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.


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

How to Cite

Khalfan , S. S., Ngwali , A. K., & Hafidh , H. A. (2023). Systematic Review of Lessons Learned from the Tanzania Mainland Health Financing System towards the Introduction of Universal Health Coverage in Zanzibar. Asian Journal of Research in Nursing and Health, 6(1), 184–192. Retrieved from


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