Exploring perceptions of clients with regards to National Health Insurance services in a selected public hospital in Dar Es Salaam, Tanzania.

Abstract

Background: The National Health Insurance (NHI) of Tanzania is commonly known as the National Health Insurance Fund (NHIF). The scheme operates under the supervision of the Ministry of Health and Social Welfare (MOHSW) together with an independent board of the NHIF. It is a mandatory form of healthcare financing primarily for public servants and other categories of employees in the formal sector which covers hospital costs for the principal member and six beneficiaries of any age. Purpose: The purpose of this study was to explore the perceptions of clients with regards to National Health Insurance Services in a selected public hospital in Dar es Salaam, Tanzania. Methodology: Guided by objectivism, this study adopted a positivist paradigm and a quantitative approach. A non-experimental, exploratory-descriptive and cross sectional research design was used and a self-administered structured questionnaire was used for data collection. Ethical clearance was obtained from the University of KwaZulu-Natal Research Ethics Committee and the Humanities and Social Sciences Research Ethics Committee (HSSREC) in South Africa, and from the Kinondoni District Hospital Research Ethics Committee in Tanzania. Results: The results of this study indicated that 64.8% of participants were the principle members of the NHIF and the majority (63.1%) were female. While joining the fund would have been compulsory for the 54.9% of the participants who were civil servants and 15.6% who were traders or business people, the majority (90.1%) of all the participants indicated that they had joined the scheme because it offered financial protection against

illness. The majority of participants acknowledged the benefits of being a member of NHI, with 93.5% agreeing that joining the scheme benefited them and their beneficiaries, 93.4% agreeing that it gave them reassurance that their family would receive care, 89.3% agreeing that it provided easy access to health care, 83.6% agreeing that it would save money from paying hospital bills and 82.8% agreeing that belonging to NHI was better than having to make out-of-pocket payments. Recommendations: Despite their positive attitude towards the NHI services, participants admitted that NHI does not permit health care access to all citizens and that, even with the cover of the NHIF, they still needed to save money to pay for hospital care. Therefore, the study recommends the expansion of the NHIF benefits packages up to the Primary Health Care level to avoid user fee for the insured. Similarly, the NHIF management must find another mechanism of funding the Community Health Fund to provide coverage for the poor rural communities who depend only on out-of-pocket payments. Further research is also recommended to explore the perceptions of the majority of Tanzanians who are not covered by the NHIF schemes.