Policy Forum on the last Friday of every month, over breakfast have discussions, hold debates on policies, and issues that affect Tanzanian citizens. These breakfast meetings are open to the public and are held at the British Council auditorium in Dar es Salaam. They give a much-needed platform to the society to voice concerns, share ideas, and think outside the box.
Furthermore, they provide you with a better understanding of the country’s policies, allow for discussions, and debates with esteemed speakers who are drawn from the public sector, academia, and professionals.
Policy Forum is a group of NGO’s united as a non-profit company, that act as a whole with the view of not only inspiring deliberations on issues, but stimulating policy processes to improve democratization, poverty reduction and equity in our country.
The topic up for discussion and after thought musings I attended was on the health sector budget allocations: Is the state of the health sector improving? Dr. Flora Kessy of Mzumbe University, Dar es Salaam campus opened the floor with a presentation on the health sector expenditure from 2006/07 to 2011/ 12.
Major key notes gathered and addressed were that - overall health as a percentage of total government expenditure is declining, which is very worrying. Though health spending is seen to be stable in nominal terms for the financial years of 2006/07 to 2011/12, it actually fell in real terms. This presentation went on to reveal that while the government health budget continues to grow and is a principal basis of public health financing, there is poor implementation and execution. Also, an almost equal amount is seen to be received from foreign funding. In 2011/12, 41% came from foreign sources and 59% from government funds.
In 2001 African health ministers met at a special summit in Abuja, Nigeria. The summit concluded with the adoption of the Abuja Declaration, African leaders promised to spend 15% of their national budgets on health. Dr. Kessy strongly advised this as a realistic target and asked government to increase the health share to 15%.
Less than 15% of Tanzanians are covered by the two major public health insurance schemes: National Health Insurance Fund (NHIF) and Community Health Fund(CHF). It is noted that NHIF has unspent funds and we should endeavour to incorporate rural neighbourhoods. “The NHIF unspent balance of its total income was 59% for 2010/11 and the percentage of funds paid out to health services against total income of NHIF was 27%.” Most citizens are not even aware of the accessibility to health insurance.
In addition, more Accredited Drug Dispensing Outlets (ADDO) should be set up to curb drug shortages. Especially in rural areas and peri-urban areas where majority of people live, and accessibility to health services is almost non-existent.
Following Dr. Kessy was Mr. Simon Moshy, Sikika Program Officer. Sikika aims for quality health services for all Tanzanians, with the vision of empowering citizens as the vehicle towards ensuring a healthy and responsible nation. The presentation delved into accountability in the health sector.
Studies suggested that healthcare does not seem to be a priority and we are a long way from the Abuja Declaration. Another key note was the seemingly unnecessary expenditure in the Ministry of Health and Social Welfare (MOHSW). Findings also revealed that the government is not applying the “Health Block Grant Allocation Formula” which takes into account - population (70%), under five mortality (10%), poverty count (10%), and district vehicle route (10%).
In addition, Sikika’s survey from May to August 2011 illustrates that 29 out of 100 medicine/medical supplies regularly appeared to be unavailable. A call was made to our government to facilitate adequate revenue towards the provision of medical supplies and medicine.
Rufaro Chatora, World Health Organization (WHO) Country Representative to Tanzania outlined some fundamental points for discussion. He was with the consensus that the government should allocate more capital into health care, but stressed that education and infrastructure is equally as important. Strong emphasis was made on human resources - training of personnel.
To provide essential healthcare for all people WHO recommends a minimal of 23 doctors, midwives, nurses per 10,000 people. In Tanzania we have 4 doctors, midwives, nurses per 10,000 people. As Dr Chatora informed us, education is just as crucial to healthcare, as is transport, and infrastructure - it is a cycle. He called upon us to look deeper into the structure of the healthcare sector, on ways to improve coverage of health insurance, and brainstorm ways to obtain supplementary means to fund our health sector.
Food for thought - Majority of Tanzanians do not have access to proper healthcare, there are grossly insufficient medical supplies, dispensaries with unqualified personnel, and we lack execution of efficient health insurance coverage. Is the 15% health share of government budget as per the Abuja Declaration in actual fact a realistic target? How do we attain additional revenue to fund our ailing healthcare system?
Could it be in reducing the tax incentives provided to companies - If the revenue losses of Ths 381 billion in 2008/09 - 2009/10 were spent on education and health, the education budget would increase by a fifth and the health budget by two-fifths. Based on figures in Uwazi, “Tanzania’s Tax Exemptions: Are they too high and making us too dependent on foreign aid?“ Policy Brief, TZ. 12/2010E.
Whatever the case may be, the government has to treat healthcare as a top priority. There has to be accountability and sustainability in our health sector, otherwise we are heading towards a healthcare disaster of epic proportions. Affordable, accessible, quality healthcare should not only be for the selected few.