Joint Annual Health Sector Review Meeting to be held on 7 th – 9 th October, 2009 Kunduchi Beach Hotel - DSM Ministry of Health and Social Welfare Health PER 2008 By Directorate of Policy and Planning

Outline Introduction Health Sector share of the budget Per capita Spending Spending central/local Govt health spending Budget Performance Funding to Focused Areas Council Study Some conclusions and Recommendations

Introduction A review of the previous Health Sector PER FY07 findings and actions taken by the sector in response to those findings Analysis of expenditures general, recurrent and development budget performance for the past three years; Analysis of expenditure trends at sectoral and sub-sectoral levels including the central-local government split; Analysis of the selected areas – HR and RCH Analysis of the contribution of Complementary Financing Analysis of health income and expenditure at the Council level

Health spending has gone up Health Budget increased by  18% between 2006/07 and 2007/08 ;  19% between 2007/08 and 2008/09. Actual Expenditures also increased:  42% between 2005/06 and 2006/07 ;  20% between 2006/07 and 2007/08 ;  11% between 2007/08 and 2008/09.

Shares of Health Expenditures to Gov Expenditures Approved Estimates

Trends in Total Health Spending (Nominal and Real) A: Approved Estimates TZS BillionB: Actual Expenditure TZS Billion

Trend of Per Capita Health Spending in USD A: Approved EstimatesB: Actual Expenditure

Shares of Government and Foreign Funds in Health Sector Financing

Recurrent Vs Development

More funding going to Development expenditure… Per capita increase in basket fund allocation from US$0.75 to US$1.00 to US$1.25 Inclusion of some other DPs eg. Global Fund in MTEF

Spending at Central/Regional/local:....Health Sector and D by D..... In FY 2005/06 about 66% of total health spend was managed by MoHSW, 4% by regional level, only 23% by councils In 2007/08, MoHSW share had declined to 60%; LGA share increased to 33.4%. On the way to D by D

Spending at Central/Regional/local:....Health Sector and D by D..... In 2008/09 MOHSW share is estimated to decline to 58% and LGAs Share around 32% Deliberate move in Policy eg drugs need to be looked unto Issues like vaccines, ARV!! Is an issue of concern.

Funding going to Primary Health Care - PHC Funding to the PHC (Dispensaries and Health Centers and Preventive Services) – increased by 22% from 2006/07 to 2007/08 However, estimated increase for 2008/09 is almost minimal 0.14% Primary Health Care has the biggest share of the funding going to the LGAs  69% in 2006/07,  70% in 2007/08,  67% in 2008/09.

Budget Performance: 2006/07 and 2007/ /072007/08 Recurrent Budget Performance 98.5%91.2% Development Budget Performance 99.7%95.4% Total Budget Performance 98.8%92.7%

Budget Performance: …. Better coordination of external resources through basket and budget support Adoption of performance based planning and budgeting by the government, Since 2004/05, Tanzania improved the budget systems, with the extension of GFS coding to the Development Budget, Inclusiveness of planning and budgeting cycle:

Complementary Health Financing Total receipts for HSF almost doubled between 2006/07 and 2007/08, About 89% of the receipts were used for health service delivery in 2007/08. NHIF contributions have also grown from TShs 45.5 bln (2006/07) to TShs 55.5 bln (2007/08). Significant amount of resources are unused both at the NHIF and HSF.

Complementary Health Financing…… About 15% of NHIF annual income is utilized by health facilities. Cost sharing implementation has challenges, HSF was approximately 2% of OC allocations to the LGAs in 2006/07, and increased to about 4% of the OC allocations to the LGAs in 2007/08.

18 Allocations for Human Resource Development The Human Resource for Health Strategic Plan stresses the training needs  at both pre-service and in-service  to curb the severe shortage of human resource for health which is currently at 62%. Analysis of funds allocated for training by MoHSW departments and subvote 5001 (Human Resource Development) shows a huge resource gap in training

Allocations for HR Development…… If HR needs as identified in the HR Strategic Plan are to be attained, about 20% of the MoHSW should be allocated to HR. However,  Only 6% of funds have been allocated to HRD in 2008/09  Only 31% of the HRD needs were funded in 2008/09

20 Allocations for Human Resource Development (2) Allocation to developmen t activities was also observed to be low in relation to recurrent allocations.

Significant Improvement PE at MOHSW 2006/072007/ /09 OC69%63% 55% PE31%37%45% 100%

Allocation for RCH Indicators for Maternal Health are not promising Share of spending on RCH accounts for about 7% of spending AreaPercentage Contraceptives89.15% Prevention of Stunting3.72% Nutrition0.54% Refresher Training0.75% Other Services5.84% Total100.00%

Contributions of Different Funding Sources-CCHPs

Timing of OC Releases in Councils, FY2007/08 Temeke MC Mafia DC Mwanza CC Kyela DC Pangani DC Ruangwa DC Same MC Tabora MC July26%1%33%31%10%0%5%17% Aug26%9%33%31%19%0%16%17% Sept26% 33%31%39%50%31%17% Oct42%26%33%31%39%50%37%52% Nov42%35%60%46%48%50%42%52% Dec51%43%60%46%58%50%56%52% Jan59%52%67%69%68%50%62%70% Feb67%52%67%69%78%50%66%70% Mar72%66%67%69%78%67%73%70% Apr86%71%100% 83%100%84%70% May92%85%100% 83%100%92%100% June100% % 127%102%108%86%100%154%96%

Recommendations Budget Performance Allocate more resources to HRD and RCH services Complementary Health Financing  NHIF  Accessibility Integration of budgets, exposing of all sources of funds Timing of OC Releases Financial Decentralizations

Recommendations.. Immediate actions on Public Procurement Systems In order to improve the performance of the development budget, Timing of PER process needs to be fixed and observed to feed into, rather than conflict with budget preparation, Where preparatory studies are necessary, need to be conducted early enough Improved Record Keeping to solve the problem of lack of information’ which associated with ‘poor record keeping’.