Using data to strengthen the financial sustainability of Zanzibar’s health system

The Zanzibar Archipelago consists of two main islands, located less than 100 kilometers east of mainland Tanzania. With its white sandy beaches and honeymoon suites, it is a well-known tourist destination. For the 1.5 million locals, however, living conditions are often not that glamorous. The islands deal with challenges typical to those of other development countries, including a chronically underfunded health sector.

Doctor Ignas Massawe giving an ultrasound to a patient (© PharmAccess Foundation)

Abdul-latif Haji is Head of Health Care financing within the Ministry of Health (MoH) in Zanzibar. He oversees the new health financing strategy that is to be developed for the next coming years. From his background as an economist, he decided to, as he explains, ‘’dedicate his career to strengthen healthcare and to understand every angle of the Zanzibari health system’’.    

''In Zanzibar, accessing primary and tertiary [specialized] services healthcare is free for all. There are no distinctions made, whether you are a born Zanzibari, a tourist or an immigrant. But the health sector is overwhelmed. With a growing population and limited sources of income, we are unable to take care for all the sick''.  

Beside capacity and financial challenges, Zanzibar also deals with a shortage of medical professionals, drugs and provision of quality services. 

‘’We only have one major referral hospital in Zanzibar which offered specialty care, and for more complicated cases like cardiac surgeries we need to refer patients abroad. Sometimes to mainland Tanzania, but more often to India and Israel. Medical treatment abroad consumes a large and increasing proportion of our ministry’s resources’’.  

After the revolution in 1964, the Zanzibar government promised free healthcare policy to its citizens. ‘’We need to keep up that promise’’, Abdul-Latif emphasizes.

‘’But financial sustainability must be the priority number one. And that is exactly what we are working on together with PharmAccess’’.  

But to develop a financing strategy, you need information first.

'We need to know how much healthcare provision costs, what diagnoses, and treatments are given and to whom—the utilization data. Currently we only reimburse facilities based on the services they provide. But without this utilization data we don't know the financing gap, and we cannot make the right decisions''.  

 

To get this data, Zanzibar is strongly focusing on digitalization, which is fully aligned with the PharmAccess approach. Thanks to the support of the programme Wehubit of Enabel, PharmAcccess is developing a Management Information System to help registering patients and collects data on healthcare performance, diagnosis and treatment. The data analytics will enable healthcare providers as well as the Ministry to identify the best and most urgent interventions to improve health outcomes, and to validate the ones being implemented. 

''With these activities, the government finds out who they are serving. Of course, everyone in Zanzibar has the right to healthcare. But for those who are not registered here, perhaps we ask for their insurance, so our costs will get reimbursed. Or we ask them to contribute. This enables the government to gain additional revenue, money that can be spent to realize improvements. We want to be able to provide every Zanzibari the care they need. They should not be sent away because a service is unavailable, or because their drugs are out of stock''.