How Tanzania lags behind on universal health coverage Jul 13, 2015

How Tanzania lags behind on universal health coverage

Despite impressive progress made in healthcare sector by reducing child mortality and mother to child HIV/Aids transmission, Tanzania still lags behind in achieving universal healthcare coverage.

By not reaching such a target as stipulated in MKUKUTA II cluster 2, it will mean that the country will also fall short of even guaranteeing equitably the right to healthcare services for the majority citizens.
Tanzania has allocated only Sh813.9bn for the Ministry of Health and Social Welfare in the 2015/16 financial year, of which Sh369.3bn is recurrent expenditure and Sh444.6bn is for the development projects.

However, with such allocations the healthcare sector still depends on one's income and accessibility, meaning that people living in urban areas have better access to private and public medical facilities than their counterparts in rural areas with low income.
The Acting Regional Administrative Secretary (RAS) in Coast Region Yusuph Kipengele revealed this during a two day Journalists Domestic Resource Mobilization (DRM) training in Kibaha mid –week aimed at increasing media knowledge, interest and engagement in health following the declining trend of donor funding. 
The training that was organised by a United States Agency for International Development (USAID), Health Policy Project Tanzania (HPP Tanzania), Evidence for Action (E4A) Tanzania through its Mama Ye! campaign and the White Ribbon Alliance for Safe Motherhood Tanzania is also expected to improve the dissemination of DRM messages to create a culture of independence in funding healthcare services.
Kipengele said the country continue to rely heavily on donor support and patients fees in funding healthcare services, a thing that needed to be reversed.
He challenged the government to turn the focus from donor dependency to DRM so as to fill the gap being left by the declining donor funding. 
“There is no way the country will be able to provide quality healthcare service with poor health budget funding,” he said. 
A review of Tanzania National Health Accounts (NHA) for the past three years points out that the country has continued to rely heavily on donor funding while recording a 2 percent government decline on health fund in the same period.
For example in 2009/2010 financial year the health sector received 26 percent in public funding with 34.4 and 39.6 percent of funds coming from private and donors while the 2005/2006 financial years received 28.1pecent in public funds with 27.8 and 44.1 percent coming from private and donors respectively.
According to Nicholas Lekule from Policy Forum, government leaders and policy makers need to see the value of increasing investment in health sector as per the 2001 Abuja declaration signed by African governments targeting 15 percent of total government expenditure on health.
Lekule said without health budget increase, the probability of bringing inequality in access to and use of health services will always be low.
The HPP Tanzania report says a number of the public lack access to high quality health services, with more than one in four women still having unmated need for family planning.
It also pointed out that HIV pandemic continue to undermine the public with the burden falling disproportionately on women and youth.
Over the past decade the country has made important progress in the area of health, life expectancy has improved, and child mortality rate has declined rapidly, yet it is still faced with a number of challenges due to insufficient health budget allocation says part of the report.
Various reports note that since the year 2000, donor funding to healthcare systems in most African countries have dwindled in both absolute and relative terms, thus forcing countries to devote substantial amounts from government revenues to funding healthcare systems.
According to a recent research report by BMC Public Health, In September 2000, global leaders gathered at the United Nations assembly and adopted a resolution on the Millennium Development Goals (MDG). 
Among the main objectives is a two-thirds reduction in child mortality in the under-fives (MDG 4) and a three-quarter reduction in maternal mortality (MDG 5) relative to 1990 rates.
The report says “Progress towards MDG 4 and 5 is promising with significant acceleration globally. However, some developing countries are still lagging behind. In Tanzania, there have been substantial reductions in maternal and child mortality.” Under-fives mortality declined from 141 deaths per 1000 live births in 1990 to 81 in 2010, maternal mortality has dropped from 578 deaths per 100,000 live births in 1990 to 452 in 2010. But these reductions are well short of Tanzania’s MDG targets of 54 deaths per 1000 live births and 193 deaths per 100,000 live births for MGD 4 and 5 respectively. 
Researchers say that, Inequity in access to and use of child and maternal health interventions has been highlighted as hindering progress towards child and maternal health MDGs. A 2010 UNICEF report on progress for children showed that in half the developing countries which had an overall reduction in under-five mortality, inequality in under-five mortality between the poorest and the richest households increased by more than 10 per cent. The report reads in part 
However the disparity in mortality is masked by national average data. In the least developed countries accounting for more than 90 percent of maternal and child mortality globally, there is inequity in coverage of key health interventions, with a country mean coverage gap of 43 among the poorest and wealthiest quintiles of the population.
 In Tanzania, there is, on average, a 60 percent coverage gap in access to health facilities and skilled birth attendants. The richest populations enjoy 90 percent coverage compared with only 33 percent for the poorest population. 
According to the report, numerous studies have showed that health systems are consistently unjust: likely to provide more and higher quality services to the well-off compared to the poor. Health inequities are a consequence of high levels of direct and indirect payment for services, unfair distribution of economic resources, and unequal political and social authority between groups in society. 
Analysis of equity trends in health outcomes can guide effective and fair service delivery strategies. Therefore it is important to generate evidence about inequity that can inform decision making and priority setting. 
Many countries in Sub-Saharan Africa, such as Tanzania, make limited use of scientific evidence to inform policy debate and health care priority setting. Inadequate use of the evidence contributes to inequity in access to and use of child and maternal health interventions and health outcomes. In order to reach MGDs targets, scale up of health interventions is essential. To achieve rapid scale up requires evidence on what works and with what resources. 
The academic document went further saying that, this can guide policy makers and governments in identifying, prioritizing and implementing high impact health interventions. However, targets for the Millennium Development Goals for maternal and child health interventions are set on the basis of national average data. 
It also explains that, used a hypothetical country to show that the use of national average data can conceal inequities in mortality between social and economic groups. Expanding intervention coverage using national average data may not address existing disparities in coverage between socioeconomic groups or geographical locations.
 In order for the health system to achieve universal coverage, it is important that any scale up addresses the needs of all population groups across geographical locations and socioeconomic status by disaggregating coverage data to reflect distinct groups within society. 
Tools such as the Lives Saved Tool (LiST) are useful to policymakers in priority setting. The tool can be used to identify which interventions can be scaled up rapidly and what their impact on mortality may be . 
The report clarifies that in the poorest population quintiles in Tanzania, the lives of more than twice as many mothers and under-fives were likely to be saved, compared to the richest quintile. Scaling up coverage to equal levels across quintiles would reduce inequality in maternal and child mortality from a pro rich concentration index of −0.11 (maternal) and −0.12 (children) to a more equitable concentration index of −0,03 and −0.03 respectively.
While, in rural areas, there would likely be an eight times greater reduction in maternal deaths than in urban areas and a five times greater reduction in child deaths than in urban areas. 
The academicians concluded that scaling up priority maternal and child health interventions to equal levels would potentially save far more lives in the poorest populations, and would accelerate equitable progress towards maternal and child health MDGs.