Healthcare in Tanzania

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AIDS awareness sign in Dar es Salaam, Tanzania AIDS sign in Tanzania.jpeg
AIDS awareness sign in Dar es Salaam, Tanzania

Tanzania has a hierarchical health system which is in tandem with the political-administrative hierarchy. [1] At the bottom, there are the dispensaries found in every village where the village leaders have a direct influence on its running. The health centers are found at ward level and the health center in charge is answerable to the ward leaders. At the district, there is a district hospital and at the regional level a regional referral hospital. The tertiary level is usually the zone hospitals and at a national level, there is the national hospital. There are also some specialized hospitals that do not fit directly into this hierarchy and therefore are directly linked to the ministry of health.

Contents

The government has several key plans and policies guiding healthcare provision and development. The Health Sector Strategic Plan III (2009–15) is guided by the Vision 2015 [2] and guides planning for health facilities. [3] The Big Results Now (BRN) was copied from the Malaysian Model of Development and placed health as a key national result area and mainly was for priority setting, focused planning and efficient resource use. [4] There are many other policies aiming at improving the health system and health care provision in Tanzania.

The leading causes of mortality in Tanzania include: HIV 17%, lower respiratory infections 11%, malaria 7%, diarrheal diseases 6%, tuberculosis 5%, cancer 5%, ischemic heart disease 3%, stroke 3%, sexually transmitted diseases 3%, and sepsis 2% [5] and this shows the double burden of disease the country has to bear.

Health care financing

Health care financing is among the key component of a functional health system. [6] Financing involves three aspects, namely revenue collection, risk pooling, and purchasing. [7] In recent years, there has been a growing demand for access to high-quality and affordable care for all, thus the government is committed to respond with a process of developing health financing strategy [8] is underway since early 2013. An inter-ministerial steering committee has been developed, composed of key ministries and department to ensure that the proposed reforms meet the needs of the population. Improving the prepayment mechanisms are the main agenda in the development of the strategy, which is assumed to be a potential facilitator in the progress towards UHC.

The evolution of health care financing in Tanzania

The Arusha Declaration in 1967 was initiated by the president Julius Nyerere, outlining the principles of Ujamaa (Nyerere vision of social and economic policies) to develop the national economy. [9] It marked the start of a series of health sector reforms with the intention of increasing universal access to social services to the poor and those living in marginalized rural areas. Followed by the Government banning private-for-profit medical practice in 1977 [10] and took on the task of providing health services free of charge.

However, by the early 1990s, the strain of providing free health care for all became evident in the face of rising health care costs and a struggling economy. Early 1990s the government adopted health sector reforms that changed the financing system from free services to mixed financing mechanisms including cost sharing policies. Cost sharing in the form of user fees was introduced in four phases: Phase I from July 1993 to June 1994 to referral and some services in regional hospital; Phase II from July 1994 to December 1994 to regional hospital; Phase III from January 1995 onwards to district hospital and Phase IV introduced to health centre and Dispensary after completion of introduction to all district hospital. Exemption and waiver were integral part of the cost sharing policy introduced in 1994.

Health spending

Current data shows in Tanzania there has been an increase in budget allocation for health over the years: Total Health Expenditure (THE) increased from US$734 million in 2002/2003 to US$1.75 billion in 2009/2010 as indicated in the National Health Accounts 2010 report. However donors have been the main financier of health, despite the decrease in their share of health expenditure from 44 percent in 2005/2006 to 40 percent in 2009/2010. [11] (Table 1). Overall, the government allocation for health spending has remained almost constant at about 7 percent since 2002/2003, far away from reaching the Abuja declaration target of 15% of total government expenditure. The increase in donor funding is attributed to the commencement of financing for HIV and AIDS by the Global Fund in 2001 and the commencement of health financing through Sector wide Approach (SWAp) [12] in early 2000.

Table 1: Financing sources as a % of Total Health Expenditure [13]

2002/20032005/20062009/2010
Public25.428.126
Private47.127.834.5
Donors27.444.139.6

On the other hand, there has been a commitment to expand the insurance coverage in the country, however the insurance schemes are highly fragmented. [14] [15] There are four health insurance schemes which are publicly owned, namely National Health Insurance Fund (NHIF), [16] Social Health Insurance Benefit (SHIB) established as a benefit under the National Social Security Fund (NSSF) [17] and the Community Health Fund (CHF) [18] and Tiba Kwa Kadi (TIKA). Recent statistics shows that there were about 7 private firms as indicated in the Tanzania Insurance Regulatory authority (TIRA) [19] which were providing health insurance per se, while a few of other general insurance firms combine health insurance benefit under life insurance. [20]

In 2023, the Universal Health Insurance Act (UHA) was signed into law, mandating that all residents have at least a minimum level of health insurance coverage, from the NHIF or from other approved providers. [21]

Health insurance coverage

Health insurance coverage is still low in Tanzania. As of 2019, 32% of Tanzanians had health insurance coverage, of which 8% have subscribed to NHIF, 23% are members of Community Health Fund (CHF), and 1% are members of private health insurance companies. [22] Beneficiaries of NHIF includes the contributing members, spouse and up to four dependents. The CHF beneficiaries include head of household, spouse and all children below 18 years. Other prepayment schemes cover less than 1% of the population. CHF mainly focuses its coverage in rural population while private health insurance schemes target urban population. Low insurance coverage leads to over-reliance on direct payment at the point of use of health care, which is among the fundamental problem that restrain the move towards universal health coverage in many developing countries. [23] Direct payment can lead to high level of inequity, and in most cases denying the poorest access to needed health care. [24]

Back in 2001, the Government of the United Republic of Tanzania through the parliament came up with the Community Health Fund Act which after its adoption established the Community Health Fund, CHF. This by far and large was in the efforts towards the attainment of Universal Health Coverage. Having faced difficulties on how to make sure that people have a system in place on healthcare that would provide and cater for their health needs despite their geographical location and proximity to major cities where healthcare could easily be accessed.

The only pressing issue with CHF which it faces to date is low enrollment rate and early drop out in membership and hence a need for a more well-structured system which will be centrally coordinated for efficiency hence the coming of National Health Insurance Fund, NHIF.

It’s a health care system that was designed by the government of the United Republic of Tanzania to help lessen the burden of access to health services on an individual by pooling of resources together and hence risk sharing. It’s a system which started off by enrolling only public servants with monthly deductions directly from their salaries. But further down the lane much progress was achieved, and this was a big milestone in healthcare financing in the country which is pooling together of resources from non-public servants and private individuals into the scheme. Which lead to more benefit packages being crafted to suit their demands in relation to how much they would contribute.

Towards achieving Universal Health Care, a good primary healthcare system is singled out as an entry point into health care system by the majority. In Tanzania a lot of health policies have established a clear objective of attaining primary healthcare for all. There are reforms such as The Health Care Reform of 1994 that focused on improving access, quality and efficiency in health delivery in Tanzania especially after the Structural Adjustment Programs of 1993.

The Medical Stores Department (MSD) which came in place in 1993 and the Prime Vendor Systems (PVS) in 2018 which were aimed at strengthening supply chain of essential medicine in primary health facilities. On top of that in efforts to improve healthcare towards attaining of Universal Health Coverage, the Government recently introduced taxation on the Mobile Money Transfers in which just after four weeks of implementation, a total of TSh 48.67 billion was collected and distributed across the country especially in rural areas aiming at healthcare infrastructure development in construction of physical facilities, investment in information systems and medical equipment.

National Health Insurance Fund (NHIF)

The NHIF was established by the Act of Parliament No. 8 of 1999 and began its operations in June 2001. The scheme was initially intended to cover public servants but recently there have been provisions which allow private membership. [25] The public formal sector employees pay a mandatory contribution of 3% of their monthly salary and the government as an employer matches the same. This scheme covers the principal member, spouse and up to four below 18 years legal dependents. There has been a steady increase in coverage from 2% of the total population in 2001/2002 [25] to 8% in 2019. [22]

A 2024 report by the Controller and Auditor General (CAG) warmed that the National Health Insurance Fund (NHIF) risked collapse if the government did not pay an estimated $80m it owed the fund. [26]

Social Health Insurance Benefit (SHIB)

Social Health Insurance Benefit (SHIB) is part of the National Social Security Benefits introduced in 2007. All members of NSSF have access to medical care through SHIB after undergoing registration process with only one facility of their choice. The scheme accredits both public and private providers. The benefit is part of their 20% contribution to the NSSF. [27]

Community Health Fund (CHF) and Tiba Kwa Kadi (TIKA)

Community Health Fund is the scheme that targets the largest population in the rural informal sector and membership is voluntary. There is a counterpart called TIKA which mainly targets the informal sector individuals in urban areas. The CHF and TIKA are both regulated under the CHF act 2001 and managed at district level. At the district level, council health service boards (CHSB) and health facilities governing committees (HFGC) are responsible to oversee the operation of CHF and sensitization. In 2009 the National management role of CHF was given to the NHIF. [28]

Private insurance schemes

Several private companies, both international and domestic offer private health coverage. These involve both company and individual plans. Strategis [29] was one of the first registered (2002) private health insurance firms in Tanzania, however the space has grown to include companies such as AAR, [30] Jubilee Insurance, Resolution Health and Metropolitan Insurance. [31]

On December 25, 2020, the Minister of Health, Dr. Doroth Gwajima, said hospitals shall inform patients about the medical expenses before the healthcare treatment because they have no legal basis to detain the remains of dead people in order to be paid by their relatives. [32]

Healthcare Providers

There is a significant deficit in doctors providing healthcare in the country, with the ratio of 1.4 doctors per 100,000 falling largely behind the WHO recommendation. [33] Doctors educated both domestically undergo a five-year training program at accredited universities and then a year-long clinical internship, during which graduates practice under supervision and undergo evaluation. They, and those trained internationally, are then licensed by the Medical Council of Tanganyika. [34] To fill the urgent need of service providers, a three-year diploma in clinical medicine leading to certification to practice medicine as a Clinical officer is also offered.

See also

Related Research Articles

Health care reform is for the most part governmental policy that affects health care delivery in a given place. Health care reform typically attempts to:

<span class="mw-page-title-main">Publicly funded health care</span> Form of health care financing

Publicly funded healthcare is a form of health care financing designed to meet the cost of all or most healthcare needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population contributing to the fund or receiving benefits from it.

Health insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among many individuals. By estimating the overall risk of health risk and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization, such as a government agency, private business, or not-for-profit entity.

Universal health care is a health care system in which all residents of a particular country or region are assured access to health care. It is generally organized around providing either all residents or only those who cannot afford on their own, with either health services or the means to acquire them, with the end goal of improving health outcomes.

<span class="mw-page-title-main">Two-tier healthcare</span> Unequal access to higher quality healthcare

Two-tier healthcare is a situation in which a basic government-provided healthcare system provides basic care, and a secondary tier of care exists for those who can pay for additional, better quality or faster access. Most countries have both publicly and privately funded healthcare, but the degree to which it creates a quality differential depends on the way the two systems are managed, funded, and regulated.

Single-payer healthcare is a type of universal healthcare in which the costs of essential healthcare for all residents are covered by a single public system.

<span class="mw-page-title-main">Healthcare in Switzerland</span>

Switzerland has universal health care, regulated by the Swiss Federal Law on Health Insurance. There are no free state-provided health services, but private health insurance is compulsory for all persons residing in Switzerland.

National health insurance (NHI), sometimes called statutory health insurance (SHI), is a system of health insurance that insures a national population against the costs of health care. It may be administered by the public sector, the private sector, or a combination of both. Funding mechanisms vary with the particular program and country. National or statutory health insurance does not equate to government-run or government-financed health care, but is usually established by national legislation. In some countries, such as Australia's Medicare system, the UK's National Health Service and South Korea's National Health Insurance Service, contributions to the system are made via general taxation and therefore are not optional even though use of the health system it finances is. In practice, most people paying for NHI will join it. Where an NHI involves a choice of multiple insurance funds, the rates of contributions may vary and the person has to choose which insurance fund to belong to.

<span class="mw-page-title-main">Health care in Argentina</span>

Argentina's health care system is composed of a universal health care system and a private system. The government maintains a system of public medical facilities that are universally accessible to everyone in the country, but formal sector workers are also obligated to participate in one of about 300 labor union-run health insurance schemes, which offer differing levels of coverage. Private medical facilities and health insurance also exist in the country. The Ministry of Health (MSAL), oversees all three subsectors of the health care system and is responsible for setting of regulation, evaluation and collecting statistics.

<span class="mw-page-title-main">Healthcare in Germany</span>

Germany has a universal multi-payer health care system paid for by a combination of statutory health insurance and private health insurance.

<span class="mw-page-title-main">Health care in Turkey</span>

Healthcare in Turkey consists of a mix of public and private health services. Turkey introduced universal health care in 2003. Known as Universal Health Insurance Genel Sağlık Sigortası, it is funded by a tax surcharge on employers, currently at 5%. Public-sector funding covers approximately 75.2% of health expenditures.

<span class="mw-page-title-main">Healthcare in Ghana</span>

Healthcare in Ghana is mostly provided by the national government, and less than 5% of GDP is spent on healthcare. The healthcare system still has challenges with access, especially in rural areas not near hospitals.

Healthcare in Georgia is provided by a universal health care system under which the state funds medical treatment in a mainly privatized system of medical facilities. In 2013, the enactment of a universal health care program triggered universal coverage of government-sponsored medical care of the population and improving access to health care services. Responsibility for purchasing publicly financed health services lies with the Social Service Agency (SSA).

<span class="mw-page-title-main">Health care systems by country</span>

Examples of health care systems of the world, sorted by continent, are as follows.

Government-guaranteed health care for all citizens of a country, often called universal health care, is a broad concept that has been implemented in several ways. The common denominator for all such programs is some form of government action aimed at broadly extending access to health care and setting minimum standards. Most implement universal health care through legislation, regulation, and taxation. Legislation and regulation direct what care must be provided, to whom, and on what basis.

<span class="mw-page-title-main">Healthcare in India</span>

India has a multi-payer universal health care model that is paid for by a combination of public and government regulated private health insurances along with the element of almost entirely tax-funded public hospitals. The public hospital system is essentially free for all Indian residents except for small, often symbolic co-payments in some services. Economic Survey 2022-23 highlighted that the Central and State Governments’ budgeted expenditure on the health sector reached 2.1% of GDP in FY23 and 2.2% in FY22, against 1.6% in FY21. India ranks 78th and has one of the lowest healthcare spending as a percent of GDP. It also ranks 77th on the list of countries by total health expenditure per capita.

<span class="mw-page-title-main">Healthcare in Egypt</span>

The Egyptian healthcare system is pluralistic, comprising a variety of healthcare providers from the public as well as the private sector. The government ensures basic universal health coverage, although private services are also available for those with the ability to pay. Due to social and economic pressures, Egypt's healthcare system is subject to many challenges. However, several recent efforts have been directed towards enhancing the system.

<span class="mw-page-title-main">National Social Security Fund (Tanzania)</span>

The National Social Security Fund (NSSF) is the government agency of Tanzania responsible for the collection, safekeeping, responsible investment, and distribution of retirement funds of all employees in all sectors of the Tanzania economy that do not fall under the governmental pension schemes. The headquartersare located in Kivukoni ward of Ilala District of Dar es Salaam Region. There are one other pension fund organizations in the country; the Public Services Social Security(PSSSF). Fund for all employees working directly under the government and for all employees working under governmental Parastatal organization

openIMIS

openIMIS is an open source software which supports the administration of health financing and social protection schemes such as unconditional cash transfers and health insurances. It is jointly funded by the Swiss Agency for Development and Cooperation (SDC) and the German Federal Ministry for Economic Cooperation and Development. openIMIS provides tools to set up schemes and insurance plans for reimbursement of health care providers like hospitals, physicians and pharmacies. Social protection programmes can use openIMIS to manage the distribution of financial of in-kind benefits to specific target groups, especially poverty population.

<span class="mw-page-title-main">National Health Insurance Act, 2023</span> South African health legislation

The National Health Insurance Act, 2023 is an act of the Parliament of South Africa, which establishes a South African national health insurance system, commonly referred to as NHI, with the aim of "pooling public revenue in order to actively and strategically purchase health care services" and creating a "single framework throughout the Republic for the public funding and public purchasing of health care services, medicines, health goods and health related products". The purpose of the act is to establish and maintain a National Health Insurance Fund that will serve as the "single purchaser and single payer" of health care services.

References

  1. ↑ Manzi, Fatuma; Schellenberg, Joanna Armstrong; Hutton, Guy; Wyss, Kaspar; Mbuya, Conrad; Shirima, Kizito; Mshinda, Hassan; Tanner, Marcel; Schellenberg, David (22 February 2012). "Human resources for health care delivery in Tanzania: a multifaceted problem". Human Resources for Health. 10: 3. doi: 10.1186/1478-4491-10-3 . PMC   3311084 . PMID   22357353.
  2. ↑ http://www.mof.go.tz/mofdocs/overarch/Vision2025.pdf%5B%5D
  3. ↑ , United Republic of Tanzania Ministry of Health and Social Welfare, Health Sector Strategic Plan July 2015- June 2020 Reaching all Households with Quality Healthcare.
  4. ↑ , documents.worldbank.org/curated/en/648601468112497753/Tanzania-Big-Results-Now-for-Health-Project.
  5. ↑ , Global Health- Tanzania Centers for Disease Control and Prevention.
  6. ↑ WHO, World Health Report: Health System Financing: The Path to Universal Coverage. 2010: Geneva
  7. ↑ WHO 2000. Health Systems: Improving performance. Geneva.[ page needed ]
  8. ↑ Haazen, Dominic (2012). Making Health Financing Work for Poor People in Tanzania. World Bank Group. doi:10.1596/978-0-8213-9473-1. hdl:10986/2240. ISBN   978-0-8213-9473-1 . Retrieved 5 October 2015– via World Bank Group Open Knowledge Repository.
  9. ↑ Hyden, G. (1980). Beyond Ujamaa in Tanzania: Underdevelopment and an Uncaptured Peasantry. Berkeley and Los Angeles: University of California Press.
  10. ↑ Kolstad, J. R.; Lindkvist, I. (2013). "Pro-social preferences and self-selection into the public health sector: evidence from an economic experiment". Health Policy Plan. 28 (3): 320–327. doi: 10.1093/heapol/czs063 . PMID   22763126.
  11. ↑ "BTrue - Your Trusted Source of Health Information and News". 9 December 2019.
  12. ↑ "Swiss TPH". swisstph.ch. Archived from the original on 26 September 2015. Retrieved 26 May 2015.
  13. ↑ NHA Tanzania 2010
  14. ↑ McIntyre, D. (2008). "Beyond fragmentation and towards universal coverage: insights from Ghana, South Africa and the United Republic of Tanzania". Bulletin of the World Health Organization. 86 (11): 871–876. doi:10.2471/BLT.08.053413. PMC   2649570 . PMID   19030693.
  15. ↑ Mills, A.; Ataguba, J. E.; Akazili, J.; Borghi, J.; Garshong, B.; Makawia, S.; MTEItei, G.; Harris, B.; Macha, J.; Meheus, F.; McIntyre, D. (2012). "Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage" (PDF). Lancet. 380 (9837): 126–133. doi:10.1016/S0140-6736(12)60357-2. PMID   22591542. S2CID   31400331.
  16. ↑ "National Health Insurance Fund". nhif.or.tz. Archived from the original on 8 June 2015. Retrieved 26 May 2015.
  17. ↑ "National Social Security Fund - National Social Security Fund". nssf.or.tz. Archived from the original on 12 July 2015. Retrieved 26 May 2015.
  18. ↑ "CHF". nhif.or.tz. Archived from the original on 27 May 2015. Retrieved 26 May 2015.
  19. ↑ Annual insurance Market Performance Report. For The Year Ended 31st December 2010: Tanzania Insurance Regulatory Authority
  20. ↑ Bultman, J.; Kanywanyi, J. L.; Maarifa, H.; Mtei, G. (2012). Tanzania Health Insurance Regulatory Framework Review. Ministry of Health and Social welfare and Social Security Regulatory Authority.
  21. ↑ "Tanzania: All residents must be covered by health insurance". WTW. Retrieved 7 July 2024.
  22. 1 2 Odunga, Maureen (28 November 2019). "Tanzania: NHIF to Roll Out New Insurance Packages". allAfrica.com. Retrieved 15 August 2020.
  23. ↑ Health systems financing: the path to universal coverage. WHO. 2010. Archived from the original on 20 August 2010.[ page needed ]
  24. ↑ Mtei, G.; Makawia, S.; Ally, M.; Kuwawenaruwa, A.; Meheus, F.; Borghi, J. (1 March 2012). "Who pays and who benefits from health care? An assessment of equity in health care financing and benefit distribution in Tanzania". Health Policy and Planning. 27 (suppl 1): i23–i34. doi: 10.1093/heapol/czs018 . PMID   22388497.
  25. 1 2 NHIF, 2011
  26. ↑ Kabendera, Erick (24 May 2024). "Tanzania: National health fund risks collapse over mounting debt". The Africa Report.
  27. ↑ "Social Health Benefits in Tanzania". NSSF. Retrieved 8 September 2015.
  28. ↑ Borghi, J.; Maluka, S.; Kuwawenaruwa, A.; Makwai, S.; Tantau, J.; Mtei, G.; Ally, M.; Macha, J. (2013). "Promoting universal financial protection: a case study of new management of community health insurance in Tanzania". Health Research Policy and Systems. 11: 21. doi: 10.1186/1478-4505-11-21 . PMC   3686629 . PMID   23763711.
  29. ↑ "Strategis Insurance (Tanzania) Ltd". strategistz.com. Archived from the original on 25 September 2015. Retrieved 26 May 2015.
  30. ↑ "Aarhealth.com". aarhealth.com.
  31. ↑ Jamu, N.; Nduhiye, L.; Macha, J.; Kessy, F.; Borghi, J. (2009). A Feasibility Study for the Introduction of TIKA in the Three Municipalities of Dar es Salaam (Report). Dar es Salaam: Ifakara Health Institute.
  32. ↑ "Health minister: I don't want to hear any hospital blocking dead bodies because of bills". The Citizen . 20 December 2020. Retrieved 10 February 2021.
  33. ↑ "Physicians (per 1,000 people) - Tanzania | Data". data.worldbank.org. Retrieved 15 August 2020.
  34. ↑ "Medical Council of Tanganyika - About Us". www.mct.go.tz. Retrieved 15 August 2020.
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