TZ@60: Why involve private sector in healthcare

  

By The Citizen Reporter

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Dar es Salaam. Like in other sectors, private sector participation in Tanzania’s

health sector started in earnest 30 years ago at the time of opening up of the economy to include the private sector. After independence there was some private healthcare service provision (for-profit) but it was banned after the adoption of the Februart 5, 1967 Arusha Declaration through the Private Hospitals Regulation Act, 1977.

But the economic crisis of the 1980s, which led to the International Monetary Fund (IMF) bailout and the Structural Adjustment Programmes, made it difficult for the government to shoulder the heal sector budget alone. The first National Health Policy of 1990 allowed the re-introduction of private health care services.

The policy said: “Private health services are vital in complementing the government and public services, though they are not evenly distributed in the whole country. The party and the government should encourage these services and control them so that they can serve the community effectively.”

The same 1990 Health Policy also prepared the ground for people’s contributions in health services. User fees stopped officially in 1967 when other means of financing the health sector, mainly through taxation and aid, were adopted. But the same economic crisis of the 1980s and pressure from the World Bank and the International Monetary Fund saw the government re-introducing cost-sharing in the 1990s.

User fees started in 1993 for secondary and tertiary public health facilities. Free healthcare provision in primary facilities continued till 1994 when cost sharing was extended to all facilities. In 1999, the National Health Insurance Fund (NHIF) started for government civil servants. The policy said: “It has been the policy of the government to offer free medical services in all hospitals and health centres and this has been a big burden on the government. At the time being the government’s financial capability to finance all health services is decreasing and is not possible to meet all the ever-increasing costs. The government is looking into ways of how the people can contribute in paying for some of the health services so as to minimize its burden.”

The 1990 policy differentiated between private health care service providers (which meant for-profit health providers) and Voluntary Agency & Religious Organisations health services (not for profit providers). These not-for-profit organisations, which started to provide healthcare services during colonial times, were never banned. After independence they continued to offer services, in most cases, in partnership with the government.

In fact, according to a historical analysis by Dr Dorothy Gwajima, the minister for Health, Community Development, Gender, Elderly and Children, it was religious organisations that first introduced western medicine between 1889 and 1916.

Dr Gwajima said the achievements of the health sector in the past 60 years were made partly because of close cooperation between the government and voluntary and religious organisations.

By 1990 there were 17 designated hospitals and two referral hospitals (KCMC and Bugando) belonging to religious organisations. In the late 1990s some Non-Government Organisations and charity organisations started establishing health care services provision.

As far as the issue of private health services providers is concerned, the first Health Policy was scant in details. It only said that private health care services shall be run according to the guidelines prepared by the ministry of Health.

And yet private sector participation in Tanzania’s healthcare provision is crucial in revolutionising the sector in the next 60 years. The benefits of the private sector are many. In addition to supplementing government efforts and helping reach where the government can’t or in helping provide the services that the government can’t, the private sector helps keep public health on its feet by increasing healthy competition in both human resources and in customer care provision.

But the government’s understanding of the role of the private sector has not yet adequately evolved. This means even on the policy standpoint the private sector is not adequately captured and no strategies have been put forward to harness the potential of the private sector. Government mistrust of the private health sector has been a barrier in the engagement of the private sector health care providers.

Effective engagement of the private sector will help reduce the financial burden from the government of providing health services to the people. As population increases and as increasing priorities brought about by pandemics, effects of climate change on environment, global economic crisis and so forth the government might not find out that its limited financial resources make it difficult to meet all Tanzanian’s healthy needs.

The government would have to continue investing in the health sector in many aspects. But as health services in public hospitals in Tanzania leveraging the full potential of the private sector in healthcare provision is crucial to enable the people reap maximum benefits in terms of quality and choices.

Private sector participation in healthcare provision goes beyond private hospitals. The hospitals are just one aspect. Private sector also includes testing laboratories, health insurance, medical training institutions, drugs and medical equipment manufacturing.

Creating an enabling policy environment is crucial in improving the quality of the Tanzanian health system. It is an open secret that public hospitals have many challenges that include shortage of drugs and overcrowding. In such situations private hospitals can come in to complement the government’s efforts.

In fact private hospitals have existed throughout Tanzania’s history, even when they were banned. Poor services in government hospitals pushed patients to underground health facilities, some of which were being run by public healthcare professionals. “The prohibition of private practice in the health sector in 1977, masked private sector activity rather than eliminated it,” Gemini Mtei and others write in a paper entitled An Assessment of the Health Financing System in Tanzania: Implications For Equity And Social Health Insurance.

They said that due to demand, registered private (for profit) dispensaries increased 36-fold between 1991 and 1996 while the number of for-profit hospitals increased five-fold during the same time.

By March 2021, the number of private for profit health facilities in all categories had reached 1,316 - equivalent to 15.6 percent - according to statistics from the budget speech of 2021/2. Currently, the private for profit organisations own 27 of all health facilities, according to Dr Gwajima’s report on 60 years of the country’s health sector.