Cry for comprehensive coverage: The detrimental gap in health insurance services in Tanzania

In recent years, the landscape of healthcare in Tanzania has seen significant transformations, with an increasing number of individuals opting for health insurance coverage.

However, despite the progress, there exists a gap in the services provided by health insurance companies, leaving many essential healthcare needs unmet.

Read: Dispute on new health insurance package drags on as team defends NHIF

Despite the pressing demands for services such as general check-ups and treatment for sexually transmitted infections (STIs), and even mental health treatments, some health insurance providers in Tanzania have been falling short in delivering these crucial services to their clients.

This issue raises concerns about the accessibility and adequacy of healthcare services provided by insurance companies, ultimately impacting the well-being of Tanzanians.

Irene Ngowi, a 41-year-old resident of Dar es Salaam, knows the juggling act of balancing work responsibilities with family duties all too well.

As a devoted mother and active member of the workforce, Irene places great importance on maintaining her health to ensure she can continue providing for her family.

Like many others in similar situations, Irene relies on her health insurance to facilitate regular check-ups, viewing them as essential preventative measures to safeguard her well-being and that of her loved ones.

Read: Health insurance covers 15 percent of Tanzanians

However, Irene's reliance on her insurance plan took a disappointing turn when she discovered that basic preventive care services were not covered. This revelation left her feeling disheartened and frustrated, as she realised that the very services she deemed crucial for her family's health were not included in her coverage.

Without access to routine check-ups, Irene found herself grappling with the dilemma of how to prioritise preventive care amidst competing demands on her time and finances.

"Investing in my health is investing in my family's future. But when essential services like regular check-ups are not covered by my insurance, it creates a barrier to proactive healthcare management," she reveals.

She adds that the inability to access preventive care not only hampers her ability to stay on top of her health but also introduces uncertainty and anxiety about potential health issues that could arise unchecked.

On his part, Jerome Thomas, a 24-year-old resident of Dar es Salaam, shares a deeply troubling experience that shook his faith in the healthcare system.

He says contracted a sexually transmitted infection (STI) nine months ago and was shocked to learn that his insurance did not cover the necessary treatment.

This revelation not only had serious implications for his physical health but also dealt a blow to his trust in the insurance system as a whole.

Jerome's story highlights the stark reality faced by many young adults in Tanzania, especially in urban areas like Dar es Salaam, where the prevalence of STIs is a pressing public health concern.

"These challenges are tormenting most youth, especially in this town (Dar es Salaam), so it’s important for insurance providers to cover them for the sake of the country’s workforce health," Jerome emphasises.

On the other hand, Yasinta Alphonce, a 27-year-old resident of Dar es Salaam, sheds light on a critical aspect of healthcare often overlooked; mental health services.

Yasinta expresses concern over the insufficient coverage for mental health services provided by her insurance plan, highlighting the distressing impact this limitation has on individuals' well-being.

"The limited coverage for mental health services is distressing. Mental well-being is just as important as physical health, and insurance should reflect that," she notes.

She says she was surprised to hear that mental health treatment isn’t being covered by insurance while it plays a vital role in overall well-being, influencing not only an individual’s quality of life but also their ability to function effectively in society.

“Mental health should get priority because we need to be mentally right to deal with our daily routines,” she says.

On top of that, another resident of Dar es Salaam, Benard Kimaro, 26, reveals that he is deeply troubled by the failure of health insurance providers to cover mental health treatment.

“It's alarming to see how many young people are grappling with mental health challenges, only to be met with a system that neglects their needs,” he says.

He continues: “Mental health is not a luxury; it's a fundamental aspect of overall well-being. Yet, insurance companies continue to ignore the struggles of countless individuals who desperately need access to mental health services. This negligence perpetuates the stigma surrounding mental illness and exacerbates the suffering of those affected,” he shares.

He went on to say that it is time for insurance providers to recognise the importance of mental health care and take meaningful action to address this issue.

“By expanding coverage to include mental health treatment, they can provide much-needed support to our youth and help alleviate the burden of mental illness in our communities,” he says.

Damas Kichele, a 38-year-old resident of the Pwani region, emphasises the importance of preventive care in insurance coverage.

Damas advocates for prioritising services such as vaccinations and health screenings, which play a crucial role in promoting long-term health and well-being.

"Preventive care should be a priority for insurers. By neglecting services like vaccinations and health screenings, they're missing an opportunity to promote long-term health," he asserts.

Damas' viewpoint underscores a fundamental principle in healthcare which states that “prevention is better than cure.”

“By investing in preventive measures, such as vaccinations to prevent infectious diseases and regular health screenings to detect health conditions early, insurers can not only improve individual health outcomes but also reduce healthcare costs in the long run,” he explains.

He adds that prioritising preventive care aligns with the broader goal of promoting population health and well-being.

The Director General of the National Health Insurance Fund (NHIF), Mr Benard Konga underscores the critical importance of health insurance providers in providing comprehensive education to their customers regarding the services they offer.

“Individuals must have a clear understanding of the benefits and limitations of their health insurance coverage so that they can make informed decisions about their healthcare needs,’ he says.

He continues: “It is not enough for health insurance providers to simply offer coverage; they must also ensure that their customers understand what is covered and what is not. This transparency is essential for building trust and confidence in the insurance system and ensuring that individuals can access the care they need when they need it.”

He explains that through targeted educational initiatives and clear communication channels, health insurance providers can empower their customers to make informed choices about their healthcare coverage.

However, Health Minister, Ms Ummy Mwalimu says that it is crucial for citizens to have the ability to choose from various health insurance companies in the country, depending on their individual needs and financial capabilities.

“We encourage our citizens to conduct thorough research on available health insurance policies so they can make informed decisions based on their healthcare needs,” she says.

Additionally, she says the government has been responsible for ensuring that insurance companies provide clear information about the services they do and do not offer.

“This helps prevent confusion among citizens and ensures they have a sufficient understanding of the services available under the respective insurance,” she explains.