The National Health Insurance Fund (NHIF)

Introduction

In human life, there are various social situations that cause the livelihood to be categorically in some of the life manners, in this regard, social security schemes and other social welfare matters are very much important at aiming good and quality livelihood, so in the country there are various means of gaining benefits accordingly to the needy of the individuals thus there are the social security schemes.

The National Health Insurance Fund (NHIF) is a Government institution under the Ministry of Health. It was established to provide health services to formal sector employees. Health care providers under the scheme include Government and Religious facilities as well as those owned by Non Governmental Organizations. 

National health insurance was established after 1990-1992 study and commenced operations on 1 July 2001. Under the act of No.8 of 1999 offering health insurance coverage to pensionable employees of the central and local Government.

Vision

The Fund envisions becoming the leading Health Insurance Scheme of choice in the Sub-Saharan region in terms of sustainability and quality of services.

Mission

The Fund is dedicated to providing support to our beneficiaries to access health services through a wide network of accredited quality health facilities throughout Tanzania.

Core Values

To provide high quality services promptly, effectively and courteously

To be a good corporate organization acting in the best interests of the members

To be responsible stewards of the funds with which the Fund is entrusted

To promote responsiveness and innovation towards evolving needs of the members

To be accountable to the stakeholders of the Fund, to work through a teamwork spirit

The following are Objectives and functions of National health insurance fund NHIF

To provide loans, In this sense the NHIF has the benefits on the different matters that associates themselves with some of the basic health matters like the issue of building the dispensaries, hospitals there after the loans shall be redirected through the benefits after the services has been active for example of the hospitals are Twin towers at MOI, The university dispensary at UDOM, and the construction of medical laboratory at Mbeya referral hospital.

To provide medical equipment, in different health centers there is the real need of the very important equipments to be used in hospitals for the aim of working upon peoples health’s so NHIF works upon that case for example the provision of microscopes, ultrasound devices, city scanner machine which is only in the country.

Security after retired providing support after retirement, this is only categorized in the sense of health in which the situation where the workers have retired they should continue to get some of health security schemes from that social security, this is only directed to a husband and wife.

Facilitate development of health services, when we say development, we mean the advancement of stages from one stage to another stage, in this regard you may find that NHIF has advanced to the extent that it is able to provide medical care even if the beneficiary is far away from their services, that means he or she can even get the medicines from the pharmacies.

Taking care to the children and contributors Parents, This is among of the benefits of NHIF that they have gone further to the provision of the services to parents and to children of those parents who are contributors to the fund.

Targeted group

Private members, with the sum of amounts of payments that differs accordingly, for example the student contributes the sum of 50,400/= businessmen and other individuals contributes the sum of 964,800/=.

Public (government), according to NHIF Act 8 0f 1999, this is compulsory to public sector employees.

(Both of the private and public people are known as follows)

Principle members, contributor members who participate effectively in National Health Insurance.

Spouse, wife and husband will be benefited from NHIF if they contribute effectively

Children, children will benefit from NHIF, when their parents are joined or their parents connect their child to the service.

Parents, parents of contributor will benefit from NHIF due to its contribution for example father and mother.

Entry condition (membership criteria)

Need to be accredited must be registered with the Ministry of Health (MoH) as health service providers in the categories of Hospital, Health Centre or Dispensary. 

They need to fill the application accreditation form - NHIF3 and submit it together with valid certificate of registration and other details as contained in the form NHIF3.

(Contributors) are known as Principle members; one among condition of NHIF is to pay, contribute and participating in different activities concerning the scheme.

Employee and employer and private are paying 3% of basic salaries per year

Students, if he/she join in NHIF supposed to contribute amount of money for example the student contributes the sum of 50,400/= 

Private individuals like businessmen and other individuals contributes the sum of 964,800/= per year.

Within the Faith Based Organizations the workers like the priests, and sisters (clerics) 100,000/= per year.

Duration of being pensionable

Retired people are pensioned till his /her death

The following are Types of benefits and it’s of offering

The National Health Insurance Fund has entered into contractual agreements with various service providers throughout the country. At these facilities our beneficiaries are entitled to access eleven benefits which include the following:

Registration, member of NHIF will benefit especially to covers costs related to Registration and Consultations in hospitals and in the health centers for example when member need to achieve a certain service  from hospital, supposed to pay amount of money therefore NHIF are responsible to support their member.

Outpatient Care Services, The Fund covers for the costs relating to medicines prescribed in Generic names and medical consumables as per the National Essential Medicines List (NEMLIT) and additional medicine list recommended (to NHIF) by experts.

Investigations, The Fund covers for the costs of Investigations and Diagnostic tests as per the Investigation List in the benefits package. There are 143 Investigations including Ultrasound, Echocardiography, CT-Scan and MRI.

Surgical Services, member of NHIF will benefit by supported when he/she need Minor, Major and Specialized surgical services performed from Health centers to Referral level hospitals.

Inpatient Care Services, The Fund covers for the daily admission costs depending on the level of the facility and the agreed daily rates as per the Fee Schedule, Investigations, Medicines and Medical Consumables dispensed while the member is admitted.

Physiotherapy, This is provided to inpatients and outpatients where the facility has specialists for the same.

Optical Services, NHIF covers the costs for optical services to all beneficiaries. Treatment of Eye diseases and refraction for visual defects.

Spectacles, the Fund also pays for visual corrective spectacles to the principle member (one pair for a period of 3 years).

 Dental Services, This is provided to inpatients and outpatients where the facility has specialists for the same. This includes dental conservation surgeries (Carries and dental filling), gum diseases, dental extractions and root canal treatment.

Retirees Health Benefits, Comprehensive Medical Services are offered to the Retired principle members and their spouses, for their entire lives.

Medical/Orthopedic Appliances, The Fund provides supportive orthopedic and medical appliances including White Cane for blind people, Neck and Thoracic Spine Collars, Hearing Aids, Lumbar Cossets and Braces, Walking Crutches and leg orthopedic Supports, (ankle, knee and above knee orthopedicsupports).

National Health Insurance Fund it covers the following areas

Shinyanga, Iringa, Morogoro, Mtwara, Lindi, Pwani, Zanzibar, Ruvuma, Kirimanjaro, Manyara, Kigoma, Mwanza, Tabora, Sumbawanga, Dar Es Salaam, and Dodoma.

Success of National Health Insurance Fund

Succeeded to provide loans, NHIF success to provide loans to its members, this is specifically to the loans that are based on the matters of health, for example the construction of hospitals and the loans to buy the equipments.     

                    

Providing health equipment, NHIF success to provide different tools in Health activities for example ultrasound and microscope machine were given to Mbeya regional hospital and Muhimbili hospital.

Building different building, NHIF success to build different building for purpose of supporting health sector for example contracting different building in hospitals, contracting health center in University of Dodoma, Mbeya region hospital also at MOI hospital.

Started with few members but now days numbers of members are increased, NHIF was starting from the presence of few members to those years, but it is too different in these years.

Success to provide retirement benefits, in previous time NHIF does not provide pensions for retired member but now days, NHIF success to provide, and it applicable for those workers who are retired they will continue to get.

Increase benefit purchase compare to the past, the benefits has been increased depending to the fact that the members are increasing in the very high rate, in 2001/2002 the benefits is too much different with the benefits of 2012/2013. 

Providing services to pharmacy and ADDO’s shops (medical shops), National Health Insurance success to provide service to new members for example from Hospital only to the other health centers for example pharmacy and ADDO’s shops this is due to fact that the services are available in these medical shops and other pharmacies.

Provide service to specialized clinic, health centers and hospitals, due to its coverage NHIF continue to register different members and start to provide its service for example providing service to specialized clinic, health centers and hospitals.

Challenges which face National Health Insurance Fund

Increase of budget and expenditure, the budget and the uses of money goes higher accordingly, for example the budget and expenditure of 2001/2002 is to low compared to the budget and expenditure of 2012/2013.

Members fail to refund their loan; this is when the benefited fail to return money that they have gained from the fund so NHIF will delay to provide service to other members because other people are not return their loans.

Lack of support from other sectors, other sectors that are within the health context have no support to the fund, even the donors are off duty when are contributing to the fund.

Few employees and equipment’s in their office, National Health Insurance Fund are faced by different problem within their service for example few employees and equipment which used to operate different activities to its members.

Lack of education concerning NHIF, People and other individuals are lacking the education and awareness toward service which are provided by NHIF. For example people they don’t know how this scheme is operating in the country.

The following are way forward

Mass education on the importance of NHIF to the people and community at large, This should be well known to the communities due to fact that the people in the societies, the people lacks education in general concerning the matters of NHIF, so its better NHIF to expand their service by providing education to the community in order to create awareness.

Government and other sectors it’s better to support NHIF, the government and other sectors should be supporting the fund due to fact that, with support the fund could get so many benefits.

Increase employees in the public and private sector and advanced equipment in their office in all branches of NHIF offices.

Strong punishment for those who fail to refund their loans, member who receive loans from NHIF re responsible to return their loans according to the agreement they made, then all law enforcement agencies should be aware with such punishment to those who fail to return the loans.

Conclusion;

There should be enough education to the individuals so that they can be able to join the fund for the sake of being under the services that are well provided in the sense of the NHIF setup, there after there should be enough support from the government for the aim of making high profits and aiming at high provision of services to mass, well commitment from both people and the working personnel is quietly needed.

Reference

Information from Human resource of National Health insurance Fund office, (2014), Mbeya

Internet source: http://www.nhif.or.tz/index.php/member-info/overview-retrieved

Internet source: http://www.nhif.or.tz/index.php/projects/overview

Internet source: http://www.nhif.or.tz/index.php/about-nhif/overview

Internet source: http://www.nhif.or.tz/index.php/about-nhif/management            

 

Written by Ausi  R. Chiwambo (June, 2014)

Tefilo Kisanji University

chiwambo@hotmail.com

0753110740