Publication: Tanzania Health Policy Note: Opportunities for Prioritizing Health in the Budget
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2021-01-12
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2021-01-21
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This is the first of a series of policy notes that address critical health finance related questions in Tanzania. They are issued as part of a larger public expenditure review exercise. The audience is government, civil society and the development partner community with the aim to initiate a dialogue around key health finance issues and present recommendations to government. This policy note discusses how the government prioritizes health in the budget.
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“Ally, Mariam; Piatti-Funfkirchen, Moritz. 2021. Tanzania Health Policy Note: Opportunities for Prioritizing Health in the Budget. © World Bank. http://hdl.handle.net/10986/35036 License: CC BY 3.0 IGO.”
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Publication Tanzania Health Policy Note(World Bank, Washington, DC, 2021-01-12)This is the second in a series of health policy notes that address critical health finance related questions in Tanzania. They are issued as part of a larger public expenditure review exercise. The audience is government, civil society and the development partner community with the aim to initiate a dialogue around key health finance issues and present recommendations to government. This policy note raises budget execution in health as a problem and discusses reasons behind low rates and the consequences for service delivery.Publication Tanzania Health Financing Policy Notes(World Bank, Washington, DC, 2020-03)This note reviews the role of domestic financing sources other than general government budget allocations in Tanzania’s health financing architecture. These include funds raised from user fees or cost sharing, reimbursements from the national health insurance fund (NHIF), funds made available from the improved community health fund (iCHF), insurance for workers in the urban informal sector (TIKA), and other private insurance. In Tanzania, these are referred to as complimentary financing mechanisms.Publication Tanzania Health Sector Public Expenditure Review 2020(World Bank, Washington, DC, 2020-04)This Public Expenditure Review (PER) report provides an update on trends and patterns of health expenditures in the public sector. It assesses the availability of fiscal space, the role of user fees and pooled financing arrangements, and provides an overview of the fund flow and financial management processes. The report also explores equity and allocative efficiency considerations, access to care and technical efficiency.Publication Budget Execution in Health(World Bank, Washington, DC, 2021-11-04)Most countries are committed to the provision of quality health services to all, without risk of financial hardship. Adequate budget provisions are an important, yet insufficient requirement in this pursuit. The budget also needs to be implemented in full and with regard to efficiency and accountability. While this is widely acknowledged, there is no systematic evidence on how well the health budget is implemented and literature remains thin on how budget execution practices relate to health financing functions and service delivery. This report is the first in a series of publications on the topic following an active World Health Organization and World Bank collaboration. It aims to define concepts, characteristics and trends in health sector budget execution. The report first calls for clarity in use of terminology. It helps to differentiate between ‘budget execution rates’ and ‘budget execution practices’. The former refers to the share of the budget being executed. The latter to processes on how well the budget is executed. Both aspects are equally important. Not implementing the budget in full is a lost opportunity, efficiency and accountability concern and undermines the health sector’s ability to deliver services. It also undermines prospects for increased fiscal space going forward. To identify trends and patterns in over and underspending, the report draws on previously unexplored PEFA annex and World Bank BOOST data. This reveals the following: Health budget execution rates are inversely related to levels of income and maturity of PFM systems. Health budget under-execution is particularly pervasive in LMICs where the budget is executed at around 85-90 percent. Some countries have chronic budget execution problems where the budget is executed at a rate below 85 percent across consecutive years. In LMICs, the health budget is systematically implemented at a lower rate than the general government budget. This means, that governments are effectively deprioritizing health during budget implementation. For Sub-Saharan Africa countries in the sample, the average health budget was 6.7 percent of the general government budget. Health spending as a share of general government spending was half a percentage point less at 6.2 percent. In some countries this is much more pronounced, where health is deprioritized by 2-3 percentage points of general government spending during implementation. The health budget was also implemented at a lower rate than the education budget in most countries at an average rate of 4 percentage points. Underspending in some categories often occurs concurrently with overspending on other expenditure items. While the wage and salary budget tend to be implemented in full, this is less so for goods and services or the capital budget. This can leave health workers without the necessary supplies or support infrastructure to provide quality services and invariably lead to inefficiencies.Publication Public Financial Management in the Health Sector(World Bank, Washington, DC, 2020)This study assesses the extent to which public financial management (PFM) in Malawi supports health service provision at the local government level. Using a conceptual framework that links the budget cycle to health service provider management and service delivery goals, the study assesses how the various stages of the budget cycle affect service delivery at health centers and hospitals. Government and faith-based health providers, known as Christian Health Association Malawi (CHAM), are assessed separately. The study provides insights into provider autonomy and flexibility; financial management capacity; payment arrangements; and the performance orientation of budget provisions or purchasing. The results suggest that significant gaps exist, which undermine the service delivery goals of efficiency, quality, equity, and accountability of service provision. A summary of the findings is presented in the report. It provides complimentary guidance as to how PFM systems facilitate provider management and service delivery at district level health centers and hospitals. Findings and recommendations from the study are expected to support decision makers and practitioners with ongoing PFM reforms.
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