Notificación de actividades que afecten el servicio

Most of micro-health insurance schemes in Tanzania are run by religious groups, informal groups, and rotation schemes that serve a given number of voluntarily enrolled members who contribute an agreed amount to cover for unforeseen contingencies. Micro‐insurance schemes such as VIKOBA, UMASITA (Tanzania Informal Sector Community Health Fund) and VIBINDO (the umbrella organization of informal sector operators in the Dar es Salaam region) seek to strengthen informal sector communities by providing better access to health care, improved quality of care and by seeking ways to promote comprehensive health-care services at affordable prices. Micro‐insurance for health care is still in its infancy. Most of the schemes enrol groups rather than individuals (for example, all market vendors are required to join), but each group operates as a separate risk pool, causing potential financial sustainability problems.

A few initiatives have been started in Dar Es Salaam. The first, organized under VIKOBA is affiliated to the social economic initiative through entrepreneurship (VIBINDO) and was facilitated by the International Labour Organization through small business operators in the second half of the 1990s. This initiative has remained small, with very low rates of registration and renewal of membership. VIBINDO covers about 1,102 people out of about 40,000 VIBINDO society members. The VIBINDO benefit package includes primary health-care services, reproductive health-care services, some referral services, minor surgery, and limited hospitalization. The second initiative, registered by UMASIDA, is now known as UMASITA. UMASITA had up to 40,000 people enrolled, although it recently stopped functioning as a result of issues related to revenue collection and management, service utilization, and continuity of enrolment. While active, the UMASITA benefit package included: maternal and child health; voluntary counselling and testing; and treatment of common diseases such as malaria, pneumonia, diarrhoea, and sexually transmitted infections. Surgical services are provided at Government facilities, and the user fee is paid by the scheme. Neither scheme requires a copayment35. A third scheme, initiated by the Anglican Health Network, had a goal of registering 40,000 people within the first six months of operations and going nationwide within three years. One of the key problems contributing to the low uptake by the population is the general lack of knowledge of the concept of insurance and of the fundamentals of insurance operations. There is also a failure to explain these fundamentals in simple terms in the local context where the majority live of target groups that would be interested. Another major issue is the lack of financial

33 _{NHIF 2009a, 17–18}

34

_{The text in this section draws heavily from Lankers and others (2008, 21–22}

).

35

37 sustainability because such schemes operate separate risk pools and suffer from cost escalation36.

Private for profit health insurance

Private health insurance was allowed as a part of health sector reforms in the mid- to late-1990s, and became popular with most private companies. According to company representatives, in the last few years, membership in Private Health Insurance has been between 100,000 and 150,000 members. This number represents only a small percentage of the overall population of Tanzania, i.e. less than 0.3%.

Since 2005, gross premium revenues have increased by an estimated 380%, amounting to TShs 156 bn. Meanwhile, claims expenditure at the four health-only insurers has risen by more than 100% per year on average, to reach about TShs 24bn in 2010.37 On average, premiums represent an estimated 8 % of payroll.

Interviewed representatives noted two factors for the lack of growth of private health care in Tanzania. First, the poor level of health care in many parts of the country. Second, the high solvency requirement that does not differentiate between a general insurer and a health insurer and has acted as a barrier to many of insurers to cover health risks. There is a technical committee among the Association of Tanzania Insurers working with the Tanzania Insurance Regulatory Authority (TIRA) to formulate different solvency requirement regulations for health insurers that will take into account the huge liquidity requirement imposed on health insurers to meet medical claims.

Different private micro-insurance schemes have been started in Tanzania, most recently a scheme under the sponsorship of PharmAccess, and with the initial participation of a private health insurer (Strategis). With substantial financial support, this programme has been able to overcome a number of challenges faced by other micro-insurance schemes such as quality of care and management processes. Nevertheless, sustainability without donor support remains a challenge.

36 _{Jamu et al. Op Cit. 2009, 32} 37

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IV.

Regulation review

1.

Frame of reference for review

It is helpful in reviewing a set of laws to draw up a frame of reference within which the review takes place. In this report the frame of reference is primarily comprised of the goals and principles of law- making and regulation, and, to a lesser extent, the standards of law-making, i.e. what makes for a good law. Finally it takes into account the goals and objectives of the Tanzania Government based on the official documents, considered in conjunction with internationally/universally endorsed best policies and practices.