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Honourable Ministers, Permanent Secretaries, Hon. Members of Parliament, Chief Medical Officer, Troika Chair, WHO country representative, Development Partners; staff of the Ministry of Health, Community Development, Gender, Seniors and Children; PO-RALG, PO-PSM, representatives of the private sector, ladies and gentleman, good morning.
On behalf of more than 100 Civil Society Organizations which are under the umbrella of Policy Forum, Sikika appreciates the opportunity to be one of the speakers in the opening of this policy day for the health sector’s stakeholders in Tanzania.

Honourable Minister, we would like to acknowledge the efforts made by the Ministry of Health, Community Development, Gender, Children and Old Persons to engage stakeholders, including CSOs, in the implementation of the recently concluded National Health Strategy Plan III and other initiatives that aim at improving the provision of quality health care services in the country. We commend the development of the new Health Sector Strategic Plan IV, which has the potential of bringing significant improvements to health service provision during the next five years.

We especially applaud the Ministry for its efforts in fighting malaria, which have translated into a significant reduction of malaria morbidity and mortality rates. Also, the significant increase in immunization coverage has contributed to a reduction in child mortality rates.

Honorable Minister, despite those improvements, there are still chronic challenges in the health sector. They persist mainly due to the fact that the health sector’s budget is inadequate compared to the actual needs. According to the new Strategic Plan IV, the required funding for the fiscal year 2015/16 is estimated to be about TZS 4 trillion. However, the approved budget for the health sector is TZS 1.8 trillion, which is less than half of the actual requirement leaving a resource gap of about TZS 2.2 trillion.

Honorable Minister, the share of the health sector of the total government budget has decreased from 12.3 percent in 2010/11 to 8.9 percent in 2013/14, and, in this fiscal year 2015/16, it is at only 8.1 percent. Over the same period, real per capita expenditures declined from $8.4 to $6.5. If this trend continues, it is unlikely that Tanzanians will enjoy Universal Health Coverage in the near future. For that reason, the government needs to reconsider its fiscal priorities. Otherwise, our goal to achieve Universal Health Coverage, as it has been stipulated in the new HSSP-IV and the Health Financing Strategy, will remain a far-fetched dream.

Honorable Minister, we see great opportunities to improve the collection and management of revenues, especially at the health facility level. For instance, as reported in the media at the end of last year, Mbeya Referral Hospital was able to increase collection from TZS 50 million per month to TZS 500 million after introducing an electronic system for the collection of internal revenues. At Tanga Regional Referral Hospital, revenues increased by 270%, at the Muheza designated district hospital, they rose by 45%, and at the Lushoto district hospital, revenues increased by 12% in a period of three years. If all health facilities in the country had an electronic system for internal revenue collection today, how much could they collect by the end of this financial year? And how would their resource management and service quality improve if they were fully accountable to service users and local communities?  

Honorable Minister, the availability of human resources for health determines the quality and reliability of health services.  For many years, the health sector has been facing a health worker shortage which currently stands at around 53 percent. The shortage is becoming more severe due to population growth and an increasing burden of various lifestyle diseases. But how can we improve the utilization of the health workers in rural areas if retention mechanisms at national, district, and facility levels are too weak? And how can our doctors and nurses perform their job if their work environment is in poor condition?

Honorable Minister, the availability of essential medicines, medical supplies and equipment at public health facilities is another stumbling block in the provision of quality health services in the country. There have been frequent stock outs of essential medicines and medical supplies including safe blood in public health facilities. In 2015, Sikika assessed the availability of medical equipment in 9 districts and found that only 43 percent of the dispensaries, 23 percent of the health centers, and 50 percent of the hospitals had adequate medical equipment. These chronic shortages obstruct the provision of quality health services and they are demoralizing health care workers who fail to help patients because the right supplies are not available. How can we ensure that essential medicines and medical supplies are accessible at all levels of the health system?

Honourable Minister, we call for deliberate efforts of your Ministry to strengthen health sector financing, revenue management, and to improve the accessibility of human resources for health and essential medicines and medical supplies. More specifically, we recommend your Ministry to implement the following actions to achieve the goal of Universal Health Coverage.

  1. Devise clear mechanisms and guidelines for the collection, management and utilization of revenues at public health facilities. Good governance principles like citizens’ participation, transparency, and accountability of public servants should be practiced at all levels.
  2.  
  3. Set a per capita spending target for the current HSSP that can and will be progressively achieved over the next 5 years.  Moreover, strengthen the existing health insurance schemes CHF, TIKA and NHIF in preparation of the mandatory health insurance system.
  4.  
  5. Promote an equitable distribution of health workers and sound retention mechanisms at all levels. Increase funding and enrollment at health and social welfare training institutions to reduce the existing shortages. The government should also consider providing loans to mid-cadre level students in both public and private health training institutes.
  6.  
  7. Pursue the target of at least 80 percent stock availability of essential medicines, medical supplies and equipment by the end of 2016. The government should allocate sufficient funding to health facilities, strengthen the procurement and delivery system, and end existing pilferages.

Thank you.
Irenei Kiria, Executive Director of Sikika (on behalf of Policy Forum)

Who are We? Tanzania Tax Justice Coalition is a loose coalition of NGOs interested in tax justice. The group was started in 2013 under Policy Forum. The group comprises of Policy Forum, Action Aid Tanzania, Kepa, Youth Partnership Countrywide (YPC), Tanzania Coalition on Debt and Development (TCDD), Tanzania Trade and Economic Justice Forum (TTEJF), Tanzania Youth Vision Association (TYVA), Governance and Economic Policy Centre, Tanzania Education Network (TenMet) and Norwegian Church Aid (NCA). To read more click here.

Only 30 percent of Tanzanians are covered by health insurance while the rest have to find their own means of treatment whenever they fall sick. This situation is more dreadful for those who are retired without reliable sources of funding.

This was said by Mr. Okumu Salvatory, Compliance and Field Operations Officer at the National Health Insurance Fund (NHIF) during the Policy Forum breakfast debate held on 27th November, 2015 at the British Council Auditorium.

Mr. Okumu challenged the Community Health Fund Act, 2001 which stipulates that there should be a community fund whereby households pay contributions to finance part of their basic health care services as this has proved to be insufficient. He therefore called upon the Government to compensate health care financing efforts on grounds that it is ineffective.

He highlighted, however, that the Government has already established mechanisms to ensure individual members in the community get access to health care and this has demarcated children, students of secondary and vocational trainings. He also revealed that the NHIF has carried extensive public awareness campaigns in order to advertise its plans.

Through these schemes, it plans to cover over 50 percent of the total population by 2020 and he mentioned community-based schemes like ‘KIKOA’ as an alternative fund which have been introduced as a solution to improve community access to health insurance.

Dr. Dereck Chitama, the discussant of the debate from the School of Public Health and Social Sciences of the Muhimbili National Hospital (MNH), said Tanzania has delayed for quite some time in establishing the health insurance facility.

“It is in records that this idea came about in 1962 but its implementation came into being in 2001. |Such a delay has caused a lot of negative impacts to people,” he stated, citing an example of one such consequence as the loss of labour power through pre-mature deaths.

Participants also challenged part IV of the Community Health Fund Act 2001 which implies that Tanzania depends so much on donor fund while it has an abundance of natural resources that could be well utilized in order to solve challenges facing the health sector.

Kindly be informed that Policy Forum Secretariat office will be closed for Christmas and New Year Holiday from 21st  December 2015 to 13th January 2016.

The office will be opened and resume its regular activities and operations on Wednesday 13th January 2016.               

We apologize in advance for any inconvenience that this may cause.                         

We encourage you all to send us any pressing/urgent matters to the PF Secretariat Office by end day tomorrow (Friday evening) by email (info@policyforum.or.tz), phone:  +255 22 2780200

All other matters will be addressed when our office will be re-opened.

We would like to wish a Happy Holiday Season to you all.

edited 25/01/2016

 

 

This  is  another  edition  of  Citizens’ Budget  which explains the  Government  budget  for year 2015/16  in a simplified way.  The  term  Government  budget  means the  annual estimates  of  the  revenues, other  receipts  and  the expenditures  of  the  Government (including  grants  to local  authorities) submitted  for  Parliamentary  approval within  a  given   period.   These   estimates   aim at implementing policy   decisions   made   by Government  to  achieve  a  set  of macroeconomic  objectives.

Budget is more  than  just numbers. It reflects the Government’s policy priorities, and ultimately, is about delivering  better services to people. To read more click here

 

Kindly be informed that Policy Forum offices will be closed for our Annual Retreat from Monday 30th to December 4th (the entire staff will be in Arusha).The office will be opened and resume regular activity and operations on Monday 7th December 2015.We apologize in advance for any inconvenience that this may cause.We encourage you all to send us any pressing/urgent matters to the PF Secretariat Office by email (info@policyforum.or.tz) or +255 782317434 . All other matters will be addressed when our offices re-open on 7th December.

Policy Forum decided to dedicate October’s breakfast debate to the issue of CSO engagement with the newly-elected administration. Titled “What Civil Society Organizations Expect in the New Government?,” the debate on Friday 30th October, 2015 focused on the manifeso that CSOs produced as part of their citizen sensitization programmes.

The 2015 elections marked an interesting time for Tanzanian politics with issues of accountability, transparency and good governance at the forefront of the agenda. As always, the role of Civil Society Organizations in the election process remained crucial and it is for this reason CSOs came together to formulate their own manifesto as guidance to citizens, political parties, government and other stakeholders during the election process of what changes civil society in the country desired to see.

The main presentation was made by Onesmo Olengurumwa, the Tanzania Human Rights Defenders-Coalition National Coordinator

Mr Olengurumwa  began with a background of the concept of the CSO election manifesto stating that it was an outcome of a CSOs meeting that took place in 24/7/2015 aimed at evaluating the position of civil society organizations in democratic process including the 2015 general election.

The main purpose of  the manifesto was to act as a road map and vision for citizens and all political parties participating in the 2015 elections. This included observing principles of free and fair elections and the constitution in the electoral process and putting forward an agenda that represents what CSOs would like to see the next administration prioritize in different sectors over the next five years. 

Moreover, Mr Olengurumwa stressed that CSOs faced many challenges such as the lack of capacity, rivalry between CSOs, lack of sustainable coordination and the constricted civic space affecting their engagement in the democratic process in the country. Despite these, he acknowledged that there are some CSOs in the country that have been at the forefront of agitating for reforms and remained the largest influencers of democracy in Tanzania.

Mr Olengurumwa went on to discuss Chapter 2 of the manifesto which comprehensively describes the CSOs wishes after the 2015 elections and calling on the government to consider them. The main priorities of the manifesto include:  the need for improvements in the rule of law (which centres on everyone including leaders to abide by the law), the importance of the separation of powers that ensures all constitutional organs adhering to their functions and reducing interference, the observation of human rights according to the constitution and the ensuring of  CSO space in the country.

He also pointed out the importance of improving the availability and access to social services, enhancing gender equality, and sustainable economic management.

The discussion that followed championed the idea of a CSO manifesto but emphasized a need to move into a plan of action as to how the manifesto shall be successfully incorporated into government policies and monitored. Discussants also stressed the need for education to enhance citizen engagement because active citizens are an important pre-requisite for an effective state.

A call has been made by Civil Society Organizations (CSOs) to the National Audit Office of Tanzania (NAOT) to strengthen its Ad hoc working group that was formed with the intention of collaborating with CSOs to promote good governance and accountability.

Speaking at a Policy Forum members meeting with the National Audit Office on 12th November 2015, Richard Angelo, the Manager for Capacity Enhancement at Policy Forum said the network is ready to provide the office with their Social Accountability Monitoring findings so as to enhance the performance audits of NAOT as part of implementing the Controller and Auditor General’s initiative to advance public participation in the audit process.

He also recommended other areas where CSOs could strengthen their relationship with Controller and Auditor General Office including the popularization of the national and local authorities audit reports so to make them more accessible for ordinary citizens for their effective engagement in public resource management processes.

A representative from NAOT, Mr. Elibariki Lyaruu, presented the work and functions of the Controller and Auditor General and expounded on how the institution works with CSOs including how they collaborate with key non-state actors in the dissemination of audit reports such as civil society and the media and train them on the audit process as well as obtaining valuable feedback.

He mentioned the areas where NAOT is already working with CSOs in Tanzania including the formation of the Ad hoc Working Group of 18 members consisting of CSOs, government members and the office of the Controller and Auditor General with the aim of offering opportunities for citizen participation in their annual audit planning process and mainstreaming Social Accountability Monitoring in the audit process.

Mr. Lyaruu assured Policy Forum members that NAOT is an independent body which annually submits its audit reports parliament and that different assessments (both national and international) done have indicated that NAOT as a Supreme Audit Institution is an efficient and effective body.

Acting Controller and Auditor General, Mr. Jasper Mero reiterated that the CAG is open to avenues for collaboration with CSOs and called on them to utilize platforms in place to assist the CAG.

Semkae Kilonzo, the coordinator of Policy Forum closed the meeting by thanking NAOT for accepting to meet with them. He said PF is looking forward to future engagements with the office especially on areas of SAM and popularization of audit documents.

“The functioning of the CSO Desk at NAOT as agreed in the Ad Hoc Working Group will be the next logical step in enhancing this collaboration since the focal persons have now been identified. Also, we hope to see future performance audits of NAOT integrate SAM findings and more regular activities coordinated under the Ad Hoc Working Group,” Semkae Kilonzo concluded.

The Ad Hoc Working Group was formed to facilitate a convening space for a constructive and open discussion between CSOs and NAOT, provide an opportunity to learn about good practices on the strategic multi-stakeholder engagement and develop a framework for implementing participatory audit approaches in Tanzania.

Related stories:

Advancing public participation in the audit process in Tanzania:

http://www.policyforum-tz.org/advancing-public-participation-audit-process-tanzania

Policy Forum Members Pay Visit to The National Audit Office and The Commission for Human Rights and Good Governance:

http://www.policyforum-tz.org/policy-forum-members-pays-visit-national-audit-office-and-commission-human-rights-and-good

Statement by the Policy Forum's Budget Working Group (BWG) on the 2011/2012 CAG’s Report:http://www.policyforum-tz.org/statement-policy-forum%E2%80%99s-budget-wo...

Advocacy work to curb illicit financial flows and increase financial transparency that can spur development is only getting started, the Financial Transparency Coalition said at the end of the 6th Financial Transparency Conference held in Jakarta, Indonesia last week.

The coalition which brings together civil society, governments, and the world’s foremost experts on illicit financial flows, explored ways to stop the illicit financial flows that are stifling economic growth and development and to strengthen the broader movement for financial transparency. 

“We must continue to push for further equity in the decision making process. It’s quite stark that we had more than 25 countries represented here in Jakarta, but more than half of these countries have no voice and no vote in tax standards being set by the Paris-led OECD, despite being some of the most affected by tax dodging and illicit flows,”  said Alvin Mosioma, Chair of the Financial Transparency Coalition.

“This is perhaps one of the most diverse groups of civil society we’ve seen yet,” said Porter McConnell, Director of the Financial Transparency Coalition. “Whether it’s tax justice campaigners, human rights groups, transparency advocates, or the open data community, we are all waking up to the fact that a broken and secretive financial system is at the heart of many problems plaguing our society.”

“This is perhaps one of the most diverse groups of civil society we’ve seen yet,” said Porter McConnell, Director of the Financial Transparency Coalition. “Whether it’s tax justice campaigners, human rights groups, transparency advocates, or the open data community, we are all waking up to the fact that a broken and secretive financial system is at the heart of many problems plaguing our society.”

A call has been made by civic actors to the new government to enhance budget transparency and public participation in the budget processes. This call was made by Boniventura Godfrey, Manager for Research and Policy Analysis Unit at HakiElimu ,a presenter of the Policy Forum Breakfast Debate held on 25th September 2015 at the British Council Auditorium.

Boniventure said this when he was presenting on the finding of the Open Budget Surevy,2015. He explained that the Open Budget Survey is a tool used to measure budget transparency, Participation and Oversight in 102 countries around the World, Tanzania being one of them.

He mentioned some of the findings of the survey as being: Tanzania scored 46 out 100 (Global average is 45), Tanzania provides public with limited budget information, 6 out of 8 key budget documents are public available and Uganda is leading in EAC with 62, Kenya-48 and Rwanda-36,Public Participation in budget process is weak and Budget oversight by Legislature is weak (the score is 39 out of 100).

Based on the findings of the survey, he recommended the following : Produce and publish a Mid-Year Review and Year-End Report, Increase the comprehensiveness of the Executive’s Budget Proposal, Increase the comprehensiveness of the Enacted Budget and establish accessible mechanisms for capturing public perspectives.

The discussant of the debate Mr. Aidan Eyakuze, Executive Director of TWAWEZA emphasized that there is a need of the government to make sure that the information it provides is relevant and important to citizens and is produced in a way that is easy for them to understand.

 

 

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