure inter-sectoral collaboration. Achieving the national and Sustainable Development Goals require strong collaboration among sectors and stakeholder coordination at all levels through HiAP. Conclusion: implementing HiAP is a win-win situation. It enhances inter-sectoral collaboration, benefiting each sector to achieve its health-related strategic indicators and ultimately achieve national and global goals.

How can Health in All Policies approaches support the transition to the well-being economy?

Health in All Policies approaches support the integration of health considerations into the policies of traditionally siloed governance systems. These siloed systems are often ignorant of the fact that health is created outside of the health system and starts long before you see a health professional. Thus, the purpose of Health in All Policies approaches is to raise the importance of the broad-based impacts on health from these public policies and to implement healthy public policy that delivers human rights for all. This approach requires significant adjustments to current economic and social policy settings. A well-being economy similarly aspires to create policy incentives that increase the importance of social and non-monetized outcomes, such as increased social cohesion environmental sustainability and health. These outcomes can evolve deliberately alongside economic benefits and are impacted by economic and market activities. The principles and functions underpinning Health in All Policies approaches, such as joined-up policy making can be helpful to transition towards a well-being economy. Governments will need to move beyond the currently held principle of "economic growth and profit above all else" if countries are to tackle growing societal inequity and catastrophic climate changes. Rapid digitization and globalization have further entrenched the focus on monetary economic outcomes rather than other aspects of human welfare. This has created an increasingly difficult context within which to prioritize social policies and efforts aimed to achieve primarily social and not profit-oriented goals. In the face of this larger context, alone, Health in All Policies approaches will not bring about the needed transformation to achieve healthy populations and economic transition. However, Health in All Policies approaches do offer lessons and a rationale that is aligned with, and can support the transition to, a well-being economy. Transforming current economic approaches to a well-being economy is imperative to achieve equitable population health, social security and climate sustainability.

Strengthening Public Health Leadership in Africa: An Innovative Fellowship Program.

PROBLEM: The Ebola virus disease crisis in West Africa revealed critical weaknesses in health policy and systems in the region, including the poor development and retention of policy leaders able to set sound policy to improve health. Innovative models for enhancing the capabilities of emerging leaders while retaining their talent in their countries are vital. APPROACH: Chatham House (London, United Kingdom) established the West African Global Health Leaders Fellowship to help develop the next generation of West African public health leaders. The innovative program took a unique approach: Six weeks of intensive practical leadership and policy training in London and Geneva bookended a 10-month policy project conceived and carried out by each fellow in their home country. The program emphasized practice, site visits and observation of U.K. public health organizations, identifying resources, and networking. Strong mentorship throughout the fieldwork was a central focus. Work on the pilot phase began in June 2016; the fellows completed their program in September 2017. OUTCOMES: The pilot phase of the fellowship was successful, demonstrating that this "sandwich" model for fellowships-whereby participants receive focused leadership training at the start and end of the program, minimally disrupting their lives in-country-offers exciting possibilities for enhancing leadership skills while retaining talent within Africa. NEXT STEPS: On the basis of this successful pilot, a second cohort of eight fellows began the program in October 2018. The expanded African Public Health Leaders Fellowship has become a central activity of Chatham House's Centre on Global Health Security.

The Global Fund's paradigm of oversight, monitoring, and results in Mozambique.

BACKGROUND: The Global Fund is one of the largest actors in global health. In 2015 the Global Fund was credited with disbursing close to 10 % of all development assistance for health. In 2011 it began a reform process in response to internal reviews following allegations of recipients' misuse of funds. Reforms have focused on grant application processes thus far while the core structures and paradigm have remained intact. We report results of discussions with key stakeholders on the Global Fund, its paradigm of oversight, monitoring, and results in Mozambique. METHODS: We conducted 38 semi-structured in-depth interviews in Maputo, Mozambique and members of the Global Fund Board and Secretariat in Switzerland. In-country stakeholders were representatives from Global Fund country structures (eg. Principle Recipient), the Ministry of Health, health or development attachés bilateral and multilateral agencies, consultants, and the NGO coordinating body. Thematic coding revealed concerns about the combination of weak country oversight with stringent and cumbersome requirements for monitoring and evaluation linked to performance-based financing. RESULTS: Analysis revealed that despite the changes associated with the New Funding Model, respondents in both Maputo and Geneva firmly believe challenges remain in Global Fund's structure and paradigm. The lack of a country office has many negative downstream effects including reliance on in-country partners and ineffective coordination. Due to weak managerial and absorptive capacity, more oversight is required than is afforded by country team visits. In-country partners provide much needed support for Global Fund recipients, but roles, responsibilities, and accountability must be clearly defined for a successful long-term partnership. Furthermore, decision-makers in Geneva recognize in-country coordination as vital to successful implementation, and partners welcome increased Global Fund engagement. CONCLUSIONS: To date, there are no institutional requirements for formalized coordination, and the Global Fund has no consistent representation in Mozambique's in-country coordination groups. The Global Fund should adapt grant implementation and monitoring procedures to the specific local realities that would be illuminated by more formalized coordination.