HEALTH POLICY PROJECT SNAPSHOT: TANZANIA'S HEALTH SYSTEM

The country is expected to achieve many of its 2015 targets for malaria, HIV and AIDS, tuberculosis, and child health, but progress in reproductive health is lagging. Neonatal mortality has declined, but not enough to meet the set targets, and little or no progress has been made in other reproductive health indicators. Tanzania suffers from a health worker shortage, with an imbalance in certain cadres and an inequitable distribution of health workers across regions. The number of clinicians and nurses is below the national average in 13 regions, and 554 dispensaries are without skilled health workers. Health worker planning is difficult due to inconsistent data from multiple sources. Inconsistency in training quality, insufficient recruitment, poor human resource management, and weak enforcement of policies and regulations have fueled the shortage and led to low productivity. The country has implemented several health system strategies, including the Third Health Sector Strategic Plan 2009-2015, the Primary Health Services Development Programme 2007-2017, and the Human Resource for Health and Social Welfare Strategic Plan 2014-2019. These strategies have resulted in notable progress in systems development, but improvements in service delivery have been slow. Further investments are needed in the areas of human resources for health, commodities and supply chain, health infrastructure, monitoring and evaluation, and health management information systems. Tanzania's health financing system remains heavily dependent on external resources, with development partners contributing a significant amount to total health expenditure. Public health spending continues to be low, and the country has not yet achieved the vision of increased equity in financing outlined in the Health Sector Strategic Plan III. The health sector as a whole relies on a health basket fund arrangement, which accounted for 10.4 percent of total government health expenditure in 2009/10. The country aims to achieve a 100 percent balanced distribution of skilled health workers at the primary level by 2017-2018 as part of the Big Results Now initiative. The Ministry of Health and Social Welfare will increase the density of clinicians and nurses in nine crucial regions and reduce the number of facilities without skilled health workers by 70 percent, requiring an estimated US$8 million. The health sector also aims to improve the availability of medicines, with an estimated US$17 million required to achieve 100 percent on-time delivery of ordered health commodities, zero percent waste, and improved inventory management by 2017-2018. The country's health infrastructure is challenging to maintain, with most facilities in need of additional refurbishment and resources, particularly at lower levels of care. Only 27 percent of facilities offer basic amenities such as consultation rooms and adequate sanitation, and the availability of six types of basic equipment ranges from 17 percent in dispensaries to 67 percent in hospitals. The Ministry of Health and Social Welfare has drafted new standards for health and social welfare services, which specify requirements for staffing, equipment, management, and other inputs across five levels of care. Monitoring and evaluation, as well as health management information systems, are critical components of Tanzania's health system. While disease surveillance has improved, there has been little progress in integrating surveillance systems. Access to health information is currently limited at all levels, and the vital registration system is not functioning properly, resulting in a lack of complete national data on births and mortality. The Ministry of Health and Social Welfare has established a data warehouse as a first step toward an envisioned data network, and there have been recent improvements in the information technology network.