世界发展银行-Tanzania-Health-Policy-Note---Reasons-and-Consequences-of-Low-Budget-Execution_4页_188kb
报告摘要
Tanzania Health Policy Note Summary: Reasons and Consequences of Low Budget Execution
Core Content
This policy note addresses the issue of low budget execution in Tanzania's health sector, highlighting the poor budget credibility and its implications for service delivery. It is part of a broader public expenditure review and aims to stimulate dialogue among government, civil society, and development partners to identify solutions and recommendations for improving the health sector's financial performance.
Main Findings
- Budget credibility is deteriorating: There is a 15–20% deviation between budgeted and actual spending, primarily due to unreliable revenue forecasts and underestimated resource needs for priority sectors like infrastructure.
- Low budget execution rates: In 2017, the health sector executed only 82% of its budget, which is lower than sectors such as security (93%), defense (89%), and education (88%).
- Recurrent and development budgets are most affected: While personnel budgets (wages) are generally protected, non-wage recurrent and development expenditures face significant cuts.
- Donor support is declining: On-budget donor financing for health has been declining in both absolute terms and proportion to total health financing, contributing to the budget execution challenges.
- Arrears accumulation: The health sector's arrears stock is significant, with the MOH share decreasing from 11% in 2014 to 4% in 2017. However, arrears still represent a large proportion of total MOH spending (up to 93% in 2016).
- Impact on service delivery: Poor budget execution leads to opportunistic budgeting, inefficiencies, and unreliable funding at the local government level, which undermines strategic planning and facility-level output orientation.
Key Tables Overview
| Table | Summary |
|---|---|
| Table 1: PEFA Assessment | Shows the decline in government budget credibility over time, with scores ranging from A to C. |
| Table 2: Budget Execution Rates by Sector and Expenditure Type, 2017 | Highlights that health's total execution rate is 82%, with goods and services and development expenditures being particularly low. |
| Table 3: Role of Unrealized Donor Commitments | Demonstrates the decline in foreign donor support and its impact on budget execution. |
| Table 4: Budget Execution in the Health Sector | Provides a historical overview of health sector budget execution from 2010 to 2017, showing fluctuations and improvements. |
| Table 5: Overview of Health Sector Arrears | Shows the decline in MOH arrears from 2014 to 2017, but highlights that arrears still constitute a large share of total spending. |
Recommendations
- Advocate for a more predictable resource envelope to the Ministry of Finance by communicating the consequences of low budget execution on service delivery.
- Reduce service providers' dependency on government other charges budget provisions by strengthening a unified payment system that integrates donor and other financing sources.
- Strengthen budget controls at the point of execution to prevent commitments without available resources and to clear outstanding arrears.
- Collaborate more closely with the donor community to ensure that donor support is channeled through the budget and that commitments are honored.
Conclusion
The health sector in Tanzania faces budget execution challenges that are rooted in poor revenue projections, unreliable fiscal transfers, and declining donor support. These issues result in inefficiencies, arrears accumulation, and unreliable funding, which hinder the strategic and efficient delivery of health services. Addressing these challenges requires a combination of improved budget forecasting, enhanced donor coordination, and stronger budgetary controls to create a more predictable and enabling financial environment for the health sector.
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