Social Protection for Individual And National Development NHIF, CHF/TIKA HEALTH FINANCING PROGRAMS The Ag Director General National Health Insurance Fund (NHIF) Dar es Salaam NATIONAL POVERTY POLICY WEEK 25 TH – 27 TH NOVEMBER, 2013

Summary of Presentation 1.From the Arusha Declaration (1967) to the Health Sector Reforms (1993/94); 2.Social Health Protection- Programs 3.Description of NHIF and CHF/TIKA Programs; 4.Anti-poverty and Development Programs at NHIF (Best Practices); 5.Challenges of extension of SHI to the poor; and 6.Recommended measures and the way forward.

National Health Financing Workshop3 1: From the Arusha Declarations to the Health Sector Reforms The Arusha declaration policy 1967 – Free health,& education (welfare system) – The government (main Provider and Financier) – Expansion of services & emphasis on PHC (disadvantaged groups assured access to health services) The health sector reform policy 1993 – Measures to address economic recessions – Introduction of cost sharing 1993 (NHIF and CHF are the products of the reforms) – Changes of attitude (from free to contributions) – Sharing of health care responsibilities between the Government, private sector, communities and individuals – The Govt set a Secretariat at the MoHSW to coordinate the reforms – Health matters are looked and considered in a Sector wider approach perspective. – The Health delivery system operates in a decentralized system

National Health Financing Workshop4 USER FEES SOCIAL HEALTH BENEFITS-SHIB (NSSF) COMPULSORY PROGRAMS NHIF PUBLIC HEALTH PROGRAMS PRIVATE/INDIVIDUAL ARRANGEMENTS MICRO INSURANCE & MUTUAL OCCUPATION PLANS 2.Social Health Protection Programs COMMUNITY HEALTH PROGRAM CHF – 120 COUNCILS

3. Description of NHIF AND CHF/TIKA (how the Program Works and how the Poor People are Involved SAREANHIFCHFRemarks 1EstablishmentAct No 8/1999 Compulsory, contributory Act No 1/2001 Voluntary, contributory Both are products of the health sector reforms 2CoverageFormal sector employee and their immediate families up to 6 (2,979,238) Informal sector. Households (spouse and children) (3,567,540) as of 30 th September, 2013 CHF and NHIF beneficiaries totals to 6,567,778 which 14.5 % of the total population. 3.Addressing special groups Children and parents of NHIF are allowed to be registered as beneficiaries. Those who cannot pay are exempted from paying CHF contributions, but the Law requires to be granted a CHF card. The arrangement has helped special groups in the society to have access to NHIF and CHF services 4Exempting retirees from contributing to NHIF services Since July, 2009 the Management of NHIF has extended health care coverage to retirees (who were contributing before retires) 60 + who does not have the means to pay for the health care services are exempted from contributions Extension of services to retirees have helped them from financing health care costs out of pockets. 5Involvement of stakeholders in the decision making Board of Directors (independent) representing key stakeholders of NHIF Council through Council Health Services Board that represents Involvement of key stakeholders in decision making organs of the scheme has helped to public agenda to be taken on board.

4. Anti-Poverty and Development Programs at NHIF (Best Practices) NoBest practicesDescription of the initiativeTargeted groupRemarks 1 NHIF/KfW Project years project, target to support access to quality health care services to poor pregnant women. Jointly financed by NHIF and KfW bank (Project costs 18 bn/=) 70,000 poor pregnant women (and their Household) in Tanga and Mbeya as of 30 th September, 68,569 poor pregnant women have been covered LGAs are being encouraging to start building capacity so as to take over after the lapse of project period. NHIF and KfW intends to extend the program to Lindi and Mtwara 2 NHIF Investments for the pro-poor NHIF management sets aside funds for investments of which income derived are used to support CHF and the pro-poor CHF scheme and pro- poor (MVCs at LGAs) Tsh 370/= m have been realized since November, Pro-poor financing under CHF An average of Tsh m/= set annually since 2010/11 for pro-poor MVCs in the LGAs (4,020 Household with MVCs have benefited. The program benefited Lindi, Pwani and Singida Regions

4. Anti-Poverty ……. NoBest practices Description of the initiative Targeted groupRemarks 4 Exempting retiree from contributing to NHIF services Since July, 2009 the NHIF extended health services to her retirees members aged 60 years and above and who have retired from employment. Retirees (and their spouses) who were members of the scheme Extension of services to retirees have helped them from financing health care costs out of pockets 5 Outreach program to periphery Regions The Fund in collaborations with Referral Hospitals (MOI and Muhimbili) is conducting outreach programs to upcountry Regions where specialized services are being offered. members of NHIF, CHF and the general public. The program has covered Kigoma, Lindi, Rukwa, Katavi and Pwani 6Medical Equipment and Facility Improvement Loan A platform that enables health facility to improve their health services through medical equipment and facility improvement loan from NHIF that are paid through deductions from their monthly claims All accredited facilities by the Fund. Total approved for 2013/14 Tsh 763 m/= Cumulative since 2007 is Tsh 7.2 bn/= A total of Tsh. 10bn has been set in the 2013/14 annual budget for MEFIC;

5. On Going Activities at NHIF a.Finalizing proposals for awarding best practices (LGAs) on extension of coverage including the pro-poor to CHF; b.Documenting and promoting best practices on NHIF and CHF; c.Technical assistance to a women group in Majohe –Ilala (so that they open ADDO) d.Countrywide sensitization campaign on CHF in collaboration with LGAs (the use of Cinema Van and drama groups)

5. Challenges a.Increased dependence to the schemes even those who are able to work demanded to be included as dependants; b.Absence of standardized tool for determining who is poor and on how to manage exemptions; c.Most LGA’s does not make a provision in their annual plans and budget to cater for the pro-poor (most LGS’s depends on NGO’s to finance pro-poor; d.Access to medicines for the pro-poor is still major challenge as they have not linked to alternative outlet such as ADDO; e.NHIF members with families exceeding six have bear costs for additional members of their families as the Fund cover up to six beneficiaries

6. Recommendations a.All those who are able to contribute to NHIF/CHF should contribute to the programs so as to reduce dependences and create a strong pool to subsidize or finance the pro-poor; b. The process of developing National tool for identification of the poor should be expedited and involve key stakeholders at all stages; c.LGAs should make provisions for the pro-poor in their councils; and d.NHIF and LGA have to work hand in hand in looking for solutions with regards to access to medicines for CHF members. e.There is an imperative need to revive and re-practice all previous best practices that helped the Country to succeed in health and other related campaign (KULENI KUKU MAYAI MBOGA SAMAKI MAZIWA- Makongoro’s Song. Mtu ni Afya- Mbaraka, SKUVI- promoted by IPP media) f. Promote the concept of social capital on health (especially at primary levels); g.A need for coordinated efforts. h.Fighting poverty in all its dimension including loosing hopes or giving up (a need of even using Religious Leaders in the anti-poverty fights)

Submission The paper is submitted for information, sharing of knowledge, experience and discussions. Thanking you all for listening and attention P.O.BOX Dar es Salaam