Nation’s Healing Promise: Tanzania’s Bold Push Towards Universal Health Insurance

By Adonis Byemelwa

In the heart of East Africa, a quiet revolution is unfolding—one with the potential to fundamentally shift how Tanzanians experience health care. For over two decades, the country has walked a determined path toward protecting its people from catastrophic health costs.

 Nonetheless, with the Universal Health Insurance Act, 2023 now enacted and edging closer to full implementation, Tanzania finds itself on the brink of a profound shift—one that boldly vows no citizen, whether wealthy or struggling, from the bustling city streets to the most remote villages, will be left behind in the pursuit of health and human dignity.

This bold vision is borne out of necessity. Despite years of reform and effort, health insurance coverage has hovered stubbornly low, with only 15.3 percent of the population enrolled across various schemes.

The largest public provider, the National Health Insurance Fund (NHIF), covers just 8 percent, while the improved Community Health Fund (iCHF) serves 6 percent, and private insurers pick up a mere 1.3 percent.

The implication is stark: over 75 percent of Tanzanians pay for health care directly from their pockets, a reality that places an unbearable burden on millions and drives countless families into poverty each year.

“Access to high-quality health care should never depend on where you live or how much you earn,” says Elizabeth Sanga, a Tanzanian health insurance expert now based in Australia. Reflecting on her homeland’s efforts, she adds, “Healthcare is not just a service, it’s a social contract between a government and its people. Tanzania is now choosing to honour that contract.”

At the heart of the Universal Health Insurance Act lies a bold promise: mandatory coverage for every citizen, formal worker, and adult foreign resident. But ambition meets complexity when much of the workforce earns irregular, undocumented incomes.

 For many in the informal sector, steady contributions feel out of reach without strong state support. Aware of this, the government has paired its mandate with creative financing—tapping into levies on mobile money, alcohol, cosmetics, and even channeling funds from investments and donations—to ease the burden and widen the safety net.

In theory, this broadens the resource base and provides a cushion to support subsidies for the most vulnerable groups, including those enrolled under the Tanzania Social Action Fund (TASAF).

“The aim is not just to collect money—it’s to build trust,” says Dr Mugisha Nkoronko, president of the Medical Association of Tanzania. “When citizens see that their contributions translate into reliable, accessible services, they will believe in the system. Until then, we must work to bridge that gap.”

But belief does not grow in a vacuum. It is nurtured by results, and the government seems keenly aware of this. Health Minister Jenista Mhagama recently reaffirmed to Parliament her ministry’s commitment to reform.

She cited plans for universal insurance packages that will encompass all citizens, ensuring that the country’s hard-won investments in health infrastructure are not enjoyed by a privileged few, but by every Tanzanian.

With an eye on vulnerable groups, she pledged improvements in emergency maternity services and efforts to stabilise the operations of the Medical Stores Department (MSD), which has historically struggled with budget shortfalls.

There’s movement too on the fiscal front. The MSD, having requested 561 billion shillings, has already received 100 billion and been allocated an additional 200 billion in tranches.

 The government has also reserved over 42 billion shillings to build new warehouses to enhance the storage of critical health equipment and pharmaceuticals, with a 119-billion-shilling grant expected from China to boost capacity further.

Yet, perhaps the most heartening sign of commitment is the growing consensus across the political divide. In a rare moment of unity, members of Parliament voiced their support for the Act while raising real, lived concerns.

From the high cost of chronic diseases like kidney failure and heart conditions, to the poor dietary habits taking root among the youth, MPs highlighted the need for public education, preventive care, and affordable access.

“You can’t compare the rich with the poor when it comes to health insurance,” said Noah Lembris of Arumeru West, echoing the sentiment of millions. “We need a system that works for all, especially those with the least.”

On the ground, the enthusiasm is palpable but cautious. For many Tanzanians, insurance is a foreign concept, long associated with bureaucracy, limited benefits, or outright inaccessibility.

 Others worry that private medical insurance—often perceived as superior—will create a two-tier system where those with means leapfrog over the under-resourced public sector.

Yet, the Act addresses this by allowing private medical insurance (PMI) as a complementary option, provided it does not undermine the universal public scheme. Employers who previously didn’t offer PMI are now preparing for new cost structures, while those already offering it hope to maintain flexibility under the new law.

Critically, Tanzania is not alone in its aspirations. As Elizabeth Sanga reflects on Australia’s Medicare system—hailed globally as a beacon of universal health care—she notes that its birth was neither easy nor cheap.

But it has endured because it was built on a foundation of equity, social justice, and political will. “Universal coverage is not unaffordable,” she insists. “What is truly unsustainable is a system that excludes its people and shifts the cost of care to those least able to bear it.”

Indeed, international evidence shows that over-reliance on out-of-pocket payments drives up social inequality and worsens health outcomes. The Tanzanian government seems to grasp this fully, especially as it incorporates control of infectious diseases like HIV, hepatitis, and STIs into the national health strategy. Prevention, early detection, and public health education are being given renewed focus.

And yet, success will depend not only on political resolve and policy architecture, but on building a public narrative that frames health insurance not as a tax, but as a shared safety net. Tanzania’s health care journey is as much about economic reform as it is about cultural transformation. It will demand trust in institutions, transparency in fund management, and relentless public engagement.

MAT’s Dr Nkoronko is hopeful. “We have the resources, we have the expertise, and now, we have the legal framework. What we need next is commitment—from every sector, every leader, and every citizen.”

The road ahead will not be easy. There will be resistance, missteps, and periods of doubt. But for a country where a hospital bill can still spell financial ruin, the dream of universal health insurance is more than a policy goal—it is a moral imperative. Ghana’s NHIS and Rwanda’s community-based model offer proof that success is possible on African soil. Still, one cannot ignore the ghosts of past scandals.

Then there’s the issue that haunts every major reform: corruption. Can Tanzania finally overcome the graft that has dogged its health insurance institutions for years? The Controller and Auditor General (CAG) has documented chilling examples.

 In one report, over 3 billion shillings were flagged as suspicious NHIF claims—some for services never rendered, others made through ghost referrals. In another instance, costly contracts for medical equipment never translated into functional services on the ground.

For ordinary Tanzanians, these aren’t just numbers—they signal broken trust. If billions once vanished, what assures citizens this new promise won’t meet the same fate? To restore confidence, reforms must go deeper than the law.

Digital claims tracking, real-time audits, whistleblower protections, and open procurement can shine a light where shadows once thrived. More critically, giving communities a voice—through health boards, patient groups, and local watchdogs—can shift power closer to the people, making them watchdogs of their care, not just recipients.