DEPENDENTS with an independent income in Zanzibar are now required to contribute to the health fund, moving away from a system of total reliance on primary contributors.

Dr Saada Mkuya Salum, the acting Health minister, made this affirmation when setting out the Zanzibar government’s new framework for Universal Health Coverage (UHC), emphasizing that the sustainability of the health fund relies on a fair contribution model. 

She detailed these changes at the House of Representatives session yesterday in response to Mihayo Juma Suleiman (Mwera), who sought clarification on the rights and limitations of dependents under the current health insurance legislation.

The Zanzibar Health Services Fund (ZHSF) operates under Act No. 1 of 2023, where Section 3(c) provides a strict legal definition of who qualifies as a dependent, indicating that such person can be a spouse or parent of a contributing member having no employment in the formal sector.

Such persons would also not be engaged in any informal sector income-generating activities and lack the financial capacity to contribute to the fund independently, she said, underlining that to be recognized as a direct dependent, an individual must fulfill all three criteria. 

“If a spouse or parent has a source of income, they lose the status of a direct, non-contributing dependent and are integrated into the contribution bracket," she stated, asserting that these criteria are in alignment with international UHC principles.

Setting out dependents in distinct socio-economic tiers is meant to ensure the fund remains financially viable while protecting the most vulnerable, as middle income earners need not unfairly benefit from a system intended to provide a safety net for those in absolute poverty, she explained.

To prevent fraud and ensure that only those truly in need receive free services, the fund has launched a comprehensive socio-economic verification exercise, collecting data on the living conditions and financial status of all registered dependents, she said.

When assessment of a dependent's standard of living is complete, those verified as having zero income will be permitted to access services in public and private hospitals, such that the poor will not be restricted to lower-quality care due to inability to pay, she said.

ZHSF is not violating the principles of dependency but is instead modernizing them for current and future generations, as by requiring those with income to pay a modest annual fee, the fund can build the reserves necessary to cover expensive treatments—such as specialized surgeries and chronic disease management—for the entire population, she added.