Spending more, and spending more effectively, on health services for mothers and babies, also has a positive impact on other parts of the economy.
Making formal commitments to improve health services is a critical first step for governments to realising a better future for our mothers and babies. Prominent among these commitments is the Abuja Declaration of 2001, which commits Heads of State from across Africa to allocate at least 15% of their national budgets to health.Right now African Heads of State are meeting once again in Abuja to take stock of the extent to which they have honoured the original commitment. It is surprising that such a major African meeting such as this one appears to have had a very subdued lead-up - there has been little media coverage and it is not clear how civil society’s views have been sought.So what has been our progress to date on this important yardstick of the priority our government places on a healthy nation? As the infographic illustrates[1], Tanzania is currently a long way off meeting its Abuja commitment. There was a period between 2006-09 when we met and indeed slightly exceeded it, peaking with 17% of budget being allocated to health in 2006 (I am assuming most likely buoyed by significant PEPFAR and GFATM funding, though this is unconfirmed). Worryingly, however, the proportion of the overall budget allocated to health has significantly dipped since then, with current levels of 8.5% marking the lowest proportion of the total budget allocated to the health sector since 2004.Perhaps more meaningful is health spending per person as an indicator of how our government invests in our health. This has been increasing in Tanzania, tripling over the last decade from about US$10 in 2001 to around US$32 per person in 2011[2]. But this still falls significantly short of the WHO recommendation that total health spending, including both government and private spending, should amount to a minimum of US$54 per person. And even more concerning, out-of-pocket spending has doubled in recent years[3], which disproportionately affects the poor[4] – denying them access to healthcare while pushing others into poverty through out-of-pocket expenses on health.What does this mean for our Tanzanian mothers and babies?Given the above picture, what is this likely to mean for our Tanzanian mothers and babies? Already we know that Tanzania is unlikely to achieve its targets for MDGs. Our goal is to reduce our maternal mortality ratio to 193 deaths for every 100,000 live births by 2015, but the latest figure is 454. The 2013 State of the World’s Mothers Report recently set out that two-thirds of all babies’ death globally occurs in ten countries, Tanzania being one of them. While the introduction of the policy to make reproductive and child health services free in 2006 is laudable, in truth there is a long way to go until this is realised, especially for the poorest Tanzanians. It is typically the health facilities serving the poorest where there are stock-outs of essential drugs and supplies. These medicines will then have to be financed by patients, the poorest of whom will not have access to private health insurance and so end up paying for them out-of-pocket. The Community Health Fund also has way to go until its benefits and protection are felt by increasingly large numbers of Tanzania’s poorest, including mothers and babies.And yet the proportion of our total budget being allocated to health is dropping; the public share of the total health spending is also currently dropping; and only 2% of the current 2012/13 health budget was allocated to maternal, newborn and child health[5]. Meanwhile it seems that those mothers and babies who currently face significant challenges in accessing maternal healthcare services and are dying as a result, will continue to face the same challenges to accessing these essential services.Towards a healthier Tanzania, especially our mothers and babiesWhile the Tanzanian government and its partners have invested in health and seen significant improvements in some health outcomes, more investment is urgently needed in order to improve maternal and newborn survival, as well as the health of the population as a whole. Spending more, and spending more effectively, on health services for mothers and babies, also has a positive impact on other parts of the economy. According to a recent study by the Partnership for Maternal, Newborn and Child Health:“For every dollar spent on key interventions for reproductive, maternal, newborn and child health, about US$20 in benefits could be generated through producing healthy children who enjoy better cognitive development, achieve more at school and become health, productive adults.”It is our hope that those representing Tanzania at the Abuja+12 meeting currently taking place will reflect on our progress and remaining challenges to date, and will determine to reaffirm Tanzania’s commitments and redouble efforts to spend more resources, and spend more effectively, on health services for our mothers and babies.[1] Source (1995-2010): WHO (2013) Global Health Expenditure Database (GHED); source (2011-2012): Budget background and medium term framework, 2012-13-2014-15[2] Source: WHO (2013) Global Health Expenditure Database (GHED): http://apps.who.int/nha/database/DataExplorerRegime.aspx. Figures expressed in 2005 dollars.[3] WHO (2013) Global Health Expenditure Database (GHED): http://apps.who.int/nha/database/DataExplorerRegime.aspx[4] Mtei, G; Makawia, S; Ally, M; Kuwawenaruwa, A; Meheus, F; Borghi, J; (2012) Who pays and who benefits from health care? An assessment of equity in health care financing and benefit distribution in Tanzania. Health policy and planning, 27. i23-i34. ISSN 0268-1080 DOI:10.1093/heapol/czs018[5] Ministry of Finance (2012). Government budget for financial year 2012/2013: Citizen’s budget edition. United Republic of Tanzania; http://www.mof.go.tz/mofdocs/budget/Citizens%20Budget/CITIZENS%20BUDGET%202012-2013%20-%20English.pdf