The National Health Insurance Fund (NHIF) in Tanzania has significantly reduced the average time taken to settle healthcare providers' claims from 120 days to 50 days. This improvement, recorded in the 2024/25 financial year, is attributed to the adoption of digital systems and artificial intelligence (AI) in claims processing. The new average payment period is below the statutory requirement of 60 days, easing cash flow pressures for hospitals and other accredited healthcare facilities.
NHIF Director General Dr. Irene Isaka presented the fund's performance to editors and journalists, highlighting gains in financial management, technological transformation, and efforts to expand health insurance coverage. The transition from paper-based claim processing to digital systems has improved efficiency and addressed delays that previously affected payments to healthcare providers. This move has been instrumental in reducing the challenges affecting service delivery in previous years.
The information and communication technology project implemented by NHIF has reduced the use of paper claim forms by 75 percent and cut the cost of membership cards by 80 percent. Members have increasingly adopted electronic cards, contributing to the project's success. Implemented using local expertise, the project also saved the fund Sh3.5 billion during the financial year. These developments demonstrate NHIF's commitment to improving its operations and service delivery.
NHIF has introduced a self-service platform for members and integrated its systems with the National Identification Authority (Nida) and the Registration, Insolvency and Trusteeship Agency (Rita). The fund's financial position has also improved, with revenue increasing by 10.5 percent and expenditure declining by 10 percent. Its assets grew by 22.91 percent between July 2024 and June 2025, while reserves increased by 34.34 percent compared with the previous financial year.
The surplus rose by 300.78 percent, while investment income increased by 10.4 percent, according to audited figures up to June 2025. The medical loss ratio, which indicates the proportion of contributions spent on healthcare services, declined to 71 percent from 87 percent previously. Dr. Isaka said NHIF was targeting a ratio slightly below the international benchmark of 70 percent to strengthen its capacity to meet healthcare costs and withstand unexpected demands.
NHIF's financial sustainability has improved, with its ability to finance obligations using available resources extending from eight months to one year and four months. However, this remains below the international benchmark of two years. The fund is seeking to expand membership amid growing demand for healthcare services. Insurance coverage has increased from eight percent of the population to 10.7 percent, with the fund targeting 20 percent by June 2027.
NHIF has expanded its network of accredited healthcare providers from 9,041 to more than 10,300 facilities, comprising public and private hospitals, health centers, dispensaries, pharmacies, polyclinics, and diagnostic facilities. The fund has also stepped up efforts to combat fraudulent claims, including closing facilities found to have engaged in malpractice. In 2024/25, it submitted the names of 19 health professionals suspected of involvement in fraudulent activities to their respective professional councils for further action.
Key points
- NHIF adopts digital systems and AI to improve claims processing efficiency
- The fund's financial position improves with revenue growth and expenditure decline
- NHIF targets 20 percent population coverage by June 2027
