Tanzania Health Reforms Impact on Financing District Reproductive Health Services

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Tanzania Health Reforms Impact on Financing
District Reproductive Health Services

• Dr. Ahmed Hingora
• Ministry of Health and Social Welfare
• Dar es Salaam
• TANZANIA

It is about them !
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Reforms of the Health Sector

• Initiated in the 1990s
• Process led by government
• Government and DPs to fund a jointly developed
  and agreed Health Sector Strategic Plan SWAp
  approach
• 9 strategic areas within the health sector
  investment plan

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THE NINE STRATEGIES

• District health services
• Role of central MOHSW
• Hospital reforms
• Support systems
• Health Human Resources
• Health care financing
• Public Private Partnerships
• Strengthening Government and Development Partners
  relations
• Combating HIV/AIDS as a cross cutting issue

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Strategic changes under the Reform Agenda (1)

• Reorganization of health service management under
  LGR
• Review of Health Policy
• Strengthening Drug supply system
• Integration of numerous Vertical programs
• Strengthening HMIS
• Strengthening PPP

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Strategic changes under the Reform Agenda (2)

• Diversification of Health Financing
• Applying SWAp
• Harmonized approaches between the Government and
  Development Partners towards meeting MDGs
• Trickle down effect at the implementation level
  the District

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DECENTRALIZATION

• Its simplest definition is
• letting go, so that others (below you) can get
  going

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However, the BIG QUESTION is ..

• How many of us practice what we talk, how much or
  how far are we prepared to let go?.....

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Tanzanias LGR - Decentralization by Devolution
(D by D)

• Transfer real power to LGAs (Councils)
• Take administrative and political control over
  services to point of delivery
• Free local managers from undue controls set by
  central level
• Improve financial responsibility and
  accountability by LGAs
• Strengthening inter sectoral and public private
  coordination and partnership

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Strengthening District Health Services

• Comprehensive Council Health Planning to include
  all players, resources
• Decentralized institutional bodies CHSBs,
  Hospital Governing Committees, Health Facilities
  Committees
• Councils are first line beneficiaries of Health
  Basket Funds US 0.75 per capita, over and
  above central government Block Grant
• Use of Resource Allocation Formula (population
  (70), lt5CM (10), Poverty(10), Distances (10)

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Financing District (Council) RCH services (1)

• RCH services is a component of Tanzania Essential
  National Essential Health Intervention Package to
  include interventions to
• Address major health problems
• Have significant impact on health status
• Be cost effective
• Improve equity
• Respond to demand and have a public good
  character

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Financing District RCH services (2)

• Other complementary financing sources for health
  (incl. RCH) services
• Council own resources
• National Health Insurance Fund
• Community Health Fund (where established)
• Drug Revolving Fund
• Community contributions in cash and kind

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Financing District RCH services (3)

• Council health expenditures health is second
  only to education
• Health expenditures increasing over time
  increased Health Basket Funds have played a major
  role (notable 28 increase in on - budget Council
  health finances from FY 2004 TO FY 2005)
• Resource Allocation Formula has strengthened
  equity generally favored rural and poorer
  Councils

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Results and Health Outcomes (1)

• With guidelines and facilitation from the centre
  mixed results from Council to Council
• On a general level, much has been achieved
• Significant progress towards goal in reducing
  infant and child mortality. Childhood mortality
  has declined substantially since 1999. Current
  infant mortality rate is 68 deaths per 1,000 live
  births and under-five mortality rate is 112
  deaths per 1,000 live births.

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Results and Health Outcomes (1)

• Some progress in aspects of child malnutrition
• No measurable progress in reducing MMR. The
  Maternal Mortality Ratio is 578/100,000. This
  does not constitute a change from the ratio of
  528/100,000 found in 1996.
• Little improvement in of births attended by
  trained personnel still only 46

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Factors limiting further progress towards MDGs (1)

• Continued critical shortages of trained health
  workers felt most urgently in rural and
  isolated regions and districts
• Despite the extensive health infrastructure
  network, geographic isolation of some under
  served areas
• Poor and expensive communications and transport
  links to access for both women and men to health
  services for women, increased risks during
  pregnancy and labor

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Factors limiting further progress towards MDGs (2)

• Poor infrastructure including lack of running
  water contributing to poor infection control
  (waste disposal system and running water in only
  30 of HFs), reliable power
• Relative under investment in some areas of care
  such as EMOC negative effects on Maternal
  Mortality and disability (Signal functions in
  EMOC present in only 2/3 of hospitals less than
  10 in all facilities i.e. hospitals, health
  centers and dispensaries)

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Factors limiting further progress towards MDGs (3)

• Despite marked improvements in Drug Supply
  System, intermittent shortages of drugs
• Cost sharing and risk sharing mechanisms unable
  to effectively manage special waivers for those
  unable to pay
• Little or no planning by HFs below the district
  (Centralization at the District !)

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WHAT NEXT (1)

• Pursue further the objectives of health reforms
  for
• Improved equity in health status and health care
• Increased and better management of health
  resources
• Improved performance of health system at all
  levels for delivery of quality care
• Greater satisfaction of consumers and providers

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WHAT NEXT (2)

• Advocacy for increased health sector financing to
  cover the gap presently only US 10.8 compared
  to target of US 34 per capita
• Further advocacy for the recently launched
  Roadmap to address Maternal Newborn and Child
  Health particularly at the district by all
  sectors
• Operationalize the strategy to address Health
  Human Recourse and Health Infrastructure network
  gaps for increased access to health services,
  especially for the underserved areas

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It can be done, play your part

• Julius Nyerere