HRH Leaders in Action: Adeline Kimambo


An interview series with HRH champions in developing countries produced by the HRH Global Resource Center, the HRH Leaders in Action series asks leaders to look at HRH leadership.

Adeline Kimambo
Faith-based health facility in Tanzania

Dr. Adeline Kimambo is the Director of the Christian Social Services Commission (CSSC) in Tanzania, an ecumenical body forging a union between a number of Catholic and Protestant churches and church-related organizations in effort to facilitate the delivery of social services, education and health. She has previously worked with the Tanzanian Ministry of Health as the District Medical Officer and as the Director of Training for Human Resources Development.

What role do faith-based organizations and HRH play in Tanzania, and what is your role within that?

As you know, the churches have been a major partner in the provision of health services in Tanzania. In 1991 the churches were getting support from their partners outside the country. In 1992 [the government] tried to see how they could [better] support faith based organizations to provide quality services. The Christian Social Services Commission (CSSC) was established to facilitate this. The CSSC was registered in 1993 and there was a memorandum of understanding with the government and the TEC, the Roman Catholic body, the CCT and the Protestants that CSSC would receive funds from outside to support the churches. The functions of CSSC include advocating and capacity building.

SPOs are the owners of the facilities in Tanzania. They charge both the Roman Catholic and the Protestant organizations. They have 87 hospitals with about 500 [health facilities]. On top of that, they provide home-based care and other services which are not hospital based. They deal with HR management, including all the recruitment and deployment. They also have to look for funding and training to develop their people.

I advocate for the provision of quality services for the churches to better understand the government policies on issues including HR. I also advocate for the church institution to have policies themselves on the different aspects in the provision of health services. We needed to ensure that we get the right qualified people in these facilities, and we also need to promote HR policies so that they can retain those people. So we have to facilitate the government support of the churches to get the people, and their support of the financing of the HR in the church institutions.

Also, we need to build the capacity of the people. So that’s why we have the advocates fund in capacity building. Training people from the church institutions we look for funding to support upgrading courses. We have established a sponsorship and have sponsored about 12 people in MD courses. Upgrading courses, short courses, these are the efforts in building capacity in the church institutions to have qualified people to provide the services.

In a nutshell we are doing mainly capacity and support for policies looking at retention issues and issues related to HR. They come into the area to campaign for them and also to support in capacity building.

What is the biggest HR challenge you face now?

The whole country has an acute shortage of HR in our facilities. It is even worse for the churches, since they cannot keep pace with the salary raises provided by the governments. They rely on cost-sharing or user chargers. Most of the [church] facilities are in the rural areas, and poor people in the community can’t afford the user charges and cost-sharing. These people are not able to pay, so the gap becomes big.

[Health workers] are moving from the field facilities to the government. Although the salaries are the main reason, they also feel there is better job security in the government. We looked at the policies in the church institutions and found that they did not have HR policies, so people did not feel secure with the way they recruit and fire. They also have a shortage of funding, so they can’t send people to upgrade for development. It complicates things.

How have you been involved in the development of the national strategy?

When I was in the Ministry of Health I was head of HR. I was involved from the beginning, since the Ministry of Health started the first Strategy plan of HR policy. Those working on the team invited me to go when there was no one to guide them. When they started asking questions we found that a lot of things had not been addressed.

I have tried to improve the public-private partnership. It needs to include the whole sector; if you make it only for the government, you will not achieve success. People move around. The FBOs provide services to the community. If you don’t address that part, there will be double standards. The government will have well-trained staff, but those who are giving services on the other side will lack that training. We need to develop this nationally.

Are you satisfied with the way public-private partnership is reflected in the national strategy?

I would not say we are there, but we are moving in the right direction. When we talk about public-private partnership we are talking about meaningful involvement, not just inviting people to a meeting to say they have been involved.

When it comes to implementation, we are not yet there. Again, we are moving in the right direction if the government is really committed to making sure we implement the plan. They must finance what is reflected in the document. Advertisements are being posted for employment and people are applying, but I want to see implementation. I want to see where these people are being posted for service and if these people are being trained. We want them placed where they are trained to be. We want to make sure the FBOs have the right people. We do not want to just rely on seconded staff. The government is paying their salaries, but they should pay for other services and not just grants.

How do you find out what approaches others are taking on HR issues?

We found that the church health associations (CHA) working with the Interchurch Medical Association (IMA) came up with the technical working group for HR, and they formed the one from which we now are learning. We visited Kenya to see what the Kenya CHA has done in relation to HR and how they are getting support from the government. We have now started learning from each other so that we can see what the best practices are. Also, based on the market study we did, we were invited to participate in and join the CCI. We are looking for experience wherever we can get it.

How do you rate the importance of accessing of information about HRHs beyond Tanzania vs. local information? Which is more important, local information or outside information?

I wouldn’t say either is more important. We need the local information and we need the international and other information to inform us. If the outside information tells us a strategy is working elsewhere, and we know those are the best practices, we can use those to develop our strategy. But we need the local information to inform us on how to go about it. We cannot copy directly what is in Malawi and apply it here. We can look at their approaches and see how it fits into our situation.

We have to learn how people handle situations; otherwise we will be trying things that don’t work. We need information from both sources. We need to learn how to adapt our situations. How can we modify things to fit into our situations? How do I mainstream things to fit into the system that already exists and make it sustainable? It may work as long as the project is there, but become obsolete when the project is completed. We need to fit it into the system, into the local situation. We need both the local information and what people can bring in from outside.

How do you think knowledge sharing can be improved or supported within the FBO community in Tanzania?

We need to create more awareness of the importance of information. If you don’t give those who are making policies the right information, you won’t get the right policies or the resources you need.

When the government raised the salaries, I asked them to send me the appropriate information. I wanted to find out the implications of this and reasons for it so that we could address the situation. Unfortunately, they did not send it. If they had, I could have explained what was going on. People were leaving, but there was nothing that could be done. If I had the information I could have shared it with the necessary institutions.

My own feeling is people don’t recognize the importance of sharing information. If you don’t share the information, the system in place will not work. For example, we are currently working on developing a web portal. Having that in place, if people are not ready to put information there, you will have the website, but no information. People have to put information in there.

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