Preliminary Proposal Equity Factor for FY13

Context Wide variation in the distribution of resources across districts in Tanzania and in the effective utilization of the available resources at the district level Ratios of the “10 best to the 10 worst” districts: Out-patient attendances per capita: 7.8:1 Out-patient attendances per health worker:15.1:1 Facility based deliveries: 8.1:1 Health workers per capita:11.0:1 Current allocation approach for health basket funds to districts do not take this into consideration The World Bank would like to propose a specific approach for doing so for FY13

Proposed indicators Performance – need further discussion for implementation in FY14 Equity – clinical health workers per 10,000 population Why: Data is readily available and collected regularly More readily available than funding data which needs to come from the MOF Looks at the distribution of the key health care delivery input

Current Distribution by District

Proposed Approach Allocate 90% of the district amount using the existing formula – if the current average of $1.30 per capita is maintained = $1.17 per capita Allocate 10% to equity factor = $0.13 p.c. Would result in ~ $5.4 million allocation Can be scaled to fit to agreed overall allocation

Calculations Convert the value for each district to an index number with the national average being 100 For health workers per capita, this would mean dividing the national average by the district value Normalize the index values to the national population to ensure that the total amount allocated is kept to the available amount Multiply the resulting index values for each district by the district population and $0.13

Results Compared to a the current allocation formula: 37 districts (28%) would get more funding those getting more would get 62% more on average in equity funds compared to the current formula and 6.2% more in total funds (range 0.2 to 51%) 95 districts (72%) would get less funding and get 4.2% less on average in total funds compared to an allocation using only the formula (range 0.1 to 8.8%) Results reflect the current wide variation in each of these indicators by district The next two graphs show the regional results (aggregated from district results)

Regional Results (equity amount in US$)

Regional Results (total amount in US$)

Proposed Next Steps Discuss/agree on including equity in the next FY allocation Discuss/agree on the approach for including this factors – i.e., 90% through formula, 10% for equity Discuss/agree on the indicator to be used i.e., health workers per capita Discuss/agree on the allocation approach Verify the data to be used, fill in missing data Run simulation with final numbers, check calculations and trouble-shoot Finalize allocations and advise districts

Thank you