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Explore the NHA and PER concepts, history, usefulness, methodology, findings, challenges, and the way forward in health financing in Tanzania. Learn about total health expenditure, funding sources, trends, and policy issues raised.
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MINISTRY OF HEALTH AND SOCIAL WELFARENATIONAL HEALTH ACCOUNTS 2011/12 TECHNICAL REVIEW MEETING 5TH NOVEMBER, 2014
Outline • NHA and PER Concept Overview • History of NHA • Usefulness of NHA • Institutionalization Process • Methodology • Overall findings • Challenges and Way Forward
NHA Concept Overview • 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 Concept Overview • 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
History of NHA in Tanzania • 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
NHA usefulness • Monitoring of trends over time • International comparisons • Financing gap • Sustainability • Comprehensive and consistent view of health spending
Methodology – NHA 11/2012 • 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
General Findings • 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%
Total Health Expenditure by Financing Source, 2002/03 - 2011/12 • 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%
THE by Financing Agent, 2002/03 – 2011/12 • 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
Spending by disease in 2011/12 • HIV/AIDS, TB and malaria together account for 45% of THE, while Reproductive and Child Health accounts for 12%
THE by provider, 2002/03 - 2011/12 • 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%
THE by factors of provision, 2011/12 Pharmaceuticals accounts for large part which is 26 percent in 2011/12
Policy issues raised • 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
Policy issues (2) • 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
Challenges • Low response rate (Donors, NGOs, Insurance Companies) • Data inconsistency, from various sources • Timeframe • Format • Scope
Way forward • Finalize the NHA 2011/12 • Disseminate the findings • Continue with the preparation of NHA 2013/14 • Institutionalization of NHA preparation
Public Expenditure Review – PER 2013-14 Update 05th November 2014
INTRODUCTION • Objectives • Trend in Health Sector Funding • Implementation of Fiscal Decentralization • Implementation of the Prepayment Scheme Financing • Further analysis on main expenditure drivers
Regional CHF coverage, 2013/14 Source: NHIF data
Conclusion • 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
Way forward • 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
Way forward • 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)
Asanteni End