By Simon Moshy

Human Rights to Health

Estimated Budget Outturn

Health Sector Resources

Consolidated Fund MDAs

Regions

Health Block Grants

Selected Subjects HIV/AIDS

Essential Medicines & Medical Supplies

Human Resources for Health

2

Safe and potable drinking water and

adequate sanitation facilities,

hospitals, clinics and other health-related

buildings,

trained medical and professional personnel

receiving domestically competitive salaries,

and

essential drugs, as defined by the WHO

Action Programme on Essential Drugs.

Source: Committee on Economic, Social and Cultural Rights (2000), General Comment No. 14, section 12(a). 3

Recurrent revenues vs. recurrent expenditures

4

Recurrent Expenditures

Recurrent Revenues

5

8.3 Trillion 6.9 Trillion

Source: Budget Guidelines (2012), p.41. 6

“[I]n light of the less favorable global financing situation,

the Government has decided to adopt mid-year measures to

reduce the 2011/12 deficit […].

A broad based range of expenditure savings have been

identified through a line by line review of the budget.

[…] Cuts are being made, without serious adverse economic

impact, …

… to extra duty allowances, training,

travel, office running costs, vehicle

operating costs, … … allocations to government agencies and boards, and some

activities of local government authorities (LGAs) and new

administrative areas; […]”

Source: Letter of Intent to IMF (2011), p. 6. 7

Abuja Target

Real per capita health expenditures

8

0%

5%

10%

15%

20%

25%

2008/09 2009/10 2010/11 2011/12

Education

Health

Source: PWC (2008,2009,2010,2011), Budget Speech Reviews. 9

0%

5%

10%

15%

20%

25%

2008/09 2009/10 2010/11 2011/12

Education

Infrastructure

Health

Others

Source: PWC (2008,2009,2010,2011), Budget Speech Reviews. 10

0%

5%

10%

15%

20%

25%

2008/09 2009/10 2010/11 2011/12

Health

Abuja Target

Source: PWC (2008,2009,2010,2011), Budget Speech Reviews. 11

Source: PER (2006,2007, 2008, 2009, 2010, 2011)

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

TSH

Real

Nominal

12

MoHSW

Regions

13

-

100

200

300

400

500

600

700

800

2009/2010 2010/2011 2011/2012

Billion T

SH

Development

Recurrent

Source: Budget Estimates (2011), Vol. II and IV. 14

Budget Line 2010/2011 2011/2012 Percentage

Change

Allowances 4,438,866,302 8,090,305,502 82.3%

Fuel, Oil,

Lubricants 1,401,832,000 1,080,140,000 -22.9%

Training 6,409,255,130 6,596,318,360 2.9%

Travel 3,467,431,384 4,139,369,000 19.4%

Hospitality

Supplies 376,738,000 683,453,000 81.4%

Acquisition of

Vehicles 33,000,000 361,000,000 993.9%

Total 16,127,122,816 20,950,585,862 29.9%

Source: Budget Estimates (2011), Vol. II 15

0

50

100

150

200

250

300

350

400

450

500

2009/10 2010/11 2011/12

Billion T

SH

Foreign

Local

Source: Budget Estimates (2011), Vol. IV. 16

27.1%

48.6%

22.1%

1.8% 0.4% Curative services

Preventive services

Policy and Planning

Human Resource Development

Social Welfare

Source: Budget Estimates (2011), Vol. IV. 17

18

-100%

-75%

-50%

-25%

0%

25%

50%

75%

100%

125%

150%

MARA

KAG

ERA

KIG

OM

A

MBEYA

MO

RO

GO

RO

MTW

ARA

DO

DO

MA

RU

VU

MA

TABO

RA

ARU

SH

A

TAN

GA

SIN

GID

A

SH

INYA

NG

A

KIL

IMAN

JARO

IRIN

GA

MW

AN

ZA

CO

STAL

RU

KW

A

MAN

YARA

LIN

DI

Source: Budget Estimates (2011), Vol. III.

0

20

40

60

80

100

120

140

2009/10 2010/11 2011/12

TSH

Billion

Foreign

Local

Source: Budget Estimates (2011), Vol. IV. 19

66.5%

12.6%

9.9%

9.6% 0.7% 0.7%

Health Sector Development

HIV/AIDS

Primary Health Services

Construction and Rehabilitation of Hospitals

Health Sector Governance

Child Survival and Development

Source: Budget Estimates (2011), Vol. IV. 20

Health block grant

21

Formula has been developed in 2002 by

Georgia State University.

Allocation Factors

Population (70%)

Under-five mortality (10%)

Poverty count (10%)

District vehicle route (10%)

22

23

Formula has been developed in 2002 by

Georgia State University.

Allocation Factors

Population (70%)

Under-five mortality (10%)

Poverty count (10%)

District vehicle route (10%)

Implementation was supposed to start 2004.

24

0

500

1000

1500

2000

2500

3000

3500

- 500.00 1,000.00 1,500.00 2,000.00 2,500.00 3,000.00 3,500.00

Allocati

on 2

005/0

6-2

010/1

1 (

TSH

)

Allocation by the Formula (TSH)

2005-06

2008-09

2010-11

Source: www.pmoralg.go.tz/ 25

Essential Medicines & Medical Supplies

HIV/AIDS

Human Resources for Health

26

Sikika’s survey from May to August 2011 shows

that from 100 inquiries for a specific essential

medicine or medical supply, on average,

29 were reported to be out of stock.

Budget for Essential Medicines and Supplies in

2011/12:

PSU/MSD est. need: TSH 198 bn (100%)

MTEF: TSH 78.6 bn (40%)

Source: MoHSW Pharmaceutical Service Unit, based on MTEFs. 27

0

10

20

30

40

50

60

70

80

90

2007/08 2008/09 2009/10 2010/11 2011/12

Billion T

SH

Foreign

Local

Source: MoHSW Pharmaceutical Service Unit, based on MTEFs. 28

Need and supply of Antiretroviral Therapy (ART)

HIV positive people 2,344,969 (100%)

Registered 740,000 (32%)

Receiving ART 384,816 (16%)

Sikika survey shows unavailability of CD4

counting service in in Care and Treatment

Centres (CTC):

Observed CTCs: 35 (100%)

CD4 machines in place: 13 (37%)

CD4 machines work: 5 (14%)

Source: National HIV/AIDS response report (2010).

29

0.04

124.61

0

20

40

60

80

100

120

140

Local Foreign

Billion T

SH

Source: Budget Estimates (2011), Vol. IV. 30

Remuneration

(1-3 years experience)

Public Sector

Hospital

Private Sector

Hospital*

Gross Salary 957,700

per month 1,800,000

per month

On-Call Allowance 10,000

per day

230,000

per month

Housing Allowance None 260,000

per month

31 * Aga Khan Hospital

Human Resource Gap:

HRH Strategic Plan indicates an HRH gap

of 96,468 in 2010 .

HRH Funding:

MoHSW estimated need: 66.3 bn (100%)

MoFEA actual allocation: 13.2 bn (22%)

Budget Execution Q1+Q2: 2.6 bn (4%)

Source: MoHSW, JICA (2012), Mid-term evaluation of HRH Strategic Plan, p. 28. 32

Health sector budget

Demand commitment to the Abuja Declaration.

Control unnecessary expenditures in the MoHSW.

Ensure the equitable allocation of Health Block

Grant and Health Basket Fund.

HRH

Compensate all health workers, who lack

protective supplies like surgical gloves for

example, with adequate risk allowance.

33

HIV/AIDS

Push for AIDS Trust Fund financed through taxes

(on alcohol etc.) to raise additional TSH 300 bn.

Request budget for CD4 counting machines that

are needed for each Care and Treatment

Centres.

Essential Medicines & Medical Supplies

Push for MTEF allocation of TSH 198 bn.

34

35

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www.sikika.or.tz

Asanteni Sana!