1. Rapid Budget Analysis FY12/13: Results and Reflection Prepared by DPG Health Troika (GIZ, USAID, DANIDA)

2. Context Stated purpose: “…input for the GBS annual review … as well as sector reviews; inform planning and budgeting guidelines and MTEF preparations…” Past: World Bank, with support of the IMF, prepared sector specific RBAs as part of its macro budget analysis (Synoptic Note) For FY 11/12 no sector RBAs were completed For FY 12/13 DPs were requested to support preparation of Sector Specific RBAs to feed into the WB/IMF Synoptic Note Caveat: Only comparison between 11/12 and 12/13 – comparison to other years are not included!

3. Using RBA, PERs and the NHA Figures are NOT directly comparable! Different definitions of “Health Sector” RBA does not capture off-budget aid, PER includes small amount, NHA bigger NHA calculates health share of GOT expenditure by excluding all donor on-budget funding at MOH level – PER/RBA include the on-budget funding (if not specified otherwise)

4. Defining “Health” “All statements are true, if you are free to redefine their terms “

5. RBA Highlights Selected Statistics 2011/12 Budget 2011/12 Actual 2012/13 Budget Total Health Sector (incl CFS) in TZS1,038 bn757 bn1,129 bn Total HIV/AIDS in TZS (on-budget)120 bn27 bn160 bn Health as % of total GOT7.7%6.9%7.4% Health as % of total GOT (excl CFS)8.2%7.4%8.4% Health & AIDS as % of total GOT8.6%7.1%8.5% Per capita health budget in TZS22,98616,77024,314 HE as % of GDP2.5%1.8%2.3% Decentralized share43.1%34.0%48.0% Budget increase nominal8.6% Budget decrease real-7.6%

6. Strong points of the budget Health Budget increased in nominal terms Within the fiscal space left by debt service, the allocation to health as a share of the GOT discretionary budget has grown between FY 11/12 and FY 12/13 GOT has been putting emphasis on its stated priorities, especially in the area of HRH (spending on health PE) Main drag on budget was the reduction in foreign on budget funding

7. Weak points of the budget High inflation has all but wiped out the nominal increase in the health budget Heavy debt service limits the GOT’s fiscal space for health. Abuja target seems increasingly unrealistic Predicted donor support was reduced, especially Global Fund (but now new commitment) Inter-district inequality in the availability of health resources remains substantial (esp. PE) The reliability of data presented is not clear. – The inconsistency of LGA data from PMO-RALG and MOF – Lack of standardized district level population estimates

8. Reflections on the budget Budget is not GOT only - When assessing GOT prioritization need to separate out foreign funding (e.g. GF this year) Data suggests PE was prioritized – salary raises, increased numbers and/or incentives for more equitable distribution? How should we define and advance a “goal” for the health sector budget: Amount, per capita amount, increase, budget share (Abuja)?

9. Reflections on the RBA process How can data become more transparent, timely and reliable? – Data comes piecemeal, with delays and without proper explanations – Comprehensive data from LGAs is lacking – LGAs not included as such in budget, transfers do not distinguish between PE / OC,… – Reliable population for all districts needed How is the RBA useful for Health DPs / Health Sector? – Macro-monitoring, DP reporting, budget advocacy,…? – How can we maximize its utility? Consideration of new budget circle. Who should do it? - WB/IMF / Troika / CSOs? How do we agree to a shared definition of “the health sector”?

10. Asanteni sana!