A 2023–25 IHI–LSHTM study urges reform of Tanzania’s provider payment mechanisms as UHI rolls out. NHIF’s fee-for-service is reliable but paperwork-heavy, while capitation faces delays and low rates. Researchers call for fair, timely, and simple systems to boost provider trust, service delivery, and public confidence.
A recent study by the Ifakara Health Institute (IHI) and London School of Hygiene & Tropical Medicine (LSHTM) (2023–2025) highlights the central role of provider payment mechanisms (PPMs) in Tanzania’s implementation of universal health insurance (UHI). Tanzania currently uses mixed financing: the National Health Insurance Fund (NHIF) reimburses on a fee-for-service basis, the Improved Community Health Fund (ICHF) and Health Basket Fund (HBF) use capitation, while the Social Health Insurance Benefit (SHIB) applies a hybrid model. Research in Singida and Manyara found significant variation in practice, with providers citing low rates, delayed and unpredictable payments, and heavy administrative demands. NHIF’s fee-for-service approach, though more reliable for costly treatments, imposes extensive paperwork, while capitation is accepted in principle but only when payments are timely, adequate and linked to fair incentives. Patient experiences also contrast: NHIF members were more likely to obtain medicines and report higher trust in facilities than ICHF enrollees.
Lead researcher Dr Peter Binyaruka stressed that PPMs must reflect frontline realities to ensure UHI succeeds under the 2023 UHI Act. Reform recommendations include aligning payments with service costs, enforcing predictable disbursements, simplifying reporting requirements, and tailoring performance incentives to local contexts. Involving providers in capitation design is seen as key to accountability and trust. While payment reforms alone may not fix challenges like drug supply gaps, weak supervision, or poor data use, well-structured systems can motivate providers, improve service delivery, and bolster public trust. Ultimately, sustainable PPMs will be critical for ensuring Tanzania’s UHI delivers quality, staffed, and equitable care.
