HighLevel Forum on the Health Millenium Development Goals

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High-Level Forum on the Health Millenium
Development Goals

• Harmonization and MDGsA perspective from
• TANZANIA and UGANDA
• By Hon. Ali Hassan Mwinyi

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A. The present situation and achievements in
Tanzania and Uganda

• Summary of the presentation
• The effect of increased harmonisation
• Tangible improvements?
• Preferred mode of donor aid
• Availability of reliable information

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1. What has been the effect of increased
harmonization ?

• Increased harmonization through SWAp and
  increased budget support has increased the
  resources available to the health sector
• Increased resources has led to increased health
  sector outputs, but not yet to measurable
  outcomes in all health MDGs

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The case of Uganda

• More efficient allocation of resources
• Increase in budget share for PHC and districts
  from 32 to 54
• More equitable allocation of resources
• Poverty sensitive Resource Allocation Formula
• Increased subsidy to NGOs (Shs. 1.7 to 17.2bn)
• Increasing level of resources for health
• GFATM would add another US 1.3 per capita per
  year if all resources would be spent

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The case of Uganda

• Some PEAP indicators improved between 2000 and
  2003

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The case of Tanzania

• The budget for the health sector, including
  budget support, has increased from US 3.4
  (98/99) to US 6.6 capita (02/03)
• Project aid contributes 40 of the external
  resources for health, but is falling
• Both domestic and donor resources have increased,
  but the main source of additional budgetary funds
  was the Governments grants to district councils
• Foreign aid was 56 of the total health sector
  envelope in 2001/02

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The case of Tanzania

• More efficient resource allocation
• Share for district health services increased from
  50 to 60
• Share of salary costs decreased from 65 to 50,
  while budgets for drugs and supplies increased
• More equitable resource allocation
• New resource allocation formula takes poverty and
  under-five mortality in account
• Increased resources for health
• GFATM would add another US 0.3 per capita per
  year if all resources would be spent

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The case of Tanzania

• Some output indicators are improving, but there
  is no recent evidence on progress towards health
  MDGs
• OPD attendance is maintained at 0.9 per capita
  per year
• Coverage of fully immunised children below 2
  years increased from 74 to 79
• Births attended by trained personnel increased
  from 50 to 80
• Drug availability at facilities improved

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2. Has increased harmonization led to any
tangible improvements?

• While many positive changes have occurred, this
  depends mainly on local leadership
• Mainly improvements in output, rather than
  outcome indicators
• Change in outcome may require more cross-sectoral
  action and broader socio-economic development
• Efficiency and equity of resource allocation
  improve
• Sector plans have improved and priorities are
  better known
• MOH has become more vocal and knowledgeable in
  defending sector budgets
• BUT, sector dialogue should be more
  cross-sectoral and more oriented towards results

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3. What is the preferred mode for donor aid ?

• Government prefers budget support to project aid
  because of
• Lower transaction costs,
• Use and strengthening of existing systems
• Enables government (central and local levels) to
  apply aid to national priorities,

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3. What is the preferred mode for donor aid ?

• Uganda has general budget support for priority
  sectors, including health. The PAF tool helps to
  prioritise poverty alleviation and MDG goals
  within the budget.
• Tanzania has mainly earmarked sector budget
  support, but recently one major donor moved
  towards general budget support

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3. What is the preferred mode for donor aid ?

• Both Uganda and Tanzania agree that budget
  support for health system development is
  essential but insufficient a targeted,
  prioritised and multisectoral approach is needed
  to achieve results.
• Both Uganda and Tanzania strongly prefer Global
  Fund money to be allocated through budget support
  and to use existing management, accounting and
  procurement systems
• Managing all different flows of funds and a large
  number of uncoordinated projects remains
  problematic