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Social Health Insurance in Tanzania

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Social Health Insurance in Tanzania An overview Table 1: Tanzania Administrative and Health System Health Financing Options in Tz These are such as: National Health ... – PowerPoint PPT presentation

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Title: Social Health Insurance in Tanzania


1
Social Health Insurance in Tanzania
  • An overview

2
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3
Table 1 Tanzania Administrative and Health
System
Source Ministry of Health Health Statistics
Abstract 2002
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8
Health Financing Options in Tz
  • These are such as
  • National Health Insurance Fund (NHIF)
  • National Social Security Fund (NSSF)
  • Community Health Funds (CHF)
  • Micro-health Insurance Schemes (MHIS)
  • Other Funding sources include
  • Government and Local Governments
  • Basket Funding
  • NGOs
  • Private Financing
  • Community Financing
  • Donor Funding

9
National Health Insurance Fund Aims
  • To strengthen cost-sharing by providing an
    opportunity for the formal sector employees to
    contribute through their contributions to a Fund.
  • To provide free choice of providers to Public
    servants who were formerly restricted to
    government health facilities.
  • To enhance health equity among formal sector
    employees in the provision of health care
    services.
  • To institute a permanent and reliable system for
    the provision of health services to formal sector
    employees.
  • To improve accessibility and quality of health
    services by introducing competition among health
    care providers from Public, Faith-based, Non
    Government Organizations and Private Health
    Providers.
  • To reduce the financing gap by supplementing the
    Government budgetary allocation to the health
    sector by contributions from formal sector
    employees.

10
Description of the NHIF
  • The (NHIF) was established in 1999 by a
    parliamentary Act No. 8 of 1999.
  • The operations of the scheme commenced on the 1st
    July 2001,
  • The benefits to Members started from October
    2001.
  • The scheme is based on internationally accepted
    insurance principles,
  • The scheme provides a wide range of short term
    benefits to her members.
  • Currently, the NHIF serves for the Public service
    employees including their spouses and four
    children and/or legal dependants
  • It is a compulsory scheme for public servants

11
Structure of the NHIF
  • Coverage
  • 4.5 pf population.
  • Contributions
  • The NHIF is financed through contributions
    (employers contribute 3 and employees 3) of the
    basic salary of the employees
  • Identification of Members
  • Though identity cards.
  • Benefit Package
  • Currently the benefit package includes
    Registration fees, Basic diagnostic tests,
    Outpatient services including medications and
    investigations, In-patient care (fixed rate per
    day per level of health facility), Surgery,
    spectacles and other services

12
Structure of the NHIFcontinued
  • Areas of exemptions of coverage
  • all public funded programs
  • illegally/socially disapproved acts
  • Accreditation of Health Facilities
  • Hosp, H/C, Dispensaries and pharmacies/ ADDOs
  • Provider Payment Mechanisms
  • Fee-for-service is the main payment mechanisms
    that was adopted at the start of the operations
    of the Fund.
  • Capitation in some

13
Successes recorded by the NHIF
  • Assurance of access to health services at all
    times
  • Contribution to the Health Sector Development as
    a component in Health financing
  • Attitude changes
  • From free services to contributions
  • From cash payments to use of Cards
  • From laisser-faire to ownership by Members
  • Use of Cards have reduced bribery tendencies
  • Sustainable system outside the Government general
    taxation system
  • Brings services closer to members (Zones)
  • Its setting has been model to most interested
    countries

14
Problems encountered by the NHIF
  • General perception at early days (mainly
    negative)
  • Some stakeholders are yet to fulfill their roles
  • Drug shortages
  • Absence of infrastructures eg part 1 pharmacies
    in most parts of the countries
  • Emergence of fraudulent tendencies
  • Problems related to the health system and
    infrastructure itself have negative impacts on
    the funds operations

15
Challenges of the NHIF
  • Limited scope of coverage
  • Operates in un-regulated environment
  • Low awareness by the public on how these
    different schemes operates
  • Preference on cash payments vs card
  • Absence of set basic package (by MoHSW)
  • Non adherence by some health service providers on
    the standards set by MoH and the NHIF
  • Fraud

16
NSSF-Social Health Insurance Benefit (SHIB)
  • SHIB is the 7th benefit to be implemented in the
    NSSF Act. Section 41 of the NSSF Act No. 28 of
    1997.
  • Established so as to provide crucial support to
    the Governments efforts of increasing access to
    health care services to the poor majority in the
    country.

17
SHIB- The Benefit Package
  • Aimed at providing most of general healthcare
    services for beneficiaries
  • Out-Patient Services
  • Consultations
  • Basic Specialized investigations
  • Drugs under the National Essential Drug List
  • Simple procedures (e.g. wound dressing)
  • Referral to higher levels special hospitals

18
SHIB- The Benefit Package
  • In-Patient Services
  • Accommodation
  • Consultation with a Medical Officer or specialist
  • Basic investigations(e.g. blood slide for mps,
    stool, etc)
  • Specialized investigations
  • Drugs under the National Essential Drug List
  • Minor and Major Operations
  • Blood transfusion
  • Specialized procedures
  • Medicines on discharge
  • Referral to higher level specialized hospitals

19
SHIB- Exclusions
  • Diseases under special preventive programs and
    Public Health Care Services e.g.TB and Leprosy,
    Cancers, HIV/AIDS, Epidemics, Maternal and Child
    Health (MCH), Mental Illness, Sexually
    Transmitted Diseases (STDs), Any other disease
    that will be categorized in this domain.
  • Self-inflicted diseases or injuries e.g. drug
    abuse, tobacco, alcohol, attempted suicide, and
    criminal abortion
  • Luxurious like Cosmetic treatments with no
    medical indications e.g. plastic surgery

20
SHIB-Limitations
  • Emergency cases for principal beneficiaries
    traveling away-
  • Outpatient - not more than 4 times/year
  • Inpatient (48 hours) - not more than 2 times/year
  • Hospitalisation a maximum of 42 days of
    inpatient care per beneficiary per year

21
SHIB-Coverage and Eligibility
  • the Scheme covers a member and dependants (one
    spouse and up to four children)
  • three months of healthcare services after
    stoppage of contributions due to termination,
    falling in arrears of contribution and
    retirement
  • qualifying members must have contributed for at
    least three months immediately before accessing
    the services and
  • pensioners willing to contribute 6 of their
    monthly pension shall continue enjoying
    healthcare benefits.
  • NB NSSF is considering inclusion of other
    persons who are not statutory members of the
    Scheme

22
SHIB-Method of Payment
  • Payment of providers is by Capitation method
  • Reasons for Capitation
  • Easy to administer
  • Builds a self-monitoring system and
    accountability among the Stakeholders
  • links members to a specific provider who is
    responsible for providing healthcare and
    record-keeping
  • provides a predictable cash flow.

23
Advantages of SHIB
  • Relief to the employers
  • Relief to the members
  • Contribution to the Government towards better
    healthcare services in the country, to become the
    2nd largest healthcare provider after the
    Government

24
Community Health Funds Background
  • It is part of the health financing reforms that
    begun in 1990.
  • Health care financing study undertaken between
    1990-1992 recommended introduction of cost
    sharing and National Health Insurance.
  • Community Health Fund was conceived later to
    mitigate the shortfall of National Health
    Insurance coverage.

25
Community Health Funds Background
  • A decentralised voluntary health Insurance scheme
    operating at district level
  • A govt initiative to target people from the
    formal and informal sector as well as the poor.
  • A way of trying to cover basic health care
    services and to give access to those excluded by
    other schemes.

26
Community Health Funds (CHF)Background
  • Started on pilot basis in one district.
  • The pilot was then extended to nine more
    districts after evaluation.
  • Policy decision has now been reached to cover all
    districts.
  • It is taken as one of the conditions to extend
    cost sharing in primary health care facilities.

27
Community Health Funds The Concept
  • Risk pooling among families in the informal
    sector.
  • Households pay once a predetermined premium for
    the medication of the whole family per year.
  • Payment is often made at the time of harvesting
    or when the season of income has arrived.
  • Since the premiums are in the form of capitation,
    providers and contributors have the liberty to
    spend in preventive and promotive health
    services.
  • Contributors have a choice of providers.
  • Provides opportunity for providers to increase
    efficiency

28
Community Health Funds (CHF)
  • Why community financing?
  • Improves efficiency and equity
  • Allows sharing of risk (community-rating)
  • Allows collection of resources
  • Facilitates community participation (contribution
    to the general welfare of the community)

29
Impact of community-based schemes
  • Increase access
  • Generate resources
  • Improve equity
  • Improved Access for members of Schemes
  • Increased utilization of the members as compared
    to non-members
  • Reduced out-of-pocket payment for members as
    compared to non-members

30
Micro-health Insurance Schemes (MHIS)
  • Are voluntary schemes set up and run by
    co-operatives, churches or local communities
  • They provide access to basic health care services
    at a single provider taken under contract
  • Cater for small sections of the population
  • Are managed locally

31
MHIS (2)
  • Most are registered under societies Act, and
    Trustees Deed.
  • Covers the informal sector or groups of common
    interest
  • Benefit package and contributions are set and
    agreed by the respective members
  • UMASIDA and VIBINDO - successful cases of Mutual
    Health Insurance
  • Started in 1994, contribution Tsh 1,500/ to Tsh
    3000/ per month (operates in Dar es salaam,
    Kilimanjaro and Arusha)

32
MHIS (3)
  • The number of MHI are on increase from Churches
    and charitable organisations
  • Based on Mutual and common interest, Most of
    these schemes covers the poor in the informal
    sector
  • MHIS are subject to many organisational and
    managerial weaknesses due to their self-managing
    character (limited skills and capacities of those
    running the schemes).

33
NGOs
  • These subsidizes specific health programmes
  • Usually operate at local levels
  • Have their own sources of funds
  • Usually have preference in the types of
    programmes or the health services they offer or
    conduct.

34
Private Financing
  • Comprise of Direct individual (out-of pocket)
    payments as well as private health insurance
    schemes
  • To-date Tanzanian households provide the greatest
    proportion of health care financing
  • Out-of-pocket payments are gradually becoming
    less popular in urban centres, as people are now
    enrolling in Insurance schemes.
  • i.e. moving from cash payments to card payments
    (at the point of receiving health service)
  • Cash payments are tricky modes especially for the
    poor

35
Private Health Insurance
  • Private health Insurance schemes are relatively
    recent modes of health care financing in Tz
  • These are such as AAR, MEDEX and Strategis.
  • Are Voluntary and cover mostly salaried workers
    on an individual basis or as employees of a
    registered employer.
  • Benefit package is rated i.e each member has a
    specific benefit package depending on the premium
    he/she paid.
  • Operates on an individual equivalency (no pooling
    of risks).
  • There is adverse selection of risk
  • Premiums are calculated according to the
    anticipated risk e.g. age, sex, risk
    exposure-medical family history, medical
    individual history etc
  • In Tz PHI schemes mostly operate in urban areas
    and with private health providers.

36
Community Financing
  • These are informal contributions for the purpose
    of health
  • Are solidarity funds and/or special arrangements
    made for health e.g. with individual companies,
    collections etc

37
Donor Funding
  • Are funds donated in kindness
  • Are usually for specifically designed health
    projects/programmes
  • Have a variety of contributions I.e both monetary
    and technical assistance
  • Provides about the same proportion of funds for
    health as the GoT
  • Recent trend by donors is channelling their funds
    into the global national budget (and not directly
    to health budget) hence impacts the health sector
    on how to secure an appreciable share of the
    funds from the government

38
Basket Funding
  • Health sector partners pool their funds
    contributed for health
  • Funds come from several stakeholders in health
    i.e the Government, Local Government, NGOs and
    other development partners
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