Performance of new national health insurance fund packages (Wekeza, Najali, Timiza) in Kinondoni municipal, Dar es salaam, Tanzania
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Background
Tanzania is one of the countries which has joined the UN efforts of attaining Universal health Coverage (UHC) by 2030 by ensuring that all citizens are able to access health services thereby reducing out of pocket expenditure. As a strategy to achieve UHC, the National Health Insurance Fund (NHIF) introduced new premium packages in September 2019 named TIMIZA, NAJALI and WEKEZA premium packages to accommodate private individuals and their families who are not in the formal employment sector to increase the coverage of citizens who are health insured in the country and to increase their accessibility to quality health services. Since the introduction of these packages no studies have been done to assess their performance. Therefore, this study evaluated the performance of the packages through process evaluation by exploring its level of utilization from September 2019, the acceptability of the packages by the health care providers and client satisfaction towards the services offered.
Methods
A descriptive cross-sectional study was conducted in selected NHIF accredited health facilities in Kinondoni Municipal using mixed method of data collection. Secondary data was quantitatively extracted from NHIF enrollment registries using a data abstraction tool to assess the percentage of citizens enrolled from Kinondoni NHIF office from September 2019 to March 2021.In-depth interview was used to evaluate the acceptability of the packages among the health care providers and Clients (beneficiaries) satisfaction towards the quality of services offered. Qualitative data was analyzed by content analysis approach and Microsoft excel for the quantitative data.
Results
NHIF has been able to enroll 17,248 members which is only 1% of the total population of people in Kinondoni MC against their set target which was to enroll at least 50% of the total population. Beneficiaries of the packages are unsatisfied and health providers are also unhappy about the packages due to poor orientation, cumbersome referral system and uncertainties in availability of medications and investigations.
Conclusion and Recommendation
This evaluation has revealed that NHIF new packages have not been performing well since their introduction in September 2019. They are far from reaching the set target due to challenges which have been brought forward by beneficiaries and health care providers. NHIF need to improve their orientation by educating their clients about every service covered in a scheme before enrollment. Also, they should perform biannual review of their list of medicines and services covered by constantly updating their medicines list according to the pharmaceutical and insurance market.
