Tanzania Private Health Sector Assessment

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Tanzania Private Health Sector Assessment TANZANIA PRIVATE HEALTH SECTOR ASSESSMENT January 2013 This publication was produced for review by the United States Agency for International Development. It was written by James White, Barbara O‘Hanlon, Grace Chee, Dr. Emmanuel Malangalila, Dr. Adeline Kimambo, Jorge Coarasa, Sean Callahan, Ilana Ron Levey, and Kim McKeon for the Strengthening Health Outcomes through the Private Sector (SHOPS) project. Recommended Citation: White, James, Barbara O‘Hanlon, Grace Chee, Emmanuel Malangalila, Adeline Kimambo, Jorge Coarasa, Sean Callahan, Ilana Ron Levey, and Kim McKeon. January 2013. Tanzania Private Sector Assessment. Bethesda, MD: Strengthening Health Outcomes through the Private Sector Project, Abt Associates Inc. Download: Download copies of SHOPS publications at: www.shopsproject.org Cooperative Agreement: GPO-A-00-09-00007-00 Submitted to: Marguerite Farrell, AOR Bureau of Global Health/Population and Reproductive Health/ Service Delivery Improvement United States Agency for International Development Shyami de Silva, Private Sector Technical Advisor Bureau of Global Health/Office of HIV/AIDS United Stated Agency for International Development TANZANIA PRIVATE HEALTH SECTOR ASSESSMENT NOTE: This draft includes the final technical results of the SHOPS-Health in Africa Initiative assessment. It will be published as a World Bank report in late 2013. DISCLAIMER The authors‘ views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development (USAID) or the United States Government TABLE OF CONTENTS Acronyms ................................................................................................................................ vii Acknowledgments .................................................................................................................. xii Executive Summary ................................................................................................................13 1. Introduction and Methodology ......................................................................................... 1 1.1 Background.................................................................................................................. 1 1.2 Context ........................................................................................................................ 2 1.3 Assessment Purpose and Scope ................................................................................. 3 1.4 Methodology ................................................................................................................ 4 1.5 Key Concepts .............................................................................................................. 6 1.6 Overview ...................................................................................................................... 7 2. The Private Health Sector within the Tanzanian Health System .................................... 8 2.1 A New View of the Tanzanian Health System .............................................................. 8 2.2 Tanzanian Health System Sectors ..............................................................................10 3. Policy and Enabling Environment to Mobilize the Private Sector in Health ................18 3.1 Historical Context for Public-Private Partnerships in Health ........................................18 3.2 Policy Environment .....................................................................................................20 3.3 Business Environment ................................................................................................27 3.4 Institutional Structure ..................................................................................................30 3.5 Forums to Dialogue on Public-Private Partnerships ....................................................31 3.6 Key Findings ...............................................................................................................34 3.7 Recommendations to Strengthen the Enabling Environment ......................................38 4. Service Delivery in the Private Health Sector ................................................................41 4.1 HIV/AIDS ....................................................................................................................42 4.2 Reproductive and Child Health (RCH) .........................................................................49 4.3 Tuberculosis ...............................................................................................................57 4.4 Malaria ........................................................................................................................59 4.5 Key Findings ...............................................................................................................62 4.6 Recommendations to Strengthen Private Sector Service Delivery ..............................64 5. Private Sector Human Resources for Health .................................................................66 i 5.1 The Private Sector Human Resource Crisis ................................................................66 5.2 Private For-Profit Medical Training Institutes ...............................................................68 5.3 Key Findings ...............................................................................................................71 5.4 Recommendations ......................................................................................................72 6. Access to Essential Pharmaceutical and Medical Commodities ..................................74 6.1 Overview and Structure of Tanzanian Supply Chain ...................................................74 6.2 Private Sector Supply Chains .....................................................................................77 6.3 Availability of Medical Commodities ............................................................................80 6.4 Supply and Access to Vertical Program Medical Commodities ...................................83 6.5 Key Findings ...............................................................................................................85 6.6 Recommendations ......................................................................................................86 7. The Role of Health Financing in Enabling a Sustainable Private Health Sector .........89 7.1 Health Financing Trends .............................................................................................89 7.2 Characteristics of Private Health Expenditures ...........................................................95 7.3 Public Funding of PRivate Health Providers Through Council Governments ...............96 7.4 Health Insurance and Private Providers ......................................................................99 7.5 Key Findings ............................................................................................................. 105 7.6 Recommendations .................................................................................................... 107 8. Strategic Priorities for Increased Private Sector Engagement in Health ................... 108 8.1 Making the Case for Partnering with the Private Health Sector ................................. 108 8.2 Short- and Long-Term Strategic Priorities ................................................................. 109 8.3 Strategic Investments ............................................................................................... 110 Conclusion ............................................................................................................................ 119 Annex A: Key Stakeholder List ............................................................................................ 120 Annex B: Validation and Prioritization Workshop Summary ............................................. 125 Annex C: Health Sector Roles and Responsibilities .......................................................... 130 Annex D: PPP Policy Framework and Organizational Structure in Tanzania ................... 133 Annex E: Summary of Findings on Financial Institutions .................................................. 138 Annex F: Comparison of Key Health Metrics ...................................................................... 141 Annex G: Kenya PPD Forum ................................................................................................ 142 Annex H: Bibliography ......................................................................................................... 143 ii TABLE OF TABLES Table 1.1 Economic and Health Development Indicators ........................................................... 1 Table 2.1: Legend of Acronyms for Key Actors by Sector .......................................................... 9 Table 2.2: Ranking of Zones by Total Number of Health Facilities ............................................14 Table 2.3: USAID-Supported PPPs ...........................................................................................17 Table 4.1: Total Number of Health Facilities in Tanzania ..........................................................41 Table 4.2: Provider Distribution as a % of Total Health Expenditures ........................................42 Table 5.1: Status of Health Workers by Cadre ..........................................................................66 Table 5.2: HRH Shortages in Private Facilities,
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