Tanzania’s Universal Health Insurance enters historic implementation phase

DAR ES SALAAM: AS Tanzania advances steadily toward the full realisation of Universal Health Insurance (UHI), the country is entering a transformative phase in its pursuit of equitable, affordable and quality healthcare for all citizens.

At the heart of this national effort is the Tanzania Insurance Regulatory Authority (TIRA), which continues to play a central role in translating policy commitments into practical, enforceable action. Through regulation, public education and institutional reforms, the Authority is ensuring that the promise of universal health coverage becomes a lived reality rather than a distant aspiration.

This progress follows the official commencement of UHI implementation on Monday, January 26, 2026 as an important milestone in the country’s health financing reforms.

The launch marks the fulfilment of President Samia Suluhu Hassan’s pledge to begin implementing universal health insurance within the first 100 days of her second term in office. The move reflects strong political will and a broader commitment by the government to eliminate financial barriers that have historically limited access to essential healthcare services.

The UHI initiative is anchored in the Universal Health Insurance Act, 2023, which establishes the legal framework for mandatory health insurance coverage for Tanzanians. Under Section 7(2) of the Act, TIRA is mandated to regulate and supervise the health insurance system, ensuring compliance, accountability and consumer protection across all schemes operating within the country.

This mandate positions TIRA as a critical institution in safeguarding the integrity, sustainability and effectiveness of the UHI system. Through sustained public education, regulatory supervision and targeted institutional reforms, TIRA is reinforcing the implementation of the UHI framework with the objective of improving access, equity and efficiency in healthcare financing.

The Authority’s approach recognises that successful UHI depends not only on legislation, but also on public trust, informed participation and effective oversight of insurers and healthcare providers.

In a special edition focusing on the supervision and regulation of the UHI system, TIRA’s Commissioner of Insurance, Dr Baghayo Saqware, outlined key measures undertaken by the Authority, with particular emphasis on strengthening oversight mechanisms and ensuring effective execution of the UHI programme.

Dr Saqware noted that a cornerstone of TIRA’s efforts is the development of a comprehensive public education strategy designed to raise awareness, deepen understanding and encourage broad participation in the national health insurance system.

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According to the Commissioner, informed citizens are better positioned to engage meaningfully with UHI, fulfil their obligations and assert their rights as beneficiaries.

Recognising the importance of structured and sustained communication, TIRA has developed and is implementing a Five-Year National Insurance Education Strategy (NIES) covering the period 2024/25 to 2029/30. The strategy aims to ensure that increasing numbers of Tanzanians are effectively integrated into the health insurance system through consistent, accurate and accessible information delivered via multiple channels.

The strategy places emphasis on simplifying technical insurance concepts, addressing misconceptions and tailoring messages to different demographic groups, including workers in the informal sector, rural communities and vulnerable populations. By doing so, TIRA seeks to bridge information gaps that have previously hindered insurance uptake and compliance.

“I would like to encourage all Tanzanians to actively participate in the UHI by registering, paying the required contributions and adhering to the established procedures,” Dr Saqware said.

“TIRA will continue to provide public education, oversee the implementation of the law and protect the rights of health insurance members to ensure that health insurance improves people’s lives,” he added.

Beyond national policy and strategic planning, TIRA has intensified grassroots outreach to ensure that UHI education reaches communities across the country. To enhance operational efficiency and ensure localised engagement, the Authority has divided Tanzania into 10 administrative zones for insurance supervision and education.

These zones include the Northern Zone, covering Kilimanjaro, Arusha and Tanga; the Eastern Zone, encompassing Morogoro, Coast and Dar es Salaam; and the Southern Zone, which includes Mtwara, Lindi and Ruvuma. Other zones are the Southern Highlands Zone (Mbeya, Njombe and Songwe), the Central Zone (Iringa, Dodoma and Manyara), and the Lake Zone (Mwanza, Geita, Kagera, Mara and Simiyu).

Additional zones include the Tanganyika Zone, comprising Kigoma, Katavi and Rukwa; the Western Zone, covering Shinyanga, Tabora and Singida; as well as the Pemba Zone (North and South Pemba) and the Unguja Zone (North, South and West Unguja).

This zonal structure enables TIRA to coordinate outreach activities more effectively while responding to region-specific challenges and opportunities. A notable example of this decentralised approach is the recent district-by-district UHI education programme implemented by TIRA’s Eastern Zone.

The initiative focuses on educating citizens, healthcare providers and local stakeholders about UHI, while simultaneously facilitating the registration of healthcare facilities into the system.

The programme has been rolled out across Dar es Salaam, Coast and Morogoro regions, reaching 17 districts to date. Districts such as Kilwa and Mafia in Pwani Region are scheduled to be covered in the next phase, ensuring full implementation in line with the Authority’s established outreach plan.

This grassroots engagement initiative forms an integral part of TIRA’s broader strategy to deliver accurate, sustainable and community-driven UHI education through direct interaction with citizens.

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By working closely with local leaders, healthcare providers and administrative structures, the Authority ensures that information is trusted, relevant and actionable.

Through these engagements, citizens are educated on their rights and obligations under the UHI framework, while healthcare providers and local leaders are empowered to support enrolment efforts, promote compliance and address emerging concerns at the community level.

In parallel with community outreach, TIRA has strengthened stakeholder engagement through active participation in national and regional forums. In December last year, the Authority took part in a health insurance education workshop held at the Songwe Regional Commissioner’s Office. The workshop brought together 286 participants drawn from government institutions, the private sector and health sector stakeholders.

These included representatives from the National Health Insurance Fund (NHIF), the Ministry of Health, CCM regional leadership, District Commissioners, Council Directors and Administrative Secretaries from several districts. Such forums provide a platform for dialogue, coordination and shared understanding among key actors responsible for UHI implementation at different levels of government.

They also help align policy objectives with on-the-ground realities and strengthen inter-institutional collaboration. Similarly, TIRA’s Lake Zone conducted targeted sensitisation sessions for leaders in Ilemela District. These sessions focused on the implementation of the Universal Health Insurance Act and equipped local leaders with the knowledge and tools needed to mobilise communities at ward and street levels.

Speaking on the regulatory dimension of UHI implementation, TIRA’s Public Relations and Communication Manager, Ms Hadija Maulid, said the Authority continues to exercise its mandate to ensure that all health insurance schemes comply with legal requirements, ethical standards and established service benchmarks.

She emphasised that TIRA places particular importance on fairness, transparency and the protection of beneficiaries’ interests, noting that strong regulation is essential to maintaining public confidence in the insurance system. To strengthen institutional capacity, Ms Maulid noted that TIRA has undertaken internal reforms, including organisational restructuring to establish a dedicated UHI supervision unit.

The Authority has also set up an AntiFraud Unit to address fraudulent practices in the insurance market, which can undermine service quality and erode trust. Looking ahead, UHI implementation will be fully integrated into TIRA’s Five-Year Strategic Plan for 2026/27–2030/31.

The plan will guide the development of detailed guidelines covering scheme registration, member enrolment, beneficiary management and claims settlement processes.

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In addition, TIRA has developed guidelines for receiving and handling complaints related to insurance claims and service delivery.

These guidelines outline clear, transparent procedures for lodging complaints, investigating grievances and resolving disputes in a timely manner. Complaints handled by TIRA include dissatisfaction with healthcare services, denial of services contrary to contractual agreements, impractical or unfair contractual conditions, disputes over claim amounts and delays in claim payments.

Under Section 34 of the Universal Health Insurance Act, dispute resolution follows procedures established under the Insurance Act, Cap 394. Insurance-related disputes are resolved through the Office of the Tanzania Insurance Ombudsman (TIO), in accordance with the Insurance Disputes Resolution Regulations (Government Notice No. 411 of 2013).

Through these combined efforts of policy enforcement, public education, stakeholder engagement and institutional strengthening, TIRA is positioning itself as a key driver of Tanzania’s UHI agenda.

As implementation gathers momentum, the Authority’s work is expected to play a decisive role in ensuring that universal health insurance delivers on its promise of accessible, equitable and quality healthcare for all Tanzanians, without financial hardship.