TECHNICAL REVIEW MEETING 5 TH NOVEMBER, 2014

 NHA and PER Concept Overview  History of NHA  Usefulness of NHA  Institutionalization Process  Methodology  Overall findings  Challenges and Way Forward

 Statistical system of accounts  Describes the totality of expenditure flows  Describes the sources of all funds utilized in the health sector  Describes uses of these funds

 PER ◦ Expenditure flow on the public funds ◦ Funding through Exchequer system ◦ Donor funding through Government systems are regarded public funds ◦ Focuses on the current pertinent issues

 Four NHA studies since 2001  First NHA estimates were for 1999/00 and focused on general NHA  The second (2002/03, 2005/06) and third NHAs (2009/10) included subaccounts on HIV/AIDS, Malaria, TB, Reproductive Health, and Child Health  The 2011/12 NHA covers more diseases

 Monitoring of trends over time  International comparisons  Financing gap  Sustainability  Comprehensive and consistent view of health spending

 Institutional Survey ◦ Donors – response rate 47% ◦ NGOs – response rate 53% ◦ Programme (NACP, NMCP, TBLP, TACAIDS)  Secondary information ◦ MoHSW,Local Government Authorities,Regional Authorities (Financial reports, Epicor and MTEF) ◦ Estimates for: Parastatals (40) Private firms (56) and Insurance (8) ◦ HH data from National Panel Survey (NPS), ◦ Economic survey-inflation and GDP ◦ HMIS for utilization by level of facilities

Total Health Expenditure (THE) has increased from TZS 2,323 billion in 2009/10 to TZS 3,364 billion in 2011/12 Government Health Expenditure (GHE) has remained at the average of 7% of Total Government Expenditure Per capita spending has increased from TZS 54,529 in 2009/10 to TZS 71,428 in 2011/12 Donors are the main financiers of health sector, at 48% of THE GHE has remained at 21% of THE Out of pocket has decreased from 32% to 27%

Donors remain the main financiers of THE, contributing an increased share of 48% in 2011/12 Households still contribute significantly (27%) though the share is falling Public sector financing continues to fall slightly, reaching 21% in 2011/12 The share of other private sector(companies) remain negligible, at 4%

MOHSW managed 16% of THE in 2011/12, a small but steady decline Local Government Authorities managed a slightly increasing share, at 17% in 2011/12 Households role declined to 25% in 2011/12 NGOs managed 22 percent of THE in 2011/12

HIV/AIDS, TB and malaria together account for 45% of THE, while Reproductive and Child Health accounts for 12%

Hospitals account for 29% of THE in 2011/12, a reduction on the 2009/10 share The share of lower level facilities rose slightly to 28% Preventive care provision fell to 17% and the share of health administration rose to 13%

Pharmaceuticals accounts for large part which is 26 percent in 2011/12

 Donor dependency is high and appears to be increasing, with DPs providing 48% of the budget ◦ > concerns re sustainability  Out of pocket payments are still high ◦ > need to establish effective pre payment schemes in context of overall HFS  Role of NGOs in managing sector resources is significant ◦ All stakeholders should work establish mechanism for improved monitoring of the operations and impact

 Almost half the funds are spent on Malaria, Tuberculosis and HIV/AIDS ◦ We need to ensure that there is a balance in distribution of resources across diseases ◦ Increase focus on non-communicable

 Low response rate (Donors, NGOs, Insurance Companies)  Data inconsistency, from various sources  Timeframe  Format  Scope

 Finalize the NHA 2011/12  Disseminate the findings  Continue with the preparation of NHA 2013/14  Institutionalization of NHA preparation

05 th November 2014

 Introduction  Public expenditure on health: overall picture  Selected sub-analyses  Complementary financing  Conclusion  Way Forward

 Objectives ◦ Trend in Health Sector Funding ◦ Implementation of Fiscal Decentralization ◦ Implementation of the Prepayment Scheme Financing ◦ Further analysis on main expenditure drivers

Source: NHIF data

 Health Sector share of Government expenditure slightly increased  Percapita has increased in budget and actual expenditures both in real and nominal terms  Slight increase on the prepayment schemes coverage

 Clarification of remaining queries with MOF (end Nov)  Analysis of LGA spending in FY 2013/14 (end Nov)  Finalise sub-analyses: (end Nov) ◦ PE : OC ◦ Medicines ◦ Budget execution ◦ Cost-sharing

 Complete first draft report (end Dec)  Present and circulate final draft to SWAp meeting (end Jan 2015)  Incorporate revisions (mid-Jan)  Discussions with MOF re harmonisation of definitions of the sector for future analyses (PER, NHA, RBA etc)

End