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The study investigates the efficiency of National Health Insurance Fund in health provision to the beneficiaries a case in Morogoro Municipality and 242 respondents participated in the study. The overall purpose of the study is to enhance efficiency in the provision of health services to the beneficiaries at all levels from dispensary to referral hospital. The study intended to answer the following questions; what are the operations of the NHIF in implementing its policies and terms, what are the operations of the accredited health facilities in implementing the NHIF policies and terms, what is the essence of the members‘ complaints, what are the existing mechanisms of flow of information to and fro between the members and the Fund, to what extent do the members have knowledge on their entitlements from the scheme and what extent knowledge on entitlements of the members do the primary service/care givers at the hospitals, pharmacies and NHIF offices have. The case study research design was employed during the study and research methods used included interviews, questionnaires, survey and documentary review schedules. The Statistical Package for Social Sciences (SPSS) was used to analyze data. By using descriptive analysis with simple quantitative technique the findings revealed that the operations of the NHIF in implementing its policies and terms. Accredited of health facilities and flow of information to and fro between members and fund are well planned. Also the findings indicated that both NHIF members and their entitlements have the knowledge about the rights and benefits package provided by the Fund. The findings showed that NHIF faces the following challenges in providing health services: late of payments from the fund to care providers ,lack of education to members, category of some services, low quality of services, poor communication, and improper facility inspection and supervision. It is recommended that NHIF should be sensitive to provide education to the beneficiaries and care providers which are the major obstacle to majority. |
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