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Tanzania’s strides in health financing reform, particularly through the 2016–26 health financing strategy, aim to address existing inequities. A recent study delves into the decision-making process surrounding the introduction of the Improved Community Health Fund (iCHF) in 2017/18. Despite the strategy’s suggestion of mandatory national health insurance, iCHF was introduced as a short-term measure to enhance coverage and financial risk protection for the informal sector. Key improvements included purchaser-provider split, portability of services, premium uniformity, and regional risk pooling.

However, the study reveals gaps in the decision-making process. While the Ministry of Health led the initiative, it bypassed mandatory legislative procedures and lacked transparency beyond key stakeholders. Notably, beneficiaries and providers were excluded from crucial decision-making processes. Although informed by evidence from pilots and literature, the reform overlooked key insights, such as reducing administrative costs by shifting oversight to the National Health Insurance Fund.

While iCHF addresses fragmentation by expanding the pool to the regional level, its decision-making process highlights the need for procedural fairness. Involving all stakeholders can enhance responsiveness, legitimacy, and implementation, ensuring equitable health financing reforms for Tanzania’s populace.