The provision of healthcare services in Tanzania is not only challenged by insufficient funds, but also by an ineffective flow of funds to service providers. Inadequate drug supplies and medical equipment in health facilities is alao a major barrier for the population to access quality services. To address these challenges, TGPSH works with selected regions and districts in improving their financial management systems and the availability and management of drugs in councils.
Interventions aim to make the flow of funds more transparent, were piloted in Lushoto district (Tanga Region) in 2008 where several challenges were identified in a prior assessment. While funding for district health services greatly improved with the availability of Health Block Grants and the Health Basket Fund, the potential of cost-sharing had not yet been fully exploited. Also, the revenue generation potential of claiming for National Health Insurance Fund (NHIF) reimbursements and Community Health Fund (CHF) matching grants was not fully exploited.
Results
In a pilot case, a set of solutions was developed by Lushoto District Council, Tanga Regional Administration, Tanga National Audit Office and the Tanga Medical Stores Department. TGPSH closely worked with relevant stakeholders on the fund disbursement process thus improving allocation of cost-sharing funds and facilitating drug supply systems at district level.
Councils are assisted in the use of cost-sharing funds, complemented by interventions from the national level. Lushoto district, for example, had collected 160 million TSH through cost sharing but was not able to spend the funds on service delivery, due to the national budgeting software lacking a revenue code for cost sharing funds.
TGPSH facilitated the pocess of reviewing the budgeting software,this enabled cost-sharing funds being reflected in the budget. Also, by supporting the council to open bank accounts for each health facility, funds could be directly transferred according to a formula developed with assistance from TGPSH.
Health facilities can now spend funds according to the plans and budgets they submit to the district. The opening of bank accounts has shown to be an important element in accessing funds for service improvement. In 2011, 41% of lower level health facilities in Tanga, Mbeya and Lindi had bank accounts (2009:11.8%) with Mtwara Region reaching 98% of facilities having bank accounts.
Selected districts have also been assisted in filing matching grant applications for CHF and NHIF reimbursement claims. This has significantly increased funds in TGPSH supported regions which are used for improving health service delivery.
Interventions in the area of drug management have resulted into better drug procurement in Tanga and Lindi regions.The programme is working closely on innovative solutions with the MoHSW and other partners in overcoming drug shortages through alternative drug procurement systems.
