28 January-1 February 2019 , Dar es Salaam: The world transitioned, in 2015, from the Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs). The transition is aimed at ensuring a more integrated and sustained approach to development. This obliges all countries and sectors in developing people and improving the lives of the most vulnerable in societies. The Health sector is reflected in Goal 3, as “Ensure healthy lives and promote well-being for all at all ages”. The SDG approach in the health sector, rather than focusing on specific diseases and programmes goes for a broader set of health targets underpinned by a target on Universal Health Coverage (UHC). The WHO AFRO UHC Flagship Program (“UHC Flagship”) aims to support and promote the development and implementation of coordinated results-oriented health systems strengthening actions in Member States with a focus on achieving a sustainable and measurable Universal Health Coverage. Tanzania has been selected as one of the focus countries for WHO AFRO’s 2019 UHC Flagship Programme.

A scoping mission to Tanzania was therefore conducted in country from 28 January-1 February 2019 to identify areas where WHO’s expertise and support can best be located. The scoping mission was facilitated by a WHO technical team from the regional and country offices. The main objective was  to review the country’s health policies and strategic plans with a view to:

• Identifying the key issues pertinent to primary health care and UHC in the country, including understanding the important gaps affecting the implementation of priority health programmes
• Engaging policy makers and stakeholders on priority actions/interventions for UHC/SDGs and the support required from WHO;
• Developing a framework for approaching UHC through effective implementation of NHPSPs in the country and;
• Agreeing on a roadmap of realistic and catalytic actions to strengthen the health system and facilitate progress towards UHC

The team met with key in-country stakeholders for consultation and desk review. Some of the observations by the mission include:

Strengths

• Strong Leadership & Political commitment to health
• Existence of regularly reviewed strategic documents
• Massive recruitment of qualified health workers
• Existence of a HR Strategic Plan and Production plan
• Pharmaceutical action plan in place
• Availability of medicines and medical supplies at HFs
• Functional LMS &eLMIS
• Extensive expansion of health infrastructure with newly built structures equipped
• Standard medical equipment and laboratory guideline completed with maintenance schedule
• Health financing strategy in final draft
• Exemption of vulnerable groups
• Increased government allocation to health
• Existence of insurance and pre-payment insurance schemes
• Institutionalized mechanisms for monitoring health  expenditure

Gaps

• Fragmented community health systems
• SWAP dialogue structure not extended to sub-national level
• Poor understanding of UHC especially at lower levels
• Inequitable distribution of health workers especially Midwives
• Poor quality of HR pre-service trainings
• Rules and regulations affecting timely procurement
• Insufficient reporting on essential medicines
• Inadequate capacity for quantification and forecasting
• Shortage of pharmaceutical technicians at health facility level
• Irregular inspection to ensure rational use of drugs
• Lack of inter-ministerial coordinating body on HRH issues
• Inadequate maintenance of infrastructure
• Inadequate in country capacity to support maintenance functions (specific Human resource)
• Maintenance and renovation of training institutions not well catered for.
• Partial disbursement of government funds allocated to the health sector
• Low Health Insurance coverage

Recommendations

• Build awareness on UHC to ensure common vision
• Strengthen accountability to stay the course
• Strengthen M&E  and use of evidence –learn as you, corrective action, documentation
• Maintain/Strengthen partnerships at all levels
• Demand generation and community engagement

A full report on the findings of the assessment will be shared in due course.