SPU8606: HEALTH CARE

MODELLING & FINANCING

Topic 2

Health System of Tanzania

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 Content

1) History
2) Distribution of Health facilities
3) Structure of Health Services Delivery
4) Human Resources for Health (HRH)
5) Health Information System
6) Organizations & Mng’t of the Health System
7) Health financing
8) Health Policy
9) Health Legislation
10) Health Sector Achievements & Challenges

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 1. History (1)
 For more than 30 years, health care services delivery was largely a
prerogative of the state.
 Only a limited number of private-for-profit health services
operated in major towns of the country.
 Primary health care and health care facilities were greatly directed
towards rural areas, in which more emphasis was on free-medical
services.
 Arusha Declaration in 1967 - free care for all
 1974 - The Traditional Medicine Research Unit was established and
works to promote and standardize traditional medicine.
 1977 profit based private health services were banned under the
Private Hospitals (Regulatory) Act, together with commercialized
medical and dentistry practices.
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 2. History (2)
 1977 - Soon after the ban of the private for-profit medical
practice, The government took on the task of financing and
providing health services free of charge through public
taxation to all individuals attending public health facilities.
 1991- Amendment of the Private Hospitals Regulation Act,
recognized the importance of the private sector’s role in the
delivery of health care.
 Following this act, individual qualified medical practitioners
and dentists could now manage private hospitals with the
approval of the Ministry of Health.

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 1. History (2)
 1993 -Cost sharing started – Exemptions for vulnerable
groups to enhance equity and waivers for the poor.
 Late 1990s, introduction of insurance to protect households
from catastrophic financing
– 1996 piloted the Community Health Fund (CHF) in Igunga
district – national roll out from 2001 to cover the rural and
informal sector population.
 . 1999 National Health Insurance Scheme (NHIF) initiated, starting
in 2001 to cover general outpatient and inpatient care, specialized
surgery, pharmaceuticals, optical services, and orthopaedics.
_ SHIB
_ Private &Voluntary CBHIS.

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 1. History (3)
 In 2007 primary health care development program (PHCDP)
(2007-2017),whose main objective is improvement of primary
health care delivery system by increasing the number of
facilities, especially in rural areas. This program ensure that, every
village has a clinic and every ward has a health centre.

 2014- The introduction of the iCHF with the aim to increase

access to quality healthcare for people in the informal sector,
mostly rural and low-income groups

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 History (4)
 The Health Policy of (2007) requires each region to have
a Regional Referral Hospital(RRH), each council to have
a hospital, each ward a health centre and each village a
dispensary. Currently, there are 6 cities, 20 municipalities,
22 town councils and 137 district councils. In addition,
there are 3,956 wards and 12,319 villages.(HSSP V,
2021).
 The number of health facilities increased from 5,253 in
2007 to 8,665 in 2020, while the total number of public
health facilities increased from 3,421 to 5,122 in the
same period.

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 2. Distribution of Health Facilities by Ownership
Facility Type Agency
Public Parastatal FBOs Private Total
Hospitals 129 15 79 34 257
Health 484 12 141 79 716
Centres
Dispensaries 4,502 116 626 716 5,960
TOTAL 5,115 143 846 829 6,933

Source: MoHSW _TSPA, 2016.

The distribution of Health Facilities has a heavy rural emphasis because
more than 70% of the population lives in rural areas.
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 3. Structure of Health Services Delivery

FigureMohamed
1: Hierarchy
A.J, 2023 of health services provided in Mainland Tanzania.
4/24/2023
Source: United Republic of Tanzania, Ministry of Health.
 3. Structure of Health Services Delivery
 1. Village Health Service:(Health post, community
health services)
 2. Dispensaries
 3. Health Centres
 4. District Hospitals:
 5. Regional Hospital:
 6. Referral/Consultant Hospitals:
 7. Referral Abroad:

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 3. Structure…..cont’d
(8) Public Education:
An integral part of community involvement in primary health
care. It is mainly concerned with identifying prevailing
health problems and disseminating to the public methods
of preventing and controlling them.

(9)Training of Health professionals:

(10) Reproductive Health:

The FPU is responsible for initiating and developing family
planning standards and guidelines on service provision,
training and other aspects of reproductive health.

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 The pyramid of health services delivery(updated)

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 5. Governance Structure of Health
System - 1
 Tanzania operates a decentralization by devolution health system
organized around three functional levels: district (primary
level), regional (secondary level), and referral hospitals
(tertiary level).
 Since mid-late 1990s, the health system has been using a Sector
Wide Approach (SWAp) with framework of collaboration among
stakeholders (MoH, PO-RALG, MoFEA, Civil Societies, Private
Sector and Development Ps -including UN agencies active in
health) .
 It aimed to coordinate financing, planning, and monitoring
mechanisms.

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 5. Governance Structure of Health System - 2
 In the health sector decentralization by devolution
translates to the following;
• The President’s Office, Regional Administration and
Local Government (PO-RALG)
• Ministry of Health (MoH)
• Ministry of Finance and Economic Affairs (MoFEA)
• Regional Health Management Team (RHMT)
• The District Health Management Team (DHMT)
• Community Health management Team
• Private Health providers.( Under APHTA)

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 6. Human Resources for Health (HRH)

 According to the Ministry of Health (MoH);

 The total number of health workers has increased from 47,000 in
2006/7 to 102,919 in 2018/2019.
 The human resources for health (HRH) shortfall is currently
estimated at 52 percent of the actual need. For all the clinical cadres,
the health worker per population ratio is still far below those
recommended by WHO. (17.2 per 10,000 population)
 In 2006 there were 29, 000 staff working in government health
facilities (an estimated 65% shortage) and about 6,000 staff working
in private facilities (an estimated 86%shortage).
 An additional 144, 700 workers are needed in the government sector
and a further 39, 400 for the non-government sector, between 2007
and 2017.

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 HRH….Cont’d…..Distrbn of health
workers
 Most of the health workforce is concentrated in urban areas
where there are hospitals.
 According to the new Staffing levels guideline (2014), the
minimum number of health workers required to provide quality
health services in these facilities is 145,454. The actual number
of health workers available is 63,447 and the shortage is 82,007,
which is about 56.38%.
 With this regard, the call for Pr. Samia on the increasing number
of the employed doctors and other professionals will decrease
the healthcare burden and tiresome to the available HRH in
different hospitals around the country.

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 HRH...cont’d....
 With regard to HRH availability, there is a clear disparity
between several regions. In Kilimanjaro, Dar-es salaam,
Iringa, Lindi and Pwani are better off compared to regions
such as Kagera, Rukwa, Tabora, Kigoma and Shinyanga.
 The reason behind this disparity which influence where
health workers choose to practice are : career plans, salary levels,
recruitment and appointment procedures, and retention measures.

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 7.Health Information System (HIS)
 Implementation a Health Management Information System
(HMIS) or (MTUHA in Swahili) for reporting health related data
from health facilities.
 This system is now being replaced by DHIS, a system which
includes open source software with the possibility of using
mobile phones to send data from the facility direct to a central
database.
 In order to collect data on HRH, disease burden and general
health service deliver, number of information systems are used,
both manual and computerized. For the purposes of executing
the computerized information systems, computers have been
procured and installed in all districts and health facilities and not
health posts.

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 8. Health financing in tanzania
 Health sector financing is characterised by diverse sources including the
government budget, the Health Sector Basket Fund (HSBF) comprising
funds from(development partners; resources from non-governmental
organisations (NGOs)); out-of-pocket payments; and funds from health
insurances.

 Tanzania is having an slight decrease in budget of the Total Health

Expenditure in the Total budget from 8.5% in FY 2012/2013 reaching up
to 5.9% in FY 2019/2020. Nonetheless, the gvt has increased it’s budget
for health, from TZS 577 billion in 2007/08 to TZS 2.8 trillion in
2020/21 in nominal terms .

 However, the expenditure of health care is characterized by a tendency of

depending from international donor agencies, (from 22% in FY 2003/2006 to
32% in FY 2011/2012, Also from that level into 24% in FY 2019/2020.
Nonetheless, it has inadequate amount of health care expenditure at the primary
level.

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 Health financing in Tanzania(Cont’d)
 There is also high dependence of the out of pocket
expenditure as a means of accessing health care, that
deteriorate the rate of access of services, esp. to the poor.
 In the 2019/2020, there was increase in the levels of
recurrent and development budget. The recurrent budget
was TZS 425.01 Billions,(43.3%) of the budget, while the
budget was TZS 544.14 billion(56.7%), WHILE in
2018/2019, The budgets were TZS 306.47(35.1)% and TZS
561.76(64.9)% respectively.
 The per capita allocation is USD 41 which is 36.66% of the
WHO recommendation of USD 112.

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 9. Selected Health System Policies & Strategies
1) National Health Policy of 1990, 2003 ,2007 and 2017
2) Health Sector Reform Plan of 1994
3) Health Sector Strategic Plan II (HSSP 2) 2003 and III (HSSP
3) (2009)
4) Tanzania’s third health sector strategic plan (2009-2015).
5) Primary health services development programme (2007-2017).
6) HRH and social welfare strategic plan (2014-2019).
7) National Health sector Quality improvement strategic plan
8) Tanzania National ehealth strategy. (July 2013-June 2018)
9) Tanzania Food and Drug authority strategic plan 2012-13,
2016-2017.
10) National Digital Health strategy 2019-2024.
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 10. Health Legislation
 There are about 27 substantive legislations and many
regulations, orders and standards for the health sector.
 The management of health services takes place within the
legal context of the Government of Tanzania, which extends
beyond the health sector.
 The ministry plays a stewardship role in the health sector
while PO-RALG plays a prominent role in implementation.
The Decentralization by Devolution (D-by-D) policy of the
Government, has put the LGA’s in charge of delivering social
services and has given the PO-RALG the task to
monitor/supervise and coordinate their activities, in line with
the policies and guidelines of the Sectoral Ministries.

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 10. Health Legislation …..Cont’d…
 To mention a few;
1)Public Health legislation which is for the control of
epidemics, infectious diseases and environmental health
protection,
2)Health professional legislation which governs the
practice and conduct of health professionals such as
doctors, dental practitioners, pharmacists, nurses etc,
3)Legislation which establishes autonomous health
institutions for a particular need, such as institutions for
medical research, national and special hospitals etc.
4)Health financing legislation which is aiming at
providing alternative health financing mechanism with the
aim of complementing government efforts to finance
health services

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 11. Achievements and Challenges of Health
System of Tanzania

1) Alleviation of the shortage of medicines

E.g.-In the past two years 'budget (2016–2018), for instance,
more than 250 billion TZS of domestic funding was
allocated for pharmaceutical services, covering vaccines,
maternal, neonatal and child health, family planning, and
antiretroviral and malaria drugs
2) Increase in the number of health facilities
Following the new regime of the Hon Pr Mama SSH,
there is an increment of the health facilities together with
the resident houses for the medical professional.
3) Increase in public health insurance awareness and
coverage. Currently is about 33% of all Citizens(8% from
NHIF, and 25% from the CHIF) which accounts for 4,217,211
and 13,029,636 respectively.(Budget speech 2020)
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 Specific challenges(Health syst B.B)
 Existence of multiple, disconnected human resources for
health systems, staffing shortages, and skills-mix imbalance;
uneven distribution of human resources for health; lack of
up-to-date comprehensive workforce registry
 Inadequate health commodities; inefficient supply chain
management, insufficient and fragmented health care
financing strategies.

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 Specific challenges(Cont’d)
 Fragmented and interoperable health information systems;
limited data-use culture; low data quality; limited ICT
infrastructure
 Inability to easily track performance of the health system and
health care providers, weak governance and leadership,
inefficient allocation of resources, inefficiencies in health
services delivery, inadequate transparency, and failure to
adhere to professionalism.

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 Specific challenges(Cont’d)
 Low level of awareness amongst communities on promoting
healthy behaviour, prevention, self-management, access to
health care. Increase in burden of communicable and non-
communicable diseases. Limited access to specialised health
services.

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 12. General Challenges
1) Limited coverage with health insurance
2) Under financing of medical providers
3) Poverty and income distribution
4) Failure in exemption and waive policy
5) Performance- Problems of Insurance schemes
6) Rapid population growth
7) Too few health workers and their poor morale
8) Lack of equipment and medical supplies
9) Increasing health burden from chronic and
emerging diseases overwhelm the capacity of
the health system.
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 Q&A

END OF TOPIC 2
THANK YOU FOR LISTENING!
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