Tanzania: NHIF Loans Boost Health Services Delivery

By Bernard Lugongo

FIVE years ago President John Magufuli made a surprise visit to the Muhimbili National Hospital and saw patients sleeping on the floor due to limited space to accommodate more beds.

He was not amused. Magufuli had just taken over from former president Jakaya Kikwete, who stepped down after two terms in office. He dissolved the governing board of the hospital after discovering the main scanning and diagnostic machines were not working and seeing other poor conditions.

He was not happy also with the pace of construction of a new hospital building and directed the construction work should be finalised and the building be used immediately. Upon his directive, the new building became operational, and the institute's patients holding capacity doubled.

The building is one of the successful cases of soft loans that the National Health Insurance Fund (NHIF) provides to health providers to improve the delivery of health services to the people. Elaborating on the extension project at the MOI, the institute's Public Relations Officer Patrick Mvungi says the new building was built using 17bn/- soft loan from the NHIF.

"The old building is small and patients were sleeping on the floor. With the new building patients handling capacity has more than doubled. The issue of patients sleeping on the ground is now just history," Mr Mvungi explains.

He notes that the previous capacity was only 150 beds but nowadays the institute's buildings accommodate 360 beds. The number of rooms for operations has also increased to 9 up from only 5.

The increased number of rooms for operations has enabled the institution to conduct operations to between 900 and 1000 every month while previously it was operating between 500 and 700 patients.

I n the new buildings, the institute has established new radiology and Magnetic resonance imaging (MRI) departments. "We couldn't establish these departments without this new building which has increased space," he emphasizes.

The KCMC northern zone hospital also reveals how the NHIF loans have changed the facility for the betterment. The hospital's capacity of handling medical emergence cases highly advanced and has set up a plant for producing oxygen and nitrogen. With the loan from the NHIF, the facility upgraded its emergence building.

Dr Gileard Masenga, Executive Director of the Kilimanjaro Christian Medical Centre (KCMC), says the NHIF has been their partner in improving facilities and health services at the hospital. Dr Masenga says NHIF loans have made improvements, among others, the construction of the modern emergency building worth 1.7bn/-.

"Previously our emergency building was just a small corridor," he notes. The NHIF has also given a loan of 800m/- to the KCMC to construct its own oxygen plant to reduce costs it incurs buying the oxygen for patients. The plant has been helpful in reducing high costs on buying the oxygen.

"Contrary to the past when we only had casualty, with the new emergence facility, we have equipped it with the necessary tools and experts... other medical cases can now get resolved there without sending patients to the wards, this avoids the congestion in the wards," KCMC Public Relations Officer, Mr Gabriel Chiseo, stresses.

About the oxygen plant, Mr Chiseo notes that the industry's daily production capacity is to refill 400 oxygen cylinders with the volume of 8 litres each. But, the KCMC consumes only 70 cylinders, thus selling the surplus to other hospitals in the neighbouring regions.

This has become another source of income for the hospital. Previously, the hospital was forced to buy oxygen because it was producing about 20 oxygen cylinders per day, something which was costly.

The NHIF Director for Finance Planning and Investment, Mr Celestine Muganga, explains that reasons behind the introduction of the system to lend the health services providers was the fact the NHIF wanted to see its members get better services.

It was after realizing that its members in many areas were facing challenges of getting quality health services since many the facility lacked better medical equipment. "We started this initiative in 1996 and our focus was mainly in rural areas where they experience poor health services due to limited equipment. So we decided to start giving them soft loans," he says.

The NHIF provides the loans as per regulations of the Bank of Tanzania (BOT) governing the loaning by financial institutions. Initially, there was an idea of providing the loans to government's hospitals only but later it was agreed that private hospitals that were accredited to the NHIF can also borrow the money.

To get the loan, a hospital should have accreditation of the NHIF. This is because the loan repayment is subject to payment claims that the hospital lodges at the NHIF after serving the Fund's members. The Fund also considers the hospital that has no record of cheatings, when submits payment claims because some hospitals have a tendency of submitting inflated claims.

Mr Muganga explains that the loans are in three categories which include giving loans for purchasing medical equipment, medicines or repair of building infrastructures.

"We believe that we have so far achieved what we targeted, that is to improve the health sector. It is good that the money that members have contributed goes back to making improvements in health services," he argues.

In the past five years, a total of 140 health facilities have benefited from the loans amounting to over 39bn/-. There was an upward trend of the amount of loans issued to the health facilities.