TANZANIA — The Health Promotion and System Strengthening (HPSS) program, driven by the Innovative Health Community Fund (iCHF) Project, has played a transformative role in bridging the insurance coverage gap in Tanzania.
Underpinned by the Swiss government’s support and expertly executed by the Swiss Tropical and Public Health Institute (Swiss TPH), this initiative has successfully enrolled over four million Tanzanian citizens into an accessible and affordable health insurance system.
This initiative marked a significant partnership with the Ministry of Health and the President’s Office – Regional Administration and Local Government, as HPSS played a pivotal role in the transformation of the Community Health Fund (CHF) into a fully functional health insurance system.
Simultaneously, it has introduced an innovative procurement channel for the government, addressing medicine supply gaps with agility.
HPSS’s comprehensive approach extends to strengthening the healthcare system sustainably, offering technical support, digital solutions, and data-driven policy decisions through operational research.
The project also placed a strong emphasis on the maintenance of medical equipment and the empowerment of communities to actively engage in health promotion.
Ally Kebby, HPSS Project Manager, expressed pride in the project’s 12-year journey, stating, “HPSS has made healthcare more accessible, affordable, and effective for all Tanzanians, regardless of their circumstances, and has had a major impact on improving people’s health and wellbeing.”
Dr. Ntuli Kapologwe, Director of Health, Community Development, and Nutritional Services at PO-RALG, lauded HPSS for implementing innovations that have significantly benefited the entire nation, underlining the project’s pivotal role in systemic healthcare improvement.
Manfred Stoermer, HPSS Project Director, emphasized the crucial role of a robust and resilient health system in achieving sustainable enhancements in healthcare delivery and public health.
Bridging the insurance coverage gap
In Tanzania’s determined journey towards achieving universal healthcare, a longstanding challenge has been the inadequate coverage of health insurance among its citizens.
For decades, this issue has loomed over healthcare accessibility, with only 15% of Tanzanians (of which 8% are under NHIF) being covered by health insurance by the end of 2021.
This stark decline from the 32% coverage reported in 2018, with 21% covered by the Innovative Health Community Fund (iCHF) and 3% under private schemes, has been a cause for concern.
Presently, health insurance contributes a mere 12% to the Total Health Expenditure (THE) in Tanzania, while the primary responsibility for healthcare funding falls on out-of-pocket payments (34%), government funding (24%), and donations (32%).
However, amidst this complex healthcare landscape, a glimmer of hope emerged in 2022 as the government put forth a proposal for mandatory health insurance.
The aim was to encompass the vast informal sector and fortify healthcare financing. Nonetheless, the path was riddled with challenges.
The Bill designed to establish mandatory Universal Health Insurance (UHI) and the Tanzania Insurance Regulatory Agency (TIRA) faced not one, but two, parliamentary withdrawals.
The heart of the controversy centered on the proposed annual premiums of 350,000 TZS (∼US$150) for a household of six or 150,000 TZS (∼US$65) per person, alongside a vague definition of entitlements for beneficiaries.
To boost enrollment, the Bill recommended that all citizens must furnish evidence of health insurance when applying for a driving license, motor vehicle insurance, or enrolling children in advanced secondary schools or higher education institutions.
However, this enforcement strategy raised concerns about potentially further marginalizing economically disadvantaged citizens who are less likely to own vehicles or require driving licenses for admission to higher learning institutions.
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