Enhancing Safe Deliveries in Tanzania
News from 2016-06-22 / KfW Development Bank
How a Health Insurance Scheme for Poor Women Saves Lives
Since Tanzania introduced a mother-and-child health insurance for poor women in 2012, the membership rate has surpassed everyone's expectations. Given the popularity and success, it may soon become part of a mandatory national health insurance scheme.
In Tanzania thousands of women lately benefit from a mother-and-child health insurance specifically addressing poor pregnant women. Just recently the 450.000th woman joined the scheme which enables her to give birth in an appropriately equipped health facility.
Next to lowering the mortality rate of mothers and infants, it also reduces women’s anxieties about potential health risks associated with pregnancy and childbirth. Many women now know that, with the help of this insurance, they can deliver safely and confidently.
Empowerment instead of embarrassment
In spite of the Tanzanian policy of free maternal health services at many health facilities patients are required to make out of pocket payments for medicines if these are in short supply. This used to cause great embarrassment for poor women who were unable to pay or had to ask their husband to help them out.
With the new health insurance women can be sure that their care and their medicines will be covered and they are free to select the provider of their choice: "It has a lot of advantages for us", says a member. "Now every pregnant woman will get the medical care she needs, whether she can afford it or not." Another beneficiary puts it even more strongly: "The insurance is a life saver."
Many health workers are also relieved because they no longer have to send patients away if they cannot pay. Their attitude towards patients and their treatment of them has markedly improved. As a consequence, facility-based deliveries have risen by 50 to 100 percent in the two regions that first introduced the insurance scheme.
Safer deliveries, healthier babies
Since the insurance program started in the Tanga and Mbeya regions of Tanzania in 2012, Germany’s Federal Ministry for Economic Cooperation and Development, through KfW Development Bank, contributed EUR 13 million to its costs. During the same period, the "National Health Insurance Fund" (NHIF) contributed EUR 6 million from its own budget. The Tanzanian-German project aims at improving the access of poor pregnant women to adequate health services in order to considerably reduce the maternal and newborn mortality rates. They currently stand at 432/100.000 (compared to 4/100,000 in Germany) and 26/1,000 (compared to 3.46 in Germany), respectively and thus are still high despite clear economic progress in the past years.
With KfW’s financial and technical support NHIF administers this insurance scheme: Every pregnant woman who has a NHIF registration number on her antenatal card is eligible for receiving all medical services of the benefit package for free, starting from her first visit and ending six months after the delivery. It is planned to extend this period to the full first year of the baby’s life.
The cost per woman and baby averages at 40 Euros, an amount which KfW project manager Elke Hellstern considers a good investment: "Given the high ´rate of return´ in terms of lives saved, healthier mothers and babies, this is great value for money!"
The Tanzanian-German cooperation, however, extends beyond the scheme that covers poor pregnant mothers and babies: The program also covers 50 % of the enrolment fee in the so-called "Community Health Funds" for the women’s whole family for one year.
Boosting staff morale and service quality
Health facilities which are accredited partners of the insurance scheme receive the payment for the services provided to enrolled mothers and babies directly from the NHIF. "These payments increase the facilities’ revenue and this allows them to further improve the services they provide", says Hellstern, pointing at another advantage of the program. According to her, facilities are using the extra income to improve the availability of medicines, to refurbish their buildings and equipment and to provide incentives to its staff.
To be able to process their claims to the NHIF more efficiently, accredited health facilities gradually introduce state-of-the-art information and communication technology for patient registration, patient records and insurance claims. This has benefits for all involved: It saves health workers a lot of time. Patients' records are available when needed and insurance claims are processed, and reimbursed, much more quickly than before.
One practical innovation is the registration of new members via mobile phone: Health workers connect to NHIF free of cost with their own mobile phones and get the insurance number for the patient instantly. No more paper forms or trips to NHIF zonal offices involved. This is comfortable, fast and saves money. In addition, mobile phone technology is used to provide pregnant women with a better service: If they subscribe to Ministry of Health’s the "Wazazi Nipendeni" ("Love me, my parents!") program they receive messages reminding them of their antenatal appointments and texts with pregnancy- and delivery-related advice, tailor-made to the specific stage of their pregnancy.
Thousands of women enroll every month
The insurance scheme was initially meant to reach 120.000 women between 2012 and 2015. In the meantime some 450,000 women have enrolled – every single month around 11,500 more join. At present, approximately half of all pregnant women in both regions are covered.
Due to this success, the government of Tanzania decided to extend the scheme to two more regions, Mtwara and Lindi. Until 2018, the German Government, through KfW, will contribute another 20 million Euros which is to help reduce maternal and new-born mortality and to support the development of a more comprehensive social health insurance program at national level. To achieve this ways to increase the financial contribution of the Tanzanian government and of the target group will be explored.