1. Directorate of Policy and Planning

2. Current Implementation/Policy Issues 1. Reduce the budget gap by mobilizing adequate and sustainable financial resources − Health budget to reach 15% of GOT budget – − Health Basket Fund increased Health Financing Strategy

3. Current Implementation/Policy Issues A.Sustainable Resources Progress on Abuja Target Other GoT competing priorities – Kilimo Kwanza, infrastructure. For 2010 its 12% Increased in absolute amounts Extensive DP resources, GF on-budget intensifying this Government share reduced Health Basket Fund increased – from $79M to $83M Health Financing Strategy

4. Progress on Abuja Target Trend is continuing downward over the last 6 years This is despite substantial GF funds coming “on-budget” FY 11 – Global Fund is 49% of total MOHSW budget

5. Progress on Health Financing Strategy Delays were experienced Contract for UDSM now signed TORs for Costing Study finalized Background work being undertaken by Abt Associates, funded through USAID TWG HF subgroup meeting regularly Health Financing session prior to TRM Momentum appears to be increasing

6. Current Implementation/Policy Issues(cont’d) 2. Enhance complementary financing, increasing the share in the total health budget to 10% by 2015 – some progress − Prepayment scheme coverage (CHF/TIKA, NHIF) increased − CHF 5.6% NHIF 5% − Maximize NHIF and CHF/TIKA financing options − Councils have started to claim more funds last FY was 1.669b Social Health Insurance development undertaken Health Financing Meeting There are some progress of the linkage between NHIF and CHF Coverage is about 5.6%

7. Current Implementation/Policy Issues(cont’d) Discussion should be initiated/continued on appropriate regulatory mechanisms Private investment discussions should also be initiated, beginning with the role/limitations of private sector involvement Strong linkage needed with HF Strategy

8. Current Implementation/Policy Issues(cont’d ) 3. Improve equity of access to health services – some progress − Effective subsidies and waiver mechanisms in place for poor and vulnerable, using prepayment schemes and other options Cost sharing Guideline has been reviewed NHIF – over 60 are cared for, all 60 and above are exempted Strong linkage needed with HF Strategy

9. Current Implementation/Policy Issues(cont’d) Strong linkage needed with prepayment discussion Is pre-payment to replace cost sharing or provide a larger share of the cost of health services? What is the role of pre-payment for services where user fees are exempt/waived (e.g., NSSF does not cover these services)? What robust mechanisms exist to identify the poor and provide waivers? How can these mechanisms be implemented in TZ?

10. Current Implementation/Policy Issues (IV) 4. Increase efficiency and effectiveness in use of financial resources – some improvements in audits Government budgeting, accounting and auditing processes are implemented in a transparent way Management of Complementary Funds CAG Performance Audit highlighted issues: most of the HCs are hardly involved in the preparation of the Councils’ planning. HCs’ own source funds collected from cost sharing such as CHF, NHIF, user fees are combined in Account No.6 at the DMO’s office. Put together, these problems are significantly hampering the ability of the HCs to promote transparency, accountability and good performance. MOHSW/PMO-RALG need to respond

11. Current Implementation/Policy Issues (V) Use of Financial Resources Overall financial audits are improving, but … CAG Performance Audit also highlighted issues: HCs are not efficiently managed and are funded without proper consideration of service demands and performance

12. Current Implementation/Policy Issues (V) HCs lack a comprehensive system for monitoring of their own spending. the current system of supervision has not been able to detect the HCs that have problems with their performance and suggest remedial action. Again MOHSW/PMO-RALG need to respond

13. Future Plans A. Sustainable Resources Abuja Target Comprehensive analysis and business case for increased health system investments Consider external financing explicitly Need to feed into budget process – Nov. 2010 Completion of Health Financing Strategy Paper completed and distributed – July, 2011 Consensus conference – September, 2011 (JAHSR) Government decision – November, 2011

14. Future Plans (II) B.Complementary Financing (pre-payment) Regular reporting on the progress of the linkage between NHIF and CHF First report – October, 2010, quarterly thereafter Discussion paper on regulatory mechanisms Paper completed and distributed – January, 2011 Consensus conference – March, 2011 Government decision – June, 2011 Discussion paper – private investment in health Paper completed and distributed – August, 2011

15. Future Plans (III) C.Equity of Access Cost sharing policy review to be completed Linked with costing work and HF Strategy Prepayment discussion to be part of HFS Methods for identifying the poor Review of currently available approaches – Nov. 2010 Assessment of applicability in Tanzania – Mar. 2011 Implementation plan (as part of above) – June 2011

16. Future Plans (IV) D.Management of Complementary Funds Response/Action Plan for CAG Audit Response depends in part on decisions re: bank accounts at the HC level Consultations needed with MOFEA/DPG-Macro Action plan will be consistent with PFM directions and capacity building activity and part of this larger activity

17. Future Plans (V) E.Use of Financial Resources Response/action plan for CAG audit Discussion of role/autonomy of health providers, including health centers March, 2011 Discussion of governance and accountability issues and potential solutions March 2011 Action plan for the above issues September 2011