What Universal Health Coverage means for Tanzanian families

MTWARA: THE government has taken another major step towards making health insurance accessible to more households by expanding a national initiative designed to protect families from the financial burden of illness.

The second phase of Universal Health Coverage (UHC), launched in Mtwara last week targets 625,000 households unable to afford health insurance, with the government pledging to finance coverage for eligible families.

At the heart of the initiative is a promise that no Tanzanian should be denied essential healthcare because they cannot afford to pay. But turning that commitment into reality will depend not only on enrolling households, but also on ensuring that members understand their benefits and can obtain the treatment they need.

Speaking during the launch in Mtwara last week, Minister for Health Mohamed Mchengerwa said the programme reflects the government’s determination to protect citizens from the financial consequences of illness.

“Today, we are launching a promise, a promise by the nation to every citizen that, from now on, no Tanzanian will be left to die simply because they have no money,” he said.

Mr Mchengerwa explained that citizens who can afford health insurance will contribute towards healthcare costs, while the government will continue financing coverage for those unable to pay.

However, translating that promise into practical benefits requires more than expanding registration. Citizens must understand how to join, who qualifies for coverage, which services are included and the conditions governing access to treatment.

Government Chief Medical Officer, Prof Bruno Sunguya sheds light on these issues as the government seeks to help citizens understand the second phase of Universal Health Coverage (UHC) and the procedures they must follow to benefit from the programme.

His explanations highlight a fundamental distinction: having health insurance provides financial protection according to an agreed package, but it does not automatically guarantee access to every medical service at any health facility.

Understanding this distinction is essential for households seeking to make informed decisions about their healthcare and avoid unexpected costs when illness occurs.

**Joining the scheme: Contributions, registration and eligibility **

Prof Sunguya said one of the packages available under the programme is Fahari Afya, which provides essential healthcare benefits to households for an annual contribution of 150,000/-.

The package covers a household of up to six people, comprising the household head, spouse and no more than four eligible dependants. For households planning their finances, the arrangement establishes a defined annual contribution for a specified number of beneficiaries.

However, the value of the package depends on understanding who qualifies as a dependant and the benefits available under the scheme.

Registration can be completed through the National Health Insurance Fund’s online self-service platform, selfservice.nhif.or.tz, authorised insurance agents, participating banks and mobile network operators, community health workers and NHIF offices operating across the regions and some councils.

The availability of several registration channels is intended to make enrolment more accessible, particularly to people who may have difficulty reaching insurance offices or completing online procedures independently.

Community health workers and authorised agents can also help extend registration services to villages and streets, bringing the process closer to households.

Prof Sunguya said applicants must provide their National Identification Authority number and evidence of their relationship with any dependants they intend to register.

“Once the registration and contribution requirements have been completed, members receive a membership identification number and a digital card,” he said.

Accurate information is important because membership benefits apply to the registered member and eligible dependants.

Providing false information or documents to avoid contributions or obtain benefits improperly is contrary to the established procedures and may result in legal or administrative action.

The rules also define how household membership is determined According to Prof Sunguya, eligible dependants include the member’s parent or the spouse’s parent, a biological, adopted or stepchild below the age of 21, or a biological sibling below the age of 21.

An individual living alone can qualify as a household and join Fahari Afya. Where a household has more than six people, another household can be established with a new head and eligible dependants.

Similarly, a child or biological sibling registered as a dependant ceases to qualify under that category upon reaching the age of 21 and is expected to join as a separate household.

The explanations also provide for situations involving a member with more than one spouse, allowing an additional spouse to register as a household and enroll eligible dependants in accordance with the law.

Prof Sunguya said students above the age of 21 may join Fahari Afya or another package available under the relevant insurance scheme. Farmers, traders and other people working in the informal sector can also join Fahari Afya, subject to its requirements.

These provisions make it important for households to establish the eligibility of each intended beneficiary before registration.

Assuming that every relative automatically qualifies could create difficulties when a member seeks treatment. For families, understanding the rules at the outset can help prevent registration errors and ensure that the intended beneficiaries are properly covered.

**Protecting households unable to pay **

While Fahari Afya provides a contribution-based option, the second phase of UHC also targets households that cannot afford health insurance.

According to Prof Sunguya’s explanations, people officially identified as unable to pay are entered into the relevant database and their insurance contributions are financed by the government through NHIF under the established procedures.

Identification involves designated authorities, including the National Bureau of Statistics, the Tanzania Social Action Fund and other authorities responsible for relevant programmes.

“The list of beneficiaries is not necessarily permanent. Assessments are conducted every three years to advise the Ministry of Health on people who should be added to or removed from the database,” he said.

This arrangement recognises that household circumstances can change and that eligibility for government support requires an established identification process.

Once registered, beneficiaries remain subject to the applicable conditions governing access to services. Government financing addresses the contribution barrier, but members must still understand where and how to obtain covered treatment.

What does Fahari Afya cover?

Understanding the services included in an insurance package is as important as knowing its cost.

According to Prof Sunguya, Fahari Afya covers 372 essential healthcare services, including medical consultations and advice, laboratory and radiological investigations at the appropriate level, medicines, medical supplies, surgery and hospitalisation.

The package also includes eye care, oral healthcare and dental services. These benefits provide a range of essential medical services through facilities operating at different levels of the health system.

However, the actual services available to a member depend on the approved package, the level of the facility and the conditions governing treatment.

For example, the inclusion of medicines does not mean that every medicine prescribed by a health professional must automatically be paid for by the scheme.

“Medicines are provided in accordance with the National Essential Medicines List issued by the Ministry of Health, while the actual benefits depend on the level of the facility providing treatment,” he said.

Similarly, the inclusion of surgery, diagnostic investigations and hospitalisation does not mean that every procedure is automatically covered regardless of the circumstances.

Members need to understand the scope of their benefits rather than assume that insurance provides unlimited access to all medical interventions.

This is particularly important when a patient requires specialised investigations or treatment beyond the capacity of the facility initially visited.

Such awareness can help members establish whether a service falls within their coverage and seek clarification before incurring expenses that may not be paid by the scheme.

Nevertheless, understanding the list of benefits is only one part of the process. Members must also know where those services can be obtained and what procedures they must follow.

** Why having insurance does not mean access to every hospital **

Prof Sunguya said Fahari Afya members must obtain services from health facilities contracted by their insurance scheme and follow the applicable referral procedures.

This means that possessing an insurance card does not automatically allow a member to obtain covered treatment at any hospital of their choice. The requirement to use contracted facilities is important because insurance coverage operates within an agreed network of service providers.

Members who visit facilities outside that arrangement may encounter difficulties obtaining payment for treatment.

Insurance schemes are required to maintain databases of contracted facilities on their websites. Members can also confirm participating facilities through the official customer service channels of their schemes. Checking this information before seeking treatment, where circumstances permit, can help members avoid unexpected expenses and identify the appropriate facility for their needs.

The referral system is equally important. It helps patients obtain treatment at the appropriate level of the health system and forms part of the conditions governing the use of Fahari Afya.

A member who fails to follow the required referral procedure may become responsible for paying treatment costs at the facility visited.

For someone unfamiliar with insurance arrangements, these conditions can be confusing, especially when illness creates urgency and the immediate concern is obtaining medical attention.

Members should therefore seek guidance from their healthcare provider or insurance scheme when uncertain about where to go for further treatment. The challenge is to ensure that the rules intended to organise access to healthcare are clearly communicated to beneficiaries so that they can navigate the system without unnecessary confusion.

The arrangement also requires effective communication when service providers change their contractual status. A facility intending to terminate its arrangement must notify the scheme and the relevant authority under the prescribed procedures.

The scheme must also inform the public so that members can be redirected and their interests protected. These provisions underline the importance of timely information.

A member who is unaware that a facility is no longer contracted may arrive expecting insurance coverage and subsequently face difficulties obtaining services under the scheme.

**Waiting periods and continuity of membership **

Another factor determining when members can use their insurance is the waiting period. Under Fahari Afya, members generally begin receiving services 30 days after registration and payment of their contributions.

However, Prof Sunguya’s explanations identify exceptions for certain groups, including public and formal private-sector employees, people officially identified as unable to afford insurance whose coverage is financed by the government and students enrolling through group arrangements.

The waiting period does not extend the membership year. Members who join through the annual contribution arrangement remain covered for 12 months from the date of contribution, subject to the applicable terms.

This distinction is important because some applicants may assume that the waiting period is added to the end of their membership year. The requirement also reinforces the principle that insurance is preparation before illness.

Waiting until treatment is needed to register can leave a household without immediate access to benefits where a waiting period applies.

** Maintaining membership is equally important **

Fahari Afya members are expected to renew their annual coverage within 30 days after expiry. A text message reminder is sent 30 days before expiry to the telephone number supplied during registration.

A member who pays the annual contribution within the 30-day renewal period is considered to have renewed membership under the outlined rules.

However, failure to renew within that period means the person is treated as a new member and must wait another 30 days before accessing services.

Members should therefore ensure that their contact details remain accurate, pay attention to renewal reminders and confirm that their payments have been processed.

Membership may also end when a member dies or when the coverage period expires without renewal. Members can transfer between schemes, but they must follow the applicable regulations and guidelines.

These conditions show that insurance protection depends not only on initial registration but also on maintaining valid membership and complying with the rules governing the scheme.

** Protecting members’ rights and resolving complaints **

The effectiveness of UHC will also depend on whether members can obtain assistance when they experience difficulties accessing services.

Prof Sunguya said that members and registered dependants should receive services fairly and without discrimination, in accordance with the applicable healthcare standards and procedures.

“When a member reaches a facility and cannot obtain a service, the first step is to contact the healthcare provider or the relevant customer service desk for guidance and resolution,” he said.

The member should also confirm that the facility is contracted by the insurance scheme and that the required referral procedures have been followed.

Where problems relating to Fahari Afya remain unresolved, citizens can contact the Ministry of Health through its toll-free number, 199, or NHIF through 0800 787800. These channels provide avenues for seeking assistance when members have difficulties understanding their benefits or accessing covered services.

The responsibilities of the institutions involved are also important. The Tanzania Insurance Regulatory Authority is legally responsible for regulating health insurance, while the Ministry of Health oversees the quality of healthcare services. This distinction helps establish where different complaints should be directed.

An issue involving insurance coverage may require a different response from a complaint about the quality of treatment received. Citizens should also verify that their insurance scheme is registered and authorised to provide services.

The relevant authority maintains a register of approved health insurance schemes and members can use official channels to confirm registration. Accountability requires institutions to provide clear information, respond to complaints and protect beneficiaries’ interests.

Members, in turn, need to understand their entitlements and use the available channels when they encounter problems. The programme also depends on accurate information from members. Using another person’s identification or providing false details is contrary to the applicable procedures and may lead to legal or administrative action.

Effective communication between beneficiaries, insurers and healthcare providers is therefore essential to making the system work as intended.

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** Turning coverage into actual access **

Universal Health Coverage should be understood as both a financing arrangement and a commitment to improving access to healthcare, rather than a guarantee that every medical need will immediately be met at any facility.

For households, the practical lesson is to prepare before illness occurs: establish eligibility, register through authorised channels, understand the package, confirm where services are available and renew membership on time.

For the government, the task is to ensure that the promise made at the programme’s launch is reflected in the experience of people seeking treatment.

As the second phase targets 625,000 households unable to afford insurance, success should not be judged solely by the number of beneficiaries registered.

It should also be assessed by whether those households can obtain the covered services they need and receive meaningful protection from medical expenses.

Ultimately, the value of Universal Health Coverage will be measured not simply by the number of insurance cards issued, but by whether membership helps Tanzanians access appropriate healthcare without facing financial hardship.

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