By Alfred Zacharia
Tanzania is stepping up efforts to roll out the Universal Health Insurance (UHI) Act of 2023, using lessons from the Improved Community Health Fund (ICHF) to address enrolment, financing, and sustainability challenges that have historically limited progress in expanding health coverage.
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, brought together health experts, policymakers, and development partners to reflect on the country’s health financing journey. Discussions centered on how evidence from ICHF can guide Tanzania’s next steps in implementing UHI.
Presenting findings from the National Institute for Medical Research (NIMR), Director of Research Information and Regulatory Affairs, Dr. Mary Mayige, said that between 2019 and 2023 a total of 898,739 individuals enrolled in ICHF.
Enrolment peaked in 2021 with 270,249 members but dropped sharply to 91,005 in 2023. New enrolments mirrored this decline, falling from 225,950 in 2021 to 59,623 in 2023, pointing to difficulties in sustaining growth despite strong initial uptake.
One area of progress has been membership renewals. According to NIMR, renewal rates improved from 10 percent in 2020 to 34.5 percent in 2023.
Male beneficiaries renewed slightly more often (19.8 percent) than females (17.6 percent).
Age-specific data showed that households with members over 45 years were far more likely to renew compared to households with children under five, with the highest renewal among the 55 or above age group at 19.9 percent.
Healthcare utilisation patterns revealed that ICHF beneficiaries averaged 1.17 health visits per person, with visits for non-communicable diseases (NCDs) slightly outnumbering those for communicable diseases.
Dr. Mayige said this trend highlights the importance of integrating NCD prevention, treatment, and long-term care into UHI, as chronic conditions increasingly shape Tanzania’s health needs.
Financial data presented a mixed picture. Regional contributions grew from TZS 2.2 billion in 2019 to Tshs 12.2 billion in 2021, before declining to TZS 3.6 billion in 2023.
While reimbursements remained stable at TZS 8.55 billion in 2023, they fell sharply to TZS 2.23 billion in 2024.
The experience varied across regions. Dodoma and Morogoro reported surpluses, while Dar es Salaam, despite being the largest contributor, recorded deficits that reached TZS 4.97 billion in 2022/23.
“The ICHF review provides critical insights,” Dr. Mayige said, adding that “Leveraging data is crucial for designing the Basic Benefit Package and ensuring equitable, financially sustainable coverage, particularly for costly NCD services.”
Policy recommendations drawn from the review include targeted enrolment strategies, especially for men over 35 who are key household decision-makers in many regions.
Broader coverage in rural and digitally excluded areas is encouraged through mobile registration units, simplified enrolment systems, and locally tailored communication campaigns.
Gender- and age-sensitive messaging using social media, radio, and community forums could further drive uptake and renewals.
On financing, the study recommends diversifying funding sources. This includes horizontally integrating disease-specific programs, such as HIV/AIDS and maternal-child health, into UHI financing, introducing progressive contributions, and establishing government subsidies for vulnerable groups including children under five.
Household-based enrolment models are also seen as a way to expand risk pools and reduce administrative costs.
A national risk equalisation fund was proposed to balance regional disparities and cushion the financial burden of rising NCD-related expenditures.
She also highlighted the need for robust monitoring and evaluation (M&E) systems, transparent provider payment mechanisms, and secure health data systems to build trust and accountability.
PharmAccess Health Systems Director, Mr. Kwasi Boahene, who shared experiences from other African countries, said progress in health insurance depends more on political ambition and financial prioritisation than on wealth.
He cited Ghana and Rwanda as examples of countries that achieved significant progress despite limited resources.
“I think Tanzania has done very well in enacting the Universal Health Insurance law, which is the foundation for a robust health insurance system. The question now is how to finance it,” he said.
“As far as I’m concerned, there is no excuse for Tanzania not to increase the momentum. They have the law, they have technology, and they have a growing population that can strengthen risk pooling,” he added.
He also pointed to the widespread use of mobile payment platforms in East Africa, arguing that technology could lower barriers to enrolment and facilitate premium collection.
PharmAccess Tanzania Country Director, Dr. Heri Marwa, said the event was meant to translate lessons from ICHF into practical strategies for UHI implementation.
“The important part of the event is to learn how we utilize the lessons shared by NIMR on CHF to make sure more Tanzanians join health insurance, in line with the law signed in December 2023,” he said.
He added that inefficiencies within the system also cost the country resources that could instead be directed towards expanding coverage.
Participants agreed that achieving universal health insurance will require political commitment, stronger financing strategies, and the integration of services for chronic diseases. Without these interventions, they warned, inequities and sustainability challenges experienced under ICHF could persist, undermining the country’s ambition for universal health coverage.
