By Elias Mhegera and Jacqueline Kachuchuru – Recently Tanzania’s President Dr John Magufuli ordered the closure of all private pharmacies around the Muhimbili National Hospital (MNH) on the pretext that they were overcharging patients whenever they buy medicines from such facilities.
Already the construction of a Government controlled big pharmacy under the Medical Stores Department (MSD) has been completed. The prices are far below than those of private pharmacies which it is claimed that they belong to the same doctors within the MNH.
Only 30 percent of Tanzanians are covered by health insurance while the rest 70 percent have to find their own means of treatment whenever they fall sick.
This situation is more appalling for those who are retired without reliable sources of funds. This is according to none other than Okumu Salvatory, compliance and Field Operations Officer at the National Health Insurance Fund (NHIF).
This revelation came in the wake of the monthly Breakfast Talk Debate that are organised by the Policy Forum in Dar es Salaam during the closing of the year 2015 breakfast seminar.
But also According to the Tanzania Insurance Regulatory authority (TIRA) website so far Tanzania has 31 insurance companies, but only 10 of those are the major providers of health insurance facilities, four being publically owned while six belongs to private companies.
The four health insurance schemes which are publicly owned are National Health Insurance Fund (NHIF), Social Health Insurance Benefit (SHIB) established as a benefit under the National Social Security Fund (NSSF)
Others being the Community Health Fund (CHF) and Tiba Kwa Kadi (TIKA), the six private companies that stand higher than others in this category so far in the provision of health insurance are: Strategis which was one of the first registered in 2002 of the private health insurance firms in Tanzania.
Its members are corporate employees that became members through their company. Another of this type is the AAR; others of the like are health-maintenance organisation (HMO) which was re-registered as a private health insurance company.
Similarly it is the Jubilee Insurance, Resolution Health and Metropolitan Insurance all these have more or less similar features as strategies and AAR. Lack of equitable provision of health insurance is a major cause of pre-mature deaths and an alarming rate of unattended patients in Tanzania.
Okumu confesses…“in this country the provision of health does not rely solely on who holds the card, because this is not necessarily a guarantee for provision of quality health services, the main question is who benefit most, and why?” he poses a challenge.
He challenges that the Community Health Fund Act, 2001 which provides that there should be a community fund whereby households pay contributions to finance part of their basic health care services is insufficient. Therefore he calls for the Government to compensate health care financing efforts on grounds of its ineffectiveness.
However he highlights that the Government has already established mechanisms to cover individual members in the community and this has demarcated children, students of secondary and vocational trainings.
He also reveals that the NHIF has carried extensive public awareness campaigns in order to advertise its plans. Through these schemes it plans to cover over 50 percent of the total population by 2020.
In summary the Okumu mentioned that access to health care from health sector reforms to its implementation, is facing several challenges which needs improvements in so many ways, including general reforms in the Community Health Funds.
In general Community Based Health Insurance, like ‘KIKOA’ an alternative community fund, which has been introduced as a solution to improve community access to health insurance is a rationale alternative.
Dr Dereck Chitama, from the School of Public Health and Social Sciences of the Muhimbili National Hospital (MNH) says Tanzania has delayed for quite some time in establishing the health insurance facility.
“It is in records that this idea came about in 1962 but its implementation came into being in 2001, such a delay has caused a lot of damage to a number of people,” he states.
He expounds that one such consequence is the loss of labour power through pre-matures deaths because of chronic diseases, but also for the fact that the Government is overburdened due to this discrepancy to the extent that it even fails to plan its priorities.
He challenges that even now there is over pulling of such funds whenever patients are directed to private hospitals, although he does not want to disclose more. But there have been reports of overcharging patients for business purposes rather than provision of service.
Although Dr Chitama is cautious in his utterances, but the message is clear that there is an overcharging in the provision of services in the private sector. There has been a chronic shortage of medicines within the Government hospitals.
“While health remains a matter of priority universally even with the Sustainable Development Goals (SDGs), but policies need to focus in the health space of Tanzania in order to understand its dynamics and change the current situation which does not meet the high demands,” he warns.
When reached for comments the executive director of SIKIKA an NGO which deals with advocacy of an equitable provision of health services in Tanzania, Irenei Kiria says that his institution has never conducted a research focusing in this area but he admits that the population which gets quality health is still very low.
Ms Upendo Sanga from an NGO, Restless Development criticizes lack of political will to improve this situation due to over expenditures in other areas.
She is immediately supported by Ms Jacqueline Silas from the National Institute of Medical Research (NIMR), who lauds President Magufuli’s efforts to cut expenditures from other unnecessary uses and to divert those to the health sector.
She is referring to the reduction of funds which were budgeted for a Parliament launch cocktail party for the new parliamentarians but President Magufuli directed those to the purchase of beds for the MNH.
Generally it was observed during discussions that there is a need for quick actions to be taken to resolve the matter by encouraging each stakeholder to play their part to ensure every Tanzanian has access to quality health services.
Participants challenged that In the community health fund Act 2001 part IV it is shown that Tanzania depend so much on donor fund while it has an abundance of natural resources that could be well utilized in order to solve challenges facing the health sector.
Ms. Jacqueline Kachuchuru is a sociologist specializing on public health, she an assistant researcher at the National Institute of Medical Research (NIMR) in Dar es Salaam, she has a passion for medical journalism.