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Intersectoral Health Action in Tanzania: Determinants and Policy Implications

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Intersectoral Health Action in Tanzania: Determinants and Policy Implications A Service of Leibniz-Informationszentrum econstor Wirtschaft Leibniz Information Centre Make Your Publications Visible. zbw for Economics Simon, Michael; Tsegai, Daniel; Fleßa, Steffen Working Paper Intersectoral health action in Tanzania: Determinants and policy implications ZEF Discussion Papers on Development Policy, No. 172 Provided in Cooperation with: Zentrum für Entwicklungsforschung / Center for Development Research (ZEF), University of Bonn Suggested Citation: Simon, Michael; Tsegai, Daniel; Fleßa, Steffen (2012) : Intersectoral health action in Tanzania: Determinants and policy implications, ZEF Discussion Papers on Development Policy, No. 172, University of Bonn, Center for Development Research (ZEF), Bonn This Version is available at: http://hdl.handle.net/10419/84804 Standard-Nutzungsbedingungen: Terms of use: Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Documents in EconStor may be saved and copied for your Zwecken und zum Privatgebrauch gespeichert und kopiert werden. personal and scholarly purposes. Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle You are not to copy documents for public or commercial Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich purposes, to exhibit the documents publicly, to make them machen, vertreiben oder anderweitig nutzen. publicly available on the internet, or to distribute or otherwise use the documents in public. Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, If the documents have been made available under an Open gelten abweichend von diesen Nutzungsbedingungen die in der dort Content Licence (especially Creative Commons Licences), you genannten Lizenz gewährten Nutzungsrechte. may exercise further usage rights as specified in the indicated licence. www.econstor.eu ZEF-Discussion Papers on Development Policy No. 172 Michael Simon, Daniel Tsegai and Steffen Fleßa Intersectoral Health Action in Tanzania – Determinants and Policy Implications Bonn, December 2012 The CENTER FOR DEVELOPMENT RESEARCH (ZEF) was established in 1995 as an international, interdisciplinary research institute at the University of Bonn. Research and teaching at ZEF addresses political, economic and ecological development problems. ZEF closely cooperates with national and international partners in research and development organizations. For information, see: www.zef.de. ZEF – Discussion Papers on Development Policy are intended to stimulate discussion among researchers, practitioners and policy makers on current and emerging development issues. Each paper has been exposed to an internal discussion within the Center for Development Research (ZEF) and an external review. The papers mostly reflect work in progress. The Editorial Committee of the ZEF – DISCUSSION PAPERS ON DEVELOPMENT POLICY include Joachim von Braun (Chair), Solvey Gerke, and Manfred Denich. Michael Simon, Daniel Tsegai and Steffen Fleßa, Intersectoral Health Action in Tanzania – Determinants and Policy Implications, ZEF- Discussion Papers on Development Policy No. 172, Center for Development Research, Bonn, December 2012, pp. 39. ISSN: 1436-9931 Published by: Zentrum für Entwicklungsforschung (ZEF) Center for Development Research Walter-Flex-Straße 3 D – 53113 Bonn Germany Phone: +49-228-73-1861 Fax: +49-228-73-1869 E-Mail: [email protected] www.zef.de The authors: Michael Simon, Center for Development Research (ZEF), University of Bonn. Contact: [email protected] Daniel Tsegai, Center for Development Research (ZEF), University of Bonn. Contact: [email protected] Steffen Fleßa, University of Greifswald. Contact: [email protected] ii Table of Contents ABBREVIATIONS AND ACRONYMS ............................................................................................ iv LIST OF TABLES ........................................................................................................................... v LIST OF FIGURES ......................................................................................................................... v LIST OF MAPS ............................................................................................................................. v ABSTRACT .................................................................................................................................. vi 1. Introduction ............................................................................................................................ 1 2. Literature Review ................................................................................................................... 3 3. Public Health in Tanzania ....................................................................................................... 5 3.1 Health System Reforms and the Burden of Disease ..................................................................... 5 3.2 Health Related Sectors: Status Quo and Trends in Public Expenditure ........................................ 8 4. Theoretical Framework ........................................................................................................ 13 4.1 Conceptual Framework and Economic Theory of IHA ................................................................ 13 4.2 The Model and the Marginal Impact on Health .......................................................................... 16 5. Quantitative Analysis: Model Estimation and Results ......................................................... 21 5.1 Data ............................................................................................................................................. 21 5.2 Model Estimation, Results and Marginal Returns to Public Investment .................................... 23 6. Conclusions ........................................................................................................................... 27 6.1 Major Findings and Priorities of Future Government Investment ............................................. 27 6.2 Limitations and Future Research Directions ............................................................................... 28 REFERENCES ............................................................................................................................. 29 APPENDIX 1: MAP OF REGIONAL PER CAPITA AGRICULTURE INVESTMENT ........................... 34 APPENDIX 2: MAP OF REGIONAL PER CAPITA WATER INVESTMENT ...................................... 35 APPENDIX 3: MAP OF REGIONAL PER CAPITA EDUCATION INVESTMENT ............................... 36 APPENDIX 4: VARIABLE DEFINITIONS ....................................................................................... 37 APPENDIX 5: ESTIMATION VARIATIONS ................................................................................... 39 iii ABBREVIATIONS AND ACRONYMS 2SLS Two-Stage-Least-Squares 3SLS Three-Stage-Least-Squares ARI Acute Respiratory Infection BEST Basic Education Statistics Tanzania D-by-D Decentralization by Devolution DALYs Disability Adjusted Life Years DISC Diagnosis of Sustainable Collaboration ESDP Education Sector Development Programme EWURA Energy and Water Utilities Regulatory Authority FBOs Faith-Based-Organizations GDP Gross Domestic Product GMM Generalized Method of Moments HiAP Health in All Policies HMIS HIV/AIDS and Malaria Indicator Survey HSBF Health Sector Basket Fund IHA Intersectoral Health Action IFPRI International Food Policy Research Institute IHI IFAKARA Health Institute IPT Intermittent Preventive Treatment ITNs Insecticide-Treated Bed Nets LGAs Local Government Authorities MDG Millennium Development Goals MoEVT Ministry of Education and Vocational Training MOF Ministry of Finance MoHSW Ministry of Health and Social Welfare MoWI Ministry of Water and Irrigation MSPAS Ministry of Public Health and Social Assistance, El Salvador NBS National Bureau of Statistics NGO Nongovernmental Organization NIP Nutrition Improvement Project iv OLS Ordinary Least Squares PASHA Prevention and Awareness in Schools of HIV/AIDS PMO-RALG Prime Minister’s Office Regional Administration and Local Government PHAC Public Health Agency of Canada PTR Pupils-Teacher-Ratio SDOH Social Determinants of Health SEM Simultaneous Equation Model SRH Sexual and Reproductive Health SWAP Sector Wide Approach TACAIDS Tanzania Commission for AIDS TDHS Tanzania Demographic and Health Survey TGPSH Tanzanian German Programme to Support Health URT United Republic of Tanzania WHO World Health Organization WSDP Water Sector Development Program ZEF Zentrum für Entwicklungsforschung / Center for Development Research LIST OF TABLES Table 1: Government Expenditure on Major Sectors ..... .......................................................... 8 Table 2: Descriptive Statistics ..... ............................................................................................. 22 Table 3: Relationship between Burden of Disease and Intersectoral Health Action ..... ......... 25 Table 4: Returns of Cross-sectoral Health Interventions..... .................................................... 26 LIST OF FIGURES Figure 1: Government Expenditure on Major Sectors..... .......................................................... 9 Figure 2: Determinants of the Health Status of the Population ..... ........................................ 13 Figure 3: Behaviour of Selected Dependent and Independent Variables Over Time ..... ........ 23 LIST OF MAPS Map 1: Regional per Capita Health Investment
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