Preliminary Proposal

Equity Factor for FY13

ContextWide variation in the distribution of resources across districts in Tanzania and in the effective utilization of the available resources at the district levelRatios of the “10 best to the 10 worst” districts:

Out-patient attendances per capita: 7.8:1

Out-patient attendances per health worker: 15.1:1

Facility based deliveries: 8.1:1

Health workers per capita: 11.0:1

Current allocation approach for health basket funds to districts do not take this into considerationThe World Bank would like to propose a specific approach for doing so for FY13

Proposed indicatorsPerformance – need further discussion for implementation in FY14

Equity – clinical health workers per 10,000 populationWhy:

Data is readily available and collected regularlyMore readily available than funding data which needs to come from the MOFLooks at the distribution of the key health care delivery input

Current Distribution by District

- 5.00 10.00 15.00 20.00 25.00 30.00 35.00 01-101-502-202-603-303-704-204-605-205-606-207-107-508-409-209-610-411-412-212-613-414-214-615-216-216-617-318-119-219-620-321-121-5

Health workers per 10,000 pop.

Proposed Approach

Allocate 90% of the district amount using the existing formula – if the current average of $1.30 per capita is maintained = $1.17 per capitaAllocate 10% to equity factor = $0.13 p.c.Would result in ~ $5.4 million allocationCan be scaled to fit to agreed overall allocation

CalculationsConvert the value for each district to an index number with the national average being 100

For health workers per capita, this would mean dividing the national average by the district value

Normalize the index values to the national population to ensure that the total amount allocated is kept to the available amountMultiply the resulting index values for each district by the district population and $0.13

ResultsCompared to a the current allocation formula:

37 districts (28%) would get more fundingthose getting more would get 62% more on average in equity funds compared to the current formula and 6.2% more in total funds (range 0.2 to 51%)95 districts (72%) would get less funding and get 4.2% less on average in total funds compared to an allocation using only the formula (range 0.1 to 8.8%)

Results reflect the current wide variation in each of these indicators by districtThe next two graphs show the regional results (aggregated from district results)

Regional Results (equity amount in US$)

- 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000

01 - Arusha

02 - Kilimanjaro

03 - Tanga

04 - Iringa

05 - Mbeya

06 - Rukwa

07 - Ruvuma

08 - Dodoma

09 - Manyara

10 - Singida

11 - Mtwara

12 - Lindi

13 - Tabora

14 - Shinyanga

15 - Kigoma

16 - Pwani

17 - Morogoro

18 - Dar es Salaam

19 - Mwanza

20 - Mara

21 - Kagera

Allocation per formula

Equity Amount $

Regional Results (total amount in US$)

0 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000

01 - Arusha

02 - Kilimanjaro

03 - Tanga

04 - Iringa

05 - Mbeya

06 - Rukwa

07 - Ruvuma

08 - Dodoma

09 - Manyara

10 - Singida

11 - Mtwara

12 - Lindi

13 - Tabora

14 - Shinyanga

15 - Kigoma

16 - Pwani

17 - Morogoro

18 - Dar es Salaam

19 - Mwanza

20 - Mara

21 - Kagera

Per formula

With equity

Proposed Next StepsDiscuss/agree on including equity in the next FY allocationDiscuss/agree on the approach for including this factors – i.e., 90% through formula, 10% for equityDiscuss/agree on the indicator to be used i.e., health workers per capitaDiscuss/agree on the allocation approachVerify the data to be used, fill in missing dataRun simulation with final numbers, check calculations and trouble-shootFinalize allocations and advise districts

Thank you