Tanzania is a country in Southeastern Africa with a population of over 53 million. It is an underdeveloped country that faces many issues with its healthcare. They have a low life expectancy and high mortality rates as well as sanitation and water access issues. There are also many communicable diseases that puts a strain on the system. The Arusha Declaration of 1967 helped prompt decades of health reforms. It led to a free decentralized universal healthcare system. However, after economic issues and a rising population, among other issues, led to the system nearly collapsing. In the 1990s, Tanzania began to switch from a free to a mixed system and to roll out fees and insurance plans to help offset the cost. There has been continuing reforms to help improve the health and health access of the population with mixed results.
The health system in Tanzania follows the pattern of government structures of leadership in the form of hierarchy. There are different levels of services. At the top are the four Consultant hospitals. They are expensive, specialized hospitals that are closer to international standards. Then there are the Regional hospitals which have one per region. They are referral hospitals with general practitioners, specialists, medical assistants, multiple departments and schools for medical assistants. District hospitals typically covers 100,000-200,000 people. They typically only have a few doctors, medical assistants and no special departments. Then there are Health Centers which cover around 50,000 people. They usually have 1 doctor, a senior medical assistant and a medical assistant. There are also some preventative healthcare workers like nurses and midwives to provide services like vaccinations and mother-child care. At the bottom of the hierarchy is the Dispensary. They provide care for around 10,000 people and are like a smaller scale Health Center. Each level usually provides oversight for those below it and referrals to those above.
Healthcare in Tanzania is financed through a few different sources. Government spending has increased in the last couple of decades but overall government allocation for it has remained around 7%. The biggest source of funding for healthcare are donors like USAID and World Bank along with religious organizations. The amount of funds from donors fluctuates and was around 57% in 2018, up from around 40% in 2009. The rest of healthcare financing comes from taxes and cost-sharing. Since introducing fees in the 1990s, Tanzania has worked to lower out-of-pocket costs. In 2000, out-of-pocket payments accounted for 47% of total health expenditure. By 2014 it was down to an estimated 23%.
Tanzania is committed to expanding health insurance coverage through their different schemes. Despite this health insurance coverage remains low. As of 2019 around only 32% of the population has health insurance. There are four different publicly owned health insurance schemes. The National Health Insurance Fund was established in 2001. It initially only covered public servants and their families but recently has allowed private membership. The employees pay 3% of their monthly salary and the government as their employer matches it. The Social Health Insurance Benefit is part of the National Social Security Fund which is for non-government employees. It is part of their 20% contribution to the fund. Community Health Fund is the scheme that targets the largest population in the rural informal sector and membership is voluntary. There is a counterpart called TIKA which mainly targets the informal sector individuals in urban areas. They are both regulated and managed at district level. There are some private health plans available as well.
Despite having universal health coverage, Tanzania has serious issues with the quality of their healthcare. The distribution of funds is usually top heavy with the most going to Consultant and Regional hospitals, leaving Health Centers and Dispensaries lacking in resources. Urban centers tend to be better staffed and outfitted and rural areas having very little. Health outcomes are usually better in urban areas. Maternal and infant mortality rates are high in Tanzania. The poor rural population are more likely to die during childbirth and infancy than their urban counterparts. The top ten causes of death are mostly treatable and curable elsewhere but are very prevalent in Tanzania. These include neonatal disorders, HIV/AIDS, malaria, tuberculosis and diabetes. Tanzania keeps trying to reform their healthcare system to address their quality issues.