by Ben Taylor

Debate on Health Insurance scheme
The government has launched new health insurance schemes, aimed at those not in formal employment, prompting discussion of such a scheme should operate in order to serve citizens best. Known as Najali Afya (I care about health), Wekeza Afya (Invest in health) and Timiza Afya (Achieve health), the new schemes are run by the National Health Insurance Fund (NHIF).

At the launch, the director general of NHIF, Dr Bernard Konga, said the newly introduced packages will enable more people to access healthcare products and services. Previously, he said, health insurance scheme mainly covered workers in the formal economy. Under the new packages, membership fees are pegged at between TSh 192,000 and TSh 516,000 for Tanzanians aged from 18 to 39 years.

Earlier, Mr Konga had appealed to the government to make health insurance enrolment mandatory, so the country would achieve Universal Health Coverage (UHC). According to him, under the current system most people remain uncovered because it is optional to join the health insurance schemes.

“At least 65% of the population doesn’t have access to the quality health services in the country because they have not enrolled on health insurance schemes,” said Dr Konga. “This can be eliminated only if the health insurance enrolment is made mandatory just like it is in some countries.”

The Parliamentary Committee on Social Services and Community Development noted that it was “no walk in the park” for low-income families to afford the annual fees. The committee’s chairman, Mr Peter Serukamba, suggested that the fees be paid on monthly basis during the year. Other committee members pointed to the fact that many health problems are not covered by the schemes, including cancer, hypertension and diabetes.

Further, opposition party ACT-Wazalendo criticised the government over the new schemes, arguing that it sought to exploit people through turning provision of basic services into a business, and that it would create social classes in accessing health care services. They argued that nobody ever chooses to fell sick or suffer from one kind or other of disease.

The Minister for Health, Ms Ummy Mwalimu, responded in a tweet, saying “the packages are entirely voluntary. No one is forced to enrol in one form or the other. Besides, they have not replaced the Community Health Insurance (CHF) arrangement, where the annual contribution rate remains TSh 30,000 for a household consisting of up to six members.”

The NHIF itself was quick to defend the fees for the schemes, arguing that they were reasonable and reflect the high healthcare costs.

Health Insurance has expanded considerably in recent years, with coverage rising to around 30% of citizens in 2018 from 20% just four years earlier. Expansion has been led by two government initiatives, namely NHIF and the CHF. This progress, and the new schemes, will not achieve the government’s previous target of universal insurance coverage by 2020. However, household surveys suggest that those with health insurance are more likely to seek professional help when they fall ill, and that they pay considerably less for their health services when the do so.

Ebola scare flares briefly
Ebola-related panic arose in Dar es Salaam and Mwanza in early September, when two patients showed Ebola-like symptoms. One of the patients, a 34 year old Tanzania doctor studying for a post-graduate course in Kampala, Uganda, died in Dar es Salaam on September 8. She was undergoing treatment at the Temeke Hospital Ebola Treatment Unit and her burial was supervised by the authorities, according to a leaked report by the World Health Organisation (WHO).

In response, some foreign embassies – including both the UK and the US – issued alerts to their citizens resident or travelling in Tanzania. The UK notice stated that “it appears probable that this is an Ebola-related death.”

The government moved quickly to allay fears. “We took samples of those two cases and I can confirm that the patients were not infected with the Ebola virus,’’ said Health Minister, Ms Ummy Mwalimu at a press conference. She added that she was the only authority mandated to announce an outbreak of diseases such as Ebola and other life-threatening epidemics, and termed reports which say six other people had developed Ebola-like symptoms as rumours.

However, several commentators reacted with some scepticism, pointing to a later WHO report that itself expressed caution: “to date [late September], clinical data, results of the investigations, possible contacts and potential laboratory tests performed for differential diagnosis of those patients have not been communicated to WHO. This information is required for WHO to be able to fully assess of the potential risk posed by this event.”

As no further cases were reported, it seems probably that these cases were not in fact Ebola. However, the government’s defensiveness and lack of transparency led to one observer of global health matters to state that “Tanzania has lost a great deal of credibility” over the matter.

There is heightened vigilance across East Africa over Ebola due to an outbreak of the viral disease in Democratic Republic of Congo (DRC) and a reported case in Western Uganda at the border with the DRC (see TA 124).

DRC is grappling with the world’s second largest Ebola epidemic on record, with more than 2500 lives lost and 3000 confirmed infections since the outbreak was announced on August 1, 2018.

“I urge the public to take precautions. We have enhanced screening for suspected cases at key border areas with Uganda and DRC and ports,” said Ms Mwalimu.

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