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Zanzibar develops and endorses health services fund bill - P4H Network

Zanzibar develops and endorses health services fund bill

The Zanzibar Health Services Fund Act, 2023, ensures universal health coverage in Tanzania by introducing mandatory health insurance with household contributions. Supported by GIZ BACKUP Health and P4H Network, it aims to improve healthcare provision and reduce disease burden.

The Zanzibar Health Services Fund Act, 2023 (ZHSF), represents a significant step towards achieving the United Republic of Tanzania’s goals regarding universal health coverage. Implementing the act began in July 2023 and is intended to provide all residents of Zanzibar – who are part of the United Republic of Tanzania – access to health care services they need without financial hardship. Implementation is expected to improve health service provision and reduce the overall disease burden throughout the United Republic of Tanzania.

Zanzibar embarks on a universal health insurance scheme

Since Zanzibar’s independence in 1964, the Revolutionary Government of Zanzibar (RGOZ) has provided universal access to public health care, with no user fees at point of access. However, the provision of health services has long faced both financing and quality challenges. A lack of adequate public facilities increased demand for private health providers and resulted in high out-of-pocket spending (19% of total health expenditure in 2017–2018)[1].

To address these challenges, the RGOZ introduced universal health insurance (UHI) in 2020. UHI intended to cover the entire population, making it the main universal health protection and financing scheme while strengthening Zanzibar’s health care system. The UHI scheme is intended to mobilize domestic resources to ensure that health services delivered are more responsive and sustainable than under the current system.

As a mandatory health insurance scheme, ZHSF would require household contributions. Households are categorized in three groups: formal sector, informal sector and households living in poverty. Households in the informal sector and those identified as living in poverty would be subsidized by the government to ensure free and equitable access to health services. ZHSF establishes an equity account, to subsidize the informal sector and people living in poverty. The equity account would be managed by the president’s office of finance and planning. Funds are expected to come from earmarked taxes and contributions from different partners.

The process of developing the ZHSF

The RGOZ formulated the ZHSF bill in January 2022, with technical assistance from GIZ BACKUP Health. GIZ BACKUP Health provided actuarial analysis and data management tools, which helped lay a strong foundation for the bill. The P4H country focal person (P4H-CFP) facilitated activities supporting the development of the bill, including seminars on UHI in the House of Representatives.

Comments and input from the P4H Network, including the P4H-CFP, contributed to the process, from its beginning in January 2022 to passage of the bill in February 2023 and enactment by the president of the RGOZ in March 2023. The ZHSF was gazetted in the Zanzibar Government Gazette of 31 March 2023, and since is known as the Act to Establish the Zanzibar Health Services Fund.


[1] Extending Social Security to Workers in the Informal Economy: Lessons from International Experience. International Labour Organization, 2021,;jsessionid=zbhHg8Sr064C-DdTCuLQLULE5zuu7JFkq6KJfPIBcvAvcUXERHx6!1945465934?id=16990.