The National Health Insurance Fund (NHIF) is a Social Health Insurance Scheme established by CAP 395 with the main objective of ensuring accessibility of health care services to all Tanzanians. Despite the compulsory 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) as well as mutual groups, whereby all members equally accesshealth services in all accredited health facilities. The Fund is also administering the Bunge Health Insurance Scheme, on behalf of the National Assembly.
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 who is also the secretary to the Board. NHIF is a Government agency under the Ministry of Health Community Development, Gender, Children and Elderly (MHCDGE), which considers health insuarance as a societal affair rather than an individual need and the NHIF 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 areto:-
Register members and issue identity cards;
Accredit and inspect health service providers
Undertake quality assurance processes;
Inspect employers to check compliance;
Collect monthly and periodic contributions;
Invest the funds so collected in order to earn income;
Account for the fund 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.
The amount that one contributes to the Scheme largely depends on the ability to pay and is not determined by the risk profile, 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.
NHIF beneficiaries include the contributing member, spouse and up to four legal dependants. Under NHIF context, legal dependants include biological children or legally adopted children, parents and in Laws. NHIF coverage is growing at a high rate and as of 31st December, 2016 it stood at 3,586,679 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 9,573,906 beneficiaries thus bringing the total size of beneficiaries for both NHIF and CHF to 13,160,585 by the end of December, 2016 equivalent to 27% of the total population.
Category of NHIF Member
The Fund has expanded its range of categories of membership that enable other members of the society to join. This is in the effort to ensure that more members join the Fund. These categories include:-
Forces under Ministry of Home Affairs
Retired NHIF members
Private individuals (with no employers/self-employed)
Private Companies, Associations and NGOs
Religious leaders such as Clergies.
Members of registered Economical Groups SACCOS
TOTO Afya kadi.
NHIF Benefit Package
Throughout its operations, the Fund has been innovative in various activities including enhancing its benefit package that aimed at meeting its members’ evolving needs. The Fund is currently providing a wide range of attractive and cost effective benefits package which includes the following:-
- Registration and Consultation fees
- Outpatient care services
- Inpatient care services
- Pharmaceutical services/Medicine and medical supplies
- Investigation tests
- Surgical services
- Dental and oral services
- Physiotherapy and rehabilitation care
- Optical services and ophamology
- Orthopedics and medical appliances
- Retiree Benefit (an extension of services to members who retires from employment).
NHIF Accredited Health Facilities
NHIF beneficiaries can access health services through a wide network of accredited health facilities in Tanzania. The Fund’s accredited health facilities among others include Public health facilities, Private health facilities and Faith Based Organization (FBO’s) which are geographically scattered all over the country. The Fund accredits all levels of health facilities which include:-
- National Referral and equivalent hospitals
- Zonal referral and equivalent hospitals
- Regional referral Hospitals
- District/Designated/ Designated Hospitals
- Health Centers
- Specialized Clinics
- Diagnostics Centers (Imaging and Laboratories)
- Pharmacies, and
- Accredited Drugs Dispensing Outlets (ADDOs).
NHIF Outreach Programs
The Fund has introduced the NHIF outreach program which is conducted on quarterly basis by involving medical specialists of different disciplines. The objective of the program is to ensure that vulnerable communities in underserved areas can access specialized quality healthcare services. By the end of June, 2016, the position of NHIF accredited health facilities countrywide stood at 6,998 equivalent to 58% of all health facilities in country.
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 Ministry of Health and Social Welfare (MOHSW) endeavor to make health care affordable and available to the rural population and the informal sector. It was piloted in Igunga District in 1996 and it’s success led to 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 144 out of 168 councils operating under Local Government Authority through NHIF coordinators.
Network Of NHIF Regional Offices
NHIF established offices in all regions in Tanzania Mainland and an Office in Unguja Island to serve members who are under the Union Government. Contacts of Regional offices can be seen through this link.