Tanzanian government and donors’ uneasy relationship over health financing

In Tanzania, health insurances were introduced around year 2000 as part of a more general health reform process aimed at improving access to health services. The introduction of insurances was expected to help mobilise funds and improve the working of the health care system. It was propagated by a policy coalition of bureaucrats in the Tanzanian Ministry of Health and development donors.

For politicians, however, health insurances were risky. If introduced too quickly in a dysfunctional health care system they could be perceived as another tax, but without improving access to health services. Therefore, Tanzanian politicians prioritised the expansion of physical health infrastructure in rural areas, which are popular with rural voters and could help them win elections, as an alternative.

In a new working paper, "Social protection in an electorally competitive environment (2): The politics of health insurance in Tanzania", DIIS researcher Rasmus Hundsbæk Pedersen and Thabit Jacob from Roskilde University/University of Dodoma analyse the introduction and expansion of health insurances in Tanzania.

Overall, the paper points to the changing positions and at times uneasy intertwining of international health sector reform trends with Tanzania’s domestic politics that has been characterized by increasingly competitive elections. Development donors have been taken by surprise several times as Tanzanian decision-makers implement their own priorities that could help them win elections. Lately, this has delayed the introduction of a mandatory universal insurance scheme in the East African country.