UNITED REPUBLIC OF TANZANIA Brasilia 20 th November 2006 Macroeconomic issues in scaling up of financing HIV/AIDS

COUNTRY PROFILE The country is in the east of the African continent. It covers about 945,087 sq km (364,900 sq miles). Total population is million The country became united Republic of Tanzania in Resulting from unity between Tanganyika mainland and Zanzibar islands

Unique Characteristics of Tanzania Home to The Kilimanjaro – the only snow capped mountain in Africa Home to the 8 th wonder of the world – The Ngongoro Crater a natural habitation of volcanic origin for wildlife and humans Peace and stability since independence and democratic change of government consistently Host to refugees from the lake zone troubled areas Julius Nyerere was the first African leader to relinquish power voluntarily to allow change in 1985.

HIV PREVALENCE Tanzania is among the countries with high rate of HIV prevalence. Currently estimated at around 7% of the population in the reproductive age group (15-49) – Mainland (2003) Tanzania mainland estimates to have 2,200,000 people living with HIV/AIDS. Orphans are estimated at 2,000,000

Tanzania is implementing its national care and treatment plan which aims to reach 440,000 within 5 years ( ). National Care and treatment program has enrolled 103,036 patients and 49,315 have started ARV drugs. Background…

MAP OF HIV/AIDS PREVALENCE IN TANZANIA Source: 2004 Tanzanian HIV/AIDS Indicator Survey Dolores Candelaria, TACAIDS Key > or = 7% 4.5%-6.9% < 4.5% Key > or = 7% 4.5%-6.9% < 4.5%

ECONOMIC PERFORMANCE The real economic growth has improved to 6.7% compared to 4.9% in the past 5 yrs. The inflation rate has stabilized at 4% for the past 3 yrs. The GDP has been growing at the rate of 5.8% over the last 5 yrs. GNI per capita: US $330 Exchange rate of the local currency against USD is at the average of Tshs. 1,300

BACKGROUND Tanzania is implementing its second generation Poverty Reduction Strategy (National Strategy for Growth and Reduction of Poverty - NSGRP). It is a 5 years strategy. It is outcome focused and aims to foster collaboration among all Sectors. The strategy mandates all public and private sectors and institutions including CSOs to mainstream HIV and AIDS as a cross-cutting issue and to initiate work place programs.

BACKGROUND… The preparation of Government budget (MTEF) is based on the NSGRP targets and interventions. A specific software was designed to link Sector strategies with the NSGRP targets and interventions and is used by all sectors for budgeting purposes. This software is also used for resource allocation. Another software was designed to collect and monitor NSGRP performance from all sectors.

A specific code for tracking HIV/AIDS in the MTEF was introduced 3 years ago and is used by the Public Sector to budget for HIV/AIDS. This specific code is used to identify budget and expenditure in the Government accounting software (tracking) Public Expenditure Review (PER) is conducted every year to assess Government expenditure on HIV/AIDS. BACKGROUND…

Coordination of HIV/AIDS in Tanzania

PRIME MINISTER’S OFFICE TANZANIA COMMISSION FOR AIDS (COORDINATING BODY) Non-Govt Orgns Faith Based Orgns Local Government Authorities Ministries Private Sector Informal Sector Regional Facilitating Agencies Tz Informal Sector Network On AIDS Initiative Technical AIDS Coordinators Council Multi-sectoral AIDS Committees AIDS Business Coalition in TZ Regional Secretariats Development Partners on AIDS TNCM GFATM

HIV/AIDS budget accounts for 10% of the national budget. Donor funds account for the 90% of the yearly budget on HIV/AIDS. The Government budget allocation on HIV/AIDS has increased 10 times in the past 5 years. The government has introduced HIV-Fund. A pooled funding mechanism for HIV/AIDS, where the Government is to prioritize areas of funding HIV/AIDS. BACKGROUND…

Financing issues Fixed budget ceilings for most of the sectors is the obstacle for scaling up HIV/AIDS expenditure on recurrent budget. Projectisation of the HIV/AIDS activities increases transaction costs. Different ways of fund flow increases transaction costs and affect absorption capacity. A lot of meetings are needed to plan before implementation.

Mainstreaming issues Mainstreaming HIV/AIDS in all sectors and especially at the Local level is still weak. Therefore sensitization on the planning and budgeting based on the NSGRP by all sectors is very important. Inter-sectoral linkages during planning through NSGRP seems to be a way out for sectors that implement the same strategy. The government to make sure that CSOs considers NSGRP in planning, implementation and monitoring of their HIV/AIDS activities.

Absorption capacity Coordination becomes difficult because of the parallel systems on the funds disbursements. Lack of Human Capacity to deal with HIV/AIDS related planning, research and budgeting, implementation and M&E of agreed interventions.

Absorption capacity Coordinators for HIV/AIDS in the public sector are overloaded with other responsibilities. Lack of integrated, comprehensive and effective programs on HIV/AIDS by Public Sector. Insufficient human resources in the Health Sector to cope with the increased burden of care and treatment program.

Commitment and leadership Some of the middle cadre leaders and bureaucrats in Public and Private sector suffer the following weaknesses: not aware of the impact of HIV/AIDS in their respective sectors. do not provide enough space for HIV/AIDS during schedule allocation. do not allocate HIV/AIDS resources in time.

Participation of all stakeholders Public/Private partnership and involvement in the implementation and monitoring of the HIV/AIDS interventions is a challenge. No culture of working together between CSOs and the Government, need to build private/ public partnership through service agreements.

CHALLENGES Change of Government sometimes involves re-structuring of the institutions, ministries, departments and agencies, which affects historical memory. Demands on the ground exceed what is available. Poor allocation of resource in the national budgets.

Challenges Not all declared assistance by development partners is actually flowing into the country, most of it is for servicing their own organizations in home countries. The governments are not able to track most of the donor assistance resources. Delay in disbursement of funds from the sources restrict achievements on some of the programmes.

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