What’s it all about?
Since 2011 a health insurance is in place in Tanzania’s Mbeya and Tanga regions which aims to improve access to maternal and newborn health services of good quality for pregnant women and their babies. The project’s objectives are two-fold:
to reduce the still high rates of maternal and newborn mortality; and
to strengthen financial protection for pregnant women and their families.
After start-up, the project expanded rapidly to cover all 16 districts in the regions of Mbeya and Tanga with their 621 government and 74 faith-based health facilities. Women are enrolled when they first visit a health facility during pregnancy, and are then covered by the National Health Insurance Fund for up to six months after their baby is born. For the same period their families gain membership of their local Community Health Fund, an insurance scheme which covers the costs of medicines and outpatient as well as some inpatient care, thus familiarising them with the benefits of being member of a health insurance scheme.
Why do women need insurance when services are free?
In Tanzania most citizens have to pay fees for health services but pregnant women, children under five and the very poor get these services for free.
However, facilities often lack the funds to purchase the drugs, supplies and equipment they need to perform safe deliveries, so when women go to deliver at a health facility, they may be asked to purchase the required medicines and items such as surgical gloves and sanitary napkins.
For many pregnant women, this is a serious barrier to access, often causing distress and embarrassment to both pregnant women and the health workers.
In the Tanga and Mbeya regions this has changed since the introduction of the health insurance scheme: With the funding provided to them in response to their claims, the facilities are now able to purchase the medicines and supplies they need to perform deliveries as well as antenatal and postnatal care, and to tackle small infrastructural problems.
Results to date
So far, the results the project has reached have exceeded both its expectations and its targets. An estimated 8,000 - 10,000 pregnant women join the insurance scheme each month, so that by mid-2016, 450,000 were enrolled. Also, more women are delivering at health facilities: between 2010 and 2014, facility deliveries increased from 41 per cent of expected total deliveries to just over 60 per cent in Tanga, and from 43 per cent of expected total deliveries to nearly 90 per cent in Mbeya.
Is it sustainable and what lies ahead?
Tanzania is committed to the introduction of a national social health insurance scheme in order to realize the internationally agreed goal of universal health coverage. The aim is to overcome the current fragmentation of Tanzania’s insurance sector, enabling more efficient pooling of funds and creating opportunities to cross-subsidise those less able to afford contributions.
And this is where this Tanzanian-German project comes in: In the longer run, it aims to develop mechanisms through which subsidies can be channelled to vulnerable and poorer groups. In the meantime, it is generating valuable lessons learned regarding the implementation of health insurance schemes and it ensures access to safe delivery and healthcare services for poor women and their families.