Why clarity is required for medical health insurance

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Lucy pic

By Lucy Tomeka

By Hellen Nachilongo

We recently read of 22-year-old, Lightness Shirima and the ordeal she endured by the hands of the Muhimbili Mloganzila Hospital after they declined to return her national identification card after she explained that she was unable to settle her late father’s hospital bill which stood at a whooping Sh9 million.

When the media delivered to light her ordeal, the Minister of Health, Ms Ummy Mwalimu acted swiftly to make sure a gross injustice isn’t carried out on a helpless citizen.

Read: Why Tanzania should spend money on universal medical health insurance

Lightness isn’t alone in her struggle to clear medical bills. One other local resident of Mwananyamala, Mr Ezekia Mmari explains how hopeful he was when he applied for a National Health Insurance Fund (NHIF) cover and that he and his children would receive higher medical care with the quilt.

Nonetheless, his hopes were crushed when certainly one of his sons was hospitalised and doctors still demanded money payment for his treatment.

“I remember in 2020, my 13-year-old boy was hospitalised at a certain referral hospital for a hand surgery but to my surprise, the doctors that requested the surgery as an alternative asked for money. I needed to pay over Sh800, 000 for them to perform the surgery. After that incident, I even have never tried to renew the NHIF services,” said Mmari.

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In one other scenario, Your Health had a chat with a boda boda rider named Mr Jumna Athuman to know if has registered for any insurance services.

“I even have heard about medical health insurance covers, but I even have not taken time to learn more about them and the way they work. I cannot talk much on the topic because am not all that informed,” he said.

Understanding and embracing of medical insurance services amongst the numerous regular residents remains to be a piece in progress.

Read: Why universal medical health insurance coverage Bill has been delayed

Nonetheless, a study conducted by the President’s Office, Regional Administration and Local government (PORALG) in collaboration with the Health Promotion and System Strengthening (HPSS) Project with funds from Swiss government also indicates that a majority of Tanzanians find out about health coverage.

When made aware of Lightness’ situation, the health minister then took to her Instagram to request each Lightness’ contacts in addition to explain that the federal government was working towards enacting a Universal Health Insurance scheme.

In one other separate event, the Annual Scientific Conference held sometime in early June of this yr, the minister also revealed that studies indicated that 73 percent of Tanzanians can be comfortable going for the service.

“A study conducted by the National Institute for Medical Research (NIMR) revealed that 73 percent of Tanzanians who were involved within the study expressed their willingness to contribute to the universal medical health insurance fund,” she said.

The country has already pledged to be certain that all households are covered by the Universal Health Coverage (UHC) and that they access quality health services to assist reduce child and maternal mortality rates, amongst other issues.

Nonetheless, many of the families which might be covered by medical health insurance face challenges when searching for medical treatment because a few of the medication will not be covered by the insurance.

Read: Government sets aside Sh149 billion for universal health coverage

Along with the UHC, Tanzania also rolled out the improved Community Health Funds (iCHF) in 2018, largely to profit those in rural and distant communities.

The improved CHF program aimed toward strengthening CHF structures and procedures to vastly improve the profit package of the CHF and to extend enrolment into the scheme.

CHFs are voluntary community-based prepayment schemes, which aim at constructing a sustainable financing mechanism for health care.

Also on the Annual Scientific Conference, the PORALG Director of Health, Social Welfare and Nutrition Services; Dr Ntuli Kapologwe explained that it will be significant to proceed providing awareness and motivation for energetic members to proceed renewing membership.

He stressed that despite having three million members registered with iCHF majority of respondents have no idea iCHF profit packages while those from the richest regions considered iCHF as insurance for the poor.

The important thing reasons for not joining iCHF is shortage of medication at health facilities and health providers not valuing iCHF members.

“Availability of health facilities can also be strongly related to the choice to affix [or not] the quilt,” he added.

“Acting on the need of the present iCHF scheme to extend enrolments and availability of medication at health facilities must be improved while promoting and marketing iCHF profit packages is equally as crucial to make sure increased enrolments.”

In line with him, each Tanzanian is able to contributing between Sh60, 000 to Sh65, 000 per yr for the quilt and in return, find a way to access health services in any respect major facilities within the country, including the Muhimbili National Hospital and Bugando Zonal Referral Hospital amongst others.

Nonetheless, the present situation still leaves quite a bit to be desired.

Data produced in Parliament by Ms Mwalimu showed that until December 2021, it was only a complete of about 9 million Tanzanians, representing roughly 15 percent of the population that had registered themselves with a medical health insurance cover.

Because of this 85 percent of the country’s population was still using hard money every time they needed access to health services.

In line with evaluation of scale-up plans and design, the plan is to have two concurrent schemes, the NHIF and the iCHF.

The NHIF, which has an enrolment of about 3.5 million beneficiaries and aimed to cover the formal sector, will proceed to pool funds nationally.

A proposed legislative amendment would make enrolment automatic and mandatory for all formal sector employees. This includes the formal public sector (comprising of civil servants, other government employees, and their dependents) and the formal private sector.

Meanwhile, in March 2018, council management teams and enrolment officers began training for the launch of the iCHF, an alternate insurance scheme to NHIF intended to cover the informal sector and rural households.

The good thing about UHC will not be for mere health issues but advantages a variety of sectors subsequently investing in UHC will impact several Sustainable Development Goals (SDG) reminiscent of poverty reduction, equitable health outcomes, quality education, gender equity and inclusive economic growth.

Investing in UHC will reduce the potential of families being pushed into poverty and families shall be healthier.

If productivity strategies are put in place, families will produce and their average expenditure shall be above $1.9 (Sh4 400) per day, hence reduction in poverty.

When the household expenditure increases, government tax collection will equally increase. Likewise, a well-designed and financed UHC is a vote-winning strategy.

Every beneficiary will remember times of illness and appreciate how the federal government took part in addressing health related issues. UHC reforms will be extremely popular with the general public as they deliver quick wins.

All beneficiaries covered by the iCHF are entitled to services available as much as the regional hospital levels, subject to an exclusion list comprised predominately of specialised procedures and medicines. Access to district and regional hospitals requires a referral letter from primary health facilities.

Project manager for Health Promotion and System Strengthening (HPSS) from Swiss Tropical and Public Health Institute, Mr Ally Kebby said they’re pleased that the federal government was making this effort to be certain that every citizen has a medical health insurance cover.

In line with him, under their project dubbed HPSS they developed revolutionary solutions in partnership with the federal government and supported their integration into national institutions, systems and policies.

The HPSS project strives to enhance access to utilization and quality of health services in Tanzania.

Earlier reports show that the majority African countries have integrated UHC as a goal of their national health strategies.

Yet, progress in translating these commitments into expanded domestic resources for health, effective development assistance, and ultimately, equitable and quality health services in addition to increased financial protection, has been slow.

Countries that achieve their UHC targets by 2030 will eliminate preventable maternal and child deaths, strengthen resilience to public health emergencies, reduce financial hardship linked to illness, and strengthen the foundations for long-term economic growth.

Should understanding and acceptance of those proposed and bettered schemes come to fruition, cases like that of Lightness and Mmari will develop into a distant unpleasant memory.

Nonetheless, before rolling out of said medical covers, one major hurdle needs tackling and that’s proper education of how these services work.

For many voters, the key criticism against signing up for insurance is that their money goes to waste as they’re denied access to the very services and products they faithfully pay for.

Why are certain services covered and others excluded? Why do some insuraces shrink back from covering full body checkups? Why do I even have to pay for certain services from my pocket and undergo the hustle of filing to get my a reimbursement from my insurance?

The questions are many, understaning is little and education from service providers is near on-existent from where many voters stand.

Transparency of how funds are dispersed for every service is perhaps more helpful in coaxing individuals to go for services from insurance providers.

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