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The Government of Tanzania (GoT) has been relatively de-prioritising the budget allocations to the health sector compared to other economic sectors. For example, in FY 2022/23 only 5.18% of the total government budget was allocated to health sector1, which is far lower than the 12% target set in the Fifth Health Sector Strategic Plan2. Total expenditure on PHC stands at USD 18 per capita, out of which only USD 8 is provided by government, which is far lower than the USD 65 global benchmark set to deliver quality PHC services in LMICs3.

Primary health services financing is currently highly dependent on donor funding. However, external financing has been progressively decreasing, moving from 39% to 33% of the current health expenditure between 2017 and 20204, and is expected to decrease further with the improvement of Tanzania’s economic conditions. Therefore, there is a need to identify additional sources of domestic revenues to finance primary health services and continue expanding the coverage of quality primary health care services.

Many countries have embarked on several domestic resources mobilization efforts to expand the fiscal space for health through a combination of general revenue measures and consumption taxes. For example, Ghana established a National Health Insurance Levy consisting of 2.5% points from the 17.5% VAT, Indonesia earmarked 5% of the central government budgetary allocations and a minimum of 10% each districts total budget, both excluding salaries, to health, and Thailand introduced a 2% surcharge on excise taxes imposed on sale from alcohol and tobacco products.

Countries have taken different approaches to earmark expenditures and revenues and health, leading to different outcomes in terms of budget transparency and accountability6, and the effectiveness of earmarking taxes to increase overall funding for health and make it more stable has been mixed7. Although earmarking may increase overall government expenditure, it does not necessarily lead to increased expenditure for a target program due to the fungibility of the overall government budget

How can you make a difference?

The consultant will be expected to identify opportunities to generate additional resources for the health sector, estimate their revenue generation potential for the health sector and review the public financial management regulations to ensure additional resources are effectively and efficiently allocated to the sector.

The consultant will be expected to travel to Tanzania (Dodoma) for the inception and dissemination meetings and spend a minimum of two weeks in the country to consult with stakeholders and collect data. The rest of the analysis will be conducted remotely.

Specifically, the consultant will be expected to:

• Identify resources mobilization opportunities for the health sector

• Estimate the revenue generation potential of such options

• Outline options to earmark such additional resources to the health sector