Having a truly workable health insurance cover just can’t wait

30Aug 2019
Dar es Salaam
The Guardian
Having a truly workable health insurance cover just can’t wait

A RENEWED drive seeking to spread health insurance coverage across the country has just been announced, with the government instructing regional medical officers (RMOs) -

- to dispatch sensitisation teams to villages in an effort to increase enrolment in what is billed as an Improved Community Health Fund (ICHF).

Reports citing affirmations from top officials in the President’s Office (Regional Administration and Local Governments) have it that stepped-up enrolment in the health fund would boost resources to improve service delivery. That is what is expected, even if making it work might be challenging, considering earlier drawbacks.

The record even in developed countries shows that health sector insurance is always a money-losing venture and that it is not practicable to spread out adequate insurance cover at the mass level or to pay substantial amounts for full healthcare coverage.

The drive for numbers is definitely important if we are to increase overall availability of funds, but it involves other challenges. It means that nearly everyone visiting a hospital, dispensary or health centre would be under insurance cover, while the sums available for the purpose are inadequate for proper medical cover – assuming that considerable numbers fall ill and incur substantial treatment costs.

The reason for popular health insurance cover at the mass level is also the reason for its repeated problems in that the funds collected are not adequate to render full medical cover, especially for elderly people.

It once used to be the case that insurance cover was meant for a working person, his or her spouse and four children – that is, unless the spouse was also entitled to insurance cover courtesy of another employment position. Elders, this taken to mean beneficiaries’ parents, were routinely excluded.

The result of the disparity between the sums paid for insurance cover and the likely liabilities is such that, operationally, the mass insurance facility was observed in the breach rather than in fact.

Of course, accounts differ of how far hospitals, health centres or dispensaries took seriously the fact of insurance cover: at times the beneficiaries are offered basic treatment drugs or generic medicine and not specialised healthcare. And the fund is applicable just up to the regional level.

As voluntary medical cover for kith and kin is a problem in many families, it remains true that the fund enables access to basic treatment to a large number of people.

There are even larger numbers who aren’t enrolled, and that is the task now being set out – not just so that the fund collects operational funds but so as to extend its reach, despite its obvious liabilities.

The rationale for mass health insurance, as in free education, is to extend the reach of the facility while making it operationally better as time goes on, and not prior exclusion to ensure its quality.

Challenges relating to ensuring health cover especially for elders remain intense, as specialised treatment requires proper personal insurance and not mass coverage.

There are procedural challenges in the prompt settling of hospital bills for a patient to be released, short of which he or she remains held up in between, with the bill rising by the day.

All this is a nightmare for families with elderly patients needing periodic hospitalisation, with satisfactory remedial action seldom coming soon enough. This calls for urgent intervention.


Dispute over Manyoni one-stop road station project defies logic


A tax dispute is impeding the construction of a key transit trade facility backed by the European Union – a one-stop road inspection station project at Manyoni in Singida Region.

Implementation of the 24bn/- project is said to have stalled for the past year owing to disagreement between the contractor and the government over the former’s demand for a value added tax (VAT) waiver.

A regional manager for the Tanzania National Roads Agency (Tanroads) is on the record as having told a meeting on the issue that two ministries are involved in the matter – Finance and Planning as well as Works, Transport and Communications.

Implementation started in March 2016 and is scheduled to take 18 months, and one wonders why the demand was not made early enough – and why the dispute is defying a resolution.

Did the contractor bring up new ideas on taxes that have all this long gone unnoticed? Was there a dispute leading to new ideas or promises to legislate on the issue?

Assuming that the contractor is engaged by the government on terms agreed with the European Union under current aid delivery procedures where taxation is one issue that is supposed to be resolved before works start, where did the problem arise?

It is as if there was change of mind somewhere along the line after the original contract was signed, and no solution has been found three years on! That would be understandable if it were a dispute between private firms, but the government or ministries and international agencies can surely resolve issues more rapidly than is the case.

It is also not clear how far this dispute falls under the kind of issues about which President John Magufuli last month cautioned regulatory agencies: that those behind bureaucratic bottlenecks impeding investments will not be tolerated.

Stalling the construction of a one-stop road inspection station for one year surely impedes the pace at which transit trade improvement can be done and is thus similar to obstructing investments. We believe that consultations between the Treasury and the EU would have ended the differences long ago. 

From what surfaces in reports on the matter, the project is funded fully by the EU to the tune of euros 9,537,607 (over 24bn/-). That means that waiving taxes would be the state’s contribution, assuming that there is a partnership engagement.

Whatever is the correct interpretation, the differences ought not to take a month to solve, unless there are auxiliary diplomatic hiccups between Tanzania and the EU – which would be expressed as stalled funding rather than a tax dispute.

Tanroads says that work had reached 60.1 per cent by September last year but has stagnated since, which is likely to prove more costly than the tax waiver being demanded.

This is because the work done starts wearing out and must be re-done or extensively restored, meaning that there are officials who aren’t in tune with the gravity of the situation.

That’s the issue – and the moment all concerned see the urgency of the matter and sort things out, the sooner as they pick up phones or put chairs around a table to discuss it. Just so but, strangely enough, even imagining doing so has taken a whole year.

Top Stories