Integrating NTD Planning and Budgeting in sub-national Council Health Planning and Budgeting processes
Neglected tropical diseases (NTDs) pose significant health, education, and economic challenges in Tanzania. Endemic NTDs including lymphatic filariasis, onchocerciasis, trachoma, schistosomiasis, and soil-transmitted helminth infections, cause suffering and disability that limit participation in the workforce and economic productivity, and also limit educational attainment of school-aged children. This creates a cycle of poverty, leading to social stigma at the family and community levels.
For various reasons, donor funding for NTDs has declined from US$ 12.7 million to US$ 7.99 million between 2015/16 and 2019/20, affecting the sustainability and reliability of NTD service delivery. To address this, Tanzania’s Ministry of Health has championed efforts to improve the sustainability of NTD services, guided by a five-year NTD sustainability plan launched last year. One of these measures is integrating NTDs into planning and budgeting of sub-national government levels at the council level to increase local resources allocated for NTD services. According to research, streamlining functions across programs — including planning, coordination and budgeting — can reduce duplication and misalignment of inputs while maximizing returns on health sector resources.
This blog summarizes the efforts undertaken by the Government of Tanzania, with support from USAID’s Act to End NTDs | East program (Act │ East), to mobilize domestic resources for NTDs at the council level. It provides insights from a two-day workshop on challenges to NTD integration in council planning and budgeting in the Comprehensive Council Health Plans, and practical next steps to overcome these challenges.
What are the challenges to inclusion of NTDS in Comprehensive Council Health Plans?
1. Parallel data sources for planning and budgeting hampers effective planning
Two systems capture data required for planning and budgeting – the District Health Information System 2 and NTD Management Information System. These parallel information systems have limited inclusion of NTD data. Indicators in Tanzania’s integrated planning and reporting system (PlanRep) are few, not well organized and do not provide a sufficient basis for council planning. In addition, councils using these national systems lack key data to inform the inclusion of NTD interventions in their health plans.
Future progress toward achieving NTD targets will depend on bringing NTD programs, functions, and interventions into these systems.1 For example, embedding a subset of NTD indicators in the District Health Information System and Plan Rep, and creating specific NTD tables in the PlanRep system will enable councils to access NTD data for annual planning and budgeting, and ensure that planned NTD interventions are captured in their health plans. This will also enhance the monitoring of funding and implementation of planned NTD activities, and increase NTD visibility for councils, enabling evidence-based decision-making on NTD planning and financing.
2. NTD interventions are crowded out by other communicable diseases in council planning guidelines
NTDs are not recognized as a stand-alone priority area in the latest guidelines developing Comprehensive Council Health Plans. Instead, NTDs are clustered together with other communicable diseases such as Malaria, Tuberculosis, Leprosy, HIV/AIDS and STI, Viral hepatitis and epidemics (e.g., Cholera, Meningitis, Yellow Fever, Measles). This creates competition for resources and jeopardizes the chances of allocating funding during planning and budgeting as attention is focused on other communicable diseases with a higher diseases burden.
This calls for the need to elevate NTDs as a specific priority area, as reflected in previous Comprehensive Council Health Plan Guidelines but recognizing that this might take long, other intermediate actions can be sought to prioritize NTDs and increase visibility. This includes strengthening the capacity of the NTD coordinators to understand available entry points within existing priority areas, and interventions and having specified service outputs for NTDs.
3. Inclusion of all relevant actors in council planning
The annual review, planning and budgeting meetings conducted by the NTD Control Program involve the NTD Coordinator for Health, NTD Coordinator for Education, Pharmacist, and Accountant.
Meeting participation should be broadened to include District Planning Officers, District Medical Officers and District Health Secretaries. These officials are critical in setting budget ceilings and advocating for resources across health priorities.
The Government of Tanzania is continuing to make incredible progress toward the control and elimination of NTDs and is increasingly working to ensure the sustainability of NTD services in line with their NTD sustainability plan, and the World Health Organization Road Map goals for 2030. As Tanzania aims to increase domestic resources, sustaining NTD programs will require thoughtful integration of NTD programs into national health systems.
At a recent workshop, stakeholders offered the following suggestions to achieve this goal of integration with broader health system structures:
- The NTD Control Program may work with MOH-Directorate of Policy and Planning, and President’s Office-Regional Administration and Local Government (PORALG) to ensure the District Health Information System and PlanRep incorporate NTD specific data collection tools and indicators that capture comprehensive NTD data. This will increase visibility, accountability, and enable monitoring and evaluation of NTD interventions at national and subnational levels.
- MOH through PORALG may provide directives to councils to set budgets for NTD interventions and during assessments of plans and budgets, confirm the council plans and budget include NTD interventions.
- MOH in collaboration with PORALG may integrate NTD assessment criteria in the PlanRep and the Comprehensive Council Health Plan Guidelines to enhance monitoring of NTD allocations and strengthen the planning and budgeting process.
- The NTD Control Program, in collaboration with PORALG, may conduct advocacy meetings with regions and councils to address the inclusion of NTD interventions.
As donor funding for NTDs declines, Tanzania should harness the opportunity to secure funding for core NTD interventions through council planning. While increasing funding for NTD interventions is important, improving NTD service integration with other health and non-health services should be strengthened as a key strategy to enhance the efficient use of available resources.