1. Regional Conference of Sector Network Health & Social Protection Africa, MENA and LAC 6-9. May 2014 | La Palm Hotel, Accra/Ghana Towards UHC in the African Region – How to argue for “more” money? Dr. Gemini Mtei | Tanzania

2. Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC THE GLOBAL HEALTH PARADIGM

3. Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC DEVELOPMENT AID FOR HEALTH SIGNIFICANT IN AFRICA 45.4% Share of health aid received by the top 10 largest recipients (out of 145 recipients) Gross bi- and multilateral disbursements for health to Africa in 2011 ca.$9.3 bil. Tanzania: $0.7 bil. Source: WHO Global Health Expenditure Database; Development Initiatives (2013)

4. Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC 10.4% of Government budget allocated to the health sector (2012/13) Source: MTR October 2013 The health sector is increasingly dependent on donor funding TZ INVESTMENT IN HEALTH NOT REACHING ABUJA TARGET

5. Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC Total health expenditure by source Source: MTR October 2013 Per capita expenditure on health of THE 41USD Share of household contribution increased from 25% in 2005/06 to 32% in 2009/10. GOT share 39%. There is a serious equity concern as high out-of-pocket expenditures limit access to care for the poorest groups. WHO FUNDS HEALTH IN TANZANIA?

6. Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC 16% of Tanzanians are covered by a SHI SHI contributes only 4.3% of funding at LGA level against the HSSP III set target of 10% Relying on the current SHI schemes to increase financing has not proven successful COMPLEMENTARY FUNDING FOR HEALTH

7. Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC Challenges in expanding SHI Large informal sector >70% Difficult to collect premiums How to incorporate the poor Who to pay their premiums Fragmentation of insurance pools Too many small pools target small segments of population

8. Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC Diverting existing domestic resources to UHC Creating new sustainable funds for UHC  Health Trust Fund  Regional Health Fund  National health strategies with a focus on UHC  Commitments to multilateral health programmes (e.g. GAVI)  Earmarked taxes (attention to equality) Introducing efficiency and effectiveness  Improving financial management  Performance management  Alignment of resources INNOVATIVE FUNDING MECHANISMS DISCUSSED IN TZ

9. Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC STILL MANY UNMET NEEDS IN THE SECTOR No trained professionals Lack of medicines Top 5 problems facing health facilities Lack of medicines No trained professionals Access to water Limited staff Distance to health facility

10. Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC A health financing strategy was envisioned within HSSP III to guide financing policy STRATEGIC HEALTH FINANCING TO MOVE CLOSER TO UHC

11. HF Strategy Vision HSSP linked/ Creation of ISC SHP Option Papers finalized Feb 2014/ Regional & Parliamentary Consultations April 2014 Fiscal Space Assessment, Institutional Capacity Assessment 1 st Draft of HF Strategy June 2014

12. Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC Lack of political appetite for UHC (not priority on political agenda of the GoT)  Decisions based on politics and economics – influence choices of where the money goes  Political leadership – need for UHC champion within the country Consequences of health aid fungibility on allocation of resources - Diversion of public resources to other sectors through strong focus of foreign aid on health CHALLENGES FOR DEDICATING DOMESTIC RESOURCE TO HEALTH IN TZ

13. Regional Conference of Sector Network Health & Social Protection | Africa, MENA and LAC SOME QUESTIONS TO DISCUSS

14. Regional Conference of Sector Network Health & Social Protection Africa, MENA and LAC 6-9. May 2014 | La Palm Hotel, Accra/Ghana gmtei@ihi.or.tz; nina.siegert@giz.de THANK YOU!