MONEY MATTERS IN HEALTH & TECH : The road towards universal coverage

Health is a fundamental human right. However, in many developing countries including Tanzania, access to health care services varies depending on individual income. People living in urban areas have the advantage to access medical services in comparison to those residing in rural areas.

To bring equity in access to quality health services by all people, World Health Organization together with member nations introduced the concept of Universal Health Coverage- (UHC).

Universal Health Coverage is meant to ensure that all people get access to health care services they need, the services of standard quality and most importantly, the healthcare services they receive should be affordable.

Tanzania like other WHO member nations is struggling to attain this goal by 2030. There comes a question, how will she attain this goal? With many other factors put into consideration, for our country to achieve Universal Health Coverage, a reliable health financing system is highly required.

International organisations are also showing commitment to ensure that there is such a comprehensive framework accross the continent.

It was announced earlier this month that The World Bank and the Global Fund to Fight AIDS, TB and Malaria committed to invest US$24 billion for health in Africa over the next three to five years. This is a positive thing that indicates progress in developing Africa.

As a strategy towards universal health coverage, the government is focusing on strengthening health financing system by introducing a health financing strategy (HFS).

This strategy aims to have established an efficient architecture of funding for health by 2025. This goes with increasing domestic financing thus reducing dependency on foreign financing.

This new health financing strategy of year 2015-2025 has come-up with a number of specific goals and ways to attain them, including the introduction of Single National Health Insurance. We will come to this later, but let’s see the current situation in health financing.

The government continues to depend on foreign aid significantly to fund health care services. This is making healthcare financing unstable. Having an unstable health financing means unstable healthcare service provision.

Currently, there are different health insurance schemes operating in Tanzania, to mention the few, CHF/TIKA, NHIF, and NSSF-SHIB. These schemes have failed to increase accessibility of health care services. The schemes favor more people who in formal sector leaving aside the majority who are in the informal sector. It is said that about 22 percent of Tanzanians have health insurances and in additional to this, the majority of them are working in formal employment.

There is very little community sensitization regarding the importance of health insurance schemes compared to out-of-pocket payment system.

Poverty and the lack of commitment by policy makers are just a few among many factors that contributed to poor coverage and performance of these insurance schemes.

With all this being put into consideration, the government has come up with new HFS.

It is this strategy that proposes an expansion and consolidation of health insurance around a new mandatory SNHI programme.

Yes, under this scheme, all Tanzanian citizens are expected to participate through contribution payments.

The poor and vulnerable will be identified, based on the national socio-economic targeting mechanism like the one applied by TASAF, and they will receive full subsidisation.

According to the plan, additional resources from government revenues including new tax levies as necessary, and continuing external development partner funding sources will be combined (or pooled) into SNHI.

This insurance may be one of the key aspects in the efforts towards universal health coverage in our healthcare system. We hope that the poor and the marginalized citizens shall have an opportunity to access and utilize quality health care services to the fullest.

However, care must be taken when implementing this health insurance scheme. The lessons learnt from existing health insurance schemes must be fully applied to mitigate the risk of failure.

My main concerns regarding this is on identification of poor and modality of contribution payments. How efficient and effective will identification of poor be? Whenever people are forced to contribute money, problems always emerge.