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TanzaniaTanzania

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ECONOMIC

SUPPORT-TZ

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Sources

Personal households

Foreignaid Governmental revenues

Insurance(voluntary)

Social security

Charity

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The distribution of income in

Tanzania

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Who pays for Health Care in

Tanzania? Donor fundingandgeneraltax revenue are

the main sources of health financingin

Tanzania About 10% oftax revenue goes to health care

Out-of-pocketpayments, ordirectpayments to

health (>50% of households) Health insurance contributions (

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Distribution of sources

of health care financing

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Breakdown of household health care

financing contributions

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Resource

Production

Resource

Production

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Population of health

care number ofDoctors

Ratio doctor/population- 23188

Nurse/population- 1,122

Other cadres

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The main service providers

in Tanzania:

Public sector facilities (health centres and

dispensaries) and hospitals (district,regional and referral hospitals)

Faith-based facilities (health centres and

dispensaries) and faith-based hospitals

Private for-profit facilities (health centres

and dispensaries) and private hospitals.

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Drugs and Supplies

MSD (The Medical Stores Department (MSD) establishedin 1993isresponsible fordeveloping, maintaining and managing procurement,

storage and distribution of approved drugs and other medical

supplies required for use by public facilities. In effectthis actgives

MSDa large degree of monopoly powerandmany facilities anddistrictcouncils have criticizedthis arrangements due to frequentdrug stock-outs

and slow delivery (MOH 2003; MOH 2006; MOHSW 2007). )

Private pharmacies (shortage, private facilities,

prescriptions)

Drug stores (prescriptions, retatil, self

prescription)

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Training Public Medical University - 2 (MUHAS, UDOM)

Private Medical University - 4 (HKMU, KCMC,IMTU, BUCHS)

Diplomaand certificate colleges (CA, CO, NTC, Physio, AMO,

AMO spec)

Number ofTraining Institutions with full NACTE

Accreditation

Currently there are 134 Health Training Institutions out

ofthese only 15Public Health training Institutions

11.2% have FULL ACCREDITATION.The rest

institutes are indifferent stages of registrationand

Accreditation

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Organization of

Programs

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Organization

Administratively, the provision of health

services is dividedinto 3levels:

National Regional

District

The referral systemassumes apyramidpattern

starting fromthe village level, where there are

village health posts; wardlevel, where

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Governmentagencies

TFDA (food and drug)

NIMR (Medical research)

NURSING COUNCIL

TACAIDS & NACP (HIV/AIDS)

EPI (Immunization)

Pharmacy board

Chief Government Chemist. Etc

Tanganyika

medical board(Registration and

regulation)

TFNC (Nutrition)

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Delivery of services

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Urban Vs. Rural Health Services

Source: Maternal

and Neonatal

Program Index

Effort

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Structure of health care delivery system in Tanzania

Level Services ResponsibleDistrict Community based services

Dispensary/Health Centres

District (Level 1) Hospital

CHMT

Local

Government

Councils

Regional Regional (Level2) Hospital

RHMT

Regional

Secretariat

National Policy, Legislation, Quality,

Standards

Tertiary (Level 3) Hospitals

Ministry of

Health

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Public health sector Governmentmainprovider of health services

Govt owns about 64 % ofalltotal health facilities.

87 % ofall facilities are dispensaries; About45 % ofthe populationlives within 1 km of

a health facility,

72 % within 5 km

93.1 % within 10km ofa health facility (MOHSW

2006).

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Challenges of Health Delivery

Decreased IMR but neonatal

mortality still high

MMR not reduced significantly

Increasing BOD: TB/HIV/Malaria

Dysfunctional Referral System

Critical shortage of qualified staff

esp. rural

Shortage of drugs, equipment

and supplies complimented by

MSD monopoly

Limited budgets

PPP implementation

Poor infrastructure Poor HMIS

Tanzania Joint Annual Health Sector Review, Technical

Review Se tember 2009