Over a decade ago, in 1999, the government introduced a statutory fund – National Health Insurance Fund (NHIF), an institution that would supplement government activities carried out by the health sector.
Accordingly, Parliamentary Act No. 8 of 1999 was enacted to allow the fund, currently the largest social health insurance scheme in the country, to offer a wide range of attractive, comprehensive and cost effective benefit package to the populace.
It was then envisaged that the services would cover about 6 percent of the country’s population. The NHIF is in effect, an alternative financing option in the health sector, established in July, 2001.
It was introduced after reforms which started in 1993 when cost-sharing was introduced in government hospitals.
Under the reforms, which unfortunately were burdensome to poverty-stricken communities in the country, provision of free health care ceased.
A patient going for medical treatment was then to meet a little cost which the government then said was to go to its coffers to supplement its health budget.
NHIF’s objective was initially to oversee health services provided by the formal sectors, non-governmental organisations (NGOs), faith-based organizations (FBO), pharmacies and the private sector.
According to NHIF, members for the fund are drawn from government, including its institutions, local government employees, Ministry of Home Affairs, higher learning institutions and the private sector whose employees register with the fund voluntarily.
The Act stipulates that after qualifying for membership, an employee will be contributor to the fund at the rate of 3 percent of his/her salary and will access services provided, along with his/her partner and four other legal dependants.
The member and the other beneficiaries, shall then access to health services anywhere in the country.
NHIF services are provided at health centres, dispensaries, regional and district hospitals and referral hospital levels.
But even with the good intention of enactment of the law, the fund is faced with numerous challenges in the course of implementation of its vested roles.
At a stakeholders forum held in Tanga recently it was revealed that serious shortage of medicines was prevailing in centres providing health services.
"It is seems the objective of NHIF chipping in efforts to supplement endeavours to provide health services to its people is being defeated,” said Idrisa Haule, a participant of the forum, adding that patients visiting health facilities, particularly in villages are often turned away for lack of medicines.
After a heated debate on the controversial issue, stakeholders sought an explanation from a representative of the Medical Stores Department (MSD), William Shija.
"According to MSD (1993) regulations, it is MSD’s responsibility to procure and distribute medicines to government hospitals at regional and district levels," he said. “However due to budget constraints we fail to satisfy demand as expected," pointed out, adding that whereas a sum of 150bn/- is needed to meet the demand, only 4Obn/- is disbursed.
According to Ally Mwakababu, Tanga NHIF Regional Manager, where MSD has failed to meet drug requirements of a certain health facility, the health provider should report to his/her respective District Council who would use funds collected from CHF or “Tele kwa Tele” packages to procure medicines from MSD.
"If District Councils were using the funds collected from the two local resources in a prudent manner, surely there should be no problem in procurement of medicines for their village dispensaries," Mwakababu said.
“What actually transpires is that some councils use funds from the two sources for un intended purposes, like payment of allowances for its officials,” he said.
He advised members who would miss prescribed drugs from health centres or dispensaries to go to appointed private health providers for supplies.
“Since private health providers are expected to have sufficient stock of drugs, members who would fail to obtain their requirements should not hesitate to approach the private facilities,’ Mwakababu explained.
He said the fund has, on the drawing board, the merging of both the NHIF and CHF in order to enroll more member -- the ultimate aim being to enable every citizen become a member of the fund.
NHIF Deputy Director General Hamis Mdee said in an exclusive interview that the fund plans to conduct stakeholders seminars to keep them abreast of activities of the institution.
He said the stakeholders would include doctors, clinical officers etc.
“The aim is to disseminate knowledge on how best to attend to clients and filling in of forms for those who have received health services under NHIF,” explained Mdee.
Among benefits package offered to NHIF members are, among others, outpatients care services, surgical services, inpatients care services, physiotherapy ,dental and optical services.