Asian Journal of Research in Nursing and Health

Systematic Review of Lessons Learned from the Tanzania Mainland Health Financing System towards the Introduction of Universal Health Coverage in Zanzibar

Seif S. Khalfan *

Department of Nursing and Public Health, Faculty of Health and Allied Sciences, Zanzibar University, Zanzibar, Tanzania.

Abdulla Kh. Ngwali

Department of Nursing and Public Health, Faculty of Health and Allied Sciences, Zanzibar University, Zanzibar, Tanzania.

Hafidh Ali Hafidh

Department of Nursing and Public Health, Faculty of Health and Allied Sciences, Zanzibar University, Zanzibar, Tanzania.

*Author to whom correspondence should be addressed.

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Abstract

Health financing is a core component of healthcare systems that has an impact on the performance of the overall health system, like delivery and accessibility to primary care. A well-established and implemented health financing system could serve as a remedy to address these issues. In Zanzibar, healthcare services are completely offered by the government. In this intern underperforming economy, healthcare is suffering from chronic underfunding resulting in satisfactory quality and poor health outcomes. To overcome this issue, the Revolutionary Government of Zanzibar is working with several stakeholders to review the health financing strategy and improve the quality of care as it strives to achieve Universal Health Coverage (UHC). We conducted the main search for this review on information from current editions of academic journal articles and other countries' health system reports and websites based on the method of a systematic literature review from 09 August 2022 to 13 December 2022. Consequently, our review describes the concerns and challenges learned found to hinder the implementation of the health insurance system in Tanzania Mainland during the period 2015–2022. The papers identified in the systematic literature search were checked for their relevance concerning the review-defined objective. We included all types of studies, quantitative and qualitative studies, as well as mixed methods. Specifically, our analysis started with the concept of health-financing mechanism, enrollment status, management skills (poor collections and management of the revenue), community involvement, and fraud including delay of reimbursement to their influence on the goals and intermediate objectives of UHC. This systematic has found that the health insurance schemes encounter both structural and operational issues which subsequently result in low uptake of the schemes. Therefore, to achieve universal health coverage, the Government of Zanzibar should consider winning the battle before the fight by doing community sensitization to conquest national support while also maintaining local accountability and developing strong strategies that will protect the scheme against any fraud intended to occur during its implementation.

Keywords: Health insurance, health system, health financing system, healthcare systems

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References

World Health Organization. Universal health coverage (UHC). Fact sheet; 2021.

Yip W, Tang S. Improving Health System Efficiency. Reforms for improving the efficiency of health systems: lessons from 10 country cases. Health Systems Governance and Financing. 2018;6(1): 6-12.

Kutzin JK. Health Financing Policy. A Guide for Decision-makers. WHO Regional Office for Europe; 2008.

Nygren-Krug H. The Right(s) Road to Universal Health Coverage. Health Hum Rights. 2019;21(2):215-228.

URT. Tanzania in Figures. National Bureau of Statistics. Ministry of Finance and Planning Dodoma. United Republic of Tanzania; 2021.

Ooms GAN, Todd MM. Regional Network for Equity in Health in East and Southern Africa. Discussion Paper no.109. A case study of the Essential Health Benefit in Tanzania Mainland, Equinet; 2017.

MP & Fünfkirchen MA. Tanzania Health Sector Public Expenditure Review. Report No: AUS0001650, Public Disclosure Authorized; 2020.

PharmAccess Foundation. Supporting the Zanzibar New Health Financing Strategy, to Ensure Better Quality Care and Achieve UHC. WEHUBIT; 2020.

Adeyemi MI. Thematic analysis: A critical review of its process and evaluation. West East J Soc Sci. 2012;1(1):39-47.

Ndomba TSM. Uptake of community health fund: why is Mtwara District lagging behind? J Glob Health Sci. 2018;1(2).Available:https://www.researchgate.net/publication/337787501_Uptake_of_community_health_fund_why_is_Mtwara_District_lagging_behind

Abraham EEA. Barriers and facilitators to health insurance enrolment among people working in the informal sector in Morogoro, Tanzania. F1000Research. 2021;10:101.

Available:https://doi.org/10.12688/f1000research.50038.1

Akintoro OA. Knowledge and attitude towards National Health Insurance Scheme in Nigerian research institutes. Niger J Health Sci. 2015;15(2):17-22.

Chomi EN. et al. Household perceptions towards a redistributive policy across health insurance funds in Tanzania. BMC Health Services Research. 2015;15(1): 1-10. DOI: 10.1186/s12913-015-0956-7.

Benjamin S. Factors affecting enrolment of community health fund members: A case of Kwimba District [Master's thesis]. Mzumbe University; 2015.

[Nchimbi F, Mgumi MM. Assessment of the performance of Community Health Fund Scheme in Central Tanzania: A case of Mkalama District; 2018.

Amani H, Mkopi NP, Mwangu M, et al. Health insurance and health system (un)responsiveness: a qualitative study with elderly in rural Tanzania. BMC Health Serv Res. 2021;21(1):540.

Kigume R, Maluka S. The failure of community-based health insurance schemes in Tanzania: opening the black box of the implementation process. BMC Health Serv Res. 2021;21(1):104.

Kapologwe NA, Kagaruki GB, Kalolo A, Ally M, Shao AF, Meshack M. Barriers and facilitators to enrollment and re-enrollment into the community health funds/Tiba Kwa Kadi (CHF/TIKA) in Tanzania: a cross-sectional inquiry on the effects of socio-demographic factors and social marketing strategies. BMC Health Serv Res. 2017; 17(1):308.

Afriyie DO, Moshiro C, Mtei G, et al. Governance factors that affect the implementation of health financing reforms in Tanzania: an exploratory study of stakeholders’ perspectives. BMJ Glob Health. 2021;6(3):e004870.

Kagaigai J, Chinkhumba J, Chimberengwa PT, Kibusi SM. Do household perceptions influence enrolment decisions into community-based health insurance schemes in Tanzania? BMC Health Serv Res. 2021;21(1):244.

Amasha H. Causes and Effects of Delayed Reimbursement to Accredited Health Facilities by National Health Insurance Fund in Delivery of Health Services: A Case of NHIF Head Office and Regency Medical Hospital. [Unpublished Manuscript]; 2015.

Phyu CM, Myint WG. Health insurance in Myanmar: Knowledge, perceptions, and preferences of Social Security Scheme Members and General Adult populaTion; 2018.

JDK SKAA. Exploring fraud and abuse in National Health Insurance Scheme (NHIS) using data mining technique as a statistical model. Afr J Educ Stud Math Sci. 2017; 13:59-67.