‘Expansion to Tanzania will raise the effectiveness of the program’
all the necessary approvals for the start have been given both from the Dutch government and the Tanzanian government. The start of the Health Insurance Fund program in Tanzania is now official. In the coming months preparations will be made for the launch. ‘The expansion to Tanzania is such an important landmark for the Fund’, explains Chris van der Vorm, Director of the Health Insurance Fund in this interview. ‘Tanzania is geographically and culturally different from Nigeria. Realizing the program in two completely different settings, in East- and West-Africa, offers the opportunity to support a wide range of low income communities and provides invaluable material for comparison.'
The workers of the fishmarket in Dar es Salaam are targeted as a group in the program.
The blueprint of the Tanzanian program is fundamentally the same as the Nigerian. Demand-driven health insurance with low premiums will be introduced for three targeted low-income groups, rural and urban. These groups are: the workers of the fish market in Dar es Salaam, small entrepreneurs with a micro-credit allied in the micro credit organization PRIDE in Dar es Salaam and small groups of organic coffee farmers in the rural north of Tanzania. The enrolment and administration of these approximately 95,000 people will be placed in the hands of the Tanzanian insurance company Strategis. The upgrading of the 21 private and public clinics in the program and the training of staff will be supported by the Fund’s implementing partner PharmAccess to ensure the people receive quality health care.
The basics are the same; however the program will be adjusted based on lessons learned in Nigeria. ‘For example, adaptations will be made in the way the target groups enrol’, says Van der Vorm. ‘The program will not start for each of the groups until at least 30 % of that group has enrolled.’ The idea behind this is that the program needs a certain threshold in numbers to minimize adverse selection and it can profit from the benefits of insurance. All layers of the community, young and old, healthy and ill need to be included to enhance the concept of risk pooling. More stress will also be put on the collection of data about patients through the introduction of a carefully thought-out IT system.
‘In Tanzania, from the start, the community itself and its leaders will play a central role in mobilizing and educating the people about the benefits of insurance; they need to emphasise the benefits of paying up front for access to affordable quality care.’ The focus will be on marketing, mobilization and communication of the program to bring it closer to the communities. ‘Another positive aspect is that that the target groups are well structured cooperatives, such as the organic farmers and PRIDE.’ For the latter group the Health Insurance Fund partners with Hivos and Stop Aids Now!, two Dutch NGO’s to mobilize the PRIDE community through activities such as training, education and incentive programs.
A house of one of the organic coffee farmers targeted in the program.
The cultural differences mean that new challenges lie ahead. Tanzania, a West African country, with a population of just over 40 million is different in many ways to Nigeria. It is less densely populated, it is geographically different and it has other healthcare challenges. ‘For example the HIV/AIDS prevalence rate in Tanzania is much higher.’ Since HIV/AIDS treatment is included in the insurance package this will have an influence on the risk of covering the community with health insurance and the associated price. ‘A major breakthrough in the program is that we are working with USAID on building a partnership with PEPFAR funding to enhance the HIV/Aids capacity in the private sector clinics and thereby making the insurance more accessible to the community. ’
An important challenge, according to Chris van der Vorm, is making a difference in a country where many other donors are active and yet so many health challenges still remain. ‘The program needs to be innovative to meet these challenges, but it also has to be complementary to the national insurance program which the Tanzanian government is introducing. By working together with the local authorities our community based scheme will provide value to the national program.’ The quality management process for the clinics and the enrolment strategies are innovative examples that can help to improve not just the level of health care for the target population, but also provide examples to strengthen Tanzanian health care.