HP+ Tanzania Kuki Tarimo October 4, 2017 An Assessment of the Government of Tanzania’s Budget Execution Performance on Allocations to Medicines and HIV HP+ Tanzania Kuki Tarimo

Budget for Pharmaceutical Services for the year 2016/17 For FY 2016/17, new allocation of TZS 251 billion in the MOHCDGEC development vote Source: MOFP Budget Books FY 2016/17 New A specific point of concern for health financing this past FY was the growing amount owed to Medical Stores Department (MSD) representing GOT’s share of the procurement and supply chain management (PSM) expense for donated commodities. MSD is the established agency that has managed procurement and distribution of medicines, medical supplies, and laboratory supplies for the Ministry of Health, Community Development, Gender, Elderly, and Children (MOHCDGEC) in Tanzania since 1993 Included in this is a first time ever TZS 10 billion allocation for the purchase of ARVs GOT supply chain responsibilities, which includes a standard contribution for HIV commodities based on MSD fees and expense ratios, equivalent to 5.6% of the cost of commodities purchased by GFATM and 11.6% of the cost of commodities purchased by PEPFAR.

FY 2016/17 Budget Execution for Pharmaceuticals Budget Line Only TZS 11.2 billion disbursed for MSD debt Only TZS 7.1 for ongoing PSM expenses Nothing disbursed at all for purchase of ARVs Overall disbursement rate of 53% for Pharmaceuticals budget line or TZS 132.1. Nominally this amount is quite high compared to previous years MSD debt grew by estimated TZS 12 billion in FY 2016/17 to TZS 156 billion Source: Pharmaceuticals Service Unite at MOHCDGEC

Historic Budget Execution to TACAIDS Personal emoluments, which account for 70% of TACAIDS recurrent budget is the only thing that gets disbursed consistently on time NACP does not have a specific budget line, it is part of the Preventative Services budget, so not possible to track on-budget execution performance. NACP heavily on external funds to perform all of its functions. Source: MOFP, 2013-2017

Root Causes for Poor Budget Execution Lack of adequate resources to finance the country budget Health is low in the priority-setting process Health budget ambitions exceed available revenue Budget execution for MOHCDGEC vote 52 was 57% for FY2016/17. Overall GOT budget execution rate as of March 2017 61% and for the financial year 2015/16 was 90%. All respondents indicated that sufficient investment for the supply chain system should be prioritized. In conclusion, improving budget execution is an important part of the DRM agenda because it increases the ability of MOHCDGEC to produce defensible budget requests.

Advocacy Massages Budget execution for health be given priority as other first charge items Need to improve quality of quantification exercises for health commodities Reducing some of PSM costs Estimations of PSM cost to be reviewed Budget execution for MOHCDGEC vote 52 was 57% for FY2016/17. Overall GOT budget execution rate was 90%. All respondents indicated that sufficient investment for the supply chain system should be prioritized. In conclusion, improving budget execution is an important part of the DRM agenda because it increases the ability of MOHCDGEC to produce defensible budget requests.