Equitable Service Delivery: Opportunities and Challenges

1. Equitable Service Delivery: Opportunities and Challenges General Budget Support Annual Review, 2009 24 November 2009

2. Contents • Introduction • Why equity remains a focus • What has happened since last year? • A story from a district • Discussion for 2009 • Classification of challenging districts • Allocation of resources according to population • Allowances • Local decision making • Way forward

3. Introduction • In 2007 and 2008 we demonstrated the link between the lowest levels of staffing allocations the highest levels of poverty in Tanzania • Using health and education as examples, we showed that the difference between district budgets can vary greatly • And we showed that even where results are improving overall those improvements are not equal across Tanzania

4. Introduction • Innovations from some regions to attract and retain HR were also discussed e.g. Rukwa and Mbinga • Recommendations were made as follows: • Local level incentive packages to ensure that new staff are attracted and retained, and that this could be funded through transfers to under served districts • Eliminate delays in the payment of new salaries • Revision of the Medium Term Pay Policy as an entry point to addressing in equity in the distribution of human resources • A road map to implement the outcomes agreed on the basis of the approved MTPP • An assessment of progress will be provided later in this presentation

5. Why equity remains a focus • Need for equal access to public services • All Governments are concerned with equity • Social economic development as a platform for growth and development

6. Why equity remains a focus • Education: • The more that is spent per child, the greater the likelihood of success in examinations • The allocation of grants per student can vary as much as Tsh13, 000 per student to Tsh188, 000 per student • Allocations are determined by the number of teachers on the payroll.

7. Why equity remains a focus • Health • Staffing budget per capita can vary as much as Tsh.1, 700 to Ths.8500 • Some regions have twice the number of health workers per 10,000 people as others

8. Staffing budget can only be disbursed against the actual number of workers on duty and... Flow of resources ...allocations follow human resources.

9. The number of health workers varies widely between authorities… IFMS MoFEA Health Staffing Budget 2008/9 per capita

10. Districts which are in the top 20% of resource allocation have a higher Standard VII pass rate than those in the bottom 20%: Login Tanzania, 2001 and EMIS

11. If you received a low level of funding per child in 07/08 you are likely to receive a low level in 99/00 There is a 600% difference in funding between the top and bottom levels Source: Login Tanzania

12. What has happened since last year?

13. Revised Medium Term Pay Policy • Situational analysis carried out • Built on LGRP 2005 study • Defined the range of measures required to tackle inequitable staffing

14. Difficulties in attracting and retaining workers to under-served areas

15. What was needed in order start resolving recruitment and retention

16. Challenges and Opportunities • Funds are finite and likely to become more scarce in the current economic climate and skewed in favour of growth • Culture of allowances BUT • Medium Term Pay and Incentive Policy developed • Districts have the best local knowledge on what the problems are • Stakeholders and Government are eager to see results.

17. A District story The cost of collecting your salary

18. Daudi

19. Lida

20. Kalinga

21. The effect on remote districts • 36 days* per person per year are lost just collecting salaries – on average • A minimum of Tsh.18,000 spent per person per year collecting their salary – approximately *Based on 20 working days a month, 36 working days lost per year

22. What this means for the community At best • Two months without a teacher • Two months with no nurse At worst • No teachers or nurses will work in your community • You cannot afford to travel to the clinic, so you leave it until you are really ill, by which time you will need more medication and your family duties will have suffered • Exam pass rates go down; parents don’t enrol children in school – what’s the point?

23. What do the workers say about what is needed? • Higher salaries are their number one request* • Increased budgets and better tools rank second *MTPP Situational Analysis 2009

24. Proposed way forward over the next year • Identify districts with the highest challenges • Give those districts the resources they need according to their population – formula based allocation • Channel overspends and disproportionate central allowances to workers in challenging districts • Encourage districts and regions to use their flexibility to put money towards attracting and retain staff

25. Identify districts with the highest challenges Where we are now What we can do in 2010

26. Allocate resources according to population needs Where we are now What we can do in 2010

27. Channel central allowances savings to workers in challenging districts Where we are now What we can do in 2010 *Public Expenditure Review Rapid Budget Analysis, PER Macro Group, 2008

28. Districts flexibility to put money into attracting and retaining staff Where we are now What we can do in 2010

29. Way Forward? • Realistic, achievable and clear actions for 2010 • Agree Temporary Process Action for 2010 Performance Assessment Framework • Agree assessment criteria for those actions