SIKIKA is dismayed by the response given by the Minister of Health and Social
Welfare with regards to the crisis facing public health facilities being unable to
purchase medicine and supplies due to the accumulated debt at MSD. It is clear that
the Minister does not comprehend the gravity of the situation and that he is less
concerned that some patients may be dying because of this crisis.
Sikika understands that cost-sharing revenue is one of the sources of funds that have
been used to increase the availability of medicine and medical supplies in the country.
Sikika also understands that this source alone is insufficient to close the gap created
by deliberate low budget allocation for procurement of essential medicines in all
public facilities. For example, the estimated demand for year 2014/15 is Tsh. 500bn
while the allocation is Tsh70.5bn, which suffice only about 14% of the demand.
Sikika reminds the Ministry of health that about 75% of all in-patients and outpatients
who access healthcare at municipal hospitals are exempted from paying for
healthcare services. These would include pregnant women, children under five years
old, patients with chronic diseases, the poor, elderly and the disabled. This means the
government is depending on the 25% of patients who are eligible for cost sharing as a
major source of medicine funds.The government must take responsibility.
The Minister for Health wants hospitals to pay the debt in order to qualify for more
borrowing. We are talking about a crisis which is a result of consistent insufficient
budget allocation. Some hospitals have already been using the cost sharing revenues
to purchase medicine, yet they are indebted.
It is not the first time the MoHSW ordered all hospitals to send 50% of cost sharing
revenue to MSD. This order has been repeating since 2012 without follow up and
support to implement. For example, in July 2014, the Minister of Health and Social
Welfare ordered all hospitals to send the 50% of their revenues to MSD. If this
instruction has not been implemented in the past and that patients continue to suffer,
the Minister must first take responsibility before repeating himself.
Sikika would like to know what plans are there for the national, referrals and special
hospitals in paying the debt. These were not mentioned in the directive while they
contribute to about 67% of the public health facilities debt. In addition, how does the
MOHSW plan to clear its own debt, which is more than 70% of the total debt, being
the cost associated with clearance, storage and transportation of vertical programs
commodities?
Moreover, the press released on 27th October 2014 by the MoHSW argued that, the
government has been paying back MSD in installments. The Minister, however, did
not explain the growth trend of this debt, which is due to the government paying back
in very small amounts while at the same time borrowing in large amounts. For
instance, in 2013 the debt was Tsh. 76.4 billion but by September 2014 the debt has
grown to Tsh. 102 billion despite the payment of Tsh. 10 billion.
Sikika would like to seek clarification from both the Minister for Health and the Deputy
Minister for Finance, Mr. Mwigulu Nchemba. Mr. Nchemba was recently quoted by
some newspapers saying that, the amount disbursed for medicine in the year 2013/14
was Tsh. 47 billion but only Tsh. 7 billion was spent in buying medicine. Sikika, and
indeed all Tanzanians, would like to know where did the difference go and reasons for
the diversion amid this chronic crisis of availability of medicine and medical supplies
in public health facilities.
Sikika would like to make clarification to the public that the recent disbursement
freeze by development partners is only for the General Budget Support. Development
Partners are funding health through Health Sector Basket Support. For the first
quarter (July-September), Sikika is informed that over Tshs 20 bilion was already
disbursed by the Development Partners to all districts in Tanzania. One third of that
amount is usually used for procurement of essential medicines and medical supplies.
Sikika appreciates efforts by the government to include health in the “Big Result Now
(BRN)” initiative, which will in part attempt to address the perennial shortages and
absence of medicine and medical supplies at public health facilities. However, the
program may not contribute to solving the current problem, which needs an urgent
solution. At the earliest, implementation of the BRN-Health initiative may start in the
next financial year. Patients are either dying or suffering today due to unavailability of
essential medicine and medical supplies in the public health facilities.
Finally, Sikika would like to call for urgent action by the Ministry of Health and Social
Welfare to address the growing chronic shortages of medicine and medical supplies
in the public health facilities. The shortages lead to inability of citizens to access
quality healthcare, and may possibly lead to deaths. Government must secure
funding sufficient to clear the MSD debt and provide for adequate medicine and
medical supplies. This must be treated with urgency and as a matter of national
security. It is unfair for any government to allow its people to suffer or die for
preventable reasons.
Mr. Irenei Kiria,
Executive Director of Sikika,
P. O. Box 12183 Dar es Salaam,
Tel: +255 222 666355/57, Fax: 2668015, Email: info@sikika.or.tz,
Twitter: @sikika1, Facebook: Sikika Tanzania, Website: www.sikika.or.tz
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