DODOMA: THE National Health Insurance Fund (NHIF) has significantly improved its financial stability, extending its operational coverage from six months to approximately 1.2 years, with a long-term goal of reaching two years in line with international standards.
NHIF Director General Dr Irene Kisaka disclosed this yesterday in Dodoma while addressing reporters on the Fund’s achievements under President Samia Suluhu Hassan’s leadership over the past four years.
Dr Kisaka revealed that the NHIF has spent a total of 2.29tri/- on medical treatments for Tanzanians receiving care at public, private and faith-based health facilities nationwide.
Despite this significant expenditure, the Fund has improved its financial standing, shifting from a 120bn/- deficit to a surplus of 95bn/- during this period, thanks to the effective implementation of an integrated ICT system.
During the same period, NHIF successfully collected 2.3tri/-. Of this amount, 92 per cent came from NHIF members, 7 percent from investments, and the remaining 1 per cent from miscellaneous sources.
Dr Kisaka explained that the 2.29tri/- expenditure covered normal, specialised and super-specialised healthcare services.
Government-owned health facilities received 37 per cent of the payments, private facilities 35 per cent and religious institutions the remaining 28 per cent.
She noted that 60 per cent of the total expenditure was allocated to treating patients with Non-Communicable Diseases (NCDs), urging Tanzanians to adopt healthier lifestyles to reduce the prevalence of such illnesses.
“We used to believe that NCDs primarily affected the elderly, but we are now seeing young people suffering from these diseases as well. It is our duty to educate the public about this,” she emphasised.
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Dr Kisaka further noted that the number of claims submitted by healthcare providers has increased due to improved services, including the adoption of CT scan technology and the expansion of NHIF-accredited facilities.
“The integration of NHIF’s system with those of the National Identification Authority (NIDA), the Registration, Insolvency and Trusteeship Agency (RITA), TIRA, WCF, BRELA, NECTA and others has enhanced fraud detection,” she added.
In its anti-fraud efforts, NHIF saved 22bn/- over the past four years by blocking more than 13,000 fraudulent insurance cards.
The adoption of ICT with AI features has significantly improved NHIF’s efficiency, reducing the time required to process hospital payments from 120 days to 40–60 days.
As the Fund continues to enhance its operations, the claim rejection rate has dropped from 18 to 9 per cent, with a target of further reducing it to 7 per cent.
In its drive toward achieving Universal Health Coverage (UHC), NHIF has recruited 2.2 million new members over the past four years, including over 280,000 in the first half of the 2024/25 fiscal year alone.
“We continue to recruit more members in workplaces and groups, including farmers, artisans, fishermen, savings groups and communities. We are also collaborating with local government authorities and TASAF to identify underprivileged individuals in need of healthcare services,” she said.
