Pact’s health and social systems strengthening creates lasting change

November 14, 2022
Pact and USAID leadership with Dr. Nandera Mhando (standing at center) at the office of the Permanent Secretary of the Ministry of Community Development, Gender, Women and Special Groups, Dr. Zainab Chaula. Credit: Aidan Tarimo/Pact

Dr. Nandera Ernest Mhando has a big job. As Tanzania’s Commissioner for Social Welfare, she oversees efforts to protect and improve the lives of the country’s most vulnerable children. Her purview includes Tanzania’s foster care and adoption systems, juvenile justice and complex issues like child abuse and children living or working on the streets.

Among the biggest challenges Mhando faces is that social welfare systems in Tanzania are relatively nascent. They lack the capacity to meet the country’s overwhelming need – Mhando notes that Tanzania urgently needs 28,000 more social welfare officers, for example. 

Pact has been a key partner in her efforts toward change. “If I rate all of my stakeholders who are working with us, I put Pact first,” Mhando says.

Pact works to strengthen health and social systems around the world so that our impact is sustainable. With a focus on HIV and AIDS and vulnerable children, Pact works at national and sub-national levels to improve inclusive and equitable access to health and social services, enabling local stakeholders to develop local solutions. Pact achieves this by building the capacity of our many partners, including civil society organizations, government agencies, community groups, and private and faith-based service providers. Last year, Pact strengthened 819 health and social systems across Africa as well as in Asia and Latin America. 

Health and social system strengthening is critical to meeting Sustainable Development Goal 3, good health and wellbeing, and PEPFAR recently identified public health systems and security as one of five main pillars for ending the HIV and AIDS pandemic by 2030.

“Strong partner country public health systems, pandemic preparedness and community-led efforts are a necessity to sustain long-term impact in the fight against HIV,” says Pact’s Jen Mulik, who leads the ACHIEVE project, a USAID-funded HIV program that works across Africa and beyond. “These important local assets can also be leveraged for epidemic surveillance and to deliver effective health services for those living with HIV and wider communities.”

The Pact-led ACHIEVE project hands over working tools to Tanzania's Department of Social Welfare to support social welfare policy coordination efforts. Credit: Aidan Tarimo/Pact

Pact’s approach to health and social welfare systems strengthening supports community engagement in social welfare planning, program design, budgeting and monitoring to facilitate access to and use of client and family-centered services, with a focus on key groups including orphans and vulnerable children and adolescent girls and young women. Pact first works to understand the system in which it is working, so that support can be tailored to address relevant structures and respond to system actor needs. Pact conducts mapping of stakeholders and actors and provides technical support to address priorities and strengthen connections among actors. 

Pact’s capacity development activities bolster the key areas of policy development, social welfare workforce development, public sector planning and finance, information management systems and coordination and networking mechanisms.

In Tanzania, Pact is working to strengthen health and social systems under ACHIEVE, mainly by collaborating with key government agencies to improve their resources and performance, including the Ministry of Health, the President's Office Regional Administration and Local Government (PORALG), and the Ministry of Community Development, Gender, Women and Special Groups, which includes the Department of Social Welfare.

What sets Pact apart, Mhando says, is that it plans with the government from the beginning to ensure its programming addresses the right needs and challenges in alignment with the government’s priorities, with government ministries in the leading role.

“Strong partner country public health systems, pandemic preparedness and community-led efforts are a necessity to sustain long-term impact in the fight against HIV.”

Pact’s Jen Mulik, head of the ACHIEVE project

Various stakeholders hold up a new Code of Ethics Handbook at a recent launch event. The handbook was developed and disseminated with support from Pact. Credit: Aidan Tarimo/Pact

Mhando offers an example: Pact’s efforts revealed that the Department of Social Welfare could benefit greatly by bringing together social welfare stakeholders to examine problems and approach their work comprehensively, rather than separately, including creating a central system for Department of Social Welfare data.

“Right now we have many separate dashboards,” Mhando explains. If she wants to see where child abuse rates are the highest or where vulnerable children have access to certain HIV services, she has to search various systems.

“Pact called for us to come together and build a comprehensive online social welfare system.” The effort is now underway. “We will be able to see needs and problems much more clearly so we can reach out quickly with the right services at the right time.”

Pact has also supported the department to set and disseminate key guidelines that are improving its work. One requires that all districts contribute three percent of their revenue for social welfare programs, helping to ensure that there is dedicated funding for vital social services. Another is aiming to set professional practices and ethical standards for social workers.

“These are the kinds of changes that will mean better social services long into the future,” Mhando says.

Overall, Pact works with Tanzania’s government to ensure sound and robust social welfare systems and structures that effectively facilitate the smooth delivery of services to vulnerable children, explains Flora Nyagawa, Pact’s technical director for systems strengthening in Tanzania.

“In Tanzania, a range of community health and social welfare interventions are taking place through multiple initiatives,” Nyagawa says. “But there are weak coordination mechanisms and systems to support effective community services.”

For example, since the introduction of a national, integrated case management system for especially vulnerable children in 2017, only 135 out of 184 councils are using the system, and the Department of Social welfare is under-resourced both financially and in staff. 

Through ACHIEVE, Pact has supported developing and operationalizing health and social policies, guidelines and information systems to support effective planning and decision-making regarding social welfare interventions through a recently launched Council Social Welfare Planning Guideline. The efforts are improving government coordination, workforce development, data use and, ultimately, services for those who need them most.

“Our systems strengthening work is deeply connected to quality, comprehensive and sustainable service delivery,” Nyagawa says. “At the end of the day, this is what is most important.”