世界发展银行-Tanzania-Health-Policy-Note---Opportunities-for-Prioritizing-Health-in-the-Budget_4页_188kb

Tanzania Health Policy Note Summary

Core Content

This policy note addresses the issue of health budget prioritization in Tanzania, highlighting the opportunities for increasing health sector investments despite a strong macroeconomic environment. It is part of a broader public expenditure review aimed at fostering dialogue among government, civil society, and development partners regarding health finance challenges and recommendations.

Main Findings

• Economic Growth and Revenue Increase: Tanzania has experienced consistent real GDP growth of around 7% over the past decade, with a notable increase in government revenue. From 2008 to 2018, government revenue almost quadrupled, indicating a strong fiscal position.
• Budgetary Space: The growth in revenue and expenditure has created fiscal space, which could be used to increase health sector allocations. However, this potential has not been fully realized.
• Health Budget Contraction: Despite overall economic growth, the health sector's share of the general government budget has declined from a higher level in 2010 to about 6% in 2017, a reduction of 3 percentage points.
• Fiscal Priorities: The government has focused on infrastructure and wage bill expenditures, which together account for the majority of total expenditures. This has resulted in a de-facto shift away from health as a priority.
• Debt and Inflation: Tanzania's debt-to-GDP ratio has increased from 33.8% in 2015 to 41.2% in 2019, but the country remains at low risk of debt distress due to manageable interest payments.

Key Economic Indicators (Table 1)

Main Recommendations

1. Present Health as an Economic Investment:

   • Emphasize that health investment is not only a social service but also an economic one.
   • Advocate for increased health budget allocations by framing them as an economic investment.
   • Recommend a dedicated study to quantify the economic returns of health investments in Tanzania.

2. Ensure Efficient Use of Funds:

   • Highlight the importance of evidence showing that health funds are used effectively to improve service delivery.
   • Suggest that the government should focus on ensuring that funds reach frontline health services.
   • Recommend adopting the model of direct facility financing used by basket fund partners to enhance efficiency.

3. Monitor Non-Wage Recurrent Expenditures:

   • Note that non-wage recurrent expenditures are easier to freeze but are essential for service delivery.
   • Recommend that the growth of these expenditures should be monitored and aligned with overall expenditure growth.
   • Suggest that they should at least match the growth rate of overall non-wage expenditures.

Conclusion

Tanzania is in a strong economic position with high GDP growth and increasing revenue. This provides an opportunity for the government to re-prioritize health in the budget. While the health budget has grown in absolute terms, its share of the general government budget has decreased, indicating a de-facto shift away from health. The government should consider health as an economic investment, ensure efficient fund utilization, and monitor non-wage recurrent expenditures to make better use of available fiscal space.