Accessible health insurance for all

Project completed
Enrolment in the health insurance system in the Dodoma region in Tanzania
Enrolment in the health insurance system in the Dodoma region in Tanzania. © SDC SDC

The SDC has been involved in improving the level of health in Tanzania since the 1960s. The establishment of a community health fund has been one of the most determining factors in this process, alongside access to better quality care and taking into account the genuine needs of the Tanzanian people. This health insurance system has been designed to also benefit the most disadvantaged individuals.

Country/region Topic Period Budget
Tanzania
Health
Governance
Health systems strengthening
Primary health care
Decentralisation
01.02.2010 - 31.03.2016
CHF 11'191'000

In 1999, Tanzania launched an ambitious reform of its health-care system in order to provide more effective services. To this end, the management and funding of the system were completely reformed, including a sharing of costs among public institutions, donors and beneficiaries. Health-care funding is one of the key issues in a perspective of sustainable development.
Improving the health-care system requires action targeting both the demand and supply sides of health services. The SDC's 'Health Promotion and System Strengthening Project' therefore focuses equally on community health insurance schemes and promoting health in villages (demand), and on providing medicine and maintaining the infrastructure (supply).

The central role of health insurance schemes
The SDC supports the re-design of community health funds with a view to transforming them into viable health insurance systems. Members of registered households each receive an electronic card granting them free access to medical care in any public health facility in the region. Previously, patients only had access to the facility where they were registered. Between July 2012 and December 2013, some 33, 000 households enrolled in the new health insurance system, which collected premiums amounting to nearly CHF 230,000. The improvement of these health insurance schemes plays a central role in strengthening the Tanzanian health-care system.
This new project, launched at the request of the Tanzanian authorities and supported by local political and administrative authorities, is considered a pilot project aimed at testing the functioning of community health funds. If the model proves its worth, it will be extended to other regions in the country.

Provision of medicine and infrastructure maintenance
In order to increase the number of clients and thus ensure the sustainability of health insurance systems, it is essential to provide high quality services. Contributing factors that have a direct influence on the proper functioning of services — such as infrastructure and well-maintained medical equipment or facilitated access to medicine — were therefore taken into consideration. The SDC established a decentralised system of medicine supplies in partnership with the private sector. One supplier was selected to supplement demand when the public health service is out of stock. Furthermore, each district nominated two technicians responsible for maintaining the infrastructure. The SDC provides them with technical support and with training modules.

Health care tailored to actual needs
Health will only improve by investing time and resources in raising awareness of the issue among the population. Calling for access to health care entails important behavioural changes. The SDC consulted with 110 villages in the Dodoma region so that villagers could identify their priority health problems and develop ideas to resolve them. In a second phase, the implementation of the action plans drawn up by the villages is supported jointly with the public health authorities. The involvement of community representatives is essential to adapting health-care services to the genuine needs of the population. Involved in the management of structures, as well as in disease prevention, these representatives become active agents of change. This has a tremendous impact on improving the health and general well-being of Tanzanians.

50 years of involvement
Switzerland, which is involved in Tanzania since the 1960s, has played a key role in the area of health by facilitating access to medical care and fighting against the spread of diseases such as malaria. Special attention is given to at-risk people such as children, women and the elderly. The promotion and funding of medical care is also one of Switzerland aid’s priorities.