Special Special Briefing on Briefing on

HealthHealthOctober 5, 2006October 5, 2006

Development Development Partners Partners GroupGroup

OverviewOverview

• Health situation and needs Health situation and needs (Julie (Julie McLaughlin, present DPG Health chair, World McLaughlin, present DPG Health chair, World Bank)Bank)

• History of SWAp and sector History of SWAp and sector dialogue dialogue (Colleen Wainwright, in-coming (Colleen Wainwright, in-coming DPG Health chair, Irish Aid)DPG Health chair, Irish Aid)

• Sector financing Sector financing (Jacqueline Mahon, out-(Jacqueline Mahon, out-going DPG Health chair, Swiss Development going DPG Health chair, Swiss Development Cooperation)Cooperation)

50% of the MDGs 50% of the MDGs Address HealthAddress Health

• Reduce by ½ the proportion of people Reduce by ½ the proportion of people who suffer from hungerwho suffer from hunger

• Reduce by 2/3 the mortality rate Reduce by 2/3 the mortality rate among children under five among children under five

• Reduce by 3/4 the maternal mortality Reduce by 3/4 the maternal mortality ratio ratio

• Halt and begin to reverse the spread Halt and begin to reverse the spread of HIV/AIDSof HIV/AIDS

• Halt and begin to reverse the Halt and begin to reverse the incidence of malaria and other major incidence of malaria and other major diseases diseases

ResultsResults

2000 DHS2000 DHS 2005 DHS2005 DHS

Infant Mortality RateInfant Mortality Rate 99/1,00099/1,000 68/1,00068/1,000

<5 Mortality Rate<5 Mortality Rate 147/1,000147/1,000 112/1,000112/1,000

< 5s who slept under a bednet < 5s who slept under a bednet the night prior (treated net)the night prior (treated net)

20.7 (10%)20.7 (10%) 36.1% 36.1% (17.8%)(17.8%)

Children <5 UnderweightChildren <5 Underweight 29.4%29.4% 21.8%21.8%

Maternal Mortality RatioMaternal Mortality Ratio 529/100,000529/100,000 578/100,000578/100,000

Delivered by Health Delivered by Health ProfessionalProfessional

38%38% 46%46%

Contraceptive Prevalence Rate Contraceptive Prevalence Rate (CPR)(CPR)

16.9%16.9% 20%20%

% women wanting to % women wanting to delay/prevent pregnancydelay/prevent pregnancy

47.2%47.2% 69%69%

Total Fertility Rate (TFR)Total Fertility Rate (TFR) 5.55.5 5.75.7

Maternal MortalityMaternal Mortality

>1 women dies in every 200 deliveries: >1 women dies in every 200 deliveries: Little Little change in risk factors: High fertility, Low contraceptive use, change in risk factors: High fertility, Low contraceptive use, malnutrition/anemia & malnutrition/anemia & role of womenrole of women

Globally, E. Africa has lowest % women Globally, E. Africa has lowest % women delivered by a skilled attendant at 34.5%delivered by a skilled attendant at 34.5% 45% in Tanzania45% in Tanzania

Progress:Progress: 90% of women seek antenatal care90% of women seek antenatal care Roadmap to Reduce Maternal & Neonatal DeathsRoadmap to Reduce Maternal & Neonatal Deaths IPT coverage (74% receive at least one dose) + IPT coverage (74% receive at least one dose) +

increased bednet use should reduce anemia increased bednet use should reduce anemia Availability of contraceptivesAvailability of contraceptives

There has been no reduction in the risk of a woman dying due to

childbirth in a decade

Nutrition is under Nutrition is under prioritizedprioritized

& a multisectoral & a multisectoral issueissue

o Malnourishment & Micronutrient DeficienciesMalnourishment & Micronutrient Deficiencies reduce learning ability, innovation & drive, reduce learning ability, innovation & drive,

productivity affecting economic growth (2-3% GDP)productivity affecting economic growth (2-3% GDP)

o Health, education, agriculture & social Health, education, agriculture & social protection all need to be involvedprotection all need to be involved

o Contributes to other health problems: AIDS, Contributes to other health problems: AIDS, maternal mortality, child mortality maternal mortality, child mortality (nutrition (nutrition associated with 50% of all child mortality)associated with 50% of all child mortality)

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0A

rush

a &

Ma

ny

ara

Kil

ima

nja

ro

Da

r es

Sin

gid

a

Ta

bo

ra

Mw

an

za

Kig

om

a

Sh

iny

an

ga

Ta

ng

a

Mo

rog

oro

Mb

eya

Pw

an

i

Irin

ga

Ru

vu

ma

Ru

kw

a

Ka

ger

a

Ma

ra

Do

do

ma

Mtw

ara

Lin

di

Per

cen

t st

un

ted

0

50

100

150

200

250

<5

mo

rta

lity

ra

te (

per

10

00

)

StuntedUnder five mortality rate

Malnutrition Malnutrition Correlates with <5 Correlates with <5 MortalityMortality

The Crisis in Human The Crisis in Human Resources for HealthResources for Health

• One physician per 138,000 peopleOne physician per 138,000 people• Production, deployment, motivation, Production, deployment, motivation,

retentionretention• Health professionals are different: Health professionals are different:

global labor marketglobal labor market• Health service delivery demands Health service delivery demands

multiple, highly specialized skills – multiple, highly specialized skills – cannot produce health with one cadrecannot produce health with one cadre

Getting the Input Mix Getting the Input Mix RightRight

Motivated Staff

Facilities (& maintenance)

Drugs

Trained Staff

Equipment

Sector Wide Sector Wide ApproachApproach

Partnerships between Govt. & Development Partners

Government Ownership & Stewardship

Sector Expenditure Framework

Comprehensive Sector Policy/Strategies

Shared Vision & Priorities

Harmonized

Implementation

Annual ReviewAnnual Review

• 7 Joint Annual Health Sector 7 Joint Annual Health Sector ReviewsReviews

• Major tool used by SWAp to monitor Major tool used by SWAp to monitor the implementation of the HSSPthe implementation of the HSSP

• PER and MTEF are reviewedPER and MTEF are reviewed• Review previous, and agree new Review previous, and agree new

milestones and key actions for the milestones and key actions for the next yearnext year

• Satisfactory? – stakeholders, M&E, Satisfactory? – stakeholders, M&E, MoHSW leadership/ownershipMoHSW leadership/ownership

Sector DialogueSector Dialogue

• Health Retreat in September 2005Health Retreat in September 2005• Troika chairing structure and Troika chairing structure and

secretariatsecretariat• Revised sector dialogue modelRevised sector dialogue model• Division of labourDivision of labour• Aid modalities – FY06/07 - PRBS Aid modalities – FY06/07 - PRBS

$70million, $51million basket, $70million, $51million basket, $53million projects (from MTEF)$53million projects (from MTEF)

Costs of delivering Costs of delivering health services are health services are

increasingincreasing

Population growth, but also Population growth, but also unit costs unit costs

Health bears the burden of the Health bears the burden of the response to AIDSresponse to AIDS

More expensive drugs due to More expensive drugs due to resistanceresistance

New technologies: more cost-New technologies: more cost-effective, but also more costlyeffective, but also more costly

Long-Term Financial Long-Term Financial Commitments with no Commitments with no

PredictabilityPredictability

Spending on AIDS ≈ total health Spending on AIDS ≈ total health sector budgetsector budget

Global Fund, USAID & WB money Global Fund, USAID & WB money for AIDS not infinite, yet costs could for AIDS not infinite, yet costs could not be taken up in health budgetnot be taken up in health budget

Meanwhile, large external Meanwhile, large external earmarked money (mainly for AIDS) earmarked money (mainly for AIDS) crowds out discretionary funding crowds out discretionary funding for healthfor health

Institutionalizing Institutionalizing External FundingExternal Funding

Project financing Project financing budget support?budget support? District BasketDistrict Basket Block Grants? Block Grants? Joint Rehabilitation FundJoint Rehabilitation Fund Capital Dev. Grant?Capital Dev. Grant?

BUT, Sector not yet preparedBUT, Sector not yet preparedAbility to negotiate for resources Ability to negotiate for resources Disincentives to move fully to budget supportDisincentives to move fully to budget support• Delays in 1Delays in 1stst quarter quarter• Time required to process paymentsTime required to process payments• Difficulty processing external consultant contractsDifficulty processing external consultant contracts

ConclusionsConclusions

• Although sector has shown substantial success, health Although sector has shown substantial success, health challenges are increasingchallenges are increasing

• HRH, Nutrition, Women’s status – issues beyond HRH, Nutrition, Women’s status – issues beyond sectorsector

• Good progress under the SWAp, but sector dialogue Good progress under the SWAp, but sector dialogue needs strengthening needs strengthening

• Sector is organising itself, but coordination of Sector is organising itself, but coordination of multiple DPs is an on-going challengemultiple DPs is an on-going challenge

• Commitments made today need to consider Commitments made today need to consider predictability of long-term funding should affectpredictability of long-term funding should affect

• GBS yes, but…. GBS yes, but…. • How best for DPGHealth to link up with DPG in How best for DPGHealth to link up with DPG in

future?future?