1. International Conference on Social Protection: December 15-17, 2014
Social Protection: Building Effective and Sustainable for Equitable Growth
Sectorial responsibilities and synergies in Tanzania: Promoting Equity and Social Protection within Health and Social Welfare
Ministry of Health and Social Welfare
International Conference on Social Protection: December 15-17, 2014
Arusha, Tanzania

2. Social Protection Policies After Independence;
Outline
Social Protection Policies After Independence;
National Social Health Protection Framework and Implementation mechanism;
Status of Social Health Protection and Equity-Achievements
Community Health Fund as anti-poverty drive for households
Challenges;
Best Practices;
On going Initiatives
Important Lessons to Uphold
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Social Protection

3. 1: Social Protection Policies After Independence
The issue of social Protection and Equity
The Arusha declaration policy 1967
Free health,& education (welfare system)
The government (main Provider and Financier)
Expansion of services & emphasis on PHC
The health sector reform policy 1993
Introduction of cost sharing 1993/94
Changes of attitude (from free to contributions)
Sharing of health care responsibilities between the Government, private sector, communities and individuals
The Health delivery system operates in a decentralized system
Expansion of PHS
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Social Protection

4. 2.NATIONAL SOCIAL HEALTH PROTECTION FRAMEWORK
PRIVATE/INDIVIDUAL ARRANGEMENTS
OCCUPATION PLANS
MICRO INSURANCE & MUTUAL
SOCIAL HEALTH BENEFITS-SHIB (NSSF)
COMMUNITY HEALTH PROGRAM
CHF COUNCILS
COMPULSORY PROGRAMS
NHIF
PUBLIC HEALTH PROGRAMS
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5. 2. IMPLEMENTATION MECHANISM OF SOCIAL HEALTH PROTECTIONSN
AREA
MINISTRY/DEPARTMENTS
ROLE 1
Ministerial duties
Min of Finance
Policy development and guidance in implementation and allocation of fund 2
Min of Health and Social Welfare
Provision of public health and nutrition services, vertical programs and financing of health of special groups in the society 3.
Prime Minister- Regional Secretariat
Agent of implementing Health Policy at Local level in a decentralized system 4
Ministry of Labour
Regulate Social Security Schemes through SSRA (Regulator) , NSSF 5
Min of Women Dev
Coordinating the MVCs, gender issues on social protections. 6
Department/ Institutions
TASAF, Health Insurance and other Pre-payment schemes including micro insurances.
Empowerment and provide access guarantee to health and nutrition services.
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6. 2. Strategy and programs that alleviate extreme poverty and malnutrition
Tanzania has a national nutrition strategy addressing both nutrition specific and nutrition sensitive interventions implemented at large scale, at all levels of causality (immediate, underlying, basic) and of society (household, community, population). They include interventions that;
promote good nutrition practices, including maternal, infant and young child feeding (IYCF) and healthy diets
improve vitamin and mineral intake,
lead to proper management of acute malnutrition including severe and moderate acute
promote enrichment of nutrient density of the diets of young children (6-–23 months of age) and pregnant and lactating women.
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7. 3. Status of Social Health Protection and Equity-Achievement
Provision of Health Bloc Grant
Formula based allocation of GOT Funds for OC aims at improved equity between districts
Availability of Health Basket Fund
Pooled funding from development partners not earmarked and using GOT systems using resource allocation formular
Public- Private Partnerships (PPP)
Use of service agreements to shift public funding for private sector provision of essential services from input to output financing.
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8. 3. ACHIEVEMENTS…
Establishment of Community Health Fund (1999) – by 2014 covers 135 out of 167 Districts Councils and some City/Municipals (80.8%) targeting to cover all Councils by June 2015
NHIF (2001) – covers nearly all public sector employees- strong mgt. systems and financial position
NSSF (2006)-SHIB Scheme for private sector employees with growing membership and provider network
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9. 3. ACHIEVEMENTS
Gradual increase in the scope of coverage to 19.42% of the total Population by June 2014
Summary of Pre-payment Plans in Tanzania as of 30th June, 2014
Scheme
Establishment
Act
Effective Date (Health)
Number of members
Number of beneficiaries
% of pop covered
NHIF
No. 8/1999
2001
602,955
3.12million
7.4
CHF
No. 1/2001
654,827
3.5 million
9.2
NSSF/SHIB
No. 36/1964 & No 28/1997
2005
102,890
0.12
Private Insurance
450,000
1.4
Micro Insurance
440,000
1.3
Total
7,612,890
19.42
Source: MOHSW
Setting of a Regulator to regulate Social Security
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10. 3. ACHIEVEMENTS (Tools For M&E)
Annual Public Expenditure Review – Review of public financing and monitoring of trends and National Health Account
Annual Joint Health Sector Review
Together with all stakeholders the trends are reviewed, achievements and challenges identified and a consensus on the way forward is reached
MTEF analysis by HSSP3 areas –Assessment of strategic planning
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11. 4. COMMUNITY HEALTH FUND AS ANTI-POVERTY DRIVE FOR HOUSEHOLDSNo
Area
Description 1
Design
Council based voluntary pre-paid scheme (supported by the MOHSW, PMO-RALG and NHIF at National level) 2
Roll over
Operational in 135 (80%) LGAs out of 167, targeting to reach all LGAs by June, 2015 3
Targeted population
Informal sector in Rural (CHF) and Urban areas (TIKA)
Coverage
As of September, 2014 A total of 4,177,194 (696,199 Households) beneficiaries (9.57% of the Main land population). Targeting to cover 20% by 2015 and NHIF (10%) Thus making a total coverage of 30%. 4
Contributions
Council based Annual contributions ranges between 5,000/= to Tsh 20,000/= Per household (spouses and children under 18 years). For TIKA is individual contributions
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12. 4. COMMUNITY HEALTH FUND…
Area
Description 5
Governance and Gender issues
Community involvement in Administration of the scheme through established structures (CHSBs and HFGCs )
Genders issues have been taken into considerations in selection of representatives.
transparency in budgetary process and notifying the community on revenue and expenditures at health facility level (through notice boards- MOHSW issued a directives) 6
Pro-poor
The CHF Act provides for exemptions and requires the exempting authority to pay for the exempted individuals and groups.
Some Development Partners paying for the health care cards to families of poor pregnant women's in Tanga and Mbeya Regions; 7
Involvement of Private sector
Through agreement with the LGAs to provide health care services to CHF members in some Councils.
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13. 5. CHALLENGES
Access to health by Households is largely financed through Out-of-Pockets payments (despite its decrease from 47% in 2001 to approximately % in 2014)
Majority of Tanzanians who are in pre-payment schemes are covered by voluntary arrangements
“It is impossible to achieve universal coverage through insurance schemes when enrolment is voluntary” (World Health Report 2010)- (Fragmentation of scheme)
Limited sources for the pro-poor funding limits extension of coverage thus continued relying on waivers approach which has some limitations.
Rural health and nutrition services (availability of medicines, diagnostics tests, awareness of the community on health Insurance and nutrition interventions).
Poor recognition of the importance of social protection measures in addressing malnutrition
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14. 6. BEST PRACTICES
Administrative Linkages of National Health Insurance Fund (NHIF) and Community Health Fund (CHF) under the Board of Directors of the NHIF and MOHSW (strong administrative pool);
Development Partners are working within the existing frame work (initially there were limited parallel initiatives that overlapped with the National Goal);
Extension of health insurance services to the pro-poor through LGAs, TASAF, NHIF support and from Councils Annual health plans (CCHP)
Political Will, Hon President has demonstrated great effort in the development of Health Sector and all top Leaders are sensitizing the community and encourage them to join CHF. All District Commissioners are currently heavily involved in sensitizing the community jointly with the service providers and local community leaders.
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15. 7. ON GOING INITIATIVES
The MoHSW is in the process of developing a country health financing strategy that will lead towards a sustainable universal coverage health financing- (Involving different sector in the Process).
There are efforts to mainstream health and nutrition into the ongoing TASAF III
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16. 8. IMPORTANT LESSONS TO UPHOLD
We should learn from each other
Government Leadership. We should appreciate both private and public toward the development of Social Protection however the government need to take leadership in this process.
Health Insurance should contribute to the development of health delivery system and should be (where possible) linked to community based scheme: Social Health Insurance schemes should seriously be involved in the development of health delivery system but without compromising with the sustainability of the scheme.
We should always emphasis the need of community involvement/participation: Intense and extensive community‘s education campaign is an important undertaking.
Community health and other pre-payment schemes are anti-poverty drives that protects families from falling back into extreme poverty.
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17. KARIBUNI SANA TANZANIA
Thanking you all for listening and attention
KARIBUNI SANA TANZANIA
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Social Protection