Health Sector Expenditure from 2006/07 to 2011/12. By Dr. Flora Kessy Mzumbe University, Dar es Salaam Campus College. 1

Outline Health Sector share of the budget Per capita health spending Government versus foreign funding Spending central/local government spilt Budget execution Health financing through health insurance 2

Health spending is stable in nominal terms but declined slightly in real terms A: Budget Trend (TZS)B: Actual Expenditure Trend (TZS) 3

Health as % of Total Government Expenditure is declining which is a big concern A: Share in budget (%) B: Share in actual expenditure (%) 4

Per capita health spending is far less than the US$54 recommended by WHO and HSSP III projection of US$ by 2009/10 A: Per Capita Health Budget (US$)B: Per Capita Health Spending (US$) 5

Government funding still remains the dominant source of public health financing 6

Central share of expenditure remains stable over time despite D-by-D 7

Part of the central funds is spent at the LGAs level through procurement of medicines 8

Development budget continues to grow but it faces poor performance 9

Recurrent budget performs better than the development budget 10

About 60% of foreign funds budget is executed 11

Performance is worse for non-basket fund 12

National Health Insurance Fund (NHIF) continues to hold significant amount of unspent funds 2006/072007/082008/092009/102010/11 Contributions45,51655,47273,28290,084134,891 Total income (incl. Income from investments and others) 56,88472,16876,512108,845164,146 Percentage of funds paid out to health services against total income of NHIF 14.4%14.1%18.4%23%27% Actual spending including administration 23,95026,71934,32539,78268,048 Unspent balance as % of total income 58%63%55%63%59% 13

Less than 15% of Tanzanian are covered by the two major public health insurance schemes Principal MembersDependants Total Beneficiaries Coverage to total Population NHIF Membership size 468,6112,030,309 2,498, % CHF Membership 561,370 3,368, % Total NHIF and CHF Beneficiaries 10,29,981 5,867, % Coverage as per 2011 population projections 14

Reimbursement to pharmacies and ADDOs is a commendable strategy to curb drug shortage OwnershipAmount Proportion to total payment Government facilities14,458, % Faith-Based/NGOs facilities19,692, % Private facilities5,854, % Part I Pharmacies4,257,7499.6% ADDOs88,7030.2% Total 44,351, % 15

Some issues for discussion Strategies to increase the health share of government budget to 15% as per Abuja commitment.  Is 15% share a realistic target considering the synergies of health sector with other sectors—water, education, agriculture etc? Health Insurance:  Facilitation of NHIF to function more effectively  Universal coverage: strategies to bring the rural communities on board (only 8% of the population is currently covered). 16

Thank you 17