During a forum organized by PharmAccess in Dar es Salaam on October 2, 2025, titled “Achieving Universal Health Insurance in Tanzania with Limited Resources: Lessons from the NIMR Study”, health experts, policymakers, and development partners convened to reflect on Tanzania’s health financing journey. The discussions focused on how evidence from the Improved Community Health Financing (ICHF) can guide the country’s next steps in implementing Universal Health Insurance (UHI).
In this exclusive Q&A, Dr. Heri Marwa, Tanzania Country Director at PharmAccess, shares insights on Tanzania’s progress toward UHI, the critical role of political commitment and financial prioritization, lessons from Ghana and Rwanda, and how technology and partnerships can accelerate coverage.
Q: How can Tanzania balance limited financial resources with the need to expand UHI coverage rapidly?
A: Tanzania can take several steps. The country should prioritize primary healthcare by focusing on a cost-effective essential package accessible to everyone before investing heavily in tertiary care.
Coverage expansion should be sequenced, prioritizing vulnerable groups such as pregnant women, children under five, and the elderly, while continuing to seek additional funding to cover all destitute populations. Health funds should be pooled and aligned; government budgets, basket funds, and vertical funds such as the AIDS Fund and Global Fund should be channeled through a single insurance pool to reduce duplication and inefficiency.
It is also essential to minimize waste in healthcare spending by improving staff allocation, medication procurement, prescription practices, and administration.
Strengthening public-private partnerships can improve efficiency, with private and public facilities sharing knowledge and resources to support both primary and tertiary care.
Again, the governance and accountability must be reinforced, including regulation of healthcare service provision, insurance management, pricing, and transparency in fund management.
Q: What lessons from Ghana and Rwanda are most applicable to Tanzania’s context?
A: Tanzania can learn several lessons from Ghana and Rwanda. From Ghana, using a portion of VAT (2.5 percent) to finance health insurance provides a single, traceable revenue source and helps subsidize the poor.
Establishing a semi-autonomous body, like the Ghana Health Service, to oversee public healthcare providers ensures accountability and separates service purchasers from providers.
From Rwanda, lessons include prioritizing primary healthcare packages, using a national poverty mapping system (RODA) to identify and subsidize destitute households, and investing early in community engagement to ensure healthcare services reach rural areas.
Q: How can the government leverage mobile payment platforms to improve UHI enrolment and premium collection?
A: Mobile payment platforms can revolutionize how Tanzanians access and pay for health insurance. The government can draw lessons from the financial sector, where digital services now allow people to open bank accounts, take loans, and complete transactions without visiting a physical office.
Similarly, UHI enrolment can be digitized, allowing people to register through mobile applications or chatbots.
Premiums can be collected securely via mobile money, which is already widely used in Tanzania.
Digital membership cards can replace paper cards, making verification at health facilities faster and more efficient.
This approach not only increases convenience for users but also reduces administrative costs, improves record-keeping, and makes it easier to track coverage, payments, and compliance, particularly for rural and hard-to-reach populations.
Q: What role should development partners and the private sector play in Tanzania’s UHI implementation?
A: Development partners and the private sector are critical to a successful rollout of UHI. Development partners should focus on strengthening Tanzania’s health system infrastructure, including investments in digital platforms, capacity building, training, and technical support, without fostering dependency.
Rather than supporting fragmented vertical programs, donor funds should be pooled through a unified insurance system to maximize efficiency and equity.
The private sector can contribute by sharing best practices in management and efficiency, offering innovative healthcare delivery models, and providing specialized services that complement public provision.
Collaboration between government and private players can enhance service delivery, reduce bottlenecks, and enable the government to concentrate resources on primary care while private facilities handle tertiary care and specialized services, such as medical tourism.
Q: Beyond political ambition and financial prioritization, what other factors could influence UHI success?
A: Several factors beyond funding and political will are critical. Institutional capacity must be strengthened, ensuring inter-agency coordination and smooth management of insurance programs.
Governance and accountability systems need reinforcement to prevent mismanagement, corruption, and inefficiency.
Expanding primary care service delivery is essential, especially given the current shortage of healthcare workers, which exceeds 50 percent in some regions.
Investments in digital technology and interoperability will improve data management, enrolment tracking, and service delivery.
Improving the quality of care across all healthcare levels is necessary to build public trust, encourage enrolment, and ensure that insurance coverage translates into meaningful health outcomes.
Alfred Zacharia is a Senior Journalist and Founder of The Respondent Online
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Email: azacharia41@gmail.com