What proposed amendment of NHIF law seeks to achieve

However, the latest amendment aims to widen the scope of beneficiaries, by accommodating other categories of persons to be registered with the fund instead of registration of government employees only.

The new move aligns with the requirements under the Universal Health Insurance Act No. 13 of 2023 which initiates health systems reforms to expand financial protection and improve access to quality health services for all Tanzania’s mainland residents.

“This Bill intends to amend the National Health Insurance Fund Act, Cap. 395 in order to align it with the Universal Health Insurance Act, No. 13 of 2023 and to address challenges that have been encountered during the implementation of the Act,” the Bill states.

The NHIF Act, enacted in 1999, has undergone nine amendments to keep pace with sectoral and technological changes, as well as regional and international standards.

Some of the proposed changes include to refine definitions to ensure clarity and consistency in line with the UHI Act and replace references to the Social Security Act with the Universal Health Insurance Act, recognising its role in governing health insurance schemes.

The Bill proposes an amendment to allow broader membership registration beyond government employees.

Apart from the public servants, the fund will also accommodate employees from the formal private sector, persons from the informal sector and indigent persons. Other members are councillors, retirees and children or students who do not fall within the category of dependants.

According to the proposals, the definition of a child’s age for coverage will also be raised from 18 to 21 years.

The Bill also specifies contribution rates for all registered members, including those in the formal private sector and certain public sector contributors, while aligning informal sector contributions with the Universal Health Insurance Act.

Further amendments include removing outdated references to the Social Security Act, expanding membership categories and recognising multiple forms of identification, including electronic means.

In another governance shift, the Bill contains proposal that the President, rather than the board, appoints the NHIF director general.

To ensure flexibility in adjusting contribution rates, the Bill mandates the Minister, upon recommendation from the board, to publish any changes in the government gazette.

Some of the sections propose eliminating NHIF’s accreditation role, instead requiring it to certify health care providers accredited by the Ministry of Health. It will also empower the board to adjust certification criteria beyond geographical constraints, enhancing service flexibility for beneficiaries.

The Bill also seeks to ensure prompt disbursement of funds to health service providers by depositing payments directly into their accounts.

Moreover, it expands monitoring measures to prevent fund misappropriation.

To comply with International Financial Reporting Standards (IFRS), the proposed law will require NHIF to present a ‘statement of financial position’ instead of a ‘balance sheet.’

Increasing financial protection has been at the heart of reforms targeting the health insurance system in Tanzania for the last two decades.

Apart from enacting the 1999 law that established the NHIF, the government established Community Health Fund (CHF) in 2000, targeting the informal sector rural households and managed by the districts.

In 2005, the National Social Security Fund [NSSF] established the Social Health Insurance Benefit (SHIB), followed by Tiba kwa Kadi (Tika) in 2009. In 2016/17, NHIF undergone amendment to include more civil servants, governance and beneficiaries and amendments on CHF to form improved community health fund (iCHF).

In 2023, the Universal Health Insurance Act was enacted to introduce mandatory health insurance for all citizens and residents.