- But her story is not isolated. In Tanzania, 51 per cent of the country’s population is made up of children. Not all have the health insurance they need, according to the Executive Director of the National Health Insurance Fund (NHIF), Mr Benard Konga.
When Abigal Mbupu heard a recent public announcement on a new child health insurance scheme, ‘Toto Afya Kadi’, it was a moment to reflect on the exorbitant costs she had incurred in the past for her child’s healthcare.
But her story is not isolated. In Tanzania, 51 per cent of the country’s population is made up of children. Not all have the health insurance they need, according to the Executive Director of the National Health Insurance Fund (NHIF), Mr Benard Konga.
The government has now embarked on a project to prioritise children in health insurance schemes because they are the most vulnerable to diseases. The plan is to register 50 per cent of all children in the country by the year 2020, says Mr Konga.
Down the memory lane
Stories of families undergoing high costs of healthcare due to lack of health insurance are many and for Ms Mbupu, 29, the recent announcement on child health insurance initiative evoked her memories.
She tells Your Health, a van passed near her home in Tegeta, Dar es Salaam and a loud announcement which came from it, alerted her to what she had been longing for—the health insurance scheme for children aged below 18 years.
But the scenario reminded her of when she once spent over Sh600,000 in less than a week to ensure that her child got healed of high fever emanating from an infection.
It was one hectic Saturday night, she says. Her daughter, aged three months at that time, was feverish. She had developed rashes all over her body, with high temperature.
“My husband and I couldn’t wait for the next morning. We decided to rush our child to a private dispensary,’’ recalls Ms Mbupu, a business woman based in Dar es Salam.
When her daughter was examined at the dispensary, health workers advised that she should be referred to Muhimbili National Hospital (MNH), but, she says, “My husband and I opted for a nearby private hospital.”
Her temperature was now reading 42.9 degrees Celsius, she further recalls. According to doctors, the normal body temperature should range from 36.5 to 37 degree Celsius.
On top of the family’s hectic rush for healthcare, another challenge cropped up—the catastrophic health cost.
“After the diagnosis and all medical treatment, the medical charges amounted to Sh600,000. This was too high for us,’’ she tells. “When we complained, the doctors advised us to register for health insurance,” she added.
“This scenario means that someone or a family that couldn’t afford Sh600, 000 could face losing a baby,’’ she explains.
A sigh of relief
By the time Ms Mbupu spoke to Your Health recently, her daughter, Laziline, was already one year and five months old.
Ms Mbupu had camped at Mnazi Mmoja grounds in the city, with hundreds of other parents who had gone to register for an initiative that would enable children to access medical treatment at an affordable cost of Sh50,400 annually.
For other parents like Mr and Mrs Elia, the health insurance scheme means that a family with a large number of children can take care of any health costs, regardless how many they are.
Mr Elia recalls, “There was a time when all our three children had a prolonged cough for two weeks and their body temperatures were frequently high, it was difficult to take them to the clinic all at once. We opted to give them pain killers because we had no money,” he says.
He further narrates an incident where the family couldn’t afford antibiotics because all their savings had been depleted.
“We later received money from one of our relatives living abroad, that’s when we took the children to the hospital,’’ he tells Your Health.
Children are vulnerable
Most people in developing countries including Tanzania do not have a culture of saving for medical treatment, says the Chairman of Regency Medical Centere, Dr Rajni Kanabar, who is one of the private healthcare providers implementing the child health insurance scheme.
Currently, the national health insurance coverage stands at about 30 per cent, the rest of the population relies on the out of pocket payment system when they want to access health services, government data show.
If the public is well educated on the matter, many families can take it up. “We started ‘Toto Afya kadi’ as a pilot project last year, and so far we have registered more than 50,000 children, this shows the demand is high,” he says.
Dr Kanabar told Your Health that the service had come at the right time because not every Tanzanian can afford the cost of medical treatment through paying cash.
Now that it has been found to work, the NHIF Administration Officer Mr Luhende Singu says more families are now being encouraged to enroll.
He says, the registration process is being done through various campaigns, including reaching out door to door.
The card holder can get information from any NHIF offices and currently the NHIF is using various platforms to ensure information is accessible in market places, schools, churches and mosques.
He says the government’s decision was a good strategic plan to help low income earners.
Affordability and ease
The Minister of Health, Community Development, Gender, Elderly and Children, Ms Ummy Mwalimu recently asked the National Health Insurance Fund (NHIF) to allow parents and guardians to pay for insurance on a three-month instalment basis rather than the full amount of Sh50,400 at once.
“Most Tanzanians can’t afford to pay full sum of Sh50,400 at a time, creating good environment of paying the fee between three and four times per year ‘for three months’ will make them respond to the service and register their children and improve their health,” she said.
Ms Mwalimu believes that an additional initiative, to be dubbed: “Mama na Mwana Afya Kadi” would enable pregnant women to access better healthcare.
Ms Mwalimu said that the National Bureau of Statistic (NBS) has confirmed the current statistics of Tanzania, “the country population has so far reached 52 million whereby 26 million were children under 18.
“Our target is to reach every child and every person must have access to health insurance by 2020, “urging parents to register their children for medical insurance.
But ... there is still an existing gap
Under the current situation, only the formal employees in the country can enjoy health cover.
As long as one is employed, then he/she is entitled to a generous package of healthcare from the government and accredited non-state providers.
Their spouses and four children are also included.
But for the 90 per cent of people who work in the informal sector, the government’s commitment to their health coverage is still very limited. Such people are forced to dig out of their own pockets in times of sickness.
People in the informal sector rely on the Community Health Fund—and the more recently introduced urban equivalent—Tiba Kwa Kadi (Tika), which was set up with assistance from the World Bank about a decade ago.
The World Health Organisation has once cautioned that a split between formal and informal populations can delay more fundamental reforms to reach citizens at scale.
According to the World Health Organisation (WHO), a country must set a minimum of $30 to $40 (which is equivalent to Sh60,000 to 80,000), per person, in order to be able to provide a minimum healthcare package.
A practical approach
Closing the gaps in the delivery of health services, such as providing healthcare to vulnerable children would help the country achieve Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs).
As the government prepares the ground for universal health coverage, two points will remain relevant for the success of universal healthcare in Tanzania, says Dr Fredrick Haraka, a research scientist at Ifakara Health Institute (IHI).
“First, the human resource for health, the government will need to scale up the uptake of healthcare professionals across different cadres in order to meet the demand,’’ he says.
“Secondly, the government will need to strengthen primary healthcare facilities which are indeed the first point of healthcare contact for the majority.”