By Adrienne Brown, World Health Organization

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Central funds The first disbursement to central activities was made in December 1999, under the following system. The MoH requests the Basket Financing Committee to approve the release of funds for activities costed in the agreed Plan of Action. If approved, this is passed to the Ministry of Finance who request forex transfer from donors. Donor funds are merged in a joint Holding Account in the Bank of Tanzania (BoT), converted by BoT into Shillings, and placed in the Consolidated Fund, where they are merged with Government of Tanzania (GoT) funds.

One donor76 suggested that both donors and government were guilty of ignoring the issue and pushing it further down the line because no one wants to admit it is a 'killer assumption' that could seriously disrupt the reform programme. At the same time, it is encouraging that the MTEF is providing an increasingly rigorous framework in which these resource discussions can take place. Efforts to include donor funds early in the budget cycle will allow for greater clarity in the definition of the resource envelope, as will the continuation of the Public Expenditure Review process which has helped to ensure that plans are resource-based and increasingly grounded in a more realistic expenditure planning process (See Box 6).

Again this is not legally binding but it is encouraging that GoT and partners have signed up to it as a way of resolving disputes. 2 Decentralisation Tanzania is undergoing a major programme of local government reform and decentralisation. This offers a particular challenge to developing and implementing a health sector reform programme through a sector-wide approach, because it will involve a major change in the way that government delivers health services: • • it will necessitate different relationships between the MoH and local government its development and implementation require a high degree of co-ordination between central Ministries.

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