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

2. 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

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

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

5. Per capita health spending is far less than the US$54 recommended by WHO and HSSP III projection of US$ 15.75 by 2009/10 A: Per Capita Health Budget (US$)B: Per Capita Health Spending (US$) 5

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

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

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

9. Development budget continues to grow but it faces poor performance 9

10. Recurrent budget performs better than the development budget 10

11. About 60% of foreign funds budget is executed 11

12. Performance is worse for non-basket fund 12

13. 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

14. 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 2,498,920 5.8% CHF Membership 561,370 3,368,220 7.8% Total NHIF and CHF Beneficiaries 10,29,981 5,867,120 13.6% Coverage as per 2011 population projections 14

15. Reimbursement to pharmacies and ADDOs is a commendable strategy to curb drug shortage OwnershipAmount Proportion to total payment Government facilities14,458,60732.6% Faith-Based/NGOs facilities19,692,09044.4% Private facilities5,854,40513.2% Part I Pharmacies4,257,7499.6% ADDOs88,7030.2% Total 44,351,555 100.0% 15

16. 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

17. Thank you fkessy@gmail.com flkessy@mu.ac.tz www.mzumbe.ac.tz 17