Tanzania, United Republic of
Social Security coverage is less than 1 per cent of the entire population, and about 6.5 per cent of the formal working population. Almost the entire informal sector is not covered by any form of social security scheme.
The existing non-contributory programmes are designed to provide assistance to a wide range of poor and vulnerable groups: the disabled, children and the elderly. Social assistance funding from the Government is 0.5 per cent GDP and NGOs account for a further 0.5 per cent GDP. All programmes suffer from limited financial and human resources and therefore cover only a part of the most vulnerable of the population.
The Government is the main provider of health services in Tanzania, which are administered by the Ministry of Health and Social Welfare, and the President's Office Regional Administration and local government. The social health system is financed by revenues from taxation, donors and fees for services. Fee-for-service charges do not apply for the treatment of children aged under five and diseases such as tuberculosis, AIDS, epidemics and leprosy. These elements represent only 2.5 per cent of total health expenditure.
There are two social insurance funds offering health and medical coverage: The National Health Insurance Fund (NHIF) providing the main access to health services, after the state tax-financed health programmes; and the National Social Security Fund (NSSF). Coverage by both schemes is low. In 2005, NSSF had 9,000 members of its health fund, just 3.4 per cent of its total active membership. The NHIF had 242,580 active registered members and, including dependents, a total of 1 million people were covered.
In addition, there is the Community Health Fund (CHF), which was established as an alternative for the fee-for-service scheme. Currently, only 29 districts out of 72 have access to this programme and to the matching grants from the Ministry of Health and Social Welfare. Currently, less than 10 per cent of households have joined such schemes, which represent 2 per cent of total spending. There is even scarcer information about the non-public schemes: micro health insurance, private health insurance and indigenous provision. It is reasonable to assume, based on total amount of insurance premiums paid in 2002 that this type of provision accounts for 1 per cent of total expenditure. There is a long history of indigenous associations being active in collecting insurance contributions for funerals and health care expenses.
There are a number of opportunities and challenges apparent for Tanzania Mainland, with the projected rapid increase in the population by 2020, and the need to think strategically about how its resources are used effectively to invest in healthcare, education, and other social protection schemes.Currently the UK Department for International Development (DFID) is funding an ILO project. This is a joint project for Tanzania Mainland, Zanzibar, and Zambia. For Tanzania Mainland the Social Protection Expenditure and Performance Review (SPER) and a Social Budget (SB) has been produced.
This work has identified that there is scope to develop an affordable Social Protection system that provides wider coverage to the population, by implementing a universal pension, a child benefit scheme, and some targeted social assistance.
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