Tanzania, United Republic of

National Health Insurance Fund (T) online hospital-pharmacy data link: Eliminating fraud in accredited pharmacies

The National Health Insurance Fund (NHIF) (T), the major health insurance organization in the country took the initiative to accredit pharmacies and drug dispensing outlets so as to enable the Fund's members to get medicines once a health facility does not have such medicines in its stock. This practice created loop-holes for fraudulent practices whereby some people benefited from the Fund by creating ghost patients in pharmacies and from patients visiting more than one facility, hence getting multiple prescriptions as a result costing the Fund millions.

Improved Community Health Funds (iCHF): Third-party relationships improving health service provision and members’ recruitment

The Community Health Fund (CHF) in Tanzania was established in 2001. Due to the dual role of “Provider” and “Purchaser” of health service played by the Council Health Boards (CHBs) such a design setup has faced challenges of poor management of funds, persistent shortage of services and unreliable membership data. CHF members access services from dispensary level up to district hospital within the Council. As such, unsatisfactory performance of the CHF in most of the councils continue to discourage people to enrol with CHFs subsequently sharply dropout rate of members each year.

Compliance enforcement through identity cards rejection: A case of the National Health Insurance Fund – United Republic of Tanzania

The National Health Insurance Fund (NHIF) has been experiencing a number of operational challenges including some attempts by non-contributing members to access health care services by using invalid membership cards.

According to the rules and procedures, members who are not contributing to the Fund for past three consecutive months, are not eligible to access medical services provided by the Fund. However, since around 95 per cent of contributing members of the NHIF are drawn out of the public sector, enforcement of this requirement has been a big challenge.

Risk-based supervision governance tool

The Social Security Regulatory Authority (SSRA) in Tanzania, was established under section 5 of the Social Security (Regulatory Authority) Act No.5 of 2008. Among other things, the Authority has powers to regulate and supervise the Tanzania Social Security Sector. The Authority regulates Five DB Schemes namely; NSSF, PSPF, LAPF, GEPF and PPF, it also regulate one Workers Compensation Fund (WCF) and one health Fund (NHIF). The Social Security Schemes have Regional and Zonal Offices across the Country.

Complaints Management System, a tool for effective supervision

The Social Security Regulatory Authority (SSRA) in Tanzania was established under section 5 of the Social Security (Regulatory Authority) Act No.5 of 2008. Among other things, the Authority has powers to regulate and supervise the Tanzania Social Security Sector. The Authority regulates five DB schemes namely; NSSF, PSPF, LAPF, GEPF and PPF. It also regulates one Workers Compensation Fund, WCF and one health Fund, NHIF.

Service quality: Short-term products

The Public Service Pensions Fund (PSPF) was established in 1999 to serve public servants employed in the central government and executive agencies. The PSPF operates two schemes, the mandatory scheme and the supplementary scheme. To date the Fund serves 340,098 contributing members in the mandatory scheme, 91,137 members in the supplementary scheme and has 77,508 pensioners.

Service Quality: Short term Products

Public Service Pensions Fund (PSPF) was established in 1999 to serve Public Servants employed in the Central Government and Executive Agencies. PSPF operates two scheme, Mandatory Scheme and Supplementary Scheme (PSS). To date the Fund serves 340,098 contributing members in Main Scheme, 91,137 members in Supplementary Scheme and has 77,508 pensioners.

Extension of coverage to difficult-to-cover groups

Tanzania has a population of about 45 million people of which working force aged between 15 and 60 years is 23 million people (Population and Housing Census 2012). Only 1.5 million people i.e. 6.5% of the working force get social security protection. Almost 99% of the people who are covered by social security schemes work in the formal sector. 21.5 million people in the working force group are not covered by any comprehensive social security protection.