Turning UHI coverage into access to quality healthcare

DAR ES SALAAM: ACHIEVING universal health coverage is increasingly central to the ambition of building a healthy population capable of contributing to social and economic transformation under Dira 2050.

At the heart of this ambition is Universal Health Insurance (UHI), a national health-financing reform designed to expand access to healthcare, reduce financial hardship and ensure that people can obtain medical services when they need them.

The government introduced the system in response to a longstanding challenge: paying for treatment directly at the point of service can place a heavy financial burden on individuals and households, particularly when illness requires prolonged or specialised care.

The Ministry of Health says the Universal Health Insurance Act is intended to ensure that Tanzanians can access quality healthcare without financial barriers. However, the bigger question is not simply how many people register or receive insurance cards. It is whether coverage translates into real access to appropriate, affordable and quality healthcare, regardless of where people live or their ability to pay.

The 2022 Population and Housing Census reported that 7.0 per cent of the population had coverage through the National Health Insurance Fund (NHIF) or Community Health Insurance Fund (CHIF), while 1.2 per cent had other forms of health insurance. Coverage was considerably higher in urban areas, where 11.7 per cent of residents had NHIF/ CHIF coverage, compared with 4.5 per cent in rural areas.

These disparities demonstrate that expanding insurance nationwide is not merely a registration exercise. It also requires addressing economic and geographical barriers that have historically limited people’s ability to obtain and use health insurance. Prime Minister Dr Mwigulu Nchemba has distinguished Universal Health Insurance from the Tanzania Social Action Fund (TASAF), which is a social protection programme.

He said the government was supporting people unable to afford insurance contributions, but the universal insurance system was intended for the entire population.

“Universal health insurance is not a TASAF programme and it is not a TASAF fund,” Dr Nchemba said. He explained that the wider system depends on participation by Tanzanians who have the ability to contribute. “For this programme to be implemented successfully, all Tanzanians must join the universal health insurance scheme,” he said. “Universal health insurance is for everyone. Every Tanzanian should participate in the system so that through that participation we can help those who do not have the means,” he added.

The approach allows the government to support people who cannot afford contributions while encouraging wider participation among those able to finance their own membership. NHIF Director of Members’ Services, Dr Alphonse Chandika, said the government deliberately began with households identified as unable to pay for insurance themselves.

He said the Minister for Health officially launched the first registration phase on January 23, 2026, targeting special groups and households lacking the financial capacity to contribute. “The government pays for this group because they do not have the ability,” Dr Chandika said.

He said NHIF was conducting the exercise nationwide in collaboration with the Ministry of Health, the President’s Office–Regional Administration and Local Government, and the Ministry of Community Development, Gender, Women and Special Groups.

The approach is provided for under the Universal Health Insurance Act of 2023, which places responsibility on the government to finance coverage for people who cannot afford contributions. The programme’s reach is becoming evident at district level.

Mlele District Commissioner Alhaji Mwanga said 1,186 households had been targeted in the district, covering 5,215 beneficiaries. In Newala District, Mtwara Region, District Commissioner Mwangi Kundya said the initial phase focused on low-income households, including people identified through processes linked to TASAF. He said the government had provided 150,000/- per household to enable up to six members to obtain UHI coverage.

“The government has decided to take steps that will enable citizens who face health problems to receive treatment without worrying about the amount of money they have in their pockets,” Mr Kundya said.

Mpimbwe District Executive Director, Ms Shamimu Mwariko, said more than 4,000 people had benefited from the programme. She said beneficiaries could access more than 200 listed healthcare services using their insurance cards instead of relying on exemption arrangements.

“Those in these special groups will no longer pass through the exemption window. They go directly with their cards,” she said.

The initiative reflects the broader direction outlined in Dira 2050. Tanzania’s Long-Term Perspective Plan 2026/27–2050/51 sets a target of increasing the proportion of the population covered by health insurance schemes from 15 to 100 per cent by 2050.

It also targets universal health coverage and mandatory health insurance enrolment by 2040. By June 2026, all 276,004 households targeted in the first phase had been registered, representing 100 per cent of the household target.

The households were expected to cover 1,206,319 beneficiaries, of whom 997,015 had been registered, equivalent to 83 per cent of the target. NHIF reported that 185,973 households had collected their membership cards, while 90,031 had yet to collect theirs.

At beneficiary level, 495,034 people had collected their cards, leaving 501,981 registered beneficiaries who had not yet collected them. The government was also verifying 209,304 beneficiaries to establish whether their information met the requirements of the Universal Health Insurance Act and implementation guidelines.

NHIF further reported that its overall coverage had increased from eight per cent to more than 10.2 per cent. The latter figure refers specifically to NHIF coverage, not the total proportion of Tanzanians covered by all forms of health insurance. While the registration figures indicate progress, they also highlight the work remaining.

Registration, card collection and actual utilisation of healthcare services are different stages of coverage. The ultimate measure of success will be whether beneficiaries can access the services promised under the scheme when they need them.

The location, capacity and range of services available at healthcare facilities are equally important. A person living in a remote community may have insurance but still need to travel to another district or region to access specialist treatment.

Such journeys involve transport expenses, time away from work and family responsibilities, even when the medical service itself is covered. In July 2026, the Ministry of Health reported that approximately 182,430 health workers were providing services, while identifying the need to increase staffing and improve distribution, particularly in rural and hard-to-reach areas.

This highlights a fundamental limitation of insurance: it can reduce financial barriers to healthcare but cannot independently eliminate physical barriers. An insurance card has limited practical value if patients cannot reach functioning facilities or if nearby centres lack personnel, medicines, equipment and referral capacity.

In April 2026, NHIF staff in Arusha called for the Basic Standards for Health Services to be revitalised and implemented consistently. They said differences in the interpretation of service guidelines had contributed to situations in which some members failed to receive services at certain facilities.

Earlier, in January 2026, Dr Nchemba directed health authorities to enforce government standards for healthcare costs following concerns that patients were being charged different amounts for similar services at different facilities. Predictable costs are essential to financial protection.

If insured people continue to face unclear or unexpected payments, the intended benefits of reducing financial hardship are undermined. Universal Health Insurance is designed to address financial challenges through risk pooling, whereby contributions from members and government support for eligible groups are combined to finance healthcare when members need services.

However, the sustainability of this arrangement remains a central consideration as membership expands. In April 2026, NHIF staff asked the Fund’s Board to advise the government to review contribution rates for public- and private-sector employees.

Under the existing arrangement cited during the discussions, employees contribute three per cent of their salaries, while employers contribute another three per cent, bringing the combined monthly contribution to six per cent. NHIF staff said rising treatment costs, particularly for specialised and super-specialised services, were putting pressure on the existing contribution structure.

A universal insurance system requires sufficient resources to pay healthcare providers while accommodating a growing membership. Its financing model must therefore balance affordable contributions with the rising costs of providing healthcare.

The private sector also has an important role in service delivery. NHIF has said its approved provider network includes government facilities, private companies and religious organisations. Private providers can expand the number of service points available to insured members, particularly where publicsector capacity is limited. Digital systems are also becoming increasingly important.

In January 2026, the Ministry of Health said it was developing an integrated health-information system capable of tracking a patient’s journey from admission through treatment and referral, while helping control unnecessary expenditure. Such systems can improve the management of membership records, services, referrals and payments while helping identify gaps in healthcare provision.

In May 2026, NHIF and Muhimbili University of Health and Allied Sciences (MUHAS) also entered into a strategic cooperation agreement to strengthen research, innovation and efficiency in health insurance implementation. The experiences of beneficiaries and local leaders provide another perspective on the programme’s significance.

ALSO READ: MPs flag UHI gaps as government warns against fraud

Hamisi Omary, Chairman of Mkwiti Juu Street in Tandahimba, Mtwara Region, said the initiative addressed a longstanding concern among low-income households. “We thank the government for this component that has followed up households of people who are unable to support themselves,” he said.

In Geita, Samina Street Chairman Joseph Petro said some residents previously identified among poor households were now receiving insurance cards. “The issue of treatment is a major test for all citizens, considering that these poor households cannot afford treatment, and treatment is expensive,” he said.

Their accounts illustrate the importance of extending financial protection to households that would otherwise struggle to meet medical expenses. However, TASAF’s social protection role remains distinct from UHI’s broader purpose of financing healthcare, even though the two programmes can intersect when identifying households requiring government support.

The long-term objective is not simply to increase the number of people holding insurance cards. It is to build a healthcare system in which people can seek appropriate treatment without illness pushing them into financial hardship.

Achieving this ambition requires insurance membership to expand while vulnerable households are protected from contributions they cannot afford. Healthcare facilities must be accessible, health workers adequately available and appropriately distributed, and medicines, equipment and diagnostic services sufficient to support the care promised under the scheme.

Referral systems must function effectively, providers must meet applicable standards, and financing must remain sustainable as demand grows. The June 2026 figures demonstrate both progress and outstanding challenges. Although all 276,004 targeted households had been registered, 90,031 had not collected their membership cards.

Similarly, 997,015 beneficiaries had been registered against a target of 1,206,319, while 501,981 registered beneficiaries had yet to collect their cards.

The government and health insurance managers will therefore need to establish how many registered people are actually accessing healthcare, whether facilities can accommodate increased demand, whether rural communities are benefiting at a comparable pace to urban populations and whether financing for vulnerable groups can be sustained.

Ultimately, universal health coverage will be measured not by the number of names in an insurance database, but by patients’ everyday experiences: whether a child in a rural village can obtain appropriate treatment, whether a pregnant woman can access essential care, whether an older person can receive treatment for chronic conditions and whether a working household can seek medical attention without illness becoming a financial crisis.

That is when national healthfinancing reform becomes tangible protection for households and a foundation for the healthy population envisioned under Tanzania Development Vision 2050.