Public Private Partnership in social health protection in Tanzania
Country of Operation
- Centre International de Recherche et Développement (CIRD, International Centre for Research and Development)Not-for-profit
- Mbozi district governmentGovernment
Target income level
- Bottom 20%
- Lower-middle income (20-40%)
- Middle-income (40-60%)
SummaryThis program seeks to provide higher quality and broader coverage options to rural villagers in Tanzania.
CIRD supports a network of mutual health organisations known as Self Managed Health Insurance Schemes (SMHISs) in Tanzania. The target population is households living in rural areas from the informal sector that had access to the services of a private religious hospital. The project was not in line with the national policy that, for this population category, promoted Community Health Funds (CHFs), voluntary health coverage organisations that only provide access to the district's public care structures and are therefore managed by district authorities. The results obtained by the network of mutual organisations provided an incentive for a partnership between public and private stakeholders.
Key program components
A Memorandum of Understanding (MoU) between the government, network of mutual organisations, and CIDR led to a public-private partnership and the development of hybrid mutual SMHIS and CHF organisations and allowed mutual organisations and the private hospital to benefit from subsidies reserved for CHFs. Access to the government's fund was negotiated as follows: a) SMHISs would transfer the total amount of contributions to the district level, b) the district would add these contributions to those collected by the CHFs and ask the fund to double the total amount, c) once this amount was obtained, the district would return the SMHIS contributions and share the matched amount received from the fund: 25% for the SMHISs, 50% for the district, 25% for the MCMH. Under this process, the district, the network of mutual organisations and the MCMH were therefore all winners and received resources to achieve their own objectives: improve public care for the district, obtain cash for the MCMH, indirectly subsidise contributions for the network. Another positive step was taken in 2011, with a new MoU: the institutionalisation of the SMHIS network and the unification of the SMHIS and CHF models. The SMHIS principles will gradually be applied to the district CHFs, which will be co-managed by the SMHIS network and the Council Health Service Board. The new Self Managed Community Health Fund (SMCHF) model was set up in 5 villages in 2011, with 288 members and 1,051 beneficiaries. This time the MoU precisely described the organisational principles of this hybrid organisation: 1- Combine the comparative advantages of the two models (SMHIS/CHF) 2- Enhance the product’s attractiveness 3- Separate supply and demand for care so providers may be paid based on the actual cost of care given to beneficiaries 4- Set up a member-based CHF association with participatory governance open solely to members 5- Organise the joint management and supervision by district authorities of collected funds 6- Introduce a system for the professional management of information 7- Improve coverage without increasing contributions 8- Allocate funds (contributions and the matching fund) in a way that promptly improves the quality of care 9- Increase the number of qualified healthcare personnel in health centres and clinics 10- Develop an efficient transport system The partnership was replicated in the neighbouring district of Kyela, with the subsidising of contributions by the district and a private company (Biolands) that sells cocoa. The coverage by mutual organisations of people living with HIV/AIDS was organised thanks to the Elton John Foundation and associations of patients. The results of this extended partnership were even better than in the neighbouring district.