NHIF ready for 2026 rollout of universal health insurance

In an interview with The Citizen yesterday, the NHIF director general, Dr Irene Isaka, said the Fund has spent the past three years strengthening systems, stabilising finances, and aligning stakeholders to support the shift from fragmented voluntary schemes to a single mandatory national pool.

“We have upgraded our systems to allow self-registration for individuals, digital enrolment and contribution submission by employers, and faster claims processing through fully digitised platforms,” Dr Isaka said.

She said NHIF systems are now interoperable with key national databases, including the Tanzania Revenue Authority (TRA), the National Identification Authority (Nida), the Registration, Insolvency and Trusteeship Agency (Rita), the Public Service Social Security Fund (PSSSF), universities and the Tanzania Commission for Universities (TCU), the Cooperative Societies Registrar, as well as government health facilities, the Ministry of Health, andthe Office of the President of the Regional Administration and Local Government (PO-RALG). The government has set January 2026 as the official start date for implementation.

Prime Minister Dr Mwigulu Nchemba reaffirmed this timeline during a working visit to Songwe Region on December 17, 2025.

It was also part of the commitments made by President Samia Suluhu Hassan within her first 100 days, which she articulated during her general election campaign.

Financing the poorest

A central pillar of the reform is protection for low-income and vulnerable groups, and according to Dr Isaka, the government is finalising the identification and registration of vulnerable households, including issuing insurance cards and mapping their geographic distribution to guide fund disbursement.

“The moment we know who they are and where they are, we can channel funds directly to the health facilities that will serve them,” she said.

The Universal Health Insurance Act provides for subsidies funded through a mix of government allocations and earmarked levies on selected products and services, including alcohol, cosmetics, gaming, mobile money transactions, and motor insurance.

The ministry of Health has prepared a standard benefits package covering 372 health services, targeting vulnerable households, low-income earners, and the informal sector.  The package will cost Sh150,000 annually for those who pay, while NHIF has developed additional, higher-tier packages for citizens who prefer expanded benefits.

“People are not restricted to one package. Those with higher incomes can choose more comprehensive coverage based on their ability,” Dr Isaka said.

A major structural shift under UHI will be the adoption of a capitation payment model, where health facilities receive lump-sum payments in advance rather than being reimbursed after services are provided.

“NHIF data show that average payment timelines to service providers have already fallen from 120 days to 55 days,” Dr Isaka said.

She said the Fund’s financial position has also improved significantly, moving from a deficit of Sh112 billion to a surplus of Sh225 billion by the end of the 2024/2025 financial year. Dr Isaka stated that the Fund’s medical loss ratio—an indicator of sustainability—has dropped from 112 percent to 69 percent, aligning with international benchmarks that cap the ratio at around 70 percent. “NHIF can now cover claims for up to one and a half years, compared to just seven months previously,” she said.

Integrating existing schemes

Under the new system, institutions in which the government holds more than a 30 percent stake have been formally instructed to ensure their employees are enrolled from January 2026.

The Community Health Fund (CHF), which currently serves largely rural and informal households, has been given a one-year transition period before its members are fully absorbed into the universal scheme.

“NHIF has also opened a separate bank account for universal health insurance contributions to assure members that their funds will not be diverted to other uses,” said the NHIF boss.

Over the past four years, the Fund has extended nearly Sh50 billion in loans to public and private health facilities for infrastructure development and procurement of medical equipment as part of efforts to improve service readiness.

Role of the private sector

Private sector participation has been built into the design of the scheme. NHIF has entered partnerships with banks, mobile network operators, and insurance brokers to support enrolment, payments and outreach.

On service provision, Dr Isaka said NHIF will contract both public and private health facilities without discrimination, expanding patient choice and reducing pressure on public hospitals.

“To improve user experience, NHIF plans to establish customer service desks, introduce a national service number and deploy staff at health facilities to assist beneficiaries, particularly during the early stages of rollout,” she said.

Special arrangements are also in place for students, with parents encouraged to enrol children through schools at an annual cost of Sh50,400, unchanged from current rates.

Household packages will cover up to six members, with flexibility to register additional packages if households are larger, even if members are not from the same nuclear family.

The Universal Health Insurance Act was unanimously passed by Parliament on November 1, 2023, and signed into law by President Hassan in early December the same year.

The legislation mandates health insurance coverage for all citizens and residents on the mainland, while Zanzibar continues to operate under its own arrangements.

The Act establishes a single public insurance pool managed by the NHIF, integrates existing schemes, such as the Community Health Fund (CHF), through a transition period, and introduces government-backed subsidies for vulnerable households.

The reform builds on earlier groundwork laid when Tanzania was selected in 2019 as a focus country under the World Health Organisation’s Universal Health Coverage (UHC) Flagship Programme.

At the time, an estimated 85 per cent of Tanzanians were uninsured, primarily due to the voluntary nature of health insurance schemes and the prevalence of the informal sector.

Guided by the Health Financing Strategy (2016–2026) and the Health Sector Strategic Plan V (2021–2026), the government embarked on harmonising multiple insurance schemes into a single mandatory system to expand risk pooling, improve sustainability, and increase equity in access to care.

Progress accelerated after President Samia took office in 2021, with UHC elevated to a core governance priority alongside infrastructure, education and energy.