UCLG Position Paper v_2 (eng)
22/12/09
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A Compilation of Case Studies
2 Tanzania’s Health Basket Fund Improves District Level Health Service
Approach – How the Health Basket Fund Works Since 2000, eleven Development Partners (Canada, Denmark, Germany, Ireland, Netherlands, Norway, One UN, Switzerland, UNFPA, UNICEF and World Bank) began pooling un-earmarked resources in support of Tanzania’s Health Sector Strategic Plan (FY04-FY09) and its MKUKUTA (Poverty Reduction Strategy).29 Creating a common fund for the health system represented an effort to harmonize development cooperation in the sector and remove distortions in sector allocation priorities, which would commonly occur before the reforms, when there were multiple distinct health interventions. The willingness to pool funds also demonstrated a commitment by both the international community and the Government of Tanzania (GOT) towards a more effective and efficient use of aid resources that is line with the Paris Declaration.30
Prepared by the Federation of Canadian Municipalities (FCM) in collaboration with the Association of Local Authorities of Tanzania (ALAT), September 2009
This case study illustrates how the implementation of a sector-wide approach to planning and management of the health sector in Tanzania, which has included a pooled fund from multiple donors, has improved district level health service and health outcomes. The case study draws heavily on the information found on the Tanzania Health Development Partners Group website.27
The Basket Fund mechanism has ensured that ownership of health sector planning and implementation rests with the GOT. Basket resources complement the GOT’s own resources and are planned, budgeted and reported using Government procedures. While partners meet with the GOT on a regular basis to review progress through the semiannual basket financing meetings and through the more general Sector Wide Approach meetings involving all stakeholders in the health sector, they do not engage in how such resources should be programmed. Their main interests lie in ensuring that funds are being targeted to the agreed priority interventions as elaborated in the Health Sector Strategic Plan and the poverty reduction strategy.
Tanzania has developed a strong reputation for its good management of aid and investment in its healthcare system. Between 1990 and 2004, annual death rates in children under five in Tanzania fell by 40 percent and between 2000 and 2004 alone, by 24 per cent. An April 2008 study published in the British medical journal The Lancet28 showed that if its trend of improved child survival is sustained, Tanzania could reach the fourth Millennium Development Goal (MDG) — a reduction of mortality in children under five by two-thirds, in the period between 1990 and 2015. Much of the gains in health outcomes in Tanzania have been attributed to health system reforms that were initiated in 1999. The reforms feature a sector-wide approach (SWAP) for planning and managing resources in the sector, and include an agreement between the Government of Tanzania and international donors through which they pool their funds into what is commonly referred to as the Health Basket Fund.
A central feature of the basket fund is that it places greater responsibility for and control of health service planning and delivery in the hands of regional and local governments, while ensuring that this planning is aligned with the national Health Sector Strategic Plan and the GOT’s poverty reduction strategy. Responsibility for oversight and co-ordination of the implementation rests with the Ministry of Health and Social Welfare, in close collaboration with the Prime Minister's Office Regional Administration and Local Government. At the local level, the Councils and District Executive Directors are responsible for preparing the Comprehensive Council Health Plans and their subsequent implementation. The Ministry of Finance and the Ministry of Planning, Economy and Empowerment (now under one Ministry of Finance, Planning and Economic Empowerment) are
27 See Tanzania Health Development Partners Group website: http://hdptz.esealtd.com/index.php?id=4 28 Child survival gains in Tanzania: analysis of data from demographic and health surveys, The Lancet, Volume 371, Issue 9620, Pages 1276-1283, April 2008. 29 http://hdptz.esealtd.com/fileadmin/documents/Key_Sector_ Documents/Induction_Pack/MKUKUTA_FINAL.pdf 30 http://hdptz.esealtd.com/index.php?id=4.
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