National Health Insurance Fund’s relationship to retail drug outlets: a Tanzania case study

Abstract

Background Achieving universal health coverage will require robust private sector engagement; however, as many low- and middle-income countries launch prepayment schemes to achieve universal health coverage, few are covering products from retail drug outlets (pharmacies and drug shops). This case study aims to characterize barriers and facilitators related to incorporating retail drug outlets into national prepayment schemes based on the experience of the Tanzanian National Health Insurance Fund’s (NHIF) certification of pharmacies and accredited drug dispensing outlets. Methods We reviewed government documents and interviewed 26 key informants including retail outlet owners and dispensers and central and district government authorities representing eight districts overall. Topics included awareness of NHIF in the community, access to medicines, claims processing, reimbursement prices, and how the NHIF/retail outlet linkage could be improved. Results Important enablers for NHIF/retail outlet engagement include widespread awareness of NHIF in the community, NHIF’s straightforward certification process, and their reimbursement speed. All of the retail respondents felt that NHIF helps their business and their clients to some degree. As for barriers, retailers thought that NHIF needed to provide more information to them and to its members, particularly regarding coverage changes. Some retailers and government officials thought that the product reimbursement prices were below market and not adjusted often enough, and pharmacy respondents were unhappy about claim rejections for what they felt were insignificant issues. All interviewees agreed that one of the biggest problems is poor prescribing practices in public health facilities. They reiterated that prescribers need more supervision to improve their practices, particularly to ensure adherence to standard treatment guidelines, which NHIF requires for approving a claim. In addition, if a prescription has any problem, including a wrong date or no signature, the client must return to the health facility to get it corrected or pay out-of-pocket, which is burdensome. Conclusions Little published information is available on the relationship between health insurance plans and retail providers in low- and middle-income countries. This case study provides insights that countries can use when designing ways to include retail outlets in their health insurance schemes.

A Journey Undertaken by Families to Access General Surgical Care for their Children at Muhimbili National Hospital, Tanzania; Prospective Observational Cohort Study

“…Although there was a higher overall health insurance coverage (75%), those who were undergoing emergency surgery had 33.3%, which is comparable to findings of another study done on surgical patients in Northern Tanzania (45.5%) and to Tanzania’s general population (32% in 2019) [ 34 , 35 ]. Patients are likely to have received their health insurance after being planned for elective surgery.…”

Healthcare workers’ perspectives on access to sexual and reproductive health services in the public, private and private not-for-profit sectors: insights from Kenya, Tanzania, Uganda and Zambia

“…PPPs and NHI can be useful tools to reduce costs for clients and improve access to medicines when it is functioning well and has a high population coverage [ 42 – 44 ].However, at the moment many bottlenecks exist in the two study countries where NHI has been implemented for a longer time that limit its potential. Premiums paid by the insured are unaffordable to parts of the population, stockouts or lack of commodities at facilities force clients to buy out-of-pocket at non-accredited facilities, shortages of HCWs affect quality of services, a pro-urban distribution of health facilities results in clients needing to travel long distances to accredited facilities in rural areas, and delays in provider reimbursement by the NHI scheme result in co-payments by clients, denial or limiting of services, and long waiting times [ 39 , 40 , 45 , 46 ]. To fulfil its potential, governments ought to focus on tackling these bottlenecks.…”

Motivations and barriers for healthy participants to participate in herbal remedy clinical trial in Tanzania: A qualitative study based on the theory of planned behaviour

“…The findings of previous studies reported that access to free better quality free medical care is an important motivation for clinical trial participation [ 40 , 55 – 58 ]. In a developing country such as Tanzania, whereas the coverage of health insurance is low [ 59 ] and poor service delivery, it is justifiable for participants to mention free medical check-ups and care in the clinical trial as a benefit.…”