Directorate of Policy and Planning

Current Implementation/Policy Issues1. Reduce the budget gap by mobilizing adequate

and sustainable financial resources

− Health budget to reach 15% of GOT budget – − Health Basket Fund increased Health Financing Strategy

Current Implementation/Policy IssuesA. Sustainable ResourcesProgress on Abuja Target

Other GoT competing priorities – Kilimo Kwanza, infrastructure. For 2010 its 12%

Increased in absolute amounts Extensive DP resources, GF on-budget intensifying this Government share reduced

Health Basket Fund increased – from $79M to $83MHealth Financing Strategy

Progress on Abuja Target

Trend is continuing downward over the last 6 yearsThis is despite substantial GF funds coming “on-budget”FY 11 – Global Fund is 49% of total MOHSW budget

5%

7%

9%

11%

13%

15%

Actual 2004/05

Actual 2005/06

Actual 2006/07

Actual 2007/08

Estimates 2008/09

Estimates 2009/10

With CFS

No CFS

Progress on Health Financing StrategyDelays were experiencedContract for UDSM now signedTORs for Costing Study finalizedBackground work being undertaken by Abt

Associates, funded through USAIDTWG HF subgroup meeting regularlyHealth Financing session prior to TRMMomentum appears to be increasing

Current Implementation/Policy Issues(cont’d)

2. Enhance complementary financing, increasing the share in the total health budget to 10% by 2015 – some progress− Prepayment scheme coverage (CHF/TIKA, NHIF)

increased− CHF 5.6% NHIF 5%− Maximize NHIF and CHF/TIKA financing options− Councils have started to claim more funds last FY was

1.669bSocial Health Insurance development undertaken Health

Financing MeetingThere are some progress of the linkage between NHIF and CHF Coverage is about 5.6%

Current Implementation/Policy Issues(cont’d)

Discussion should be initiated/continued on appropriate regulatory mechanisms

Private investment discussions should also be initiated, beginning with the role/limitations of private sector involvement

Strong linkage needed with HF Strategy

Current Implementation/Policy Issues(cont’d)

3. Improve equity of access to health services – some progress

− Effective subsidies and waiver mechanisms in place for poor and vulnerable, using prepayment schemes and other options

Cost sharing Guideline has been reviewed NHIF – over 60 are cared for, all 60 and above are

exemptedStrong linkage needed with HF Strategy

Current Implementation/Policy Issues(cont’d)

Strong linkage needed with prepayment discussion Is pre-payment to replace cost sharing or provide

a larger share of the cost of health services? What is the role of pre-payment for services

where user fees are exempt/waived (e.g., NSSF does not cover these services)?

What robust mechanisms exist to identify the poor and provide waivers? How can these mechanisms be implemented in

TZ?

Current Implementation/Policy Issues (IV)

4. Increase efficiency and effectiveness in use of financial resources – some improvements in audits Government budgeting, accounting and auditing processes are

implemented in a transparent way

Management of Complementary FundsCAG Performance Audit highlighted issues:

most of the HCs are hardly involved in the preparation of the Councils’ planning.

HCs’ own source funds collected from cost sharing such as CHF, NHIF, user fees are combined in Account No.6 at the DMO’s office.

Put together, these problems are significantly hampering the ability of the HCs to promote transparency, accountability and good performance.

MOHSW/PMO-RALG need to respond

Current Implementation/Policy Issues (V)Use of Financial ResourcesOverall financial audits are improving, but …

CAG Performance Audit also highlighted issues: HCs are not efficiently managed and are funded

without proper consideration of service demands and performance

Current Implementation/Policy Issues (V) HCs lack a comprehensive system for

monitoring of their own spending. the current system of supervision has not

been able to detect the HCs that have problems with their performance and suggest remedial action.

Again MOHSW/PMO-RALG need to respond

Future PlansA. Sustainable ResourcesAbuja Target

Comprehensive analysis and business case for increased health system investments

Consider external financing explicitly Need to feed into budget process – Nov. 2010

Completion of Health Financing Strategy Paper completed and distributed – July, 2011 Consensus conference – September, 2011

(JAHSR) Government decision – November, 2011

Future Plans (II)B. Complementary Financing (pre-payment)Regular reporting on the progress of the

linkage between NHIF and CHF First report – October, 2010, quarterly thereafter

Discussion paper on regulatory mechanisms Paper completed and distributed – January, 2011 Consensus conference – March, 2011 Government decision – June, 2011

Discussion paper – private investment in health Paper completed and distributed – August, 2011

Future Plans (III)C. Equity of AccessCost sharing policy review to be completed

Linked with costing work and HF Strategy

Prepayment discussion to be part of HFSMethods for identifying the poor

Review of currently available approaches – Nov. 2010

Assessment of applicability in Tanzania – Mar. 2011

Implementation plan (as part of above) – June 2011

Future Plans (IV)D. Management of Complementary FundsResponse/Action Plan for CAG Audit

Response depends in part on decisions re: bank accounts at the HC level Consultations needed with MOFEA/DPG-Macro

Action plan will be consistent with PFM directions and capacity building activity and part of this larger activity

Future Plans (V)E. Use of Financial ResourcesResponse/action plan for CAG audit Discussion of role/autonomy of health

providers, including health centers March, 2011

Discussion of governance and accountability issues and potential solutions March 2011

Action plan for the above issues September 2011