Tanzania’s new revised universal health coverage scheme launched this week, is meant to protect vulnerable groups from scourges of expensive care. But the programme is also about lessons from the past where previous bids collapsed under weak cost controls and administrative hurdles.

 

The programme, dubbed Bima ya Afya kwa Wote (health insurance for all), became operational on January 26. It makes enrolment mandatory for all citizens and households.

Annual premiums will range from Tshs150,000 ($60) for a basic package to Tshs2.7 million ($1,100) for the most comprehensive services.

The scheme is anchored in an updated version of the Universal Health Insurance Act, enacted in 2023 to address corruption, low enrolment and fragmented policies that undermined earlier initiatives.

Enforcement of the law had previously stalled amid disputes between government and private healthcare providers over unpaid bills and revised rates. This time, officials insist all bases have been covered.

Health Minister Mohamed Mchengerwa said the law compels all citizens, regardless of social or economic status, to enrol.

The standard Tshs150,000 premium covers households of up to six members, including the payer, spouse, and up to four dependants under 21.

Benefits include primary and preventive care, outpatient and inpatient treatment, maternity services, diagnosis and treatment of common illnesses and referrals.

To finance the scheme, the law earmarks taxes and levies on products and services such as carbonated drinks, alcohol, cosmetics, mobile money transfers, and other electronic transactions.

Mandatory enrolment is expected to boost premium contributions and help offset costs for marginalised groups.

Yet scepticism remains. Many citizens are reluctant to join government-backed insurance schemes, citing mismanagement, fraud, and corruption that crippled earlier programmes.

By 2024, NHIF had only five million paying members against a national population exceeding 61 million.

Government audits show NHIF recorded the highest losses among public entities for two consecutive years: Tshs205.95 billion ($79.82 million) in 2021/22 and Tshs156.77 billion ($60.76 million) in 2022/23.

Controller and Auditor General Charles Kichere said the Fund’s dire finances were worsened by government debts, rising fraud in card use, and soaring bills for non-communicable diseases.

Some members and their spouses accessed NHIF services “without contributing anything”, pushing the Fund to the brink of bankruptcy, Mr Kichere noted.

Even as the new scheme takes off, NHIF remains at odds with several private hospitals over delayed refunds and payments for services provided to patients using NHIF cards.

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