By Adonis Byemelwa
Gairo Member of Parliament, Ahmed Shabiby, has ignited a fiery debate with his groundbreaking proposal for a citizen-driven initiative to establish universal health insurance in Tanzania, stirring discussions on equitable healthcare access
Shabiby’s suggestion of monthly deductions of Sh2,000 from every mobile phone user and Sh10,000 from MPs, traders, and employees to finance the program comes hot on the heels of Finance Minister Mwigulu Nchemba’s controversial proposal to levy taxes on mobile money transactions.
Nchemba’s remarks, which included telling dissenting citizens to consider relocating to Burundi for lower levies and cost of living, sparked widespread criticism. These events have reignited debates on socioeconomic disparities, with many questioning the concern of the affluent for the struggles faced by the less fortunate.
Shabiby projected significant revenue generation, estimating that the deductions from the country’s 72 million mobile phone owners alone would yield Sh1.7 trillion annually, with additional contributions from other sectors totaling Sh2 trillion. This revenue, he argued, would provide a reliable source of funding for universal health insurance.
However, the proposal has faced criticism from various quarters. John Heche, a member of the Chadema Central Committee, challenged the feasibility of the deductions, citing the widespread poverty among mobile phone owners who may struggle to afford even minimal contributions. Heche attributed Tanzania’s challenges not to revenue but to mismanagement and corruption, highlighting instances of extravagant government spending and lack of accountability.
According to John Heche, a prominent member of the Chadema party, Tanzania’s revenue collection is not the issue; rather, it’s the lack of clarity in spending and planning. He cited an example involving the Minister of Land and Housing Development, Jerry Slaa, who allegedly flew from Dar es Salaam to Mwanza with a convoy of drivers to address a land dispute, staying for only three hours. Heche questioned the rationale behind such extravagant travel arrangements for a brief visit.
Heche further criticized the government for its apparent disregard for public funds, particularly evident in its continued procurement of luxury vehicles. He highlighted a concerning pattern where these vehicles, upon encountering minor faults, are parked in government yards and subsequently sold by public servants at significantly reduced prices. He emphasized the urgent need to address corruption loopholes and adamantly opposed unnecessary expenditures.
Dr. Elizabeth Sanga, the shadow Health Minister from ACT-Wazalendo, opposed the proposal, advocating for improvements to social security funds to attract private sector investment. She emphasized the importance of voluntary enrollment in health insurance, particularly for self-employed individuals.
Khamis Suleiman, CEO of Sanlam Tanzania, criticized the proposal as impractical, stressing the need for effective management to sustain any insurance fund. Experts echoed concerns about the potential side effects of imposing levies on phone lines for health insurance, suggesting alternative taxation methods such as those targeting harmful products.
Oscar Mkude, an economist, voiced concerns over the potential repercussions of the proposal, particularly its impact on low-income earners. He emphasized the importance of implementing income-based deductions to ensure fairness and affordability for all segments of society. Mkude highlighted that such deductions would not only promote equity but also contribute to the stability of the proposed universal health insurance system.
He stated, “Income-based deductions are crucial for ensuring fairness and stability in funding universal health insurance. By tailoring contributions to individuals’ income levels, we can alleviate the burden on low-income earners while ensuring that the system remains financially sustainable.”
Tanzania’s commemoration of World Health Day on April 7, 2024, saw Dr. Charles Sagoe Moses, the WHO Representative in Tanzania, reaffirming the nation’s commitment to achieving universal health coverage. Emphasizing the importance of respecting everyone’s rights and fostering inclusivity in policies and strategies to ensure equitable access to healthcare, Dr. Moses outlined crucial steps for leveraging the Gairo MP’s proposal effectively.
To implement the Gairo MP’s proposal without harming citizens, measures must be taken to carefully calibrate deductions based on income levels. Progressive taxation methods and streamlined collection processes leveraging technology could alleviate the burden on low-income earners while still generating sufficient funds for universal health insurance.
Furthermore, the WHO can play a fundamental role in leveraging Tanzania’s efforts towards universal health coverage by providing technical assistance, facilitating partnerships, and advocating for policies prioritizing equitable healthcare access. Through collaborative efforts with government officials, healthcare providers, and community leaders, the WHO can catalyze tangible progress toward realizing the vision of universal health coverage in Tanzania.
