Dodoma. The National Health Insurance Fund (NHIF) has announced the return of the Toto Afya scheme for children after a hiatus. This announcement was made during a ceremony held at Takwimu House in Dodoma. The scheme will now be available to children in groups, primarily through their schools, at a cost of Tshs. 50,400 per child.
Individual children can also access the scheme under three pricing options. The first option costs Sh. 150,000, providing outpatient benefits capped at Sh. 1 million and inpatient benefits capped at Sh. 2 million. The second package is priced at Tshs. 237,000, with outpatient benefits capped at Sh. 2 million and inpatient benefits capped at Sh. 8 million. The third option costs Sh. 658,000, offering outpatient benefits capped at Sh. 3 million and inpatient benefits capped at Sh. 22 million.
The Toto Afya scheme was suspended in March 2023, with NHIF citing the need to improve the process of administering the scheme, which had become the fund’s most loss-making product. This suspension led to significant public outcry. Speaking on the reintroduction of the scheme, Minister of Health Jenista Mhagama highlighted its importance in addressing public concerns.
“I commend you for reintroducing the Toto Card, the health insurance card for children. In the previous system we had, sustainability was a challenge,” said Minister Mhagama during the officiation ceremony. She further noted, “The solution you’ve introduced will establish two categories. There will be group insurance for those who join as groups, but we cannot leave out individual children.”
As of October 2024, NHIF had registered 1,359,772 paying subscribers and over 5,106,957 beneficiaries. The fund works with 10,004 registered hospitals, of which 7,181 (72%) are government-owned, 848 (8%) are owned by religious institutions, and 1,975 (20%) are private facilities.
However, the NHIF has been struggling with its long-term sustainability. The Controller and Auditor General (CAG) has warned of the high financial risks the fund faces. For instance, the NHIF reported a loss of Sh. 156.77 billion in the 2022/23 financial year, following a loss of Sh. 205.95 billion in 2021/22.
Additionally, the CAG report highlighted that the fund has an outstanding debt of about Sh. 208 billion owed to the government, which was used to finance the construction of the University of Dodoma. This debt has significantly constrained the fund’s operational capacity.
