Health Sector Expenditure from 2006/07 to 2011/12. By Dr. Flora Kessy Mzumbe University, Dar es...
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Health Sector Expenditure from 2006/07 to 2011/12. By Dr. Flora Kessy Mzumbe University, Dar es Salaam Campus College . 1
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Transcript of Health Sector Expenditure from 2006/07 to 2011/12. By Dr. Flora Kessy Mzumbe University, Dar es...
Health Sector Expenditure from 2006/07 to 2011/12.
By Dr. Flora KessyMzumbe University, Dar es Salaam Campus College .
1
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
Health spending is stable in nominal terms but declined slightly in real terms
A: Budget Trend (TZS) B: Actual Expenditure Trend (TZS)
20
06
/07
20
07
/08
20
08
/09
20
09
/10
20
10
/11
20
11
/12
0
200
400
600
800
1,000
1,200
1,400
520
616
734
925
1,2201,164
342395
439533
656585
NOMINAL REAL20
06/0
7
2007
/08
2008
/09
2009
/10
2010
/11
200
300
400
500
600
700
800
900
1,000
517
577
707
918 924
340370
423
529497
NOMINAL REAL
3
Health as % of Total Government Expenditure is declining which is a big concern
A: Share in budget (%) B: Share in actual expenditure (%)
20
06
/07
20
07
/08
20
08
/09
20
09
/10
20
10
/11
20
11
/12
8.0
8.5
9.0
9.5
10.0
10.5
11.0
11.5
12.0
12.5
13.0
11.611.3
11.1
11.6
12.3
10.0
10.510.3
10.0
9.7
10.5
8.6
EXCLUDING CFS INCLUDING CFS
2006/07 2007/08 2008/09 2009/10 2010/11
9.0
9.5
10.0
10.5
11.0
11.5
12.0
12.5
13.0
13.5
14.0
13.4
12.312.1
13.1
11.911.9
11.110.8
9.9
9.5
EXCLUDING CFS INCLUDING CFS
4
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$) B: Per Capita Health Spending (US$)
2006/07 2007/08 2008/09 2009/10 2010/11 2011/12
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
22.0
11.0
12.513.3
15.4
19.8
17.3
7.38.0 8.0
8.9
10.6
8.7
NOMINAL REAL2006/07 2007/08 2008/09 2009/10 2010/11
6.0
7.0
8.0
9.0
10.0
11.0
12.0
13.0
14.0
15.0
16.0
11.0
11.8
13.5
15.3
14.9
7.27.5
8.18.8
8.0
NOMINAL REAL
5
Government funding still remains the dominant source of public health financing
budget Actual budget Actual budget Actual budget Actual budget Actual Budget2006/07 2007/08 2008/09 2009/10 2010/11 2011/12
0%
20%
40%
60%
80%
100%
120%
71% 68% 67% 66% 60% 66%59% 64%
53%63% 59%
29% 32% 33% 34% 40% 34%41% 36%
47%37% 41%
Foreign Government Funds
6
Central share of expenditure remains stable over time despite D-by-D
Budget Actual Budget Actual Budget Actual Budget Actual Budget Actual Budget2006/07 2007/08 2008/09 2009/10 2010/11 2011/12
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
64% 63% 61% 60% 60% 60%56% 57% 61% 59% 60%
36% 37% 39% 40% 40% 40%44% 43% 39% 41% 40%
CENTRAL
LOCAL
7
Part of the central funds is spent at the LGAs level through procurement of medicines
2007/08 2008/09 2009/10 2010/11 2011/120%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
46%41%
34% 33% 37%
15% 22%
22%28%
20%
Local
Medicines
Central
8
Development budget continues to grow but it faces poor performance
Budget Actual Budget Actual Budget Actual Budget Actual Budget Actual Budget2006/07 2007/08 2008/09 2009/10 2010/11 2011/12
0%
10%
20%
30%
40%
50%
60%
70%
80%76.5% 76.3%
64.1% 63.1%
52.7%
61.1%
53.9%58.7%
47.4%
59.4%54.3%
23.5% 23.7%
35.9% 36.9%
47.3%
38.9%
46.1%41.3%
52.6%
40.6%45.7%
RECURRENT DEVELOPMENT
9
Recurrent budget performs better than the development budget
2006/07 2007/08 2008/09 2009/10 2010/1140%
50%
60%
70%
80%
90%
100%
110%
99%
91%
107% 107%
94%
100%95%
75%
88%
57%
RECURRENT DEVELOPMENT
10
About 60% of foreign funds budget is executed
2006/07 2007/08 2008/09 2009/10 2010/1140%
50%
60%
70%
80%
90%
100%
110%
120%
94%91%
100%
105%
89%
111%
95%
79%
87%
59%
Government Funds Foreign Funds
11
Performance is worse for non-basket fund
2006/07 2007/08 2008/09 2009/10 2010/1140%
50%
60%
70%
80%
90%
100%
110%
120%
130%
103%100%
86%
106%
79%
126%
92%
75%79%
51%
Basket Funds Non-Basket Funds
12
National Health Insurance Fund (NHIF) continues to hold significant amount of unspent funds
2006/07 2007/08 2008/09 2009/10 2010/11
Contributions 45,516 55,472 73,282 90,084 134,891
Total income (incl. Income from investments and others) 56,884 72,168 76,512 108,845 164,146
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 23,950 26,719 34,325 39,782 68,048
Unspent balance as % of total income 58% 63% 55% 63% 59%
13
Less than 15% of Tanzanian are covered by the two major public health insurance schemes
Principal Members Dependants
Total Beneficiaries
Coverage to total Population
NHIF Membership size 468,611 2,030,309 2,498,920
5.8%
CHF Membership 561,370 3,368,2207.8%
Total NHIF and CHF Beneficiaries
10,29,981 5,867,12013.6%
Coverage as per 2011 population projections
14
Reimbursement to pharmacies and ADDOs is a commendable strategy to curb drug shortage
Ownership Amount Proportion to total payment
Government facilities 14,458,607 32.6%
Faith-Based/NGOs facilities 19,692,090 44.4%Private facilities 5,854,405 13.2%Part I Pharmacies 4,257,749 9.6%ADDOs 88,703 0.2%Total 44,351,555 100.0%
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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).
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