The National Health Insurance Fund (NHIF) is a compulsory Health Insurance Scheme established by the Act of Parliament No. 8 of 1999 (CAP 395 R.E 2002) with the main objective of ensuring accessibility of health care services to all Central Government employees as well as formulating and promulgate policies for sound administration of the scheme. The Act establishing the Fund was further amended to include private sector institutions, individual members and their respective legal dependents that joined the Fund on voluntary basis.
Management Of The Fund
The Management of the Fund is vested in the Board of Directors. However, day to day operations of the Fund are implemented by the Director General who is the secretary to the Board. NHIF is a Government agency under the Ministry of Health and Social Welfare (MOHSW), which considers health as a societal affair rather than an individual need. Since inception, NHIF operates under the principle of risk sharing and solidarity among members.
Core Functions Of The Fund
As it specified by NHIF Act, the core functions of the Fund among others are to:-
- Register members and issue identity cards;
- Accredit and inspect health service providers and avail a broader network of health facilities thus improve access to health services in the country particularly in the rural areas;
- 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, sex or previous utilization rate of prospective member(s).
According to the NHIF Act, employers and employees in the public sector are obliged to register themselves and contribute to the Fund a total of six (6) percent of each employee’s 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 such as students, Police force, Immigration, Prisons services, Fire Brigade, clergy, associations, private companies and private individuals registered by the Fund.
Beneficiary to the scheme took into the cognizance the African pattern and social capital for taking care of the children and contributor’s parents. NHIF beneficiaries thus include contributing member, spouse and up to four dependants who are legally identified. Under NHIF context, dependants include biological children or legally adopted children, parents and in Laws. NHIF coverage is growing at a high rate and as of 30th June, 2015 it stood at 3,237,434 beneficiaries, an exponential increase as compared to its size during the dawning days.
The Fund also manages the Community Health Fund (CHF) with a total of 6,677,244 beneficiaries thus bringing the total size of beneficiaries for NHIF and CHF to 9,914,678 by the end of June, 2015 equivalent to 22.7% of the total population.
Category Of NHIF Members
The Fund has a wide range category of membership and invites other members of the society to join. This is in the efforts to ensure that no one is left out of scope of protection. These categories include:-
- Central Government employees that include Ministries and independent departments
- Regional Administration and Local Government Authority employees
- Public Institutions
- Police, Prisons, Fire Brigade and Immigration
- Students of higher learning institutions
- Retirees who were previously NHIF contributing members
- Private Individuals (with no employers/self-employed)
- Private Companies, Associations and NGOs
- Spiritual leaders such as Clergy
- Members of registered Economical Groups SACCOS.
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
- Orthopedically 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/Council Designated Hospitals
- Health Centers
- Specialized Clinics
- Diagnostics Centers (Imaging and Laboratories)
- Pharmacies, and
- Accredited Drugs Dispensing Outlets (ADDOs).
Furthermore, in order to complement and guarantee improved accessibility to quality health care services for NHIF beneficiaries, the Fund has introduced the NHIF outreach programme which is conducted on quarterly basis by involving medical specialists of different disciplines. The objective of the programme is to ensure that vulnerable communities in underserved areas can access specialized quality healthcare services. By the end of June, 2015, the position of NHIF accredited health facilities countrywide stood at 6,185 equivalents to 55% 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 first 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. The scheme was piloted in Igunga District in 1996 and later on 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 that is arranged by the community itself.
The scheme was 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. The linkage decision made by the Government aimed at improving CHF operations and ensuring that it covers the majority of informal workers in Tanzanians. Statistically, CHF has been rolled over to 144 out of 168 councils operating under Local Government Authority. So far, the scheme has a total of 1,112,874households that translates to 6,677,244 beneficiaries as of 31st June, 2015.
Network Of NHIF Offices
NHIF has established its offices in all regions in the Tanzania Mainland and an Office in Unguja Island to serve members who are under the Union Government.