THINKING ALOUD: Treat NHIF as precursor to universal health coverage

Thursday October 11 2018

Professor Zulfiqarali Premji

Professor Zulfiqarali Premji 

Almost invariably, countries across the world aspire for universal health coverage (UHC) for their people. Under the UHC system, citizens access virtually all the healthcare products and services they need without themselves “suffering financial hardships.”

Essentially, UHC is NOT about sharing healthcare budgets. It is about redistribution of a country’s wealth for the healthcare of all the citizens regardless of their status in society.

UHC is one of the UN’s 17 sustainable development goals (SDGs) intended as an equalizer between rich and poor in healthcare.

Usually, national health insurance (NHI) is one way of implementing UHC. Under NHI, the rich subsidize the poor; the working young subsidize the old; urbanites subsidize rustics, and the healthy subsidize the sick…

I strongly believe that this is how Tanzania can achieve UHC –and I’d be more than happy to learn of any other way in which we can do that.

If Tanzania is committed to attaining UHC, then it has to surmount any and all barriers in its way – including some private hospitals.

Indeed, a large number of private hospitals accept NHI cards regardless, providing medical products and services to card holders – although there are a few private hospitals that do not accept NHI members.

These latter give all manner of reasons seeking to justify their non-conformity with the national vision. In my opinion – for what it is worth – such hospitals should not be tolerated, and the Health Ministry should put a full stop to this immediately.

Unfortunately, such private hospitals continue to blatantly operate for some reason or an(other) – and the song ‘best practices’ is nothing but rhetoric at its best.

A free market economy does not mean that the national vision and goals should be compromised. Try to do anything that is against the laid down policy guidelines in a truly free market economy like Canada – and you would be abruptly stopped in your tracks, and be heavily penalised for that on the spot!

Why a country like Tanzania should tolerate such open violations is something to wonder about.

Healthcare is a very sensitive area within society, and it should be treated with utmost caution. When private hospitals are ‘made’ to serve the few rich elite, this invariably creates classes within the citizenry – and is of little or no help to national healthcare. In theory, non-governmental organizations (NGOs) are de facto the best institutions to provide social services to the poor. But, while I view this as heroic, it is nonetheless important to take time to deeply examine how NGOs are being used for political purposes, thereby trampling underfoot the national vision and mission.

The idea of ‘civil society’ is at the foundation of Western liberal thinking, with citizens and NGOs coming together on important issues and missions which represent the will of local communities. Yet, we still do have some private hospitals that are totally insensitive to local needs. What sort of ‘civil society’ is this, pray?

Such private hospitals operating in the name of ‘civil society’ are not accountable to their communities, and operate to transplant neoliberal ideology. They are a shrewd conduit of neoliberal policies and – if closely scrutinized, will be found to be of little or no help at all to the citizenry.

While, in the broader sense, the role of NGOs is beyond the scope of this article, it is nonetheless relevant to suggest that private hospitals should be revisited in terms of their functions, their charges, their staffing – especially expatriate staff – and many other salient features of their operations.

Currently, NGOs in Tanzania are in the process of re-registration. As such, this is a good time to re-examine the status and functions of private hospitals that do not accept NHI cards. But, my fear is that this may not happen deeply or far enough!

If the fifth phase government of President John Magufuli is serious in giving succor to the poor, then UHC should be of top priority. There should indeed be zero-tolerance for anyone or any institution that’s a barrier to achieving this cherished national goal.

The government should not leave its health agenda to free market forces as, by doing so, the poor will be the biggest losers – and will continue to suffer.

In healthcare matters, we do not need bureaucratic inertia. We do not need chronic lack of political will. We do not need perennial underfunding… Nor do we need to compromise with international NGOs that have a blueprint defining medicine as ‘a science dealing with the treatment of the wealthy and privileged, but a theoretical abstraction for the majority.

Finally, we do not need private hospitals that do not accept ‘NHI patients’.