United Republic of Tanzania
Health financing reform agenda discussion with non-governmental stakeholders
March 2013 After establishing an Interministerial Steering Committee (ISC) to develop a health financing reform agenda, the Ministry of Health and Social Welfare (MoHSW), supported by P4H partners, launches the second stage of stakeholder consultations. In the first of a series of meetings with non-governmental stakeholders, the MoHSW is reaching out to health financing and social health protection stakeholders from the private sector, including civil society organizations, labour unions, employer organisations, social and private health insurers, health service providers, academia and development partners. The aim of this initiative is to familiarize stakeholders with the health financing reform agenda, so that they can then develop their own positions for consideration as part of the consultation process in the preparation of the Option Papers for the nine reform areas identified by the ISC. The next meeting will be hosted once the draft option papers have been completed and before the formulation of a first health financing strategy draft.
Interministerial Steering Committee receives health financing training
December 2012 A delegation from the Tanzanian Interministerial Steering Committee (ISC) for health financing reform participates in the World Bank Institute’s Flagship Course on Health System Reform and Sustainable Financing. With support of the P4H partners from Germany and Switzerland, Tanzania’s designated health financing policy makers receive training from leading experts on various aspects of health financing reform. Facilitated group work and case studies allow the group to develop an in-depth understanding of the key areas of health financing reform in their own country.
Interministerial Steering Committee decides on health financing reform agenda
October 2012 The Interministerial Steering Committee (ISC) decides on a health financing reform agenda. Based on work undertaken by the Ministry of Health and Social Welfare (MoHSW) with the support of P4H partners, the ISC decides to develop Option Papers focused on nine reform areas which will form the basis for drafting a health financing strategy. The nine areas identified are:
- Ensuring access through defined benefit packages
- Regulation of the health insurance market
- Strengthening the Community Health Funds
- Improving access to services for poor and vulnerable people
- Increasing performance through financing
- Strengthening equity of resource allocation
- Leveraging public-private partnerships
- Sound public financial management
- Assessing fiscal space and identifying innovative financing options
All P4H partners in Tanzania pledge to support the drafting process as well as supporting stakeholder discussion.
Interministerial Steering Committee and National Health Accounts launched
August 2012 A high-level Interministerial Steering Committee (ISC) for the development of a Health Financing Strategy (HFS) is launched under the leadership of the Minister of Health and Social Welfare (MOHSW) and strongly supported by P4H partners. Chaired by the Permanent Secretary HSW, the Committee comprises the Directors from key ministries responsible for finance, labour, and industries, as well as departments responsible for decentralization, public service, and planning. The ISC will be responsible for coordinating the development of the HFS, including consultations with other stakeholders, drafting, and liaison with government decision-making bodies. The formation of the ISC is a major step forward
in the reform process aimed at achieving universal health coverage.
Together with the ISC, updated National Health Accounts (NHA) are also launched, providing an in-depth view of the situation of health financing in Tanzania for the financial year 2009/10. They reveal that while Total Health Expenditure per capita has doubled since 2002/03 to US$41, it still falls short of the US$54 recommended by the Taskforce on Innovative Financing. While funding from all sources has grown considerably over the last 4 years, growth in private financing through out-of-pocket spending has outstripped the increase in public and donor funding. This is a set-back on the path to universal health coverage and financial risk protection. The NHA are supported by USAID, a partner in the local P4H network.
More details can soon be found on the MOHSW website and the Development Partners Group for Health in Tanzania website.
Health Insurance Regulation Study
December 2011 to March 2012 – P4H is supporting a review of the regulatory framework of health insurance in Tanzania, looking in particular at regulation governing social health insurance. Tanzania has a number of health insurance institutions and oversight bodies, which have enabled the country to extend social health insurance to a growing population, but regulation has remained fragmented. The study will provide recommendations on streamlining regulation with a view to further expanding coverage.
Health Financing System Analysis Produced
November 2011 – the first draft of the health financing system analysis was produced, supported by P4H, and further discussions are planned for January 2012, which are expected to provide strategic inputs and recommendations for the transition to universal coverage and Social Health Protection.
Joint Annual Health Sector Review
October 2011 – At Tanzania’s Joint Annual Health Sector Review, health financing was identified as a core reform area by all stakeholders of the health sector – civil society, private providers, government, and development partners. Equity, efficiency, transparency and increased financing were cited as necessary components of financing reform, setting the stage for the development of the health financing strategy.
Results of Health Sector Cost Driver Study
October 2011 – In order to foster cost-conscious decision-making in the health sector, P4H supported a study on health sector cost-drivers – strategic decisions that have large cost implications for the sector. The results show that Tanzania has taken a number of cost-intensive decisions in various health sub-sectors that are not refinanced and only loosely coordinated.
MoHSW orientation workshop for Health Financing Strategy
July 2011 – The Ministry of Health and Social Welfare (MoHSW) organized a health financing strategy orientation workshop, run by the resident P4H expert and local WHO staff. The WHO framework for developing a strategy was introduced and the strategies adopted by neighbouring countries analyzed in depth. The specific challenges faced by Tanzania were also identified and the decision taken to produce a health financing system analysis to serve as the basis for the strategy development.
P4H Coordination Desk visit
June 2011 - P4H Coordination Desk (CD) invited to visit Tanzania to clarify Tanzania’s needs and expectations with regard to P4H, and to assist in the development of a joint action plan / roadmap which includes: a Ministry of Health and Social Welfare (MoHSW) orientation workshop on the Health Financing Strategy process; the presentation of the World Health Report 2010 to underline the importance of a workable health financing strategy; the production of a draft health financing strategy after stakeholder consultation; separate draft strategy review workshops for health and all relevant stakeholders (health, finance, labor, private sector, health insurance schemes, etc); and the submission of a final draft strategy to the cabinet.
WB tables policy note on health financing
April 2011 - The World Bank (WB) tabled a Health Financing Policy Note as input to the Tanzania strategy process and to get the ball rolling on the high-level multi-stakeholder process. As requested by the Ministry of Health and Social Welfare (MOHSW), and endorsed by the local network of partners, Germany (through GIZ) hired a health financing expert to strengthen the capacity of the MOHSW Health Economics Unit.
P4H accepts MoHSW request, works on details
Jan 2011 – P4H partners at the global level work on the identification, confirmation and commitment of complementary resources to support Tanzania’s health financing strategy development process. The Ministry of Health and Social Welfare (MoHSW) revised its request for support, tightening the focus on the health financing strategy process. Furthermore, the MoHSW expressed interest in appointing a resident health financing expert financed by a P4H member to support the Health Economics Unit on a longer term basis. The MoHSW also called for further clarification of the kind of support that P4H can offer.
MoHSW considers P4H involvement
Dec 2010 – The Ministry of Health and Social Welfare (MoHSW) issued a request to the P4H network to explore the possibility of P4H supporting Tanzania’s health financing strategy process. The World Bank (WB) contract with the consulting firm supporting the strategy process expired at the end of 2010, while the process was still in its early stages. Discussions began on how global and regional level P4H support could be engaged to ensure continuity of support.
Developing a health financing strategy for Tanzania
April 2010 – The Ministry of Health (MoH) / health financing strategy subgroup drafted a plan for the development of a health financing strategy, setting targets that include deciding on and constituting a “high-level steering committee” by May2010; producing a first draft of the plan by Jul 2010; initiating an internal consultation with stakeholders and an external consultation by Oct 2010. The job of supporting the development of the health financing strategy has been contracted out to a local consulting firm by the Ministry of Health and Social Welfare (MoHSW) and World Bank (WB).