The government of Tanzania both in mainland and Zanzibar has made significant progress toward achieving Universal Health Coverage (UHC) by passing a bill to establish Universal Health Insurance (UHI) as part of the efforts to ensure that all citizens are accessing quality health services without financial hardship. To support this, the Government of Germany, through its Federal Ministry for Economic Cooperation and Development (BMZ), has commissioned GIZ with 2 million EUR to support the governments in Tanzania mainland and Zanzibar with implementation of UHI. This funding supplements the 10 million EUR already allocated to the Improving Health Care Programme (IHCP) for initiatives such as maternal and neonatal health, reproductive health, and evidence-based planning. Furthermore, the Swiss Development Cooperation (SDC) has committed additional to 2.1 million EUR to co-finance the project.
Objectives and Indicators:
The main objective of the UHI output is to strengthen the capacity of the health insurance system to expand coverage to the Tanzanian population, including mothers and newborns. To achieve this, three intermediate outcomes are targeted:
1. UHI policy and regulatory framework are developed and implemented - this framework is necessary to ensure alignment of actors towards a goal and achieving coordinated action.
2. The capacity of targeted UHI institutions to manage financial sustainability is improved - only financially stable institutions can grow and serve their members in the long-term.
3. The acceptability of UHI in the informal sector has increased - in the absence of strong enforcement mechanisms, the 85% of workers in the informal economy have to accept the value proposition of health insurance and enrol voluntarily.
The output will be monitored through indicators such as the integration of international best practices into UHI regulations, improved cost control in health insurance operations, and increased acceptability of UHI among informal sector groups.
Partners and Methodological Approach:
The partners include Ministries of Health in mainland and Zanzibar, Ministry of Finance and Planning both in mainland and Zanzibar, National Health Insurance Fund (mainland), Zanzibar Health Service Fund (Zanzibar) and the Tanzania Insurance Regulatory Authority (TIRA).
The implementation will focus on capacity development through expert support, technical advice, and training for staff at key institutions.
Main activities per output
Output 1
- Advise on developing reform roadmaps and related M&E frameworks (overall and institution specific), policies, regulations and guidelines.
- Advise on organizational development to establish effective organizational structures and core processes.
- Equip newly established units for UHI.
- Train individuals on health financing and social health protection policy, and health insurance regulation.
- Support Tanzanian participation in the Leadership for UHC (L4UHC) to enable senior decision-makers develop leadership skills and collective actions needed for effective UHI implementation.
Output 2
- Advise Ministries of Health on modelling sectoral resource needs,
- Build capacity among regulators and insurance providers for projecting sustainability and solvency of insurance schemes,
- Build capacity of regulators and insurance providers for regulating and negotiating service prices,
- Strengthen claims management system of insurance providers incl. fraud prevention.
- In Zanzibar: Support setting up of the Health Equity Account and the unit that will run it.
Output 3
- Develop communication strategies and core messages on the strategic orientation of UHI for Ministries of Health.
- Develop and pilot marketing strategies and materials and expand distribution channels expanded for health insurance providers.
- Advise the health insurance regulator on structures and processes for grievance mediation and resolution.

The Government of Tanzania, with support from GIZ and funding from BMZ and the Swiss Development Cooperation Agency, is seeking a qualified contractor to assist in implementing Universal Health Insurance (UHI) across mainland Tanzania and Zanzibar. This initiative aligns with the government's goal of extending health insurance coverage to 58% of the population by 2025, a significant increase from the current 14.7% on the mainland and 7% in Zanzibar. UHI aims to improve access to quality healthcare and protect citizens from rising out-of-pocket healthcare costs, which increased from 22% in 2015/16 to 32% in 2019/20. The UHI laws introduced in Zanzibar in March 2023 and on the mainland in December 2023 are critical milestones. However, a 2023 assessment showed that the institutional frameworks and capacities required for successful UHI implementation are inadequate.
The planned tender seeks a contractor to assist in achieving the program's objectives through two key work packages. The first work package focuses on strengthening the UHI policy and regulatory framework. This includes conducting organizational assessments to identify strengths, weaknesses, opportunities, and threats, and recommending measures to address gaps. The contractor will provide technical advice and capacity-building services to staff within key institutions such as the Ministries of Health in both regions, the National Health Insurance Fund (NHIF), the Tanzania Insurance Regulatory Authority (TIRA), and Ministries of Finance and Planning. This work will involve developing UHI-related policies, regulations, guidelines, and standard operating procedures (SOPs).
Additionally, the contractor will support the establishment of equity funds to ensure healthcare access for vulnerable groups and propose effective organizational structures and processes to strengthen institutional capacities. Collaborative mechanisms among involved agencies will be fostered, and twinning programs will be developed for knowledge exchange with similar institutions. Regular assessments of capacity gaps and workshops or training sessions will be key components of this work package.
The second work package focuses on enhancing the financial sustainability of the UHI system. The contractor will provide expert advice to improve resource modeling, project the solvency and sustainability of insurance schemes, and regulate service pricing with healthcare providers. Tasks will include strengthening claims management systems, implementing fraud prevention mechanisms, and conducting medical audits to ensure effective use of resources. A new actuarial study will be conducted in 2025 to ensure the financial viability of the insurance system.
The contractor will also organize workshops and training sessions for institutional staff and stakeholders to promote inclusive, collaborative UHI implementation. The project will prioritize the needs of marginalized populations, particularly women and underserved areas, and integrate gender equality, environmental sustainability, and human rights considerations into all activities. Attention will be given to reducing inequalities in healthcare access, especially for women facing systemic barriers to health insurance due to factors such as lower employment rates and fragmented work histories.
The contractor must adopt a conflict-sensitive approach, considering the differing healthcare priorities and contexts of mainland Tanzania and Zanzibar. Efforts will be made to prevent conflicts, ensure equitable resource distribution, and maintain a unified vision for UHI across both territories. The contractor will also follow security guidelines from the GIZ security team to ensure safe operations.
The contractor is expected to demonstrate expertise in UHI implementation and manage complex, multi-stakeholder projects. Responsibilities will include selecting and training expert personnel, managing expenditures, ensuring compliance with GIZ reporting requirements, and contributing to results-based monitoring. Regular reports will document the progress of implementation, achievement of objectives, and identification of risks. The contractor will also support knowledge management, sharing lessons learned and best practices to ensure the program"s long-term success.
The program aims for sustainable and inclusive development, creating a robust health insurance system that addresses the diverse needs of the Tanzanian population. By strengthening institutional capacities, fostering collaboration, and integrating gender, environmental, and human rights considerations, the project seeks to improve healthcare access and equity, laying the foundation for a financially sustainable UHI system. The contractor will play a crucial role in supporting Tanzania's healthcare transformation and reducing disparities in health outcomes.

GIZ may optionally commission contract amendments and/or increases based on the criteria in the tender documents to the successful bidder of this tender. For details, please see the terms of reference.

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