The HP+ project is inviting applications from Tanzanian civil society organizations (CSOs) currently advocating for advancements in health and development to implement targeted and discrete family planning advocacy efforts through the sub-award opportunity, CATALYST (Champions for Accelerating Family Planning Success in Tanzania).
The purpose of the CATALYST opportunity is to support proven and/or innovative advocacy strategies to advance the achievement of the country’s family planning goals as articulated in the National Family Planning Costed Implementation Plan 2019-2023 (NFPCIP 2019-2023). HP+ anticipates awarding up to five (5) local CSOs on the following advocacy topics and goals:
- CATALYST 1: Improving family planning budget execution at central government level.
- CATALYST 2: Improving family planning budget allocation and execution at LGA level.
- CATALYST 3: Advancing policies for equitable and sustainable financing for family planning.
- CATALYST 4: Mainstreaming family planning as a priority for overall national development.
- CATALYST 5: Amplifying the youth voice to harness the demographic dividend.
The CATALYST opportunity will advance progress toward the following NFPCIP 2019-2023 results:
- Increased domestic resource mobilization from three main sources: government’s own resources (i.e., public sector finances), insurance schemes, and the private sector (which includes the adoption of a total market approach for family planning).*
- Mainstreaming of family planning as a cost-effective development intervention to drive national economic growth across diverse sectors such as education, agriculture, environment, health, and youth.
- Increased local CSO capacity to advocate for family planning at various levels, including national and sub-national levels, as well as health and development sectors.
CATALYST 1: Improving family planning budget execution at central government level During execution of the National Family Planning Costed Implementation Plan 2010-2015 (NFPCIP 2010 2015), advocacy efforts resulted in several “wins,” including a government budget line item for contraceptive commodities, increased family planning allocations from the government, and an increasing number of districts or councils allocating funds for family planning in their comprehensive council health plans. Over the years, budget advocacy efforts have mainly focused on increasing family planning budget allocations, and although allocation levels at the central level have increased, disbursements have unpredictably fluctuated and seldom matched allocation levels. However, spending levels tend to match disbursement levels, meaning absorption capacity in spending unit-sis high. In 2010/11, disbursements exceeded allocations by 417 percent; in 2017/18, only 14 percent of the family planning budget was actually disbursed.† The reasons behind these fluctuations are unclear. The unreliability of budget disbursements may impact contraceptive commodity financing, which is partially funded by the government’s central budget. Data from annual commodity supply plans between fiscal years 2010/11 and 2016/17 show inconsistencies in the government’s share of spending towards contraceptive commodities; the highest share was in 2011/12, where over half (52.5 percent) of the commodity budget was financed by the government, and the lowest was in 2013/14 at 6 percent.
The purpose of CATALYST 1 is to increase the percentage of the approved budget allocated for family planning that is executed. In the last fiscal year of 2018/19, only 10.7 percent of the approved budget allocated to family planning was disbursed. With the understanding that Tanzania works with a cash budget system that is managed by the Ministry of Finance and Planning, and that low and unpredictable disbursement levels may be associated with shortfalls in funding availability, the CSO will identify the key drivers (including political and economic processes) and actors responsible for decision-making on budget disbursement levels within the respective government institutions. With that information, the CSO will formulate its advocacy strategy.
CATALYST 2: Improving family planning budget allocation and execution at the local government authority level Local government authorities (LGAs) are an increasingly important source of financing for health, including family planning. Funds for the health sector managed at the local level are generated from multiple sources. The major sources for LGAs are budgetary allocations from the central government, health basket fund allocations, LGAs’ own sources, user fees, contributions from health insurance schemes, and other sources. An analysis by the Engender Health/RESPOND project showed that through concerted capacity building and advocacy efforts at district level by the Ministry of Health, Community Development, Gender, Elderly and Children, President's Office Regional and Local Government and partners, the number of districts that included family planning in their comprehensive community health plan budgets increased from 51 (46 percent of all districts) in 2012 (equivalent of US$258,545) to 91 (83 percent) in 2016 (equivalent of $US465,222) ‡
Recent reforms resulting from the implementation of the Direct Health Facility Financing (DHFF) program entail fiscal decentralization through directing health facility financing to health facilities to plan, manage and use funds. Under the DHFF program, the Council Health Management Teams (CHMT) are responsible for effective implementation of the DHFF program and provision of technical assistance to health facilities, including financial management and preparation of annual plans and budget for the individual health facilities. The Facility Management Teams and Health Facility Governing Committee Governance (HFGCs) have responsibility for planning and budgeting for the health facilities in addition to endorsement of all transactions at the health facilities.
These reforms, together with strategic shifts articulated in the NFPCIP, call for a review of advocacy strategies and audiences currently used by CSOs at LGA level. Family planning stakeholders have oriented district councils to the NFPCIP 2019-2023 and supported them to develop family planning District Action Plans (DAPs) ─ as of November 2019, 90 percent (i.e. 167 of 185) of district councils have FP DAPs. However, advocacy efforts are needed to ensure that the DAPs are included in CCHPs and Health Facility Plans, and that budgets are allocated and executed for planned activities.
The purposeof CATALYST 2 is to define and generate a scalable approach to influence FP budget allocation and execution at LGA level, i.e. the council and health facility levels. The CSO will develop, implement, and test appropriate advocacy strategies to support 1-2 district councils and at least two facilities in each council, in one of the following regions: Mbeya, Songwe, Coast, and Rukwa regions, to influence the budget process for family planning (specifically relative to budget formulation and execution) at district council and facility level. The
CSO’s advocacy strategies will influence and support LGAs to mainstream formulated DAPs in the Council Health Plans (CCHP) and Facility Plans, support decision-making processes for budget allocation and execution. Efforts under this sub-award will also help to provide answers to questions such as: how do family planning advocates efficiently and effectively reach and influence budgeting at the health facility level? How should CSOs engage CHMTs in budget advocacy given their evolved role in LGA budgeting process?
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Questions, Submission, and All Correspondence: Catalyst.Subawards@thepalladiumgroup.com
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