HEALTH CARE FINANCING IN
ZANZIBAR
Presented by : Ms. Khadija S. Simai, Chief Planning Officer
Introduction
• There have been a number of activities in the
area of health care financing which this
presentation brings together
• This presentation covers the past year’s
expenditure on health, plans for future financing
in health and the main challenges and solutions
for health in Zanzibar.
• The Ministry of Health would like to invite DPs to
work with the government to promote
transparent and effective coordination between
all stakeholders
Structure of Presentation
Current financial performance
– Expenditure on health in 2013/2014
Plans for health expenditure
– Costing of HSSPIII
– Plans for social health insurance
– POA for 2014-2015
– Expenditure tracking
Challenges and way forward
Public Expenditure Review
• Following the first National Health Accounts for
2011-2012 and 2012-2013, the MoH has
conducted a Public Expenditure Review for 20132014
• This involves a more detailed analysis of the
sources of income and modes of expenditure of
public bodies: the Ministry itself, PHCUs and
hospitals.
• The results contained within this presentation are
preliminary findings, but the final report should be
ready by end of February and will be circulated to
interested parties.
Key results
• Government funding remains on a downward
trend, considerably below neighbours, at just 7%
of total government funds.
• User fees remain inconsistent across Zanzibar and
there are few waivers for the poor, which may
rule out some people from receiving treatment.
• Although overall budget performance is good,
this hides significant discrepancies between
planned and actual expenditure by department
or by activity.
Planned and actual support for MoH
Source
Planned
2012-2013
Disbursed
2012-2013
Planned
2013-2014
Disbursed
2013-2014
Planned
2014-2015
GoZ
20.8bn
20.9bn
27.6bn
28.1bn
34.9bn
Development 28.6bn
Partners
16.2bn
43.8bn
19.7bn
31.1bn
Total
37.1bn
71.4bn
47.8bn
66bn
49.4bn
• In 2013-2014, the District Basket Fund disbursed 97.6% of
planned spending (2.5bn TZS of planned 2.6bn).
• For 2014-2015 the commitment for the Basket Fund is 2.2bn
TZS (from Danida, GF, UNICEF, RGoZ, HIPZ and Pathfinder)
• Planned 2014-2015 figures are from the Plan of Action, after
which further confirmed funds for Malaria have been
provided.
Overall government spending
Expenditure as a
% of plans
Budget Performance
• Budget performance for the Ministry is good, but
development funding significantly below plans
• Curative over 600% of budgeted expenditure, many units
underfunded.
Costing of HSSPIII
• A team have worked on the costing of the
Health Sector Strategic Plan III.
• The team used the One Health Tool (OHT)
with support from the WHO and Futures
Institute.
• Direct and allows us to know how much is
required to execute the plan
• Examine funding gaps
Overall cost of HSSPIII
Summary overview of plan
2014 2015 2016 2017
2018
Total cost of plan (Bn TZS)
127.2 131.2 135.4 140.4
152.9
Recurrent expenditures (Bn TZS)
82.9
86.9
91.1
96.2
108.6
Capital expenditures (Bn TZS)
44.3
44.3
44.3
44.3
44.3
Cost of plan per capita (USD)
55.94 56.15 56.36 56.88
60.24
• Recurrent spending in 2014 in the plan should be 82.9bn
TZS for government activities (funded by both donors and
government). This compares to actual expenditure of
36.5bn TZS recurrent in 2012-2013 according to the NHA
• Total cost of plan is 687.1bn TZS among which Capital
expenditures planned total 221bn .
Areas fully funded
• Malaria (left) and IHIV/TBL (right) are
expected to be fully funded.
Areas significantly underfunded
• IRCH expected to have less than 1/3 funds required
for HSSPIII
• Infrastructure funds only secured for ORIO and for
Abdalla Mzee hospital but not for district hospitals,
new tertiary hospital or renovations for PHCUs and
other facilities
• Pharmaceuticals have
been increasingly funded
by RGoZ in the last two
years but without
external source, funding
will be significantly below
targets.
Health Insurance
• One way to raise funds is by social health
insurance
• The MoH produced a report providing the
design of a future social health insurance
scheme in Zanzibar.
• Helps to see the financial projection for the
fund and its sustainability.
• Process of actuarial evaluation study has been
started.
POA 2014/2015
Development Partner
CGC
CGP
DAHR
DCMS
DCS
DPPR
DPS
MMH
Grand
Total
RGoZ
Total budgeted Total budget share
TZS
0
4.8bn
2.4bn
0.3bn
1.4bn
0.8bn
15.3bn
6.0bn
%
0.0%
15.6%
7.7%
1.0%
4.4%
2.6%
49.3%
19.4%
TZS
0.8bn
3.0bn
16.3bn
0.2bn
2.1bn
0.4bn
1.4bn
10.7bn
%
2.1%
8.6%
46.7%
0.6%
6.0%
1.0%
4.0%
30.9%
0.8bn
7.8bn
18.7bn
0.5bn
3.5bn
1.2bn
16.7bn
16.8bn
1.2%
11.9%
28.3%
0.8%
5.3%
1.8%
25.4%
25.5%
31.1bn
100%
34.9bn
100%
66.0bn
100%
• RGoZ money mostly towards human resources, development
partners mostly to DPS.
• RGoZ larger than development partner support
• Gap to HSSPIII is 61.2bn TZS
NGO support for health in Zanzibar
2014/2015
Budgeted (TZS)
576,905,755
Share of NGO
funds
30.0%
D-Tree
Rotary Club of
Zanzibar
435,744,878
22.6%
254,513,800
13.2%
ZOP
Kendwa Maternity
Clinic
Jhipiego
474,043,600
24.6%
146,060,000
7.6%
37,100,000
1.9%
1,924,368,033
100.0%
NGO
HIPZ
Grand Total
• Many thanks to all who
shows great response
• Call others to join (USG, UN
GF)
• Mostly for health promotion
and disease prevention
though some support for
infrastructure
POA objective
Ensure adequate and effective health workforce
Ensure adequate and sustainable financing for health sector
Ensure availability of required infrastructure, medicines, commodities and
health equipment at all levels
Ensure equitable provision of quality curative care services
Improve health promotion and disease prevention
Grand Total
166,200,000
399,000
Share of NGO
funds
8.6%
0.0%
565,066,755
29.4%
9,900,000
1,182,802,278
1,924,368,033
0.5%
61.5%
100.0%
Budget (TZS)
Expenditure Tracking
• Introduced 2014-2015 MoH has started a
scheme to track expenditure by the activity as
listed in the annual Plan of Action.
• Helps better analysis of the extent to which
plans are followed, and lead to better
planning in future.
• Will improve and significantly simplify analysis
for PER
Challenges and Way Forward
Challenges
Solutions
1. Current expenditure only one third of
that needed for HSSPIII.
Increase government funding for MoH.
Try to encourage donor support for
HSSPIII. Insurance/cost sharing?
2. Low response from some partners to
provide total envelope during budget
process
Early response during joint planning
meeting. Early invites from MoH to
engage all DPs to participate.
3. Problems tracking fund flows when
channelled directly through vertical
programs, making expenditure tracking
more difficult
Request that all DPs channel funds
through the exchequer so that all
activities are signed off centrally. Central
MoH should at least be aware of all funds.
4. Few partners support involved in
genuine joint planning joint financing
exercises (Basket fund)
Convince more partners to join district
Basket Fund and increase Basket Funds to
cover other sectors of the MoH.
Key message
The Ministry of Health would like to encourage
support for the funding of its strategic plan by all
Development Partners present.
We look forward to working jointly with all of
our DPs to improve the health of the citizens of
Zanzibar