Health insurance cover for all people a huge challenge

Thursday January 28 2016

Nurses attend to patients at a local hospital.

Nurses attend to patients at a local hospital. A significant number of Tanzanians are not on medical aid. But that could change if a new plan by the government is rolled out. PHOTO | FILE 

By Syriacus Buguzi @buguzi

Dar es Salaam. The government’s new plan to introduce health insurance for all Tanzanians is seen as a game-changer in the country’s healthcare financing system but healthcare planners and stakeholders are raising questions on how the plan would be implemented.

Some of the planners and insurance stakeholders are of the view that the new strategy may take “too long to yield results” due to financial hurdles that Tanzania is currently facing--especially in the health sector.

The Ministry of Health, Community Development, Gender, Children and the Elderly is expected to table a Bill in the National Assembly, aimed at making it compulsory for all Tanzanians to enroll on the medical insurance schemes.

If the Bill is passed by parliament, it means that all Tanzanians—from the formal and informal sector—would now be required by the law to access prepaid health services at health facilities across the country, the Health Ministry said.

Currently, only 20 percent of all Tanzanians have access to health insurance. The rest, at least 36 million people, rely on the out of pocket payment system to access healthcare services, according to data released in the National Assembly last year.

Under the current situation, only the formal employees 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 percent 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.

The World Health Organization has once cautioned that a split between formal and informal populations can delay more fundamental reforms to reach citizens at scale.

Now that the government wants to extend the health cover to all who have always missed out on the service, some experts believe the plan won’t succeed overnight—and it may require strong political will under the current financial circumstances.  

Dr Samuel Ogillo, a healthcare planner and CEO of the Association of Private Health Facilities Tanzania (APHFTA) noted recently that the government would be required to stretch its healthcare budget in order to make the plans effective.

According to the World Health Organization (WHO), a country must set a minimum of USD 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.

According to Dr Ogillo, the adoption of such best practices proposed by the WHO, goes hand in hand with the growth of the country’s economy, healthcare infrastructure and human resource capacity.

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.

It is a voluntary pre-payment scheme with an annual membership fee of Sh5, 000 – 10,000(US$3-$6). Member contributions are matched by government at district level but the benefits are much less than those offered under the National Health Insurance Fund(NHIF) because expensive hospital care is not covered.    

Dr Ogillo argues that the government should not expect a “miracle” to happen through the [current] Community Health Fund(CHF), where people in the informal sector contribute an average of Sh10,000 for health cover.

“For instance, when a family of six contributes Sh15, 000 annually, and the government and the government pays the same amount as matching fund, making it Sh30,000 per family of six, it is very little contribution but still it could be a good start,’’ says Dr Ogillo.

He argues that for a country such as Tanzania to achieve Universal Health Coverage (UHC), at least 90 percent of the country’s population must be covered.

“[But with a little contribution], Tanzania may still need stronger government commitment and donor support,” he says.

Giving an example of Ghana, which has tried the same project in its healthcare reforms, Dr Ogillo believes that it would take a long time Tanzania to achieve the plans if all the people cannot raise enough funds.

“Ghana started their Universal Health Coverage journey with high expectations, just to realize that the plans were becoming [too ambitious to achieve],’’ he points out.

“The Ghanaian government had to quickly introduce additional taxes, including some additional tax cuts in the Value Added Tax (VAT), as a desperate measure to save the Health Insurance Fund from collapsing,’’ warns Dr Ogillo.

The Jubilee Insurance Company CEO, Mr George Alande, says that the government’s plan may be of benefit to the poor—who have always been  neglected in healthcare provision—but, he says, huge investments in public hospitals would be required if the government aims to provide quality services.

“Imagine if one has a health insurance card and goes to the hospital but he/she does not get the services that are already paid by the insurer. Discouraging, doesn’t it?’’ says Mr Alande.

A researcher on healthcare financing based in Dar es Salaam, Dr Edward Komu sees gaps in the provision of sustained education to the local communities on the importance of health insurance.

“The key thing is to make sure that citizens are adequately informed about health insurance and that they are involved in the implementation of the plans,’’ he says.