Joint Annual Health Sector Review Meeting to be held on 7th – 9th 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 Billion B: Actual Expenditure TZS Billion

Trend of Per Capita Health Spending in USD

A: Approved Estimates B: 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 2007/08

2006/07 2007/08

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.

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Allocations for Human Resource Development

The Human Resource for Health Strategic Plan 2008-2013 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 2008-2013 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

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Allocations for Human Resource Development (2)

• Allocation to development activities was also observed to be low in relation to recurrent allocations.

Significant Improvement PE at MOHSW

  2006/07 2007/08 2008/09

OC 69% 63% 55%

PE 31% 37% 45%

100% 100% 100%

Allocation for RCH

Indicators for Maternal Health are not promising

Share of spending on RCH accounts for about 7% of spending

Area Percentage

Contraceptives 89.15%

Prevention of Stunting 3.72%

Nutrition 0.54%

Refresher Training 0.75%

Other Services 5.84%

Total 100.00%

Contributions of Different Funding Sources-CCHPs

Timing of OC Releases in Councils, FY2007/08 Temeke

MCMafia

DCMwanza

CCKyela

DCPangani

DCRuangwa

DCSame

MCTabora

MC

July 26% 1% 33% 31% 10% 0% 5% 17%

Aug 26% 9% 33% 31% 19% 0% 16% 17%

Sept 26% 26% 33% 31% 39% 50% 31% 17%

Oct 42% 26% 33% 31% 39% 50% 37% 52%

Nov 42% 35% 60% 46% 48% 50% 42% 52%

Dec 51% 43% 60% 46% 58% 50% 56% 52%

Jan 59% 52% 67% 69% 68% 50% 62% 70%

Feb 67% 52% 67% 69% 78% 50% 66% 70%

Mar 72% 66% 67% 69% 78% 67% 73% 70%

Apr 86% 71% 100% 100% 83% 100% 84% 70%

May 92% 85% 100% 100% 83% 100% 92% 100%

June 100% 100% 100% 100% 100% 100% 100% 100%

% 100% 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’.