Live and let live best to end NHIF cards use disputation

The Guardian
Published at 11:03 AM Mar 04 2024

THERE have lately been impressions that legal action was awaiting private hospitals refusing to provide health services to National Health Insurance Fund (NHIF) card holders.

 This was widely feared to be setting the stage for a stand-off between the government and the private sector and, even more accurately, between the bureaucracy and private hospitals.

A number of policy, legal and even moral issues are being raised, including as to whether making a profit in medicine is decent or – more generally – acceptable.

It is this sort of debate that Health minister Ummy Mwalimu risked in one aspect of reactions to reluctance or outright refusal by private hospitals to serve NHIF clients.

The first reaction heard from the public in reporting from at least two regions is that those visiting or seeking medical consultations in private hospitals with NHIF cards finally had to resort to public health facilities.

That doing so entailed – or even induced – immense discomfort is easy to comprehend, but whether it is something to touch off a crisis is subject to discussion.

There possibly would be no problem were it merely that the issue was getting patients treated, as there is no policy left or right that such and such a patient ought to be treated in a private hospital.

The case would thus be that anyone wanted medical attention in such facilities, that particular person (alone or with members of his or her family) would know where to take out an insurance policy.

The scenario would be would be similar to that of employers – including the government – wishing their staff to be treated in private hospitals.

Trouble lies elsewhere, though, in that NHIF wants to fill its coffers by getting everybody on board when it levels out charges in most hospitals.

The recent ministerial statement on this issue had elements of wishing to live in peace with private hospitals by declaring that doors for dialogue were wide open – while insisting that they insisting that they continue accepting NHIF card holders.

The latter aspect had a corollary, in asking the registrar of private hospitals to issue a notice on apparent regulatory acceptance of NHIF cards in all hospitals, and all reference to the registrar implying that non-compliance would automatically mean deregistration.

If that was a clearly figured out option, to restore the status quo ante (that is, before hospital administration was liberalised in 1992), there would be no point in also hinting at legal action against non-compliant hospitals.

The way the reference to such action was made was to hint at criminal pursuit in connection with negligence of a patient in need of being treated, etc.

On might however argue that it would in reality be a civil suit, the issue being whether a service provider had no freedom to place tariff limits to accessing services.

It would thus stand as refusal of access on a non-tariff basis that would constitute discrimination, even legal claims.

While the regulatory authorities aren’t there yet, and are unlikely to go that far, there is a temptation on their part to restore the 1977-1992 modalities, where there were two types of public hospitals: those run by the government and those run by religious organisations.

Even now this scenario is emerging, as institutions run by the various denominations show willingness or even readiness to comply with the NHIF sets of charges or packages, unlike individually-run private health facilities.

However, just as most observers have noted, public health is an overly delicate matter and the manner in which it is administered, extended or otherwise handled calls for extremely level-handed consideration.

Our neighbours rightly cherished President Mwinyi’s trade reforms


NOT surprisingly, African leaders and range of members of the diplomatic corps this past week joined Tanzania in mourning former president Ali Hassan Mwinyi, who died in a Dar es Salaam hospital on Thursday evening.

A few voices were especially noticeable, not only those of the likes of Kenyan President William Ruto and opposition leader Raila Odinga but also ‘ordinary citizens’ with sound memories of the mid-1980s.

It was not just Tanzania that came out of the rut of living with biting shortages in most of what people routinely need but neighbouring countries as well.

This was vivid from reactions elicited from a raft of people interviewed on various local, national and international media outlets.

When too few goods for comfort were available in the Tanzanian market or could only be imported with impossibly prohibitive tariffs, the fresh air of free importation of home use goods was unfathomable in its positive impact.

This is something that was evident in what most of the people interviewed said, with most crediting it almost exclusively on the late former president.

Even if fronting tinges of “well-meaning” exaggeration, even distortion, some had the feeling that all this had to do with President Mwinyi’s treatment of neighbouring countries.

For the major point for many observers was the regional impact of free imports of goods – as then the neighbours could easily obtain such goods, changing the atmosphere appreciably. It was in the spirit of the adage of welcoming the stranger to save the native.

This kind of impact is one area of unspoken efficacy of neigbbourliness, not just in serving as role models of how the future ought to be organised or designed by imitating policy action but also in opening up opportunities hitherto absent.

By implication, while founding president Mwalimu Nyerere had a much heralded role in the sub-region with his steadfast support for liberation movements, his economic policies locally were also stressful for the region.

Rather to the contrary, his successor (Mwinyi) took the region to new heights in living up to popular expectation with respect to the availability of literally all basic necessities, that is from basic needs like food and clothing to “luxury items” like TV.

The problems that caused Mwinyi immense discomfort right towards his final years as president included the public bitterness experienced when he started moving in the direction of a profound restructuring of the country’s parastatal sector.

A speech he gave to the national legislature in 1994, outlining successes in that direction, showed that the country had something like 525 state-owned firms.

Since at present there are upwards of 350 such entities, from which the government habitually reaps profits and dividends, it implies that roundabout 200 were disbanded, sold or turned into joint ventures.

There are lessons researchers have usually refused to draw and indeed even study – as to which companies succeeded after being privatised and which failed, and why.

The IMF and the World Bank may once have been directly to blame for having kept insisting on structural reforms.

In between, particularly during the past two decades, they may have been rather silently watching various “collapse socially and economically” but desisted from even as much as raising a finger.

One point here is that Africa still badly needs systematic reforms for the fast-tracking of its own social and economic development.

Many believe this constituted part of the philosophy of the Mwinyi presidency, and no wonder many cherish the reforms whose execution he spearheaded.