Tanzania’s Healthcare System in Turmoil as NHIF Reforms Spark Standoff with Private Hospitals.

By Adonis Byemelwa

In a seismic upheaval within Tanzania's healthcare landscape, the prolonged deadlock between private hospitals and the government over transformative NHIF reforms has crumbled, unleashing a riveting twist in the nation's pursuit of a fair and resilient healthcare system.

Several private hospitals, including the influential TMJ Hospital, have made a noteworthy decision to welcome NHIF cardholders, offering much-needed relief to beneficiaries of the insurance scheme.

This positive shift follows a period of suspension initiated by various private hospitals, including TMJ, amidst disagreements with the Health Ministry over proposed NHIF reforms.

The initial decision to suspend services originated from concerns raised by private hospitals regarding the proposed lower rates by NHIF, fearing a potential impact on the quality of healthcare services delivered to patients.

In response, the Private Hospitals Advisory Board (PHAB) stepped in, emphasizing the legal obligation of private healthcare facilities to provide medical services to all emergency patients and those already admitted, irrespective of their insurance status.

On March 1, PHAB reiterated this stance, issuing a statement that highlighted the legal prerogative outlined in Section 15, Regulation 32 of the Private Hospital (Regulation) Act 151.

This regulation underscores the necessity for private hospitals to prioritize patient care, emphasizing the provision of medical services to all emergency cases and those already admitted, irrespective of their insurance status or financial circumstances.

While some private hospitals, such as TMJ and Bochi, have opted to resume services immediately following discussions with the Ministry of Health, a joint statement by the Private Health Facilities in Tanzania (APHFTA), the Christian Social Service Commission (CSSC), and the National Muslim Council of Tanzania (BAKWATA) announced their decision not to accept NHIF members starting March 1, 2024, citing disagreements over proposed rates.

This decision arises from the failure to reach an agreement between NHIF and private healthcare providers regarding the newly introduced rates by the fund. The suggested rates, intended to mirror prevailing market prices, faced opposition from private healthcare sector entities, leading to a boycott initiated in late 2023.

Efforts by a ministerial committee, including the formation of an independent committee in January 2024, have so far failed to bring about a resolution. The lack of consensus between NHIF and private health providers raises concerns about potential adverse effects on ordinary Tanzanians who rely on NHIF for quality and affordable health services.

In the fiscal year 2023/24, the Tanzanian government planned to collect and spend 44.39 trillion shillings, with the health budget pegged at Shilingi 1.2 trillion. Despite this allocation, Tanzania's health expenditure per capita remains notably low, standing at US$ 36.8 compared to US$ 88.4 in Kenya and US$ 58.3 in Rwanda.

Regional disparities in health expenditure raise questions about the equity and accessibility of healthcare services across the country. Tanzania's health expenditure as a share of GDP is also lower than that of neighboring countries, including Kenya, Rwanda, and Uganda.

The ongoing struggles between private hospitals, the government, and NHIF in Tanzania underscore the complexities within the healthcare system. While some private hospitals have chosen to resume services for NHIF cardholders, others remain firm in their boycott, emphasizing the need for a comprehensive resolution to address the concerns of both parties.

This impasse over proposed rates and the resulting boycott has significant implications for the millions of NHIF members who rely on the fund for healthcare coverage. As negotiations continue, it remains crucial to prioritize the interests of Tanzanians, ensuring they have access to quality and affordable healthcare services, irrespective of their economic status. The government's commitment to engaging all stakeholders is vital for achieving a sustainable and equitable healthcare system in Tanzania.

Amid these healthcare challenges, echoes of Zitto Kabwe's 2016 address to the Tanzanian Parliament resound. The ACT Wazalendo leader emphasized the pressing issue of medicines in the country and revealed corruption involving a substantial amount in the "Tegeta Escrow Account," equivalent to more than three times the entire national medicine budget.

Kabwe highlighted challenges within the Medical Stores Department (MSD) and the limited budget allocated for essential medicines. He recommended transferring MSD debts to the Ministry of Finance to boost the medicine budget and urged the government to allocate a more substantial portion of the national budget to the health sector, as recommended by the "Abuja Declaration."

The critical shortage of healthcare personnel across various roles in health facilities was also addressed, along with discussions on ongoing pilot projects in Ruangwa and Ujiji and the government's "Universal Health Care" plan.

Kabwe's recommendations included consolidating contributions from all National Social Security Funds into the National Health Insurance Fund (NHIF) to establish a single, national health insurance fund. He emphasized the lack of coordination in the existing health insurance system, resulting in people essentially paying for health insurance twice.

On December 4, 2023, President Samia Suluhu Hassan signed into law the Universal Health Insurance Bill, a significant milestone that had been unanimously passed by the Parliament on November 2, 2023. This marked a historic moment after a five-year deadlock since the bill's revival in 2018.

Despite this positive step, concerns linger among Tanzanians about the signed billion insurance coverage for every citizen. A notable discrepancy has been highlighted between the situation in Zanzibar and that of Tanzania mainland. In the isles, patients receive dialysis treatment for free, while in Tanzania mainland, one has to pay Sh180,000. Although the health docket is not a union matter, Tanzania could borrow a leaf from its partner in the union.

In the labyrinth of Tanzania's healthcare intricacies, shining examples from other African nations stand as guiding lights, showcasing the triumphs of comprehensive health insurance coverage. Rwanda, with an impressive 78.7% coverage, leads the pack, followed by Ghana at 58.2%, Gabon at 40.8%, and Burundi at 22.0%.

As these nations demonstrate the efficacy of robust health insurance frameworks, Tanzania finds itself at a crucial juncture, emphasizing the imperative for a united and strategic approach to surmount healthcare challenges and safeguard the well-being of its citizens. The stark contrast between Tanzania's current predicament and the success stories of its African counterparts heightens the urgency for transformative measures and collaborative efforts to ensure every Tanzanian enjoys accessible and quality healthcare coverage.