Magufuli 2015-2020: Matarajio ya uchumi na changamoto zake

Nguruvi3 said:
Hoja nzuri, swali , unawezaje kutenganisha majukumu ya central gov na local gov ikiwa wizara inayoshughulikia local gov ipo chini ya central gov directly

Pili, huoni kwa muktadha huo twakimu za Mchambuzi zina make sense ingawa unaziponda?
Click to expand...
Simple .. Sources za mapato ya local government zinatoka PMO,'s na Local taxes na wizarani na Bima ya Taifa.
Matumizi yanatoka DMOs office. DMO sasa ndiyo inatakiwa apange fungu kubwa.
Solution, ni LGA councils na wakazi through town hall meetings wapange au wagawe hela dispensaries. Siyo wizara.
It's so easy!
 

Je, Local Government Authorities (serikali ngazi za manispaa/halmashauri) zinachangia kiasi gani cha mapato ya serikali (mapato ya kodi)?

Je, ngazi hii ya serikali inawajibika kwa asilimia ngapi ya matumizi yote ya serikali?
Je, how is the deficit covered?

Iwapo ulipitia vyema mjadala wetu, huko juu, tulijadili kwamba - Serikali ngazi ya halmashauri zina umuhimu wa kipekee katika utoaji wa huduma za kijamii na kiuchumi kwa wananchi, ikiwepo huduma ya Afya. Tukasema kwamba halmashauri zetu zinakusanya chini ya asilimia kumi ya mapato yote ya ndani ya serikali (fuatilia mchango wa LGAs katika mapato ya serikali kwa kuangalia bajeti za kila mwaka). Lakini serikali katika ngazi hizi za halmashauri zinawajibika kwa zaidi ya asilimia ishirini ya matumizi yote ya huduma za kiuchumi na kijamii kwa wananchi, ikiwemo Afya (hii takwimu nayo ni rahisi kuipata, nenda kachambue bajeti za kila mwaka). Pengo husika huwa linazibwa na ‘fiscal transfers’ kutoka serikali kuu. Tulijadili kwa undani jinsi gani hili hufanyika, athari zake, na tufanye nini kurekebisha changamoto husika.

Tukasema pia kwamba Serikali zetu ngazi za halmashauri zinakabiliwa na changamoto kubwa za kifedha, na miongoni mwa changamoto hizi ni pamoja na ‘unpredictable fiscal transfers’ kutoka serikali kuu. Such transfers ni muhimu katika kuziba ‘the fiscal gap/imbalance’ husika, hasa ikizingatiwa kwamba serikali kuu imeendelea kuzinyima LGAs 'taxation powers'. Matokeo yake ni uwepo wa huduma duni za kiuchumi na kijamii kwa wananchi, Afya ikiwa ni moja wapo.

Tukahimiza kwamba iwapo serikali ya awamu ya Tano chini ya Rais JP Magufuli imenuwia kuwaletea wananchi mabadiliko ya kweli katika maisha yao, serikali kuu inapaswa kuleta na kusimamia ‘a sound framework’ kwa ajili ya mfumo wa fedha za halmashauri zetu ili kuleta ufanisi katika matumizi na utoaji huduma za kiuchumi na kijamii kwa wananchi.

Tukasema pia kwamba iwapo serikali ngazi za halmashauri zinapewa uwezo mkubw zaidi wa kujitegemea kimapato kwa nia ya kujenga nidhamu ya fedha za umma, decentralization italeta faida kubwa kwa maana ya ufanisi na uwajibikaji na kupunguza gharama/hasara zinazojitokeza katika serikali ngazi za halmashauri kutokana na matukio katika uchumi mpana kisera, muktadha ambao haupo mikononi mwa serikali ngazi ya halmashauri. Lakini ni jadi kwako Kobello kuhamaki unaposikia neno 'decentralization'.

Nimalizie kwa kukudokeza kwamba 'government financing' wizara ya afya inakuwa channeled via four sources namely:

1. Wizara ya Afya (Bajeti)
2. Bajeti Wizara ya Tamisemi
3. Bajeti Ofisi ya Waziri Mkuu
4. Mapato ya manispaa/halmashauri.

Source: WHO (Country Office for Africa).

Sidhani kama hapa nina haja ya kukutafunia kwani imani yangu ni kwamba una upeo wa kutosha 'to figure out' ni kwanini tunaendelea kukwama miaka yote.
 
Yes ni simple kama unavyosema, lakini sivyo on the ground. Ndiyo maana nasisitiza 'hand on experience' inaeleza mengi

Tunapozungumzia primary healthcare tunakwenda hadi katika dispensaries
Kuna program nyingi ambazo LGA haziwezi kutekeleza kwasababu
1. Ni program za kitaifa
2. LGA Hazina uwezo

Kwa mfano, PHC kuna eneo la kinga (vaccination) hili lipo katika program za EPI
DMO ana influence gani hapo katika kupanga na kubajeti ikiwa ni program kutoka central gov na ambayo inachukua sehemu kubwa ya bajeti yake

Na unakosea unaposema DMO apange fungu kubwa. DMO hana fungu bali anapangiwa fungu. Mara nyingi sana fungu analopewa halitoshi hata kwa huduma kama kununua Lysol au gauze, lazima achague vipaumbele

Lakini pia ukisoma bandiko lilotangulia la Mchambuzi, tueleza DMO anafidiaje nakisi ya mgao wa LGA na mahitaji halisi akiwa na deficit kubwa kiasi kilichoonyeshwa?
 
Halmashauri tofauti zinapanga fungu tofauti. Halmashauri chini ya DMO ina uwezo wa kuongeza fungu (kwa asilimia) LA dispensaries na healthcare centers.
Hatuzungumzii ukubwa wa fungu Bali mgawanyiko wa shilingi moja.
Unagawaje shilingi moja. Local government ina sehemu tatu, dispensaries, health centers na district hospitals.
Unagawaje ulichopata?

DMO wa Arumeru, wa Ukerewe na Mkuranga wanagawa tofauti, wana numbers of dispensaries tofauti, number of health centers tofauti, idadi tofauti ya staff, vitanda, population etc...
Miradi tofauti ya preventive care, maintenance cost, a lot of differences... Magonjwa ya Meru siyo sawa na Pwani.

Fungu LA chini linategemea sana LGAs.
Kuhusu cost of healthcare, Mchambuzi anachangaya mambo Mzigo wa healthcare unasupportiwa na vyombo mbalimbali, Ila tunazungumzia uamuzi, uamuzi, uamuzi.

NGO hazina maamuzi (at least directly), development partners hawana maamuzi.
LGASs zina maamuzi.
 

Kobello, unazurura zurura tu na viroja ili mradi ujira wako Lumumba utimie. Usipotoshe watu. Mifani ipo mingi kuonyesha kwamba haupo makini. Tuangalie miwili tu kwa sasa:

Moja, kwa mujibu wa WHO (Country Office for Africa) on Tanzania:
"Most public dispensaries lack access to funds to provide appropriate services. Some have funds accruing from cost - sharing but are not authorized to utilize these collections directly."

Uamuzi gani huo bila ya mamlaka husika?

Pili, kwa mujibu wa ripoti ya REPOA (2005) on Local Government Authorities and Fiscal Autonomy:

Fiscal autonomy katika wilaya/halmashauri zetu ipo limited both with respect to 'revenues and expenditures'. Iwapo ulipitia vyema sehemu ya tatu ya uzi huu ambayo ilijadili "Taxation and Revenue Powers", nilijadili hili katika muktadha wa serikali kuu na serikali ngazi za halmashauri. Tukiendelea na ripoti ya Repoa (2005), walichukua sample ya Six District Councils namely - Bagamoyo, Kilosa, Iringa, na Moshi, na kubaini kwamba these generated less than 8% of their own revenues in 2005, compared to 17% in 2002. Kilosa (for instance), the district council generated only 2% of her revenues in 2005, compared to 13% in 2002. This drop was due to the abolishment of many local revenue sources (kwa mkono wa SERIKALI KUU) and also due to sharp increase of grants transfers from serikali kuu/central government.

Hata kwa much bigger district councils kama ilala na Mwanza, they experienced the same i.e a drop in their own contributions to total revenues because of same reasons above. For instance, in 2005, Ilala contributed 45% of their own revenues, a drop from 64% in 2002; Mwanza District Council, they contributed 22% of their own revenues in 2005, a drop from 48% in 2002.

Hapa unaposema uamuzi uamuzi uamuzi, unaongelea uamuzi gani ambapo unakunyima revenue powers?

Na serikali ya JPM will make matters worse kwani Kitendo cha kupora Tamisemi kutoka kwa waziri mkuu na kuiweka moja kwa moja chini ya the 'executive himself', means allocation of resources sasa itafuatana ameamka vipi siku hiyo. Akiamua kufuta sherehe ya kitaifa kwa utashi wake na kuelekeza fedha kwenda halmashauri fulani, itakuwa imekula kwa wengine. Tusisahau pia kwamba pale Kinyerezi wakati anazindua mradi wa Kinyerezi II, Rais alieleza umma wa watanzania kwa uwazi kabisa kwamba watoto wa kambo (halmashauri na majimbo ya wapinzani) hayatapewa kipaumbele.
 

Sijui kwanini hawa jamaa awaipati hii dhana na kubadilisha mtazamo wao.


Halafu wameng'an'gana na halmashauri kuchangia afya sijui wakoje despite common sense, malalamiko ya wabunge wanaokumbana na hizo changamoto za uhaba wa huduma huko kwenye majimbo yasiyo na mapato mengi and advice za wataalamu; the current policy implementation can never produce equal access to all nor equal health system nationally.
 
Huwezi kutenga ukubwa wa fungu na mgawanyiko.
Soma bandiko la Mchambuzi namba 65. Katoa mfano wa takwimu za REPOA kuwa, Wilaya ya Kilosa ilikusanya 2% ya mapato yake.

Sasa DMO unampa kiasi gani na agawanyeje katika hali kama hiyo?
Ukiendelea kusoma, anasema revenue ina drop kutokana na central gov
Mengine amekuonyesha kwa namba nadhani utayaona mwenyewe

Pili, unapozungumzia uamuzi inashangaza sana. Kuna baraza gani la mji au jiji lililohuru kupanga mipango yake? Wakurugenzi wanaopelekwa huko ni watumishi wa central gov

Madiwani, wenyeviti na mameya wana nguvu gani ya kukabiliana na wakurugenzi wanaoteuliwa na serikali kuu? Uamuzi gani unaotegemea katika hali hiyo?

Tatu,kuhusu DMO wa Arumeru na Mkuranga, ni kweli wana idadi tofauti ya watumishi.

Ina maana kuwa population ndiyo ina determine uwepo wa dispensary na health centre

Hapa usichanganye na standard. Kuna idadi ya wananchi wanaotakiwa ili kituo cha afya kipewe hadhi hiyo (50,000 kama sijakosea).

Idadi ya staff inakuwa determined na sifa zilizoanishwa kuhusu kituo cha afya

Hii maana yake ni kuwa idadi ndogo ya vituo vya afya kati ya Arumeru na Mkuranga haiathiri idadi ya staff katika kituo kimoja.

Ni std kuwa kituo kiwe na idadi kadhaa yenye watu wenye sifa kadhaa.
Nadhani hapa utaweza kutofautisha

Kuhusu preventive care, hakuna program tofauti kati ya wilaya moja au sehemu moja na nyingine. Kama utakumbuka nilikueleza kuhusu EPI.

Naomba unipe preventive care moja tu inayotofautiana kati ya eneo moja na jingine

Kuhusu magonjwa ni kweli yanatofautiana kati ya eneo na eneo.
Kutofautiana huko hakumaanisha tofauti katika idadi ya watoa huduma.

Narudia kama kituo cha afya kinatakiwa AMO 2, CO 4, Reg Nurse 5, Nursing assistant 6 n.k. hiyo haibadiliki kutokana na maradhi ya eneo. Ni std inayotakiwa, mapungufu si std.

Ninajua unachotaka kusema, ni kuwa matumizi ya Arumeru na Mkuranga yanatofautiana katika huduma za matibabu na dawa.

Matibabu ya Morogoro yatazingatia sana epidemiology ya eneo kama ilivyo Kigoma.
Zaidi ya hapo dawa zinazotumika zinatofautiana na hilo ndilo linatoa tofauti.

Med Kit inayotumwa Morogoro ni tofauti na inayotumwa Arumeru au Rombo.
Kwa mfano Kit ya dawa kwenda Moro itakuwa na Phernobarbitone na Carbamezapine, kule Rombo utapeleka Mebendazole na C'mphenicol

Hii tofauti ya 'pharmaceuticals ina impact kubwa sana katika bajeti na ndiyo inaleta tofauti unayozungumzia kibajeti kati ya Arumeru na Mkuranga.

Siyo suala la kubahatisha ni suala la Biostatistics na Epidemiology na kuyafanya kisiasa kwa mtazamo wako ni sehemu ya matatizo makubwa tuliyo nayo
 














Kwa data hizo hapo juu, fananisha kama LGAs zote zinafuata mkondo mmoja. Usibadili mjadala na kusema fedha hazitoshi. Fedha ndiyo hazitoshi na hazitotosha.
Ila ulichozungumza wewe ni policy kuwa Serikali inawekeza sana kwenye hospitali za wilaya kwenda juu. Wakati hayo majedwali yamekuonyesha jinsi LGAs mbalimbali zinavyo-allocate pesa zake (the issue here is allocation).
Allocation haijali uwingi wa fedha bali mipango ya fedha ulizonazo.
kuna halmashauri zinatoa fedha nyingi kwenye dispensaries na zingine kwenye hospitali za wilaya.

Pia umekosea ulipoainisha mfumo wa healthcare kwenye three-tier system as if central government ipo responsible for all the systems ...NO, No and No!! LGAs zinapanga matumizi independently.
Hiyo ni mifano current kabisa.
 

Kobello, ni jadi yako kutupia humu jamvini michoro na data nyingi bila mpangilio ikiambatana na analysis kiduchu, ukitarajia kwamba tutakuwa mesmerized, hypnotized and bewitched. It’s not going to happen.

Kabla ya kuingia katika mjadala wa allocation, kwanza tujadili major sources of Revenues for Local Government Authorities (LGAs). Kama tulivyojadili throughout, Serikali kuu ndio main source of revenues for our Local Government Authorities (Serikali ngazi za halmashauri). Kuna aina kuu nne ya funding flows kutoka serikali kuu kwenda serikali ngazi za halmashauri:

1. Kwanza ni component ya ‘Recurrent Block grants’: Personal Emoluments (PE).

2. Pili ni component ya ‘Recurrent Block grants’: Other Charges (OC) Component.

3. Tatu ni Recurrent Subversions and Basket Funds.

4. Nne ni Development Grants and Development Funds.

Hivyo ndio jinsi gani modalities za LGA finances zilivyogawanyika. Katika mgawanyiko huu, ‘recurrent block grants’ imeendelea kuwa the major source of funding kwa serikali ngazi za halmashauri, as they represent over 50% (in some cases, karibia 80%) of LGAs funds in each financial year.

Swali linalofuata ni je:

· Hizi block grants zinaenda kugharamia vitu gani?

Jibu ni kwamba zinaelekezwa kugharamia ‘key public services delivery’ zifuatazo katika ngazi za halmashauri:

a) Health care (our main focus in this discussion).

b) Primary education (we will deal with this later).

c) Agriculture Extension services (we will deal with this later).

d) Water supply (we will deal with this later).

e) Road Maintenance (we will deal with this later).

f) General administration (e.g. salaries for senior employees) and compensation for revenues.

Baada ya kujadili hayo, sasa tuje kwenye hoja yako kuhusu “allocation”.

Mwaka 2004 chini ya Rais Mkapa, Baraza la Mawaziri lilipitisha ‘a formula based recurrent transfer system’ ambayo ililenga kuweka ‘grant ceilings’ kwa maeneo matano kati ya sita tuliyoona hapo juu. Maeneo hayo ni:

· Health care

· Primary education

· Extension services (Agriculture)

· Water supply (Rural)

· Road Maintenance (local)


Miaka miwili baadae (2006), serikali ikaja na ‘a formula based general purpose grant’ ambapo ‘local administration & compensation grants’, ziliunganishwa. Vigezo vilivyotumika kupitisha ‘formula’ husika ili kufanikisha resource “ALLOCATION” kwa serikali ngazi za Halmashauri ilizingatia ‘factors’ kuu tano kama ifuatavyo:

1. Population.

2. Number of School aged children (kwa ajili ya primary education grant).

3. Poverty count/incidence.

4. Infant Mortality rate kama proxy ya “burden of diseases” (kwa ajili ya sekta ya afya).

5. Distance from Council headquarters to service outlets kama proxy for “land area.”


Tujadili kidogo suala la ‘Burden of Diseases’.

Kwenye hili, tukumbushane kwamba kwa mujibu wa utafiti wa World Health Organization, 85% of the disease burden in the country can be addressed by available, cost-effective interventions.”

Pia tukumbushane kwamba kwa mujibu wa tafiti mbalimbali including WHO, majority of the causes of ‘Morbidity” (or causes of disease burden) nchini ni magonjwa ya kuambukiza (Communicable Diseases), na sio non-communicable diseases. Miaka 56 baada ya Uhuru!

Mchanganuo wake ni kama ifuatavyo:

- Communicable diseases 60%

- Perinatal (magonjwa immediately before and after birth) 15%

- Non-Communicable diseases 10%

- Nutritional 5%

- Underdetermined 5%

- Injury 3%

- Maternal 2%


Muhimu

1. Hapo juu tumeona kwamba KIGEZO muhimu cha Serikali wakati wa kufanya grants “allocation” kwenye sekta ya Afya katika serikali ngazi ya Halmashauri zetu nchini ni “Infant Mortality rate kama proxy ya “burden of diseases”.

2. Kuna mgongano mkubwa baina ya ‘original design’ na ‘actual implementation’ linapokuja suala la formula – based recurrent grant system. Tofauti na design, in practice, each of the sectoral block inajengwa na sehemu kuu mbili ambazo ni:

- Component ya ‘Personal Emolument’ (PE)

- Component ya ‘Other Charges’ (OC)

Kati ya hizi mbili, sehemu kubwa ya funding flows kutoka serikali kuu kwenda serikali ngazi za halmashauri ni ‘Personal Emolument’ (PE), karibia 80% ya jumla ya block grants allocations zote. Kwa maana hii, ‘Personal Emolument’ (PE) inachukua sehemu kubwa zaidi ya financial resources zote katika ngazi ya LGAs.

3. Kwa kuazima maneno yako makuu matatu “UAUMUZI, UAMUZI, UAMUZI”, tofauti na malengo yaliyodhamiriwa katika ‘formula based grant system’, ‘Personal Emolument’ (PE) kwa kila Local Government Authority inaendelea kuwa determined in a ‘discretionary manner’ na Ofisi ya Rais, Menejimenti ya Utumishi wa Umma. Kwa maana hii, viwango vya rasilimali fedha kwa ajili ya ‘Personal Emolument’ (PE) kwa kila Local Government Authority haifuati the formula based “allocation”.
 

Mkuu Eric Cartman, Serikali ya CCM ni ya ajabu sana. Kwa upande mmoja, inazibana halmashauri zisiwe na vyanzo vingi vya mapato kwani mchango wa Local Government Authorities (LGAs) katika mapato ya serikali katika kila mwaka wa bajeti, haufiki 10% ya mapato yote. Lakini linapokuja suala la matumizi, serikali ngazi za halmashauri zinatarajiwa kuchangia zaidi ya 20% ya matumizi yote ya bajeti ya nchi kila mwaka kwa ajili ya:
  • Health care.
  • Primary education.
  • Agriculture Extension services.
  • Water supply.
  • Local Road Maintenance.
  • General administration.
Unazipa serikali ngazi ya halmashauri 'Spending Powers,' lakini unawanyima 'Taxation Powers'. Ni aidha wanaotuongoza hawana akili sawa au umaskini wa watanzania ndio mtaji mkuu wa CCM.
 
Nguruvi3 said:
Ina maana kuwa population ndiyo ina determine uwepo wa dispensary na health centre

Hapa usichanganye na standard. Kuna idadi ya wananchi wanaotakiwa ili kituo cha afya kipewe hadhi hiyo (50,000 kama sijakosea).
Click to expand...
Haujakosea.

-Dispensaries zinahudumia watu kati ya 6,000 na 10,000.
-A health Centre inahudumia watu 50,000.
-A district hospital inahudumia watu 250,000.
-A regional hospital inasimama kama a referral centre kwa hospitali kati ya 4 na 8 za wilaya.
-Specialized hospitals serve several regional hospitals.
 
Hapa kwa faida ya wasomaji ningeomba kufafanua mchanganuo huo ili uweze kueleweka vizuri

Communicable diseases
Ni maradhi yanayoambukiza. Kwa mfano, kuhara, kuhara damu, kipindupindu,TB n.k.

Perinatal inaamanisha kabla ya baada tu ya kuazaliwa.
Hapa wanaongelea maradhi yanayoambatana na ''uzao'' kwa vichanga

Non communicable
Ni maradhi (siyo magonjwa) kwa maana kuwa hayaambukizi bali yanatokana na sababu zingine. Mfano Kisukari, ugonjwa wa moyo, kifafa, sickle cell n.k.

Nutrition ni maradhi yanaotokana na lishe. Hapa napo kuna ufafanuzi.
Kuna kitu kinaitwa malnutrition ikiwa na maana 'mal=mbaya' na nutrition(Lishe)
Hivyo Malnutrition ni Lishe mbaya.

Lishe mbaya ni tofauti na upungufu wa lishe.
Ukimuona mtu amejazana kama pipa ile ni malnutrition kwa maana ana lishe mbaya. Na ukimuona amekoandeana ana malnutrition kwa maana ile ile lishe mbaya

Tukiongelea maradhi ya 'nutrition' tuna maana ya malnutrition ambayo inaweza kugawanyika sehemu mbili, Kwashiokor ambayo ni upungufu mkubwa wa viini kama protein, tofauti na marasmus ambayo ni upungufu wa lishe

Tofautisha hapa, kimoja unakosa essential nutrients kingine hupati right amount

Undetermined diseases
Ni maradhi ysioyoingia katika makundi hayo ikiwemo vitu kama kichaa cha mbwa

Injury hapa si kuanguka tu, ni ajali zote ikiwemo ajali za nyoka au zinazotokana na majanga ya asili, maoromoko n.k.

Maternal Hapa inahusu akina mama ambao huweza kukabiliwa na changamoto zinazotokana na uja uzito kama upungufu wa damu anemia n.k.

Ni katika kuweka kijimwanga ili tuweze tufuatilie majadiliano kwa urahisi

Turejee katika mada
 

Bado nipo very calm.

Nimekupa majedwali, jibu maswali.
Angalia bandiko lako # 38. Halafu ndiyo ujibu maswali. Bandiko hilo linazungumzia allocation of funds. Kwanini unatapatapa? Kaa kwenye mstari.

1. Kwanini Ukerewe inaallocate hela nusu ya Nkasi kwenye dispensaries?
2. Kwanini Ukerewe inaallocate more kwenye hospitali ya wilayani?

Hao ndio wa kuwaambia, wanadil na allocation kwa sababu hizo takwimu zinaonyesha dhahiri jinsi halmashauri zilivyo na allocation powers.

Usibishe kwa kuniletea vimeo zaidi, they don't mean squat to me.
 

Hivi kumbe upo hapa kubishana. Ndio psychological tactic mnayofundishwa Lumumba? Hapa tupo kujadiliana.

Unakimbia hoja ya msingi kwa sababu unajua hauna hoja yenye mashiko. Unajadili masuala ambayo hayana umuhimu wowote na tumeeleza hilo kwa kina. Akili ya kawaida ilitakiwa ikusaidie uelewe kwamba most of the funds zinazoenda LGAs zinatoka serikali kuu, na zinafuata allocation formula determined na serikali kuu. Hapo juu nimeeleza mapungufu ya mfumo huo, tena kwa kwenda huko huko kwako kwenye suala la 'allocation'. Hoja imekulemea unaanza ku panic.

Tutafika tu taratibu. Nikuulize - kipi muhimu zaidi katika kuboresha maisha ya wananchi, je ni kwa halmashauri kuwa na allocation powers au kuwa na taxation and revenue powers?
 

Asante kwa ufafanuzi mzuri Nguruvi3
 
Asanteni wachangiaji wote, mimi nachota tu elimu na kwa kweli kwa kipindi hiki kifupi nimejifunza mengi tu ila naomba mvumiliane, mjue mnasomwa na watu kama mimi. Hii mada ni muhimu sana na ningeshukuru kama mjadala huu ungeweza kuwafikia wahusika popote walipo serikalini...both Central and Local govts. Na kwa Mchambuzi asante kwa hoja makini pamoja na viambatanisho, kwa Kobello asante kwa hoja chokozi, zinakoleza mjadala na kwa Nguruvi3, hoja zako zinafikirisha...hivyo endeleeni tafadhali, tupo tunaofuatilia.
 
Kuwa na taxatibn powers ...
OK twende slowly, mind you tunajadiliana kuhusu vertical allocation of funds. Bandiko lako #38 linazungumzia allocation, au nimekpsea?

Fungu LA serikali kwenye sekta ya Afya ni asilimia 18 tu. Yaani 18% ya hela za afya za LGAs hutoka serikali kuu (That is not "most"). Na serikali kuu imetoa guidelines kuhusu mgawanyo ambapo 50% can be allocated to health centers na dispensaries.
Hii siyo sheria na halmashauri nyingi tu zina allocate up to 70% kwenye dispensaries na health centers.

Pia, pamoja na kuwa si kweli most of funds zinatoka serikalini, most of funds hazitoki halmashauri, ni 16% only.

Tatizo LA fedha lipo sekta zote, tunajua kuwa kodi zote hazitoshi Hata tumeamua kutoa 30% ya budget kwenye afya, bado hiyo ni kama 4bn$ na haitotosha. Hili hakuna ubishi.

Tunazungumzia bandiko lako #38 ambalo linachambua mfumo wa afya (politically).
Mpaka sasa:
1. Three tier analysis yako nilikuwa na kasoro kwa sababu haikubainisha responsibility ya LGAs.kwenye primary care.

2. Umedai serikali ndiyo source kubwa ya mapato, hii si kweli. Serikali hugharamia 18% of total healthcare ya halmashauri. Na haina sheria ya kulazimisha mgawanyo.

3. Nimekuonuesha jinsi Ukerewe inavyotoa 22% compare to Nkasi 42% na Mbinga 62% kwenye primary healthcare. Hii kukuthibitishia tu kuwa halmashauri zina allocation powers.

4. Nimwkuuliza data zako za bandiko #38 ulipozitoa, kwamba asilimia 75 inatumia primary health centers na clinics, wakati 25% inatumia za rufaa.
Je, what role hospitali za mkoa zinaplay? Hukuainisha role ya Ofisi ya rais tawala za mikoa kwenye afya na especially primary healthcare. What about them?

Sasa ukitaka watu wanyamaze inakuwa unakosea kwa sababu hizo flaws katika maandishi yako ni laza zijibowe, may be you purposely omitted or added something to stress a point, that's okay but just say it.

PS: Tusiende kwenye vijembe kuwa Mimi nimetumwa. Hatutafika popote cos I will hit back.
 
Mchambuzi said:
Unazipa serikali ngazi ya halmashauri 'Spending Powers,' lakini unawanyima 'Taxation Powers'. Ni aidha wanaotuongoza hawana akili sawa au umaskini wa watanzania ndio mtaji mkuu wa CCM.
Click to expand...
Ndipo mantiki ya hoja ilipo na mfumo mzima unapokuwa dhaifu huyo Kobello ata hilo bandiko lake alilolileta linaelezea concerns hizo hizo unazoongelea kutokana na uwezo wa halmashauri na local demographic. Kwenye hiyo research wanakiri hakuna available facts to pin point exactly the causes of death to conclude the health inequality ya mfumo mzima.

Kwanini waseme hivyo in essence if you are serving twice number of people to some other district in comparable you might also need twice the amount resources from primary care units, professionals and capital budget. Pungufu ya hapo services zinaweza kuwa stretched and therefore increase the level of limited access to primary care in some are and high levels negligence which are responsible for unnecessary causes of death (na kuna repoti zinaonyesha hivyo large number of death occur in urban areas ata huko kwa wazungu pia kwa sasa kuna nchi zina mgomo na junior doctors kwa sababu wanalazimishwa kufanya kazi wknds kutokana na research kubaini siku vifo vingi utokea kutokana na ukosefu wa wataalamu).

The whole thing need overhauling kwanza ata hao DMO kumbe for the most part they have to comply with central health objective all they do is to facilitate provision of health services locally na kuwachiwa mzigo wa kuongezea budget (hapo ni kama serikari inakimbia vipaumbele vyake vya afya in terms of directly investing).

Kwa mantiki hiyo watu wakisema kuna uhaba wa zahanati na wao awana hela ya kutoa au wakisema kuna uhaba wa wataalamu ambao central government is responsible kuwapatia unajiuliza kuna philosophy yoyote huko juu ya afya ya watanzania maana hivyo vitu vina complement each other. Kwa sasa sera ya afya ni sanda kalawe mwenye kupata apate na mwenye kukosa akose kutotana na uwezo wa jimbo alipo mgonjwa; the whole thing lacks morality.
 
S
Since you mentioned my name, ngoja nitoe maoni yyangu.
Cuba ina afya bora kuliko US. Siyo sababu ya funding, Bali policy.

Tuweke funding pembeni kwa sababu, pamoja na umuhimu wake, planning ni kitu muhimu.
Unaposema taxation powers za halmashauri ni ndogo, Je taxation power zikipelekwa halmashauri unareuniondhani wilaya kama ya Kasulu itakusanya kiasi gani? Na wilaya ya Mbinga itakusanya kiasi gani?
Una data za kueleza jinsi halmashauri hizi zinakosa fedha kwa ajili ya kutopewa Uhuru wa kukusanya kodi?
Usililie Uhuru wa hukusanya tu. Uhuru wa kugovern ni muhimu pia kwa halmashauri. Kuna mikoa, tax base yake is almost nothing.Income ya watu is barely subsistent.
Lakini I'm giving y'all a break ... Let's say allocation siyo muhimu. Nimeweka data on per capita basis.

Kwanini bado kuna halmashauri zinaallocate pesa kidogo kwenye primary care? Is that a "money" issue?
Tell me.
 
Kobello said:
Kwanini bado kuna halmashauri zinaallocate pesa kidogo kwenye primary care? Is that a "money" issue?
Tell me.
Click to expand...

Ntajibu swali na swali

Some where along the lines of the paper which you have quoted they mentioned LGA being required to adapt and implement 'STANDARD TREATMENT GUIDELINES' technically it means regardless on how local policies are planned in the end they should meet the end goals of government desires that is the national framework (ndio maana hiyo karatasi pia likaitwa devolution of health systems).

Sasa unless unaweza kuelezea government threshold to every citizen in budget kwenye hivyo vipaumbele vyake, au walau justify local expenditure to Fair Access on Care Services’ kama wanao huo uwezo to meet the national requirement na kama halmashauri hazina hiyo hela ya kufikia malengo ya sera sasa ina maana gani na akina nani wanaoathirika?

Jumlisha na changamoto za investment in amount of primary care units let alone secondary care units to meet demand access za hiyo sera unadhani halmashauri zote zinaweza fikia vipaumbele vya serikari maana hata hiyo DMO inatakiwa izingatie hivyo vitu kwenye budget yao ndio maana ata unao wa quote wanashindwa kuitimisha ubora wa system kutokana na kwamba hakuna details za data ku analyse magonjwa ambayo primary care wanatikiwa ku intervene pamoja na causes of death data to conclude..

Common sense tu hiyo national policy inatekelezeka vipi kwenye level za halmashauri bearing in ming standard treatement guidelines kama sehemu kubwa inategemea mapato yao wakati kuna variation kubwa kati ya halmashauri na halmashauri isnt that the reason wabunge kila siku wanaulizia wataalamu, zahanati kukosekana vifaa tiba na basic supporting; na kila siku jamaa wanakuja na porojo ya vipaumbele vyenu huko sasa si ndio kukimbia majukumu yao.
 
You must log in or register to reply here.
Menu
Log in
Register
Cookies are required to use this site. You must accept them to continue using the site. Learn more…