Dar es Salaam. As Tanzania moves forward with the implementation of universal health insurance (UHI), stakeholders have underscored the crucial role of artificial intelligence (AI) in expediting claims processing, curbing fraud, enhancing service delivery and meeting the growing demands of the healthcare sector.
In the past, disputes between healthcare providers and insurance firms often arose from contract breaches or delayed payments, ultimately affecting patients seeking care.
However, the introduction of digital systems, particularly those powered by AI, has significantly reduced such challenges.
This development comes as Tanzania prepares to roll out its much-anticipated UHI scheme. President Samia Suluhu Hassan, who is also the ruling party’s presidential candidate in next week’s general election, has pledged to launch the initiative within her first 100 days in office if re-elected.
Speaking when she launched her campaigns in Dar es Salaam late in August, she said the pilot phase of the UHI would initially cover children, the elderly, expectant mothers and people with disabilities. Their treatment costs would be fully financed by the National Health Insurance Fund (NHIF).
“Within the same 100 days, we will also finance specialised medical treatment and diagnostic services for underprivileged citizens suffering from non-communicable diseases such as cancer, kidney failure, heart conditions, orthopaedic complications and neurological disorders,” President Hassan said.
To strengthen service delivery, she added, the government would employ 5,000 health workers, including nurses and midwives, with the aim of improving maternal and child health.
At a recent panel discussion during the launch of the 2024 Insurance Market Report in Dodoma, the chairman of the Medical Insurance Council and CEO of Jubilee Insurance, Dr Adamson Harold, noted that claims management had improved considerably over the past two years thanks to digital systems supported by AI.
“For instance, Jubilee Insurance has made significant investments in technology to ensure that claims are processed on time and results are transparent.
Between January and September, we processed over $700,000 in hospital claims without any disputes because everything went according to plan,” he said.
Dr Harold stressed that the integration of AI into the UHI rollout was inevitable, as it reduces human error and enhances operational efficiency.
“When both parties trust the results generated by AI systems, it minimises disputes and eliminates issues like duplicate payments for services,” he added.
Sharing similar sentiments, the NHIF Membership Services director, Dr Alfonse Chandika, said the fund was developing an AI-powered system to process claims more swiftly and accurately, reducing reliance on manual methods that have previously caused misunderstandings with healthcare providers.
“It’s true that in the past, there were challenges that caused friction between us and service providers. However, through the systems currently in place and those under development, these issues are being addressed.
As the population continues to grow, AI is essential to help us work more efficiently,” he said.
As part of preparations for the full UHI rollout, NHIF has expanded its operations to 42 strategically selected districts across the country to ensure faster and more efficient service delivery.
Currently, only about 15 percent of Tanzanians are covered by formal health insurance schemes, highlighting the need for broader access. Citizens can now register digitally, eliminating the need for physical cards and expediting access to care.
To further increase reach, NHIF has partnered with the Association of Tanzania Insurers, with 23 insurance agents already working alongside the fund.
It is also collaborating with mobile phone operators, social workers and grassroots organisations to promote enrolment in the UHI scheme.
Benjamin Mkapa Hospital’s Director General, Prof Abel Makubi, commended the progress made so far but emphasised the need for further improvements to ensure high-quality services, particularly in access to medicines and diagnostic tests.
“The introduction of UHI will raise expectations among citizens. It’s essential that services are enhanced before the rollout begins. Citizens deserve quality care, timely access to medication and respectful, compassionate service,” he said.
On the technological front, the Ministry of Health has made notable strides in strengthening digital infrastructure, an essential step as the number of insured clients increases. However, stakeholders emphasised the need for greater system interoperability to ensure seamless service delivery.
They also highlighted the importance of creating a supportive work environment and equipping health personnel with continuous training on digital systems and insurance claims management.
Dedicated teams within healthcare facilities, they said, should oversee claims to ensure efficiency and accuracy before submission to insurance funds.
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