Extraordinary Healt Financing and PFM TWG UPDATE November, 2017

to provide up-dates on HFS/SNHI cabinet paper process:

  1. HFS up-dates

During the extraordinary TWG meeting, MoHCDEC via ADP officially communicated the new proposed strategy on the future health insurance system as proposed by the IMTC of the Cabinet.

Aspects that remain unchanged from the initial HFS Draft:

• Mandatory health insurance for all TZ citizens

• Minimum benefit package (MBP) entitlement for all TZ citizens

• The poor being included and subsidized

• Purchaser – provider split (financial management and reimbursement of providers entirely with the health insurance not the districts/ regional authorities, via national pools)

Aspects proposed for change:

• No single national health insurance, NHIF will remain (insuring public sector) plus a new insurance will be introduced, emerging from the CHF (called Community Health Insurance Funds, CHIF – insuring the rest of the population) – 2 national mandatory health insurance funds.

• Earmarked taxes for financing subsidies to health insurance not approved, will be forwarded to tax committee for further discussion

Key features of the CHIF:

• Will be a separate agency from NHIF on national level, reporting to MOHCDEC

• Caters for the informal sector, the poor and potentially also the formal private sector

• Pays on a capitation based system (as was foreseen also by ICHF)

• Will be funded by member contributions, gov’t subsidies for the poor, some cross funding from NHIF; some general revenue funds also being pooled on national level

• Benefits package envisaged: access to all facility levels up to regional referral hospitals (like in the iCHF concept). With potential to be extended in the future.

NHIF caters for civil servants as per its initial purpose, in its current framework of service package and fee for service payment. It is still in discussion whether private sector formal employees will be allocated to NHIF of CHIF. MOHCDEC is advocating that these will fall under CHIF.

There shall be a unified information system for both NHIF and CHIF together.

Also cross-subsidies from NHIF to CHIF will be proposed under the new strategy to cater for equity under the SHI solidarity principle.

Details of the setup of the CHIF will be elaborated in the next weeks.
DPs of the HF TWG had the opportunity to provide detailed recommendations to the Ministry on the new concept in order to ensure an equitable SHP approach is maintained under the new vision.

  1. Policy recommendations for HF as elaborated at TRM
  • More realistic and attainable budgeting practice
  • Advocate for full disbursements to the sector as budgeted
  • Increase efficiency to free resources within the sector (assessment proposed to look into areas where efficiency gains can be achieved and prioritized for the coming years)
  • Complete the process for submission of the mandatory health insurance bill to parliament
  • Commitment to provide subsidies for the poor so they are equitably accessing health services
  • Request for clear direction on the future of CHF to better align and ensure effective support
  • Strengthen PFM structures to strengthen funding flows and services delivery at facility level
  • Improved resources tracking down to district level for better planning and use of funds

Next HF TWG tentatively Wednesday13thDecember2017

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