Assessing the implementation gap of disability inclusive health in Tanzania’s universal health insurance act

Abstract

Tanzania’s Universal Health Insurance (UHI) Act of 2023, which came into effect on August 16, 2024, represents a significant step toward achieving Universal Health Coverage (UHC) by mandating health insurance for all citizens, including subsidized premiums for “poor and vulnerable populations” such as persons with disabilities (PWDs). While the Act signals a strong commitment to health equity and disability rights in line with national and global frameworks, financial coverage alone is insufficient to guarantee equitable access for PWDs. This article highlights the persistent disconnect between legislative intent and the lived realities of PWDs in accessing health services. It argues that true inclusion requires a multidimensional implementation strategy that confronts structural, social, and systemic barriers. Key challenges include the need for a disability-inclusive benefit package that encompasses assistive technologies and rehabilitation; removal of accessibility barriers beyond infrastructure such as communication, information, and stigma; improved availability of disability-disaggregated data for policy accountability; strengthening of health worker competencies in disability-inclusive care; and active, sustained engagement of Disabled People’s Organizations (DPOs) in policymaking and implementation.Without addressing these gaps, the Act risks falling short of its transformative potential. To ensure no one is left behind. Tanzania must invest in deliberate, inclusive, and well-resourced implementation measures that center the rights and experiences of persons with disabilities in its UHC journey.