Strategy #5: Health Financing

1. Strategy #5: Health Financing Directorate of Policy and Planning

2. Current Implementation/Policy Issues • 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

3. Current Implementation/Policy Issues A. Sustainable Resources • Progress 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 $83M • Health Financing Strategy

4. Progress on Abuja Target Trend is continuing downward over the last 6 years This is despite substantial GF funds coming “on-budget” FY 11 – Global Fund is 49% of total MOHSW budget

5. Progress on Health Financing Strategy • Delays were experienced • Contract for UDSM now signed • TORs for Costing Study finalized • Background work being undertaken by Abt Associates, funded through USAID • TWG HF subgroup meeting regularly • Health Financing session prior to TRM • Momentum appears to be increasing

6. 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 1.669b • Social Health Insurance development undertaken Health Financing MeetingThere are some progress of the linkage between NHIF and CHF • Coverage is about 5.6%

7. 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

8. 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 exempted • Strong linkage needed with HF Strategy

9. 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?

10. 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 Funds • CAG 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

11. Current Implementation/Policy Issues (V) Use of Financial Resources • Overall 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

12. 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

13. Future Plans A. Sustainable Resources • Abuja 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

14. 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

15. Future Plans (III) C. Equity of Access • Cost sharing policy review to be completed • Linked with costing work and HF Strategy • Prepayment discussion to be part of HFS • Methods 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

16. Future Plans (IV) D. Management of Complementary Funds • Response/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

17. Future Plans (V) E. Use of Financial Resources • Response/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

18. Thank you for your attention …