National Health Insurance Fund
Tanzania, United Republic of
Africa

Offline member verification system: Verifying and authorizing access of health care services in remote areas

Implementation year
2019

Before July 2019, the National Health Insurance Fund (NHIF, hereafter the Fund) of the United Republic of Tanzania had a service portal; a verification system that required internet connectivity to verify members prior access to medical services. Requirement of internet connectivity was a challenge to most of the health facilities located in remote areas. As such, some health facilities in remote rural areas used to provide medical services even to ineligible beneficiaries.

In annual audits, the United Republic of Tanzania’s Controller and Auditor General presented to the Fund audit queries related to payment of claims related to ineligible beneficiaries accessing services. In 2018/19 report, there was a query related to payment of 115.80 million Tanzanian shillings (TZS) for ineligible beneficiaries who accessed medical services.

Challenges on the service portal to require internet connectivity in verification of beneficiaries made the Fund to deploy offline verification systems using unstructured supplementary service data (USSD)/mobile App and short message service (SMS). The offline systems helped facilities in remote rural areas with limited internet connectivity to verify beneficiaries prior accessing medical services.

As a result of implementing offline membership verification system, the reports issued from July 2019 onwards did not have this audit query.

Topic:
Information and communication technology