The 6th Annual Joint Health Sector Review was concluded successfully at Kunduchi Beach hotel, between 4th and 6th April 2005. It was preceded by a Technical preparatory meeting, held at Belinda Hotel. This year’s was the largest Review yet, with over 200 participants. As well as government and donor representatives, the meeting was attended by a variety of civil society and NGO representatives. The Honourable Minister of Health opened the meeting. Judged by the milestones, performance over the last year has been mixed. The advent of the Joint
Rehabilitation Fund, the successful integration of Health into MKUKUTA, the scaling up of AIDS Care and Treatment and a steep budget increase (FY2004/5) were all registered as achievements. However, little if any progress was achieved in tackling the Human Resources crisis. The meeting resolved to address the issue with renewed commitment and urgency. A good deal of quantitative data was presented at the meeting, including the State of Health report, the updated health sector performance profile, and the ten-district study. In most respects these reports point to improvement in health service delivery between 2000 and 2003. The major areas of concern were maternal health services and child malnutrition – neither of which seem to have made any improvement over the last 2 decades. Weaknesses in the routine information system mean that data for 2004 is still patchy. Public Private Partnership was the theme of the technical review this year. The clearest message emerging in plenary was the need to replace the current government subsidy to faith-based providers by a service agreement, linked to outputs. Another resonating theme was the need to expand the opportunity for NGOs (including FBOs) to participate in health planning and management at district level. More generally, there was a commitment by both public and private stakeholders to deepen their collaboration. The recommendations of the Technical Review extended well beyond these themes. A good start has been made with the rehabilitation of district health infrastructure. This is expected to accelerate in the year ahead. Participants called for a holistic approach towards prioritisation and effective monitoring of implementation. The Honourable Minister called for a new approach and renewed urgency in tackling the human resources crisis. The challenges and the priorities are clear enough. But the shared commitment of MOF, PO-PSM, PORALG and MOH will be needed in order to move forward. A cabinet paper was seen as one way to secure this joint commitment. The financing situation for Health has improved markedly. The PER demonstrates a 33% nominal rise in health budget between 2003/4 and this budget year. FY2005/6 will witness a further steep increase. This good news is tempered by the fact that payroll expenditure is not keeping up with “other charges”, and central government expenditure is expanding much faster than local government. Even these increases are not sufficient to cover the requirements of the health sector. A T. Shilling 167 billion resource gap was documented by the MOH. New financial commitments continue to come on stream, often initiated by short-term donor funding. Moreover, a substantial portion of new money coming into the sector is tightly earmarked. Flexible, discretionary resources remain highly constrained and tough choices on resource allocation will have to be made. Detailed discussion of health financing in general, and user charges / CHF in particular, was deferred to the Health Financing Workshop due in early May. A new set of Milestones, some of them carried over from last year, was debated and concluded after the meeting. These are reproduced in Table 7.