Universal health coverage plan on track: minister

Dar es Salaam. Health minister Ummy Mwalimu has said the Universal Health Coverage (UHC) Bill will be read in Parliament for the second time on January 31, 2023, with the new arrangement expected to come into effect on July 1, next year.

MPs will debate the Bill following its second reading after which Parliament is expect to pass the proposed law, signalling the end of a process that began 16 years ago.

The second reading was postponed last month due to a number of reasons, including lack of funds for sustaining procedures and the need to accommodate the views of stakeholders across the board.

The second reading will come with major changes, including removal of conditions that were made mandatory for someone to have health insurance in order to access services such as travel documents, Taxpayer Identification Number (TIN), Simcard registration and national ID.

The changes will include introduction of two insurance covers, including one that will enable beneficiaries to receive treatment at public and private hospitals all over the country.

The second will comprise special insurance with a basic bundle that will enable beneficiaries to be treated at dispensaries, health centres and district hospitals at costs of between Sh50,000 and Sh60,000.

Ms Mwalimu disclosed various issues related to UHC during a recent exclusive interview with The Citizen.

She said the UHC Bill would be resubmitted in Parliament after incorporating stakeholder’s opinion.

“We are returning to Parliament in January, next year, after initially getting stuck. We are proposing the UHC Act to come into effect on July 1, 2023,” she said, adding that the government plans to take the issue step by step.

“People in the special groups will be reviewed and the number of those joining the service individually will be reduced in order to encourage groups of people in households to join the scheme. This will make it possible for people who are unable to contribute to be supported by their families,” added Ms Mwalimu.

She said next year, the ministry’s priority would be to improve the quality of services provided in public and private hospitals, as well as funding healthcare services to ensure that Tanzanians get quality services without any financial restrictions.

Faltering

Ms Mwalimu, who is also the Tanga Urban Member of Parliament, said the UHC process started 16 years ago in Tanzania, and got a boost through the Sustainable Development Goals (SDGs).

She said ensuring that citizens are able to access quality health services without financial hindrances and making healthcare services readily available was made mandatory for all countries.

“However, the UHC process gathered momentum in 2016 during the Fifth Phase Government. Some documents were prepared, this time to meet country procedures for formulation and enactment of the new law.

“Procedures require the process to involve the Cabinet, experts, stakeholders and a committee of professionals of permanent secretaries under the Chief Secretary,” added Ms Mwalimu.

Furthermore, she said the document was for the first time submitted before the Cabinet in 2021, noting that it was resubmitted in September 2022 after working on ministers’ views.

“Thereafter, we were given the green light to proceed with the process of preparing the Bill that was tabled in Parliament. It was debated by the relevant committee that also provided significant input,” she said.

According to her, the Bill that was due for the second reading in November 2022 was withdrawn from Parliament to pave the way for accommodation of opinions that were gathered from various stakeholders.

“I’m happy to inform the public that the said views have been accommodated. We are ready for the Bill’s submission next January,” she said.

Passionate debate

Ms Mwalimu said UHC has been the subject of passionate debate in developed countries, including the US and the UK, noting that the same has been the case in Tanzania.

“This is because UHC has been confirmed to be the only avenue for the rich and the poor to equally access quality health services. However, models of implementation remain a huge challenge,” she said.

Ms Mwalimu also said that attracting contributions from healthy people and people who are not sick was another headache following lessons learned from the National Health Insurance Fund (NHIF).

According to her, 90 percent of public servants who joined the fund compulsorily spent up to three times their contributions for treatment.

Ms Mwalimu said ongoing consultations between the government and stakeholders were another reason for delaying the Bill.

“These consultations have led to the removal of some conditions that made it compulsory to have health insurance in order to access several services, including travel documents, business licences, national IDs and TIN numbers,” she said.

Ms Mwalimu added that including TIN number in the list of conditions would impede tax payment and revenue collection, therefore negatively affecting government operations.

According to her, students’ admission in Form One and Form Five could be seriously affected if the condition that requiring selected students to have insurance cover would remain unchanged.

“This condition was common in colleges and higher learning institutions. However, we have discovered that respective institutions are not making better use of the collected money,” she said.

Strong stakeholder’s opinions

According to the minister, the need to include financial challenges was another issue which stakeholders dwelt on.

“However, this is also an international requirement that prohibits the ministry from making independent decisions. The ministry had to involve the Ministry of Finance because 2012 statistics show that 26 percent of Tanzanians are living below $1,” she said.

“Some people could use the loophole and mislead the public that the government has introduced a new levy, something that could be a huge blow, considering the fact that inadequate education has been provided to citizens,” added Ms Mwalimu.

The media has played an important role in allowing debate relating to UHC, something that got the attention of opposition political parties who included the issue in their policies despite being in the CCM election manifesto for a long time.

“However, the UHC is a process. It has taken 100 years for the US to debate the issue. We have found it necessary to start executing the law and make assessments in future,” she said.

Secondly, she said it was proposed that a procedure should be designed to enable those lacking financial capabilities to be given cards whose contributions have been exempted.

However, MPs suggested the need to introduce a fund whose contribution will come from levies from offenses made in alcohol, sugar and cigarette businesses.

Citing decisions made by Ghana, she said they decided to take 2.5 percent of the Value Added Tax (VAT) to the fund, noting however that Rwanda was doing better.

Furthermore, she named other issues that were highly debated as the amount to be contributed especially basing on the NHIF experience that has been providing services to 4.8 million beneficiaries.

“Opinions say that beneficiaries should choose insurance services provided in public and private hospitals and the amount to be contributed. Also, beneficiaries will be allowed to pay a maximum of Sh60 million to access health services in dispensary, health centres and district hospitals through a special insurance bundle,” she said.

During the interview, Ms Mwalimu was categorically saying that the service will not establish criminal offenses to people who will not join the UHC, refuting claims that failure to join the service could subject someone to criminal charges.

“This will unnecessarily increase the number of people in prisons. It is important that citizens should assess themselves and make decisions between spending a large amount of money for treating themselves through cash and or enrolling themselves in insurance covers,” she said.