United Republic of Tanzania
0-Draft Health Financing Strategy produced
Aug 2014 – After extensive technical assessments and stakeholder consultations, the Ministry of Health and Social Welfare in Tanzania, guided by an interministerial steering committee, has produced a 0-Draft Health Financing Strategy.
This 0-Draft has now entered the first stages of stakeholder validations. The first validation step seeks feedback from the Health Financing Technical Working group during the first week of September 2014. After this technical feedback, the 0-Draft will be ammended and presented to the MOHSW management and the inter-ministerial steering committee for approval.
This process coincides with the Big Results Now initiative (http://www.pmoralg.go.tz/quick-menu/brn/index.php), which has this year also included the health sector as one of its priority sectors [though not yet reflected in the above link – an update of the website is expected]. Health Financing will play a big role as part of the targets the BRN will set to be achieved over the next 2-3 years.
Progress on Health Financing Strategy Development
May 2014 – Since the beginning of 2014 to the end of April, the Ministry of Health and Social Welfare (MOHSW) and the Health Financing Strategy (HFS) Inter-ministerial Steering Committee (ISC) in Tanzania have been conducting regional stakeholder consultations (including consultations with parliamentarians) on three different health financing options discussed and evaluated for Tanzania. These consultations provided feedback to the ISC on the different concerns of stakeholders and helped them select one preferred SHI model to pursue with the Health Financing Strategy.
Some of the key recommendations of the ISC for the Strategy formulation included:
- Opt for a Single Payer System compulsory for the whole population, with private health insurances offering doublicative or supplementary health insurance (no opting out option of the single social health insurance fund)
- Have a Minimum benefit package entitlement for all, offered through the SHI
- Access to the MBP by the poor will need substantial government subsidies
- Identification mechanisms of the poor have to be put in place and implemented as part of the strategy
- Create tax levies earmarked for SHI (e.g. from pension funds, car insurance, private insurance etc.)
- Enable certain autonomy of public providers and create a certain level of competition between them and private providers to enhance service quality
- Create consumer protection mechanisms as integrated part of the Single SHI System
- Ensure a strong regulatory mechanisms are in place for the SHI
- Integrate the current work on the RBF system into the HFS
With these and some more detailed recommendations in mind, a MOHSW internal team was tasked to work on the development of a 0-Draft of the Health Financing Strategy in mid-May 2014. The 0-Draft is currently reviewed within the management of the MOHSW before being shared with a wider stakeholder group.
A second HFS writing workshop under inclusion of key national stakeholders and DPs/ P4H partners is envisaged for July/ August this year under guidance of an international HF expert, likely provided by WHO.
- HFS Workshop 3 Options Comparison Table Dec 7 2013 (xlsx, 30.75 KB)
HFS synthesis workshop
Dec 2013 – Health Financing Strategy Synthesis Workshop, 2-4 Dec 2013
The results and recommendations were recently reviewed and consolidated by the Health Financing Technical Working Group (HFTWG) of the Ministry of Health and Social Welfare. The consolidation workshop had the overarching goal to provide informed advise on HFS Options to the Interministerial Steering Committee (ISC) overseeing the HFS development process.
In order to achieve this task a 3-day HFTWG Retreat, technically and financial supported by P4H Partners (GIZ and WHO), was conducted. During the Workshop a narrowed down selection (by ISC) of Health Insurance Market Options was closely assessed within the framework of the main health financing pillars (Resources Generation, Pooling, Purchasing and Governance/ Stewardship).
- 2013 12 07 HFS-Workshop 3-Options-Comparison-Table (xlsx, 30.75 KB)
MoHSW issues request for technical support to drafting of HFS
Nov 2013 – On 5 Nov 2013, the Ministry of Health and Social Welfare issues an official request to the P4H members for technical support to drafting of the Health Financing Strategy. The Inter-Ministerial Steering Committee (ISC) is currently reviewing the options from the various HF studies that have been commissioned in preparation of the HFS. The ISC will narrow down and select options for moving forward with HFS.
The actual drafting will commence after a consolidation workshop proposed for early December 2013.
Health financing reform agenda discussion with non-governmental stakeholders
Mar 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
Dec 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
Oct 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
Aug 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 be found on external Websites:
Health Insurance Regulation Study
Dec 2011 – Mar 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
Nov 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
Oct 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
Oct 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
Jul 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
Jun 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
Apr 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.
- Health financing policy note (pdf, 2.10Mb)
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
Apr 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).