Pioneering Social Health Insurance in Tanzania: The case of the National Health Insurance Fund. (NHIF)

Transcription

1 IMPROVING ACCESS THROUGH EFFECTIVE HEALTH FINANCING Pioneering Social Health Insurance in Tanzania: The case of the National Health Insurance Fund. (NHIF) Presented by the Director General of NHIF Mr. Emanuel Humba 2011.

2 Tanzania the roof of Africa Peaceful country that has enjoyed political stability since independence Home of Great Lakes reconciliation + The Land of Kilimanjaro & Spices of Zanzibar. 2

3 NHIF ZONAL OFFICE NETWORK 3

4 Summary of a Presentation 1. Introduction. 2. Tanzania: Social Economic Indicators. 3. Seeking universal coverage (conditions & necessary steps). 4. The Health sectors reforms and lessons leant. 5. NHIF: Historical perspectives & setting of the scheme. 6. Description of the NHIF. 7. Recent developments and trends. 8. Projects with Local and Development Partners. 9. Lessons. 10. Challenges. 11. Strategies for the extension of CHF. 12. Strategies for the pro poor funding. 13. Plans for the future. 14. Submission. 4

5 1. Introduction Health Insurance and social security are Human or Constitutional Rights in most sub Saharan Africa. Of recent, some countries in this Region have even gone further to realize and include Health Insurance in elections manifesto of respective Governments Ruling Parties (Tanzania, Uganda) Most sub Saharan African countries offers health services through Government, Health Insurances, Private, Community and micro insurance but the initiatives are not LINKED to address the poor. As a result 80% of the population South of Sahara are excluded from adequate health More than 50% of the population in the Region are living with less than 1 $ a day More than MORE THAN HALF of spending in POOR countries comes from out of pocket payments Developing countries account for about 84% of the global population with 90% of the Global disease burden and with only 12% of the health spending. 5

6 2.Tanzania: Social Economic Indicators Life expectancy 53 years for Males & 56 years for Female; Under 5 Mortality 91/1,000 birth; Infant Mortality Rate 58/1,000 birth; Maternal Mortality Rate 578/100,000 per live birth; HIV/AIDS prevalence among Adults 5.7% (2007/08) GDP (2009/2010) 5.5 % Inflation rate 5.6% (as of December, 2010) Exchange rate 1 USD = TZ SH 1,500 Health expenditure to total Govt budget= 12.2% (2010/2011) 3 rd in the priority list. 6

7 3. Seeking Universal Coverage (UC) Introduction Social protection is essential tool for poverty reduction and sustainable development Globalization, the Millennium Development Goals (MDGs) and the need by the International Community to reduce poverty are therefore international interventional strategies geared towards establishing systems which ensure every citizen of a community is protected against shocks and causes of ill health. 7

8 3. Seeking Universal Coverage (UC) Some of the international and Regional initiatives : WHO (1978) Health for all initiative, the Alma Ata declarations. Bamako initiative (1987) WHO and UNICEF for improved drug supply, community ownership and involvement ILO (2001) STEP Strategies and tools against social exclusions initiative WB (2005) Integrating Health Insurance in Social Protection GTZ initiatives and projects to various developing countries. The ECSA initiatives The East, Central, and Southern African (ECSA) Health Community. A Regional organization that fosters and encourages cooperation in health in East, Central and Southern Africa Manila October 2006 (WB,WHO,GTZ,ILO) 8

9 3 Conditions for Universal Coverage Government commitment to solidarity and equity in access to health care; Government commitment to support the poor and other vulnerable groups; The Law should be inclusive but implementation may assume a phased approach; Linkages be established to create a strong united network of social Insurance schemes both in the formal and informal sectors of the Economy; Good governance and compliance with appropriate legislation and regulations; Affordability of contribution rate to cover majority of the population; Basic health Package for all with possibilities of improvements as and when conditions allows. 9

10 4. The Health Sector Reforms & lessons to Learn Introduced in 1990s as ideological changes from free services to cost sharing; Programs introduced: User fees,chf, DRF and NHIF Secretariat at the MoHSW to coordinate the reforms Health taken in its wider perspective. 10

11 5.Historical perspective & trend 1.1 PRE FEASIBILITIES AND WILLINGNESS TO START NHIF 1990s All studies supported the introduction of Social health insurances; Employers were willing (health expenditures were increasing & ranged between 11% 20% of their total wage bill); Employee (Sept, 1995) requested the Govt to establish NHIF but when the scheme started in 2001 they were reluctant, adamant and resisted to cooperate especially Trade Unions Leaders; The country s health facilities infrastructure (network) were available but almost were in poor state. (acute shortage of human resources, medicines, medical supplies and diagnostic equipments). Despite shortcomings and challenges the Government resolved to start. 11

12 5.Historical Perspective. 1.2 PRE IMPLEMENTATION STRATEGIES Comprehensive study on the viability of a scheme Willingness of people to pay for medical services (Affordability). The structure of health care facilities in the country. Population characteristics. Common diseases. Administrative capacity including Government commitment to Health for all and trained manpower. A detailed actuarial study: The population to be covered to make the scheme viable. Establish the break even point. Premium rate that will cater for the benefit package envisaged. The benefit package. The rate of administrative expenses. Eligibility conditions to benefits. Projection of investments and reserves 12

13 5.Historical Perspective. 1.2 PRE IMPLEMENTATION STRATEGIES.. Accreditation Process: technical competence of the respective facility, the stat of the facility itself, manpower status, state of medical equipments, levels of facilities and distributions (Mapping). Documentations and Logistics: Member registration forms. Provider claims forms and monthly report forms. Member identification cards. Sick sheets and Referral forms. Accreditation agreement forms. Advocacy Programme: Psychologically preparation and sensitization of health Providers 13

14 5.Historical Perspective. 1.3 REASONS BEHIND ESTABLISHING NHIF To have a National Scheme that covers groups in phases; To have a scheme that will provide local solutions to the problems existing in the health delivery system; Strengthen the cost sharing in public health facilities by providing an opportunity for the formal sector employees to contribute through their contributions to a Fund; Provide free choice of providers to Public Servants who were formerly restricted to government health facilities; Enhance health equity among formal sector employees in the provision of health care services; To institute a permanent and reliable system for the provision of health services to formal sector employees; To improve the accessibility and quality of health services by introducing competition among health care providers from the Public, Faith based, Non Government Organizations and Private Health Providers; To reduce the financing gap in the health sector by complementing the Government budgetary allocation to the health sector. 14

15 6.Description of the NHIF AREA DESCRIPTION REMARKS 1 Establishment Statutory Scheme, Act No 8/1999 with Autonomous Body of Directors representing the Members, Service Providers, the Govt and the Professionals/Academicians 2. Coverage Total coverage is 15% of the total population (NHIF 7.1% and CHF 7.9%) (as per 2002 population census) 3. Beneficiaries NHIF: Acknowledge the African setting extended family (but with limits in numbers). Each is issued with Identity Card. NHIF is now administering CHF since July 2009 The target is to cover 30% of the total population by Introduction of mplus underway to allow additional dependants (special groups) CHF: beneficiaries are members of household (spouses and children) 15

16 6.Description of the NHIF.. AREA DESCRIPTION REMARKS 4 Contribution rate 6% shared equally between employer and employees. (Both spouses contributes if are employees members) Rate for self employed on the final process. 5. Accreditation Public, FBOs and Private for profit facilities of all levels including Pharmacies & ADDO. 80 % of the total market have been accredited. (Strategic accreditation) Members have the choice to where to access services. 6. Benefits package The package is comprehensive covering consultations; Medicines (including cancer drugs & immune suppressants); Diagnostic services (including CT Scan & MRI); OPD; Inpatients; All surgical services, physiotherapy; dental services, issuance of reading glasses and orthopedic appliance such as hearing aids The services are portable throughout the Country. 7 Providers payment mechanism Fee for service was adopted since inception with daily rate for few special facilities. Intends to introduce capitation to primary level facilities 16

17 7.Recent Developments Administration of CHF w.e.f July, 2009; Inclusion of the Police force; Councilors (who are not members of the Parliament); Religious Leaders & Students to the NHIF; Extension of health services coverage to retirees; Introduction to medical equipment and facility; improvement soft loans to accredited providers; Chairperson of the sickness and Medi care Technical Committee under the auspices of the International Social Security Associations (ISSA) ( ) Construction of centers of excellences (ocean road clinic and at Dodoma Regional hospital); Construction of modern Medical centers at the University of Dodoma on progress. 17

18 Construction of Modern Medical Centre at Dodoma on progress. 18

19 8.Projects with Local and Development Partners With SDC/Swiss Tropical Public Health Institute on strengthening CHF in Dodoma Region ( ) (started and showing good indications); Support poor pregnant mothers and their families in Tanga and Mbeya to access CHF services+ maternal health care With KfW (at designing stage); targeting 70,000 poor H/holds; Group enrollments: With GIZ/TGPSH PPP on CHF and Health Promotions in Tanga and Lindi Regions (on going); So far 102 informal economic groups have been registered since Sept, 2010; We are at initial discussion with Ifakara Health Institute, WHO, Tanzania Social Action Fund (TASAF) on extension of CHF coverage 19

20 9. Lessons Since Inceptions Political will is a central issue for the establishment and development of SHI in Africa; Africa and developing Country should set SHI schemes that reflect their local needs but without total departure from the basics; Accreditation is a trick issue in Africa ( a balance on what is available, members concern and standard requirements should fairly be sorted out); Dialogue with members and involvement of media is healthier for the scheme acceptability and transparency. SHI schemes should seriously be involved in the improvement and development of health systems delivery; Sustainability of the scheme should not be comprised for political or popularity reasons. 20

21 10. Challenges Medicines: non availability and unpredictable changes in the prices (currently un regulated); Health services to the rural areas: shortage of Medicines; Human resources shortage & lack of equipments (addressed through MMAM program and medical and facility improvement scheme by NHIF) Fraudulent claims & collusion between members and providers Extension of CHF coverage Pro poor funding (sustainable approach). 21

22 11.Strategies for the extension of CHF coverage Implementation of CHF action plan; Implementation of CHF projects (open for collaborations) on the following: Data base management; Development of CHF financial management system Membership Identification system Public Education and Awareness Program Implementation of TIKA in urban areas Scaling up group enrollments to all Councils 22

23 12.Strategies for the Pro poor The introduction of mplus within NHIF for the aged 60+; People living with disability and children; Project test with KfW for poor pregnant women; Talks with TASAF on the possibilities of funding those who are un able to pay. 23

24 13.Plans for the future Making the CHF a National Agenda; Development of sustainable funding options for the propoor; Vigorous promotion of the CHF to cover majority of Tanzanians; To join hands with Partners who will be ready to collaborate with NHIF on extension of coverage; research and development; data tracking; ICT and M &E Linkages/Strategies towards UC (the NHIF/CHF model); 24

25 . Modal developed by Mr E.B.D Humba NHIF TANZANIA 25

26 14. THANKING YOU FOR LISTERNING & WELCOME TO TANZANIA AND TO NHIF For more details please visit contact us at Welcome to Kurasini bendera tatu 26