Tanzania. May 2018.
CMI Final HLH evaluation Report.pdf
Program overview
Haydom Lutheran Hospital (HLH) opened in 1955. HLH is owned by the Evangelical Lutheran Church of Tanzania (ELCT), Mbulu Synod, but for decades, HLH has relied primarily on financial support from the Norwegian government through the Ministry of Foreign Affairs. The support was until 2014 channeled through the Royal Norwegian Embassy but from 2015, the management of the fund was transferred to Norwegian Church Aid (NCA). The four-year program managed by NCA has focused on supporting HLH to gradually sustain itself through expanding its revenue base, with the aim of reducing HLH’s dependency on a single donor (Norad) while maintaining the quality of services. HLH has committed to reducing overall budget dependence on Norwegian government grants from 47% in 2014 to 22% by 2018.
Evaluation overview
The main focus of the evaluation is to assess progress and deviations in relation to the main purpose of the main Grant Agreement. However, a main incentive for Norad/RNE in choosing NCA as grant manager was the assumption that NCA could have a unique added value for HLH, beyond the formalities of grant management. A secondary priority is therefore to assess the role of NCA in supporting HLH, especially on the deliverables defined in the Sub-Project Agreement.
Key findings and recommendations
There is a critical need to develop a more concrete plan for how to further reduce dependency on Norwegian funds based on an analysis of the hospital’s functions, sources of income and national and international funding trends for the health sector. Efforts must continue to identify alternative funding sources, including donors who can sponsor equipment and infrastructure investments.
For NCA and Norad, the main recommendation is to continue funding the hospital at a level that should be at least as the same level as for the last year of the current agreement. It needs to be kept at this level for at least two years before further reductions to allow the materialization of alternative funding to fill the gap. A further reduction will force the hospital to cut expenses that are likely to seriously compromise the range and the quality of the services. There is a critical need to develop a more concrete plan for how to further reduce dependency on Norwegian funds on a longer term based on an analysis of the hospital’s functions, sources of income and national and international funding trends for the health sector. Efforts must continue to identify alternative funding sources, including donors who can sponsor equipment and infrastructure investments.