The National Health Insurance Fund (NHIF) is a Social Health Insurance Institution established under the National Health Insurance Act, Cap 395 with the main objective of ensuring accessibility of health care services to people. It is a Government entity that operates under the Ministry of Health (MOH). The management of the Fund is vested to the Board of Directors while its day to day operations are overseen by the Director General. The Fund considers health insurance as a societal affair rather than an individual need and thus operates under the principles of risk sharing and solidarity among members.
Despite the compulsory enrollment arrangement to public servants, the Fund has expanded its coverage to include other groups like Councilors, private companies, education institutions, private individuals, children under the age of 18, farmers in cooperatives as well as organized registered groups like Machinga and Bodaboda groups. The Fund is also administering the Bunge Health Insurance Scheme and covers Members of the Zanzibar House of Representatives.
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Categories of NHIF Members
Members of the Fund are categorized as follows: -
- Public Employees
- Non Public Employees
- Retired Public Employees
- Students
- Children under 18 years
- Farmers in Cooperative Societies
- Members of Organized Socioeconomic Groups e.g. Machingas, Bodaboda, Drivers, etc.
- Individual members under Health Insurance Bundles
- Bunge Health Insurance Scheme for Members of Parliament
- Councilors
NHIF Benefits Package
The following medical services are covered by NHIF at all health facilities certified by the Fund:-
a) Registration and consultation;
b) Medicines and medical consumables;
c) Investigations;
d) Dental and ophthalmological services;
e) Inpatient care services;
f) Procedures;
g) Surgical services;
h) Medical and orthopaedic appliances;
i) Rehabilitative services.
However, the following services shall require special approval of the Fund before access:-
a) CT-Scan and MRI
b) Chemotherapy
c) Dialysis services
d) Anti-cancers
e) Immunostimulant
f) Immunosuppressant
g) Orthopaedic appliances
h) Reading spectacles
NHIF also facilitates provision of services that are normally out of standard package under special agreements basing on the need of the employer through Health Insurance Administration or Supplementary arrangements.
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