MPs flag UHI gaps as government warns against fraud

DODOMA: THE government has warned that fraud could undermine the Universal Health Insurance (UHI) scheme, as MPs raised concerns over medicine shortages, referral procedures and other service gaps that could discourage citizens from enrolling.

Minister for Health Mohamed Mchengerwa said misuse of insurance cards and false declarations could compromise the programme and deny legitimate beneficiaries access to healthcare.

He urged MPs to educate their constituents against using other people’s insurance cards or providing misleading information to obtain services they are not entitled to.

“Fraud by one person can affect the benefits of many. I urge us to become guardians of this programme because what we are building today is for the benefit of present and future generations,” he said.

Mr Mchengerwa was speaking during a Ministry of Health seminar for MPs on the implementation of the scheme.

He said the government was targeting 25 million beneficiaries by June 2027, with MPs expected to play a key role in mobilising citizens and raising awareness about the importance of health insurance.

However, MPs who contributed to the seminar warned that weaknesses in service delivery and insurance procedures could undermine public confidence in the scheme.

Ushetu MP Emanuel Cherehani questioned why some insured patients were reportedly being directed to buy medicines from pharmacies outside hospitals, while patients paying cash received medicines at the same facilities.

“How are you ensuring that insured patients get medicines? When they go to hospitals, they are told to buy them from outside pharmacies, while those paying cash receive medicines at the hospitals,” he asked.

Katoro MP Kija Ntemi called for a review of referral procedures that require patients to first attend dispensaries before accessing regional or referral hospitals, even when their conditions demand urgent attention.

He said treatment should be guided by medical needs and the seriousness of a patient’s condition.

Mr Ntemi also urged the government to integrate insurance systems to enable patients to continue treatment at different facilities without being denied coverage because their insurance had already been used elsewhere on the same day.

Ilemela MP Kafiti Kafiti, meanwhile, called for individuals to be allowed to enrol independently at a contribution of 60,000/- rather than being required to join groups of at least six people, arguing that the condition could discourage potential beneficiaries.

Responding, Permanent Secretary in the Ministry of Health Dr Grace Magembe acknowledged the shortage of health workers, saying recruitment was ongoing and that 90 per cent of newly recruited personnel were being deployed to primary healthcare facilities alongside the provision of medical equipment.

On concerns about continuity of treatment across facilities, she said insurance systems were now interoperable, allowing patients to access specialist services elsewhere without unnecessary disruption.

Mr Mchengerwa also urged MPs to assess the readiness of health facilities in their constituencies, including infrastructure, medicines, equipment, staffing and information technology systems.

He said integration of the AFYAEMS and GoTHOMIS systems would improve information exchange and allow patients’ medical records to follow them securely between facilities.

“We are not investing in technology simply to have many computers; we are investing so that citizens can receive quality services on time and without inconvenience,” he said.

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Assistant Director for Policy, Research and Innovation in the ministry, Tumainiel Macha, said health insurance enrolment had risen from eight per cent in 2023 to 11 per cent.

He said community health workers and regional authorities were being brought into mobilisation efforts, with regional targets set to guide implementation.

Mr Macha urged MPs to make health insurance a regular agenda item in meetings with their constituents and help mobilise more people to enrol.