Transcript Wrap Up of the first day

“Engaging in a Sector Wide Approach in Health
in Tanzania: Negotiating Financing for
Women’s Health”
Nicola Jones
UNFPA Country Representative Tanzania
“Experiences on Financing for Women’s Health” Panel
52nd Session of the UN Commission on the Status of Women
New York 26 February 2008
The Health Situation for Africa
Sub-Saharan Africa:
 Accounts for 11 percent of world’s
population
 Bears 24 percent of global disease burden
 Commands less than 1 percent global
health expenditure
 Deploys 3 percent of world’s health
workers
How can a Sector-Wide Approach
(SWAp) help in Tanzania?
 Introduced in 1990s to improve aid
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effectiveness
To reduce fragmentation of aid and financing
gaps, improve predictability of funding
Put government in better position to achieve
sector outcomes
Mature health SWAps in several countries,
including Tanzania
What defines a Sector-Wide
Approach in Health?
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Government in leadership role
Strong partnership among development actors
Shared vision for improving health
All partners commit to sector-wide priorities,
policies, and strategies
One comprehensive expenditure framework
Harmonized implementation and monitoring
procedures
Why a Health SWAp in Tanzania?
 Health sector in 1990s deteriorating
 Reflected in poor health status and reproductive
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health indicators
Looked for ways to implement health sector
reform in context of SWAp and decentralization
First HSSP and SWAp basket funding 1999
Second HSSP highlights HIV/AIDS, maternal and
under-five mortality, malnutrition, adolescent
pregnancy, and declining proportion of deliveries
in health facilities
Tanzania a model health SWAp?
• Major expansion in expenditure
• Much external support captured in MTEF
• Increase in pooling partners – UNFPA first
UN agency
• Flexible funds reach down to district level
• Quality of sector-level dialogue and
partnership
• Joint annual reviews and monitoring
What are the challenges for
Women’s Health?
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Uneven progress in health outcomes
Decrease in infant, under five mortality
High Maternal and newborn mortality
Unmet need for FP
Women and girls most at risk from HIV/AIDS
Adolescent sexual and reproductive health
Need for equity and HIV/AIDS or RH?
Global health initiatives HIV/AIDS or RH?
What has gender equality got to do
with it?
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Cannot improve RH through health sector alone
RH gender and women’s empowerment issue
Women lack household decision making power
Less than one third Tz women make decisions
concerning own health care
One third women agree man is justified in
hitting wife if she refused to have sex
Widespread inequities, reflected in RH status
and attitudes to access to health care
So what can a SWAp do?
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Joint advocacy and planning to address RH issues
Put sector expenditure planning in context national PRS
Government and basket funds for RH
Division of Labour - UNFPA focal agency in policy
dialogue and technical support – RHCS, MNCH, Gender
• Increase in flexible funding to districts
• Pay for Performance for maternal and newborn health?
• Disaggregated data systems to plan and monitor for
women and youth-focused activities
What else has to be done?
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Increase pressure to address HR gap
Influence flow of money through GBS
Integrate RH indicators into GBS monitoring
Continue to build sector and local commitment,
capacity for gender budgeting
Entry points for UN/ CSOs in GBS dialogues
Partner with religious and cultural leaders
“Delivering as One” pilot to strengthen UN role