Road to Results: PlanRep and FFARS as the Bookends of Facility Autonomy for Improved Malaria Service Delivery

Improved transparency, efficiency, management, and service delivery at the facility level require that facilities have the autonomy to develop their own plans and budgets, and the accountability to manage their money and staff and report on outcomes. PS3's strategy for driving systems strengthening revolves around a 'wedge' of four tenets designed to transform service delivery in line with the project's system strengthening assumptions. The wedge consists of: catalyzing the core system transformation by extending interoperable systems to service providers; shifting to output-based payment directly to facilities better matching payment to priority services and populations; allocating and distributing staff to facilities to efficiently meet need; and realigning the Government of Tanzania's (GOT) institutional structure, roles, and relationships to accelerate, institutionalize, and sustain ownership and progress. The GOT and PS3 have invested extensively in developing interoperable systems, which function at the service provider level. Two such systems, the Facility Financial Accounting and Reporting System (FFARS) and PlanRep, are critical to the second tenet of allocating money to service providers for malaria service delivery and other critical services. A major achievement has been the national implementation of a redesigned PlanRep, which gives Tanzania a functioning centralized web-based planning, budgeting, and reporting system for use nation- and sector-wide. Through GOT and PS3 deployment and mentoring, PlanRep is now in use by all 185 Local Government Authorities (LGAs). For Tanzania's fiscal year (FY) 2018/19, 24,229 public health facilities and schools used the system to develop, review, and approve plans and budgets. The introduction of PlanRep is a game changer for public service delivery in all sectors and all levels of government. With PlanRep, malaria services and other public services/entitlements are clearly stated, allowing a shift from input-based to output-based planning, budgeting, payment, and reporting. Within the first year of use, there were clear benefits from the PlanRep system, including early evidence of efficiency gains, such as savings in both time and money, and more realistic budgets matching Ministry of Finance and Planning (MOFP) ceilings. PlanRep directly contributes to improving malaria service delivery by better defining service outputs, improving plans and budgets, and increasing efficiency, thus enabling an extension of malaria service coverage.