Wrap Up of the first day

1
Nicola Jones UNFPA Country Repr
esentative Tanzania Experiences on Financing for
Womens Health Panel 52nd Session of the UN Com
mission on the Status of Women
New York 26 February 2008
Engaging in a Sector Wide Approach in Health in
Tanzania Negotiating Financing for Womens
Health
2
The Health Situation for Africa

• Sub-Saharan Africa
• Accounts for 11 percent of worlds population
• Bears 24 percent of global disease burden
• Commands less than 1 percent global health
  expenditure
  
• Deploys 3 percent of worlds health workers

3
How can a Sector-Wide Approach (SWAp) help in
Tanzania?

• Introduced in 1990s to improve aid effectiveness
• To reduce fragmentation of aid and financing
  gaps, improve predictability of funding
  
• Put government in better position to achieve
  sector outcomes
  
• Mature health SWAps in several countries,
  including Tanzania

4
What defines a Sector-Wide Approach in Health?

• Government in leadership role
• Strong partnership among development actors
• Shared vision for improving health
• All partners commit to sector-wide priorities,
  policies, and strategies
  
• One comprehensive expenditure framework
• Harmonized implementation and monitoring
  procedures
  

5
Why a Health SWAp in Tanzania?

• Health sector in 1990s deteriorating
• Reflected in poor health status and reproductive
  health indicators
  
• Looked for ways to implement health sector reform
  in context of SWAp and decentralization
  
• First HSSP and SWAp basket funding 1999
• Second HSSP highlights HIV/AIDS, maternal and
  under-five mortality, malnutrition, adolescent
  pregnancy, and declining proportion of deliveries
  in health facilities

6
Tanzania a model health SWAp?

• Major expansion in expenditure
• Much external support captured in MTEF
• Increase in pooling partners UNFPA first UN
  agency
  
• Flexible funds reach down to district level
• Quality of sector-level dialogue and partnership
• Joint annual reviews and monitoring

7
What are the challenges for Womens Health?

• Uneven progress in health outcomes
• Decrease in infant, under five mortality
• High Maternal and newborn mortality
• Unmet need for FP
• Women and girls most at risk from HIV/AIDS
• Adolescent sexual and reproductive health
• Need for equity and HIV/AIDS or RH?
• Global health initiatives HIV/AIDS or RH?

8
What has gender equality got to do with it?

• Cannot improve RH through health sector alone
• RH gender and womens empowerment issue
• Women lack household decision making power
• Less than one third Tz women make decisions
  concerning own health care
  
• One third women agree man is justified in hitting
  wife if she refused to have sex
  
• Widespread inequities, reflected in RH status and
  attitudes to access to health care

9
So what can a SWAp do?

• Joint advocacy and planning to address RH
  issues
  
• Put sector expenditure planning in context
  national PRS
  
• Government and basket funds for RH
• Division of Labour - UNFPA focal agency in policy
  dialogue and technical support RHCS, MNCH,
  Gender
  
• Increase in flexible funding to districts
• Pay for Performance for maternal and newborn
  health?
  
• Disaggregated data systems to plan and monitor
  for women and youth-focused activities
  

10
What else has to be done?

• Increase pressure to address HR gap
• Influence flow of money through GBS
• Integrate RH indicators into GBS monitoring
• Continue to build sector and local commitment,
  capacity for gender budgeting
  
• Entry points for UN/ CSOs in GBS dialogues
• Partner with religious and cultural leaders
• Delivering as One pilot to strengthen UN role