1. Technical Review Meeting (TRM), Blue Pearl 6-8 September, 2010 Department of Policy and Planning

2.  Background ◦ `Objective Of the Meeting  Areas covered  Issues raised  Way Forward

3.  Provide evidence to inform the scale up of health insurance in Tanzania  Identify key steps to achieve UC

4.  Historical background and Situation analysis  Who pays and who benefits?  FIA pro poor  BIA pro rich

5.  In Tanzania, compared to other countries, health financing to be more or less progressive  Benefits are similar as in other countries, are regressive  The typical distributions of the poor going to lower level facilities.

6.  The CHF is regressive by design  Matching grant - Is it not perpetrating inequity?  A flat rate premium, means everyone pays the same irrespective of income  The scheme also targets the poorest.

7.  Concern ◦ If coverage were to expand and premia to increase, the regressivity of the CHF would be an issue

8.  Current status of the NHIF and CHF ◦ Support to poor pregnant women  SHIB ◦ Formal Private and planning for informal  Private sector ◦ Private firms ◦  Micro insurances ◦

9.  All NSSF members contribute but very few benefit, SHIB members contribute but NOT benefiting from the scheme  Health Funders Board  Adverse Selection

10.  Price inflation (prices charged by private providers),  Patients not respecting referral system

11.  Weak management – especially CHF and Micro  Limited benefit package  Establishment of district drug buffer stocks for supplementary drug supply  Need to wake up a sleeping giant. ◦ Establishment of bank accounts and petty cash

12.  No incentives for districts to promote CHF  Office bearers of the scheme are often overburdened and not full-time professionals.  Poor health insurance literacy within the population 

13.  Regulatory framework for health insurance ◦ Many players ◦ Different perspectives ◦ Some how different objectives ◦ Should we put health insurance in social security or leave it out?

14. ◦ Contributions of the community are rather limited, hence low enrolment  How are we going to handle the informal sector? Exempt? Or pay for them and issue a card? Who will pay for them? ◦ Scaling-up for universal coverage is also implying an increase in usage of services – need for supply side investment to meet increased demand

15. ◦ Fragmentation is an issue  Affects financial sustainability and equity  Modeling - Options to expand health insurance in Tanzania. Done in shorter time ◦ UC per se would have limited impact on GDP and gvt exp on health, ◦ HOWEVER  HSS WILL REQUIRE HUGE INVESTIMENT

16. ◦ Key lesson from other countries  Fund authority response to Insurance Scheme  Earmarked tax works - Ghana and Thailand  It is possible to collaborate with social security fund need action -

17.  A minimum package of Health and Related Management Activities  The required inputs and outputs will be determined as per level of care.  Essential Health Package(EHP)/Services per level of care  Review the Service Agreement

18.  Review the stock list at MSD and TFDA per level of care ◦ Medicines ◦ Devices ◦ Reagents  MOHSW + PMORALG +PARTINERS + MSD+TFDA  Expand Network at all Levels for both public and private as per MMAM and Policy.  PPP

19.  Universal Coverage of the Financing Agenda i.e Social H.I Scheme- ◦ Action Plan ◦ PRIVATE FORMAL ◦ INFORMAL  A lot is in Place in use available Data  Need to develop a milestone for health financing  Financing Strategy