Tanzania

ECONOMIC SUPPORT-TZ

Sources
Personal households Foreign aid Governmental revenues Insurance(voluntary) Social security Charity

The distribution of income in Tanzania

Who pays for Health Care in Tanzania?

Donor funding and general tax revenue are the main sources of health financing in Tanzania About 10% of tax revenue goes to health care Out-of-pocket payments, or direct payments to health (>50% of households) Health insurance contributions (<10% of population)

Distribution of sources of health care financing

Breakdown of household health care financing contributions

Resource Production

Population of health care

number of Doctors Ratio doctor/population - 23188 Nurse/population - 1,122 Other cadres

The main service providers in Tanzania:

Public sector facilities (health centres and dispensaries) and hospitals (district, regional and referral hospitals) Faith-based facilities (health centres and dispensaries) and faith-based hospitals Private for-profit facilities (health centres and dispensaries) and private hospitals.

Drugs and Supplies

MSD (The Medical Stores Department (MSD) established in 1993 is
responsible for developing, maintaining and managing procurement, storage and distribution of approved drugs and other medical supplies required for use by public facilities. In effect this act gives MSD a large degree of monopoly power and many facilities and district councils have criticized this arrangements due to frequent drug stock-outs and slow delivery (MOH 2003; MOH 2006; MOHSW 2007). )

Private pharmacies (shortage, private facilities, prescriptions) Drug stores (prescriptions, retatil, self prescription)

Training
Public Medical University - 2 (MUHAS, UDOM) Private Medical University - 4 (HKMU, KCMC,IMTU, BUCHS) Diploma and certificate colleges (CA, CO, NTC, Physio, AMO, AMO spec) Number of Training Institutions with full NACTE Accreditation Currently there are 134 Health Training Institutions out of these only 15 Public Health training Institutions 11.2% have FULL ACCREDITATION. The rest institutes are in different stages of registration and Accreditation

Organization of Programs

Organization
Administratively, the provision of health services is divided into 3 levels: National Regional District The referral system assumes a pyramid pattern starting from the village level, where there are village health posts; ward level, where

Government agencies
TFDA (food and drug) NIMR (Medical research) NURSING COUNCIL TACAIDS & NACP (HIV/AIDS) EPI (Immunization) Pharmacy board Chief Government Chemist. Etc

Tanganyika medical board (Registration and regulation)

TFNC (Nutrition)

Delivery of services

Urban Vs. Rural Health Services

Source: Maternal and Neonatal Program Index Effort

Structure of health care delivery system in Tanzania

Level District Services Responsible Local Government Councils

Community based services Dispensary/Health Centres District (Level 1) Hospital CHMT

Regional

Regional (Level2) Hospital RHMT Policy, Legislation, Quality,

Standards Tertiary (Level 3) Hospitals

Regional Secretariat Ministry of Health

National

Public health sector

Government main provider of health services Govt owns about 64 % of all total health facilities. 87 % of all facilities are dispensaries; About 45 % of the population lives within 1 km of a health facility, 72 % within 5 km 93.1 % within 10km of a health facility (MOHSW 2006).

Challenges of Health Delivery



Decreased IMR but neonatal mortality still high MMR not reduced significantly Increasing BOD: TB/HIV/Malaria Dysfunctional Referral System Critical shortage of qualified staff esp. rural

Shortage of drugs, equipment and supplies complimented by MSD monopoly Limited budgets PPP implementation Poor infrastructure Poor HMIS

Tanzania Joint Annual Health Sector Review, Technical Review September, 2009