What it takes to improve rural health

Dealing with rural people, most of who are in the informal sector, without guarantee to medical insurance is a challenging experience that requires commitment.

This has been our experience at Benjamin W. Mkapa Foundation(BMF)for the past 12 years that have seen us work to improve the health of rural people in Tanzania.

Now as the coountry is spearheading the national agenda on Universal Health Coverage, (UHC), it is important to ensure every Tanzanian has access to health insurance.

In reference to the recent 2015/16 Tanzania Demographic Health Survey, it has been reported that 1 out of 10 Tanzanians are covered with health insurance.

Data from the National Health Insurance Fund (NHIF) show that only about 33 per cent of Tanzanians have health insurance which is either in the formal or informal model.

That is (7 percent on NHIF, 25 on CHF and 1 percent other health insurance).

The national target is to reach 50 per cent of Tanzanians with health insurance by 2020.

But there is disaggregation between the urban and rural. Majority of the people having health insurance are in urban settings since they have wider access, financially, to the public and private health insurance.

It is further presumed that more affluent and middle class are the ones with better access and can afford health insurance. Informal sector in rural settings are challenged given the high poverty levels.

Nevertheless, the government has set an affordable health insurance scheme for the rural settings, namely Community Health Fund(CHF) where each household is able to contribute annually an amount ranging from Sh10,000 to Sh30,000/- in the CHF and a co-matching fund is availed by the government.

The annual premium paid will serve the head of the household and 4-6 family members. Best practices exist in some parts of the country which needs to be emulated.

The challenge we see here is the lack of awarness among the rural people on the benefits for CHF as well as practical solutions on how they can obtain the finances to contribute to the CHF.

Furthermore, how we balance demand and supply is another existing challenge which needs to be addressed by all players in this sector.

One will be more motivated to have CHF if he/she is assured of quality health care at the facility end that is, being attended by a skilled health worker, ensuring availability of diagnostic tests and medication when being attended at the public health facility.

To facilitate the poor segment of the population in rural setting access health care, the government has also set an exemption system which caters for vulnerable population such as pregnant women, children under five, people living with HIV/AIDS and tuberculosis, the elderly and so on.

Likewise, those not having health insurance, will be obliged to share the cost share (out of pocket fees) to receive health care which is further challenging to the poor population.

Now that the country is striving to bridge the gaps in healthcare provision through promoting UHC, stakeholders, including Benjamin Mkapa Foundation (BMF) which I lead, have a role to play.

On our part, we believe Tanzania needs to embark comprehensively into UHC. This is the plan that we are part and parcel of, in an effort to attain the goals.

There is need to balance the investment to be made on supply and demand.

Whilst we mobilize the communities to be covered with health insurance, we need to ensure our supply-end are client oriented and well equipped with basic resources such as qualified health staff, functioning diagnostic services with reliable quality results, availability of medications, suitable infrastructures and effective referral systems.

Likewise, on mobilization of community, we have been working with the Local Government Authorities (LGAs) and related structures as well as CSOs. However, we feel the role of Civil Society Organisations(CSOS) in the UHC plan has not been fully optimised. CSOs could be an effective medium to reach community.

There is a pressing need to build a strong network of CSOs countrywide who will mobilise communities. This way, we will help the rural people attain better health via UHC.

Dr Senkoro is CEO of Benjamin W. Mkapa Foundation, Medical Doctor & Public Health Specialist.