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NHIF reinvented healthcare coverage in four years

By Issa Miraji - October 9, 2026

Between the 2020/21 and 2024/25 financial years, Tanzania’s National Health Insurance Fund (NHIF) undertook one of the most significant transformation journeys in its history. Guided by the Health Insurance Act, Cap 395, and aligned with the Government’s vision of Universal Health Insurance (UHI), the Fund focused on strengthening financial sustainability, expanding access to healthcare services and modernising its operations through technology and institutional reforms.

At the heart of this progress was a deliberate shift towards efficiency and accountability. NHIF’s total revenue grew steadily from TZS 570 billion in 2020/21 to TZS 836 billion in 2024/25, driven by increased member contributions, improved investment income and tighter financial controls. Member contributions alone rose from TZS 489.5 billion to TZS 773.42 billion over the period, reflecting growing confidence in the Fund and wider coverage across different population groups.

This growth was matched by a disciplined approach to expenditure. Administrative costs declined markedly, from TZS 98 billion in 2021 to TZS 67 billion in 2025, largely as a result of cost-cutting measures and the expanded use of information and communication technology (ICT). Paper-based systems were replaced with digital processes, reducing printing costs and eliminating the need for physical membership cards. These efficiencies allowed NHIF to redirect resources towards services that directly benefit members.

As a result, spending on member services nearly doubled, rising from TZS 8 billion to TZS 15.9 billion. More importantly, the Fund’s overall financial position improved significantly. From a deficit of TZS 110 billion in 2021, NHIF moved to a surplus of TZS 225.26 billion by 2025. This turnaround strengthened the Fund’s ability to meet its obligations and plan for long-term sustainability.

“The progress we have recorded over the past four years is a clear demonstration that financial discipline, transparency and innovation can coexist with expanded access to quality healthcare,” said Irene Isaka, Director General of NHIF. “Our focus has been to ensure that every shilling collected is used efficiently to protect members and support the national goal of universal health coverage.”

The improved financial position translated into tangible benefits for healthcare providers and members alike. The average time taken to settle claims fell from 120 days to 55 days, easing cash-flow pressures on health facilities and improving service continuity. Over the four-year period, NHIF paid a total of TZS 3 trillion to healthcare providers, with 40 per cent going to private facilities and 34 per cent to public institutions. Retirees alone received medical services worth TZS 370.5 billion, underscoring the Fund’s role in social protection.

Service utilisation also increased significantly. NHIF financed 64.3 million healthcare attendances, with private facilities accounting for 44 per cent, government facilities 32 per cent and faith-based facilities 24 per cent. At the same time, deduction rates applied to facilities declined from an average of 18 per cent to 8 per cent, improving provider confidence and participation in the scheme.

Beyond service payments, NHIF invested directly in strengthening the health system. Through its medical equipment loan programme, the Fund issued TZS 17.2 billion to health facilities, with 66 per cent allocated to medical equipment, 16 per cent to facility renovation and 19 per cent to medicines. More than a third of these loans supported government facilities, contributing to improved diagnostic and treatment capacity nationwide.

Safeguarding these gains required strong governance. NHIF intensified its anti-corruption and fraud control measures, conducting 538 investigations over four years. These efforts led to the recovery of TZS 30.5 billion, termination of contracts for 33 fraudulent health facilities, deactivation of nearly 14,000 beneficiary cards and disciplinary action against staff involved in misconduct. The medical loss ratio improved from 122 per cent in 2021 to 69 per cent in 2025, while reserve coverage rose to the equivalent of one year and six months, strengthening the Fund’s resilience.

ICT innovation was a key enabler of this transformation. In-house development of digital systems saved TZS 3.5 billion in 2024/25 alone, reduced paper use by 75 per cent and cut membership card costs by 80 per cent through the introduction of e-cards. 

The NHIF Self-Service platform streamlined registration and claims processing while significantly reducing opportunities for fraud.

Equally important was investment in people. All staff participated in targeted professional development programmes, improving efficiency and service delivery. Workplace initiatives addressing HIV/AIDS, non-communicable diseases and mental health reinforced staff well-being and productivity.

These achievements laid a strong foundation for the rollout of Universal Health Insurance following the enactment of the Health Insurance Act No. 161 of 2023 and its 2024 regulations. NHIF began enrolling diverse groups, from farmers and fishers to small traders, while integrating Community Health Fund members into the UHI system. Partnerships with cooperative unions, banks, insurance agents and mobile network operators are now accelerating national registration.

“As we move forward with Universal Health Insurance, our priority is sustainability, inclusiveness and quality,” Irene Isaka noted. “The reforms of the past four years have prepared NHIF to play its role as a reliable pillar of Tanzania’s healthcare system.”

Together, these reforms tell a story of an institution that has not only stabilised its finances but also positioned itself as a central driver of equitable healthcare access for all Tanzanians.