Kenyan President William Samoei Ruto has announced that as of October 1, 2024, the dream of Universal Health Coverage will materialize. All types of illnesses will be covered without any cost to the patients.
In Tanzania, a nation blessed with more natural resources, a larger land area, and a superior geographical location compared to Kenya, one might have expected us to outperform Kenya in this regard, but we have not.
The NHIF is in critical condition, dragging all medical services into obscurity. Hospitals are struggling to meet their running costs, and strikes by medical practitioners are on the rise. Hospitals are complaining that NHIF has not been clearing its debts for months, leaving them unable to meet even their minimum obligations. I think now is the perfect time to come up with our own Universal Health Coverage.
The relationship between NHIF and medical care providers is precarious. While medical providers claim unpaid or delayed payments, NHIF is quietly scrutinizing bills, suspecting over-invoicing. Over-invoicing by medical providers is not new. In the USA, post-COVID audits revealed over $50 billion in fraudulent medical claims.
Medical practitioners claiming for services not provided is a major reason for the disproportionate rise in medical claims. NHIF has no way of countering over-invoicing but is reluctant to pay up, leading to a “dead on arrival” relationship with medical providers. Most caregivers hesitate to publicly air their grievances for fear of reprisals.
NHIF has been misappropriating funds budgeted for medical services. The lack of clarity on administrative expenses has allowed health insurers to misuse health funds. Budgets for SUVs, personal items, and other luxuries have been prioritized over the corporate objective of managing health insurance.
Also, read: Is healthcare a Human Right or a Privilege?
This self-serving behaviour has turned NHIF into a parasitic relationship where health insurance managers are the parasites and NHIF is the host. Such an unhealthy relationship is unsustainable, and something must change.
For a country with constitutional imperatives to build a socialist nation, how can we achieve a just society if healthcare isn’t free for all? What kind of nation are we building if medical services are prohibitively expensive for the majority? Since when is health not a human right, but something to be auctioned to the highest bidder?
Today, those without cash are left to die without state help, despite the government collecting more in taxes, aid, and loans than any post-independence administration. The real problem is the numerous “armyworm caterpillars” consuming everything in sight without facing any consequences.
Kenyan adoption of a Universal Health Coverage programme has left Tanzania in a serious quandary. Tanzania used to be a bellwether of national free medical services that was globally lauded.
But now we have privatized medical health services when we imposed access to health services with preconditionalities. Health access must be free of any conditionalities for a simple reason: health is a human right, and NHIF is now posing a serious threat to universal access to medical care.
How Mismanagement and Corruption Plague Tanzania’s Health Sector
The way NHIF is structured and managed benefits its employees the most, with staff swimming in cash while the program fails to improve national health coverage. Prioritizing the health market economy over humanity and realism poses a serious threat to our national well-being.
This system benefits NHIF staff but not the nation’s sick. NHIF assumes most Tanzanians can afford the monthly bills, while the reality is that many struggle to get three meals a day. Indeed, very few can even manage a daily long call due to persistent hunger.
Without a universal health coverage programme, NHIF becomes not a means to an end but an end in itself. Most of the defenders of NHIF have relatives and loved ones enjoying huge salaries and allowances there at our expense. We have created a monument that is infamous for embezzlement of public funds without meeting even the basic health needs of the majority of Tanzanians,
Where medical services used to be free for all now regional commissioners organize to provide inadequate and frantic medical services that glorify hypocrisy and over-dependence rather than addressing the real core issues in access and sustenance of national medical care. It is excruciating to see a regional commissioner turning medical services into a campaign issue to promote his employer! How degrading can we be before we come to our senses that “enough is enough!”
Disbanding NHIF is the first step to reclaiming our lost glory in national medical care for all. Nearly half a trillion has been allocated to NHIF in this budget, but it will likely support the lavish lifestyles of the health insurers running the program. The Ministry of Health lacks ideas and displays sheer ineptitude.
Read Related: Thinking Out Loud: Could This Be The Right Time to Disband The NHIF?
The health minister, who I have previously called incompetent, should be removed from office. She seems content with failed Western ideas and shows no effort to learn from the past or embrace realism and pragmatism. Her supporters are clearly not acting in our best interests. She should be shown the exit door immediately, as her talents are better suited elsewhere, but not in the health ministry.
The health budget has soared while medical services have dwindled. When confronted with her sheer mediocrity, she becomes defiantly defensive blurting something like “…yaani wacha tu. Mimi ninapigwa vita sana.” She never bothered to take time to address her flaws which are many but blame others for her personal failings.
Since she cannot conduct a meaningful self-assessment, she stands zero chance of self-improvement. Just acknowledging that NHIF is a senseless idea would have gone a long way to reduce the waste.
Who Truly Benefits from Our Health Funds?
It was a concession she would never offer lest her cronies at NHIF lose their vacuous livelihoods. At NHIF, staff pretend to work in order to eke out a living at the detriment of our health! It is all self-serving without an inkling of collective public interest at heart. It is so sad.
We never needed NHIF, a money-guzzling machine that is now killing our hospitals. It was a Western idea that had not worked even in their own countries. Obamacare as correctly pointed out by former US President Donald Trump is imploding with health insurers and lawyers making a killing out of it at the expense of the unfortunate sick.
Why does anybody in his right sense keep up NHIF It is not solving even a single problem to our dire health situation but is gobbling almost half a trillion shillings year in and year out. The math speaks for themselves but political will to do the right thing is lacking.
What is the Ministry of Health gaining beyond providing jobs to loved ones who now are hibernating at NHIF? Once NHIF is disbanded all the money saved should go to public hospitals just like in the heyday of Nyerereism, and let those who are dissatisfied with our public hospitals fork out money to attend private hospitals.
It was an excellent system that left most of us happy but now the Ministry of Health has created NHIF that is killing the goose that used to lay us golden eggs. And nobody is being brooked for sacrificing our national health for self-interest!
We also need an end to medical tourism abroad. No public funds should ever be set aside for public servants to get overseas treatment at our expense. Cuba has the best medical system because nobody gets overseas treatment. This has put pressure on all Cuban public leaders to ensure public hospitals are state of art where they are confident and comfortable to be treated locally.
Don’t miss out: How Kenya’s Finance Bill 2024 is Shaking Up Politics and Public Opinion – What’s the Real Story?
Unless medical tourism for leaders is terminated we should expect local medical services to continue to be awful because leaders are not treated locally. It is a shame and disheartening to witness presidents and ministers treated and dying in foreign lands where they had brazenly run to secure elusive medical services. Accountability demands no budget for overseas medical tourism.
The burning question each and every Tanzanian needs to ask himself why enduring NHIF is enriching very few of us while endangering our collective health. Why should well-placed politicians hinder our access to a national medical programme that is free for all and come back to feed us with semi-cooked medical services that are not comprehensive? Now such politicians are positioning themselves as healthcare givers at their chosen moments while our sick defy those timeliness.
If we concur that a nation with Universal Health Coverage is beneficial to all then let’s say it is better than keeping a white elephant that benefits a tiny of us while leaving the majority high and dry. The cost of lack of national health medical services is staggering and nobody in the authority is willing to do the maths. This will be a subject I will pursue with vigour next time around!
