In 2013, Pendo Inana Gama developed complications while in labor with her fourth child at nearby Kigamboni Health Center, and doctors determined she needed an emergency C-section. But Kigamboni, a large municipal facility that sees 250-300 patients a day on a peninsula of Tanzania’s commercial capital, Dar es Salaam, didn’t have enough medical supplies or medicines for a safe C-section delivery.
She was referred to Temeke Referral Hospital in downtown Dar es Salaam, 10 kilometers away through chronically bad traffic and accessible then only by two ferry boats a day. Gama’s situation wasn’t unusual: For many years, Kigamboni was above the national average for hospital referrals.
Many health facilities in Tanzania face challenges in managing their own source revenues. Since 2017, national guidelines have mandated facilities set aside 35 percent of these revenues for essential medicines and health commodities, but these were often diverted to pay for other items or services, like overtime and other allowances.
Since 2018, USAID has supported the government at all levels—including public health facilities—to use the official online planning and budgeting system, PlanRep, via regular annual training just before budget season. The system enables transparency: Facilities can set their own budgets, and national, regional, and local health authorities can review them for alignment with national priorities.
PlanRep’s enhanced features for assessing plans and budgets revealed that many facilities weren’t following the 35-percent rule for own source revenues. In October 2021, USAID’s Public Sector Systems Strengthening Plus Activity (PS3+) collaborated with the President’s Office Regional Administration and Local Government to set and automate the ceiling allocation within the PlanRep system. The Comprehensive Council Health Plan guidelines were also updated to guide facilities on annual purchase plans for specific health commodities, minimizing diversion of funds.
PlanRep has contributed to distinct council improvements at Kigamboni. Between 2018 and 2020, the facility’s rate of hospital referrals fell below the national average. Patients also do not need to buy more expensive medicines at private pharmacies now that facilities have them in stock at their own pharmacies. Health center and hospital pharmacies are considered revolving funds for facilities’ own source revenue.
“A patient with at least five prescriptions can get four out of five dosage/medicines,” said Bernadetha Bupamba, Health Secretary at Kigamboni Health Centre. “That was never the situation before.”
The improvement has made a huge difference to Pendo Gama, who recently delivered her fifth child by C-section at Kigamboni Health Centre, and to her husband, Fredy Mathew Gama (pictured the morning of delivery looking over the list of required medicines and supplies).
“I won’t have more expenses going to and from Temeke hospital until my wife recovers to get back home,” Fredy Gama said. “I have managed to get 17 of the 23 listed drugs and minor medical equipment here at the Health Centre and with a fair price that I can well manage.”
PS3+ aims to strengthen Government of Tanzania management systems, especially at the local level, and promote quality service delivery to citizens.
