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Technical Review Meeting (TRM), Blue Pearl 6-8 September, 2010 Department of Policy and Planning Background ◦ `Objective Of the Meeting Areas covered Issues raised Way Forward Provide evidence to inform the scale up of health insurance in Tanzania Identify key steps to achieve UC Historical background and Situation analysis Who pays and who benefits? FIA pro poor BIA pro rich In Tanzania, compared to other countries, health financing to be more or less progressive Benefits are similar as in other countries, are regressive The typical distributions of the poor going to lower level facilities. The CHF is regressive by design Matching grant - Is it not perpetrating inequity? A flat rate premium, means everyone pays the same irrespective of income The scheme also targets the poorest. Concern ◦ If coverage were to expand and premia to increase, the regressivity of the CHF would be an issue Current status of the NHIF and CHF ◦ Support to poor pregnant women SHIB ◦ Formal Private and planning for informal Private sector ◦ Private firms ◦ Micro insurances ◦ All NSSF members contribute but very few benefit, SHIB members contribute but NOT benefiting from the scheme Health Funders Board Adverse Selection Price inflation (prices charged by private providers), Patients not respecting referral system Weak management – especially CHF and Micro Limited benefit package Establishment of district drug buffer stocks for supplementary drug supply Need to wake up a sleeping giant. ◦ Establishment of bank accounts and petty cash No incentives for districts to promote CHF Office bearers of the scheme are often overburdened and not full-time professionals. Poor health insurance literacy within the population Regulatory framework for health insurance ◦ Many players ◦ Different perspectives ◦ Some how different objectives ◦ Should we put health insurance in social security or leave it out? ◦ Contributions of the community are rather limited, hence low enrolment How are we going to handle the informal sector? Exempt? Or pay for them and issue a card? Who will pay for them? ◦ Scaling-up for universal coverage is also implying an increase in usage of services – need for supply side investment to meet increased demand ◦ Fragmentation is an issue Affects financial sustainability and equity Modeling - Options to expand health insurance in Tanzania. Done in shorter time ◦ UC per se would have limited impact on GDP and gvt exp on health, ◦ HOWEVER HSS WILL REQUIRE HUGE INVESTIMENT ◦ Key lesson from other countries Fund authority response to Insurance Scheme Earmarked tax works - Ghana and Thailand It is possible to collaborate with social security fund need action - A minimum package of Health and Related Management Activities The required inputs and outputs will be determined as per level of care. Essential Health Package(EHP)/Services per level of care Review the Service Agreement Review the stock list at MSD and TFDA per level of care ◦ Medicines ◦ Devices ◦ Reagents MOHSW + PMORALG +PARTINERS + MSD+TFDA Expand Network at all Levels for both public and private as per MMAM and Policy. PPP Universal Coverage of the Financing Agenda i.e Social H.I Scheme◦ Action Plan ◦ PRIVATE FORMAL ◦ INFORMAL A lot is in Place in use available Data Need to develop a milestone for health financing Financing Strategy