How to improve health services May 31, 2016

How to improve health services

This article was originally posted to the Citizen Tanzania. You can read the original version here

The World Bank Group's vice president for human development, Mr. Keith Hansen, explains how Tanzania can implement its current and future strategies in streamlining the health financing system in this interview with health reporter Syriacus Buguzi.

Question: Tanzania's vision to achieve Universal Health Coverage (UHC) is manifested in the government's plan to adopt a 'Health Insurance for All Citizens' strategy for ensuring access to healthcare. As you may know, only 20 per cent of all Tanzanians have health insurance cover, what does the World Bank think is the best approach for the country to achieve this plan?

Answer: Universal Health Coverage (UHC) and health insurance are commendable; and just last year 59 per cent of adults in Tanzania were able to save money.

But health costs can be very catastrophic to them, as health shocks can wipe out all their savings.

Every year, over 110 people worldwide are forced to become poor mainly as a result of healthcare expenditures, and in Tanzania, where Out of Pocket (OP) costs are very high, this risk is real. So it's laudable to see Tanzania aspire after health insurance cover for all citizens.

And recently, the World Bank commissioned a study of about 2,000 countries that are implementing the UHC and findings show a couple of things: First, every country can make its own path towards achieving the UHC, but there are important lessons some countries can learn from others. Second, making things work calls for important building blocks such as countries' ability to get best performance and capacity in terms of services health facilities provide.

The UHC is quite ambitious and very expensive, so you have to ensure people see the value for their money. In this case, the government has to be careful to avoid overspending in some areas and under-spending in others.

There is a level of complexity which has to be carefully handled. Therefore, this needs good planning, especially the forecast of people you expect to be put on health cover, you need a good mechanism of processing the payments, there has to be a verification of the quality of health services. And the government has to be very careful about the right set of services to provide the people and avoid subjecting them to "shock' in terms of health spending.

Various reports have praised Tanzania's performance in immunisation coverage of over 90 per cent which shows to have an impact on the reduction of child mortality from 143 deaths per 100,000 live births to 81,000 over the past half a decade. However, the government still relies heavily on foreign aid to finance its vaccines. How can the country graduate from begging to develop its own capacity to mobilise its resources. And do you think it matters where the money is coming from?

The important point is not what individual items the foreign partners provide in terms of financial assistance, but it's the overall picture that matters.

The thing is: How and where does the financial assistance fit into the Tanzanian Health budget and the country has in fact made considerable headway.

In the last 10 years, the overall donor assistance, as presented in Parliament, has been 40 per cent. This means the country is in the right direction.

It's true that in health there is still a larger share of funding coming from donor assistance, but one of the major reasons why this is so is that foreign partners are more willing to finance health programmes.

Obviously, it's very easy to explain to donors and other fianciers that vaccines are more important in the prevention of diseases. So it's easier for them to finance this.

It's not so important where the money is coming from because the progarmmes are still headed and supported by Tanzania and in this case, I can see that immunisation programmes and poverty alleviation projects such as Tasaf (Tanzania Social Action Fund) are at the core of the government's delivery services and in that sense, this is very important.

Over time, Tanzania can become less reliant and run these progarmmes such that they do not exist because of donor interests.

Some of the pathways the country can become self-reliant is obviously through revenue mobiolisation, and right now the share of the taxes in the GDP is about 12 per cent.

There is room for progress there. In general, things are headed to the right direction and the programmes are fully owned by the government so, the most important thing is for Tanzania to continue delivering.

Human resource gaps in the health sector are still a major obstacle to efforts of controlling maternal mortality, as presented in various reports. Owing to its small wage bill, the government cannot absorb enough health personnel. Just recently, the government ironically said it can only employ 400 out of 1,000 newly licensed medical doctors, while there is an outcry over the shortage of medical doctors in public hospitals. How can Tanzania get out of this trap in case the World Bank also sees it that way?

The best way would be to see how to work with the current cohort. One way is to ensure equal distribution of health personnel around the country.

Eighty percent of the poor people live in rural areas, while only 25 per cent of the health workforce is found in the rural areas. There is a miss-match there.

I wouldn't necessarily expect a 1:1 ratio because typically the larger facilities are found in urban centres, but that's quite a big discrepancy.

Secondly, the focus should be on improving the available staff through continuing with medical education because the Services Delivery Indicators show that health workers can only diagnose the commonest illnesses accurately by 60 percent.

Thirdly, according to the same indicators, there is more space to improve the delivery of health services by using the same personnel without compromising quality and performance. So, these three can be a good step towards improving the quality of health services without necessarily being required to absorb all the health workers that are produced by the country per year.

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