PROFILE

The National Health Insurance Fund (NHIF) is a Social Health Insurance Scheme established by CAP 395 of 1999 with the main objective of ensuring accessibility of health care services to all Tanzanians. Despite the compulsory enrollment arrangement to public servants, the Fund has managed to expand its coverage to include councilors, private companies, religious and education institutions, private individuals, children under 18 (TOTO Afya), peasants in cooperatives (Ushirika Afya) as well as mutual groups, whereby all members equally access health services in all certified health facilities. The Fund is also administering the Bunge Health Insurance Scheme, on behalf of the National Assembly of Tanzania and covers members of Zanzibar House of Representatives.

Management of the Fund

The management of the Fund is vested to the Board of Directors. However, day to day operations of the Fund are overseen by the Director General of the Fund. NHIF is a Government agency under the Ministry of Health Community Development, Gender, Elderly and Children (MHCDGEC), which considers health insurance as a societal affair rather than an individual need and operates under the principle of risk sharing and solidarity among members.

Core Functions of the Fund

As it is specified by the NHIF Act, core functions of the Fund are to:-

- Register members and issue identity cards;

- Certify and inspect health service providers

- Undertake quality assurance processes;

- Inspect employers to check compliance;

- Collect monthly and periodic contributions;

- Invest the funds collected in order to earn income;

- Account for the funds so collected and invested;

- Process providers’ claims;

- Carry out Actuarial Assessment and Valuation; and

- Provide health insurance education to the public with the aim of marketing it and enhance public relations.

Contribution
The amount that one contributes to the Scheme largely depends on the ability to pay and is not determined by age, sex or previous utilization rate of each respective member(s).

According to the NHIF Act, employees in the public sector are obliged to register themselves and contribute to the Fund a total of six (6) percent of monthly basic salary which is equally shared between the employer and employee. However, after the amendment of the NHIF Act, the Fund has put in place a separate contribution arrangement for other groups registered by the Fund.

Beneficiaries
NHIF beneficiaries in a family include the contributing member, spouse and up to four legal dependents. Under NHIF context, legal dependents include biological children or legally adopted children, parents and in laws. NHIF coverage is growing rapidly and as of March, 2019 it stood at 4,170,155 beneficiaries, an exponential increase as compared to its size during the initial years.

The Fund also manages the Community Health Fund (CHF) with a total of 12,799,788 beneficiaries thus bringing the total size of beneficiaries for both NHIF and CHF to 16,969,943 by the end of March, 2019 equivalent to 32% of the total population.

Categories of NHIF Members

The Fund expanded its range of categories of membership to enable other members than public employees to join, in the efforts to ensure more members join the Fund. These categories include:-

- Public employees

- Students

- Retired NHIF members

- Private individuals (with no employers/self-employed)

- Employees from the private sector such as Private Companies, Associations and NGOs

- Religious leaders such as Clergies.

- TOTO Afya Kadi for children under 18 years

- Ushirika Afya for peasants in Cooperative Societies

- Bunge Scheme for Members of Parliament

- Members of Zanzibar House of Representatives

- Councilors

NHIF Benefits Package

The following services are provided to beneficiaries;

a) Registration and/or consultation;

b) Medicines and medical consumables;

c) Investigations;

d) Dental and ophthalmologist services;

e) Inpatient care services;

f) Procedures;

g) Surgical services;

h) Medical and orthopedic appliances;

i) Rehabilitative services.

NHIF also facilitates provision of services that are normally out of general package under special agreements with some employers.

Categories and Network of Certified Health Facilities

The Fund undertakes certifications of facilities that are fully registered by the Ministry of Health, Community Development, Gender, Elderly and Children. Currently the Fund has certified the following levels of facilities to serve Fund’s beneficiaries:-

  • National Referral,
  • Zonal Referral,
  • Regional Referral and
  • District Hospitals

The Fund also certifies:

  • Specialized Clinics,
  • Health Centers,
  • Dispensaries,
  • ADDO’s and;
  • Pharmacies.

NHIF enters into agreements with both government and non-government owned facilities. Currently a total of 7,478 facilities have been contracted in Tanzania mainland and Zanzibar.

NHIF Medical Outreach Program

The Fund introduced a periodic medical outreach program which is conducted once every quarter in a selected and needed region. The program by involves medical specialists of various disciplines. The objective of the program is to ensure that vulnerable communities in underserved areas can access specialized quality healthcare services, and for the Fund this is part of the Corporate Social Responsibility.

CHF Operations

Community Health Fund (CHF) is a voluntary scheme established by the Parliament Act No 1 of 2001. The Scheme was introduced in the country as part of the so Ministry of Health and Social Welfare (MOHSW) endeavor for the quality and affordable health care services through sustainable financing mechanism and improved health care services management in the communities. CHF was piloted in Igunga District in 1996 and its success led it being rolled over to other district councils of Tanzania. CHF is a pre-payment council based scheme aimed at facilitating the community to access health care at an affordable contribution rate that is arranged by the community itself.

The scheme was at first administered by the MOHSW and PMO RALG until July, 2009 when the Government entrusted and deputized its function to the Fund through a Cabinet decision NO. 36/2007. This Government decision aimed at improving CHF operations and ensuring that it covers the majority of informal workers in Tanzanians. Currently statistics indicate that, CHF has been rolled over to 177 out of 181 councils operating under Local Government Authorities through NHIF coordination’s.

Network of NHIF Regional Offices

NHIF has established offices in all regions in Tanzania Mainland and Zanzibar to bring services closer to members who are under the Union Government. Each regional office is manned by a Regional Manager and contacts of offices can be seen through this link.

ISO 9001:2015 Certification

The National Health Insurance Fund is ISO 9001:2015 Certified.