Understanding the role of the Tanzania national health insurance fund in improving service coverage and quality of care

Bibliographic Data

ID8018220
AuthorsDoris Osei Afriyie (0000-0002-9062-7506, Swiss Tropical and Public Health Institute, corresponding author), Pei Shan Loo (0000-0001-8861-8849, Swiss Tropical and Public Health Institute), August Kuwawenaruwa (0000-0001-8459-443X, Ifakara Health Institute), Kassimu Tani (0000-0003-4955-5560, Swiss Tropical and Public Health Institute), Tani Kassimu, Günther Fink (0000-0001-7525-3668, Swiss Tropical and Public Health Institute), Fabrizio Tediosi (0000-0001-8671-9400, Swiss Tropical and Public Health Institute), Sally Mtenga (0000-0001-6100-7562, University of Glasgow)
Year2024
Volume347
Pages116714-116714
Publication date2024-02-29
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2024.116714
PMID38479141
OpenAlexW4392303074
LanguageEN
Citations received3
References cited35

Health insurance is one of the main financing mechanisms currently being used in low and middle-income countries to improve access to quality services. Tanzania has been running its National Health Insurance Fund (NHIF) since 2001 and has recently undergone significant reforms. However, there is limited attention to the causal mechanisms through which NHIF improves service coverage and quality of care. This paper aims to use a system dynamics (qualitative) approach to understand NHIF causal pathways and feedback loops for improving service coverage and quality of care at the primary healthcare level in Tanzania. We used qualitative interviews with 32 stakeholders from national, regional, district, and health facility levels conducted between May to July 2021. Based on the main findings and themes generated from the interviews, causal mechanisms, and feedback loops were created. The majority of feedback loops in the CLDs were reinforcing cycles for improving service coverage among beneficiaries and the quality of care by providers, with different external factors affecting these two actions. Our main feedback loop shows that the NHIF plays a crucial role in providing additional financial resources to facilities to purchase essential medical commodities to deliver care. However, this cycle is often interrupted by reimbursement delays. Additionally, beneficiaries' perception that lower-level facilities have poorer quality of care has reinforced care seeking at higher-levels. This has decreased lower level facilities' ability to benefit from the insurance and improve their capacity to deliver quality care. Another key finding was that the NHIF funding has resulted in better services for insured populations compared to the uninsured. To increase quality of care, the NHIF may benefit from improving its reimbursement administrative processes, increasing the capacity of lower levels of care to benefit from the insurance and appropriately incentivizing providers for continuity of care

Actuarial science · Business · Economic growth · Economics · Health care · Health insurance · Public economics · Quality (philosophy · Socioeconomics · Tanzania · Global Maternal and Child Health · Healthcare Policy and Management · Healthcare Systems and Reforms