Transcript SOCIAL HEALTH PROTECTION FOCUSING IMPLEMENTATION …

NATIONAL POVERTY POLICY WEEK
25TH – 27TH NOVEMBER, 2013
Social Protection for Individual And National
Development
NHIF, CHF/TIKA HEALTH FINANCING
PROGRAMS
The Ag Director General
National Health Insurance Fund (NHIF)
Dar es Salaam
Summary of Presentation
1. From the Arusha Declaration (1967) to the Health
Sector Reforms (1993/94);
2. Social Health Protection- Programs
3. Description of NHIF and CHF/TIKA Programs;
4. Anti-poverty and Development Programs at NHIF
(Best Practices);
5. Challenges of extension of SHI to the poor; and
6. Recommended measures and the way forward.
1: From the Arusha Declarations to the
Health Sector Reforms
• The Arusha declaration policy 1967
– Free health,& education (welfare system)
– The government (main Provider and Financier)
– Expansion of services & emphasis on PHC (disadvantaged groups assured
access to health services)
• The health sector reform policy 1993
–
–
–
–
Measures to address economic recessions
Introduction of cost sharing 1993 (NHIF and CHF are the products of the reforms)
Changes of attitude (from free to contributions)
Sharing of health care responsibilities between the Government, private sector,
communities and individuals
– The Govt set a Secretariat at the MoHSW to coordinate the reforms
– Health matters are looked and considered in a Sector wider approach
perspective.
National
Health Financing
3
– The Health delivery system
operates
in a Workshop
decentralized system
2.Social Health Protection Programs
PRIVATE/INDIVIDUAL
ARRANGEMENTS
OCCUPATION PLANS
MICRO INSURANCE & MUTUAL
USER FEES
SOCIAL HEALTH BENEFITS-SHIB (NSSF)
COMMUNITY HEALTH PROGRAM
CHF – 120 COUNCILS
COMPULSORY PROGRAMS
NHIF
PUBLIC HEALTH PROGRAMS
National Health Financing Workshop
4
3. Description of NHIF AND CHF/TIKA (how the Program
Works and how the Poor People are Involved
S
AREA
NHIF
CHF
Remarks
1
Establishment
Act No 8/1999
Compulsory, contributory
Act No 1/2001
Voluntary, contributory
Both are products of the
health sector reforms
2
Coverage
Formal sector employee and
their immediate families up
to 6 (2,979,238)
Informal sector. Households
(spouse and children)
(3,567,540) as of 30th
September, 2013
CHF and NHIF beneficiaries
totals to 6,567,778 which
14.5 % of the total
population.
3.
Addressing
special groups
Children and parents of
NHIF are allowed to be
registered as beneficiaries.
Those who cannot pay are
exempted from paying CHF
contributions, but the Law
requires to be granted a CHF
card.
The arrangement has
helped special groups in
the society to have access
to NHIF and CHF services
4
Exempting
retirees from
contributing to
NHIF services
Since July, 2009 the
Management of NHIF has
extended health care
coverage to retirees (who
were contributing before
retires)
60 + who does not have the
means to pay for the health
care services are exempted
from contributions
Extension of services to
retirees have helped them
from financing health care
costs out of pockets.
5
Involvement of
stakeholders in
the decision
making
Board of Directors
(independent) representing
key stakeholders of NHIF
Council through Council Health
Services Board that represents
Involvement of key
stakeholders in decision
making organs of the
scheme has helped to
public agenda to be taken
on board.
4. Anti-Poverty and Development Programs at
NHIF (Best Practices)
No
Best practices
Description of the initiative Targeted group
Remarks
1
NHIF/KfW
Project 20112014
4 years project, target to
support access to quality
health care services to poor
pregnant women. Jointly
financed by NHIF and KfW
LGAs are being
encouraging to start
building capacity so
as to take over after
the lapse of project
period. NHIF and
KfW intends to
extend the program
to Lindi and Mtwara
bank
(Project costs 18
bn/=)
70,000 poor pregnant
women (and their
Household) in Tanga
and Mbeya as of 30th
September, 68,569
poor pregnant
women have been
covered
2
NHIF
NHIF management sets aside
CHF scheme and pro- Tsh 370/= m have
Investments for funds for investments of which poor (MVCs at LGAs) been realized since
the pro-poor
income derived are used to
November, 2011
support CHF and the pro-poor
3
Pro-poor
An average of Tsh 50.00 m/=
financing under set annually since 2010/11 for
CHF
pro-poor
MVCs in the LGAs
(4,020 Household
with MVCs have
benefited.
The program
benefited Lindi, Pwani
and Singida Regions
4. Anti-Poverty …….
No
Best practices
Description of the
initiative
Since July, 2009 the NHIF
extended health services to
her retirees members aged
60 years and above and
who have retired from
employment.
4
Exempting retiree
from contributing
to NHIF services
5
Outreach program The Fund in collaborations members of NHIF,
to periphery
with Referral Hospitals (MOI CHF and the general
Regions
and Muhimbili) is
public.
conducting outreach
programs to upcountry
Regions where specialized
services are being offered.
6
Medical Equipment
and Facility
Improvement Loan
A platform that enables health
facility to improve their health
services through medical
equipment and facility
improvement loan from NHIF
that are paid through deductions
from their monthly claims
Targeted group
Remarks
Retirees (and their
spouses) who were
members of the
scheme
Extension of services to
retirees have helped
them from financing
health care costs out of
pockets
The program has
covered Kigoma,
Lindi, Rukwa, Katavi
and Pwani
All accredited facilities by A total of Tsh. 10bn has
the Fund. Total approved been set in the 2013/14
for 2013/14 Tsh 763 m/= annual budget for MEFIC;
Cumulative since 2007 is
Tsh 7.2 bn/=
5. On Going Activities at NHIF
a. Finalizing proposals for awarding best
practices (LGAs) on extension of coverage
including the pro-poor to CHF;
b. Documenting and promoting best practices
on NHIF and CHF;
c. Technical assistance to a women group in
Majohe –Ilala (so that they open ADDO)
d. Countrywide sensitization campaign on CHF
in collaboration with LGAs (the use of
Cinema Van and drama groups)
5. Challenges
a. Increased dependence to the schemes even those who
are able to work demanded to be included as
dependants;
b. Absence of standardized tool for determining who is
poor and on how to manage exemptions;
c. Most LGA’s does not make a provision in their annual
plans and budget to cater for the pro-poor (most LGS’s
depends on NGO’s to finance pro-poor;
d. Access to medicines for the pro-poor is still major
challenge as they have not linked to alternative outlet
such as ADDO;
e. NHIF members with families exceeding six have bear
costs for additional members of their families as the
Fund cover up to six beneficiaries
6. Recommendations
a.
b.
c.
d.
e.
f.
g.
h.
All those who are able to contribute to NHIF/CHF should contribute to
the programs so as to reduce dependences and create a strong pool to
subsidize or finance the pro-poor;
The process of developing National tool for identification of the poor
should be expedited and involve key stakeholders at all stages;
LGAs should make provisions for the pro-poor in their councils; and
NHIF and LGA have to work hand in hand in looking for solutions with
regards to access to medicines for CHF members.
There is an imperative need to revive and re-practice all previous best
practices that helped the Country to succeed in health and other related
campaign (KULENI KUKU MAYAI MBOGA SAMAKI MAZIWA- Makongoro’s
Song. Mtu ni Afya- Mbaraka, SKUVI- promoted by IPP media)
Promote the concept of social capital on health (especially at primary
levels);
A need for coordinated efforts.
Fighting poverty in all its dimension including loosing hopes or giving up
(a need of even using Religious Leaders in the anti-poverty fights)
Submission
The paper is submitted for information, sharing
of knowledge, experience and discussions.
Thanking you all for listening and attention
www.nhif.or.tz
P.O.BOX 11360
Dar es Salaam