INTERSECTORAL HEALTH ACTION IN TANZANIA – DETERMINANTS AND POLICY IMPLICATIONS

Purpose: The tremendous human resource and economic burden of HIV/AIDS, malaria and diarrhoeal diseases is well acknowledged in many developing countries. Most of these diseases have multifaceted causes such as malnutrition, the consumption of contaminated water or poor education. Thus, cross-sectoral action is needed to lower the burden of disease in the long run. However, little has been done to investigate the causal relationship between investments in ‘health related’ sectors and the reduction of disease prevalence. 

Method: This paper aims at achieving two objectives: First, the marginal health returns to cross-sectoral government spending are quantitatively analysed for the case of Tanzania. For this, the normative assumption is to maximise the amount of Disability Adjusted Life Years (DALYs) saved per dollar invested. A Simultaneous Equation Model (SEM) is developed to estimate the required elasticities. Second, the challenges and opportunities of Intersectoral Health Action (IHA) in practice are evaluated qualitatively. This is done with the help of semi-structured interviews with key stakeholders of government and non-government institutions. 

Result: The results of the quantitative analysis show that prevalence of diseases is positively associated with nutrition, access to safe water sources, sanitation, education and income. The highest amount of DALYs can be averted by improving nutrition and access to safe water source, followed by sanitation and education. The qualitative analysis shows that certain preconditions have to be fulfilled for successful intersectoral collaboration for health. 

Conclusion: If Tanzania seriously wants to reduce it’s burden of disease, this study suggests to put more weight on the allocation funds to the agriculture, water, sanitation and education sector. As the example of the handwashing initiative shows, some first steps have been made in this direction.