THE INSTITUTE OF FINANCE MANAGEMENT (IFM)

FACULTY OF INSURANCE AND SOCIAL PROTECTION DEPARTMENT OF SOCIAL PROTECTION BACHELOR OF SCIENCE IN SOCIAL PROTECTION YEAR II A FIELD TRAINING REPORT BASED ON ADMINISTRATION OF SOCIAL HEALTH INSURANCE BENEFIT (SHIB) AT NSSF.

NAME OF STUDENT: PROGRAM OF STUDY: REGISTRATION No.: ACADEMIC YEAR: FIELD LOCATION: SECTION/DEPARTMENT WORKED: REPORT SUPERVISOR:

EMILLY, AMISA Bsc. SP-YEAR 2 BSP/10/41953 2011/12 NSSF HEAD QUARTERS SHIB ADMINISTRATION MR. E. MAGOTI

ACKNOWLEDGEMENT
The completion of this work has involved various kinds of inputs from different source and institutions.

The best way is to thank those supporting me in all preparation of this report. First I give an honor to GOD, the head of my life. I would like to thank him for the immeasurable blessing that he has given me. I thank him for wake up me each morning and turning my dark nights into brighter days. You have truly made a way out no way. This is forever my prayer day and night. With much respect, I would like to extend my profound gratitude to my supervisor MR. E. MAGOTI, for his effort in providing more invaluable assistance and necessary guidance till the production of the final report. Further more I would like to thank all people motivate and challenge me in preparations of my report, my friends Judith and Joyce also my brother Hussein and all place I stayed when I was in field, as well as people whom I was working for NSSF members. I would like to extend my appreciation to my colleagues on the Bachelor of social protection program for contribution of the material. I am particularly grateful for the field work guidance received from NSSF under SHIB department during the field attachment.

DEDICATION
I sincerely thank those who assisted me to do this report successfully. This report is dedicated to my beloved parents, Mr. and Mrs. Emilly for their great contribution on the prosperity of my life, since childhood up to now. Also special regards should go to my brother who assisted me financially, physically, and psychologically, throughout this exercise.

LIST OF ACRONYMS
NSSF SHIB NPF ATE ILO HQ NATIONAL SOCIAL SECURITY FUND SOCIAL HEALTH INSURANCE BENEFIT NATIONAL PROVIDENT FUND ASSOCIATIONS OF TANZANIA EMPLOYERS INTERNATIONAL LABOUR ORGANIZATION HEARD QUOTER

LIST OF TABLES AND FIGURES

FIGURE 1 TABLE 1 THE ORGANIZATION STRUCTURE OUT-PATIENT AND IN-PATIENT HEALTH BENEFITS PROVIDED UNDER SHIB TABLE 2, LIST OF SHIB FORMS

LIST OF APENDIX
APPENDIX 1 STUDENT LOG BOOK

EXECUTIVE SUMMARY
The National Social Security Fund (NSSF) is among much formal social security in Tanzania. It has branches spread all over regional centers in Tanzania, has also managed to open branches at district level in Tanzania. The purpose of the scheme is to offer protection to its members against economic and social distress that otherwise would have been caused by suddenly stoppage or substantial reduction in earnings as a result of old age, invalidity and death of the bread winner, employment injury and maternity benefits. The scheme covers the health care needs of a member and his/her immediate family. The fund also assists with funeral expenses when a member dies. The field training took eight weeks at National Social Security Fund (NSSF) and during these eight weeks I perform different task and duties. The task I undertaken was distributing of SHIB forms to members, files the name of those members who suffer from diabetes mellitus, offering information about SHIB issue to members of NSSF, entering the cards in to the computer, entering the accredited medical provider in to the system, writing the letter for those who requesting refund for spectacles, renew SHIB agreements/contract. These different activities I performed during the field training I found that good services will attract more members to join SHIB in order to get benefits. From the tasks I undertook I learned that there are three levels of accredited medical providers which are dispensary, health care and hospitals. Also I learned that there are some other medical services shall not be covered by the scheme because they are covered by other nation vertical programs. They are considered as self-inflicted or luxurious. Briefly explain your conclusion and recommendation The work I under take during the field is not different from what I have learned in the class. I performing these different task and duties and I came to conclusion that good service has advantages. If service provided properly the number of beneficiaries will increase.

TABLE OF CONTENTS
LIST OF .. PAGES

AKNOWLEDGEMENT... i DEDICATION... .. Ii LIST OF ACRONYMS iii LIST OF TABLE AND FIGURES... iv LIST OF APPENDIX.. EXECUTIVE SUMMARY.. TABLE OF CONTENTS. v vi vii

PART A INTRODUCTION PART B BACKGROUND OF THE ORGANIZATION PART C WORKDONE AND LESSONS LEARNT.... 5 PART D CONCLUSION PART E RECOMMENDATIONS PART F REFERENCES 11 10 9 2 1

PART A
INTRODUCTION
The field training was conducted at National Social Security Fund (NSSF) Head office at the Social Health Insurance Benefit (SHIB) department. The aim of SHIB is relieving the member from the burden of cost sharing in medical services. After the NSSF HQ considers my field application and gives a post for me to NSSF HQ, the field work was done as a given time to practice it. The objective to do field was to enable me to know the practical skills relate with what I have been learnt from the classroom. Members used to monthly or periodic payments are assured of continued monthly dues after retirement or invalidity. My field training was conducted under SHIB department. SHIB means social Health Insurance Benefit which is under NSSF. Social Health Insurance Benefit (SHIB) provides free medical support to the insured person and his/her family at times of illness and injury. This field practical report is organized into different parts. Part A is concerned with an introduction, part B is background of the organization, part C comprises work done and reasons learnt, part D presents the conclusion, part E offers the recommendations, and finally part F contains the list of references used in this report.

PART B
BACKGROUND OF THE ORGANIZATION
The National Social Security Fund (NSSF) was established by the Act of Parliament No.8 of 1997 to replace the defunct National Provident Fund (NPF). NSSF is a compulsory scheme providing a wider range of benefits which are based on internationally accepted standards. The scheme is administered by the ministry of labor and youth welfare. NSSF is administrated by nine members in the board of trustees three each from ATE (Associations of Tanzania employers), Trade Unions, and Government. The Chairperson of a board is selected by minister of Labor and youth development and the Director General is appointed by the President of United Republic of Tanzania. NSSF covers the Government ministries and departments employing non-pensionable employees, parastatal organizations, self-employed person not covered by any other scheme, any other category as declared by the Minister of Labour and private sector which includes; y y y y y Company Non governmental organizations Embassies employing Tanzanians International organizations Organized groups in the informal sector

NSSF performs the following range of functions; y y y y y To register members as defined in the Parliament Act. To give benefits of ILO standards To collect benefits from members they register To invest the surplus in social interests. To advice the government about fund advancements new benefits suggestions and managing. y To conduct survey, research, on the social security need.

To spread knowledge of social protection, and its importance to Tanzanians

MISSION STATEMENT OF NSSF The fund is committed to meeting members evolving social security needs and expectations. SOCIAL HEALTH INSURANCE BENEFIT (SHIB) Under SHIB, The benefit is provided through accredited medical services providers covering Out-Patient Services and In-Patient Services. With the same 20% contribution he/she can enjoy the seven NSSF benefits that include Health Insurance Benefit for beneficiaries and his/her family. TABLE 1: OUT-PATIENT AND IN-PATIENT HEALTH CARE BENEFITS In patient services
y y Accommodation. Consultation with Clinical/Medical Officer, Specialist or Consultants. y y y Basic and Specialized Investigations Minor and major Surgeries. Dispensing of Drugs in the Essential drug list. y Dispensing Drugs on discharge. Referral to higher levels and special hospitals.

Out patient services y Consultations with clinical/Medical Officer, Specialists or Consultants. y Basic and Specialized Investigations. y y Minor Surgical Procedures Dispensing of Drugs in the Essential Drug list. y Referral to higher levels and special hospitals.

Coverage SHIB covers Insured person, spouse and up to four children. Children include biological and legally adopted below 18 or 21 years if in full time education.

Qualifying conditions
y y y At least 3 months contributions. 3 months access of service after stoppage of contributions. 6% deduction of pensions for pensioners willing to join after retirement

Limitations of medical services y Emergency services for mobile members (traveling on duty) Out-patient not more than 4 times per year and In-patient (48 hours) not more than 2 times a year. y Hospitalization for a maximum period of 42 days of In-patient care per family per year.

PART C
WORKDONE AND REASSONS LEARNT
This chapter explains the tasks that I did in Social Health Insurance Benefit (SHIB) at NSSF HQ Posta. It also explains the lessons from the tasks. I. WORKDONE During the field work at SHIB which is under NSSF, I went through different tasks related to beneficiaries and hospitals for a period of eight weeks. Different tasks were undertaken and lesson learned from the tasks were summarized and written down at daily bases. The following are the tasks undertaken during the field work for eight weeks, Firstly, I was oriented into the administration of about SHIB forms. There are ten types of SHIB forms. The table below shows a list of SHIB forms. TABLE 2 S/N 1 2 3 4 5 6 LIST OF SHIB FORMS USAGE Accreditation of Medical Service Providers Certificate of Accreditation Enrolment of SHIB beneficiaries Enrolment of pensioners Beneficiary amendment form Provider change form COPIES 1 1 3 2 or 3 3 2

TITLE SHIB 1 SHIB 2 SHIB 3A SHIB 3B SHIB 4 SHIB 5

SHIB 6

Patient treatment form

SHIB 7

Patient treatment form

9 10

SHIB 8 SHIB 9

Mobile member coupon Monthly Utilization form

1 2

11

SHIB 10

Complaint form

Secondly, another activity which I performed was offering information about SHIB to beneficiaries of NSSF, The aim was to inform all members of NSSF about objectives, and benefits services covered under SHIB. Through this members will join SHIB and enjoy different health services. Thirdly, I filed the names of the beneficiaries who suffered from Diabetes Mellitus (DM). Each name is recorded with medicine and amount of that medicine as well as the date that beneficiaries visit the accredited medical providers. Fourthly, another task I did was to renew SHIB agreements/contracts, SHIB use two agreements /contracts which are capitation and fee per visit. These agreements are used in making payments for health services rendered to SHIB beneficiaries. Fifthly, I collected the cards from different files and arrange that according to hospitals and put in to shelf that pebbled different regions with different hospitals that provide benefits with NSSF agreement. Furthermore, Distribution of SHIB forms to members was another activity which I performed. The form I distribute is form SHIB 4 (beneficiary amendment form) and form SHIB 5 (provider change form),

More than that, I got the knowledge about payment procedures which are capitation fee system and fee per visit system in making payment for healthcare services rendered to SHIB beneficiaries. Entering the accredited medical provider in to the system, this was done successfully by considering the important information about the accredited medical provider if it is at level of dispensary, healthcare or hospital. Writing the letter for those who requesting refund for spectacles. II. LESSONS LEARNT This section explains the lessons learnt during the field work under Social Health Insurance Benefit (SHIB) at NSSF. Firstly, I got the knowledge about all SHIB Forms each of which contains details as follows, Accreditation form is the form that should be filled by the hospital that entered in to a contract with NSSF and the certificate of accreditation (form SHIB 2) should be displayed in a prominent place at the Healthcare providers premises and it should be surrendered to the Fund upon revocation of accreditation. Form SHIB 3A and form SHIB 3B contains personal details of principal member and dependant details. Form SHIB 3A is for those pensioners because in order for a pensioner to get benefit from SHIB must accept to contribute 6% each month and form SHIB 3B is for NSSF beneficiaries who join SHIB in order to get benefit. This form SHIB 3A and form SHIB 3B must be attached with a copy of marriage certificate for spouse and birth certificate for children. Form SHIB 4 involves personal details of principal member and amendment sought. This form shows information about removal of dependants or additional of dependants. The member must attach a copy of marriage certificate for spouse and birth certificate for children /other dependants. When a member decides to make some changes to dependents by adding or removing them must fill this form and submit all certificates required.

Form SHIB 5 is for members who want to change the provider (Healthcare provider). The member must state the reasons for changing medical provider at this form. Through this form I discover that many beneficiaries decide to change the provider and choose the better one because of poor services that provided by that accredited medical provider. Form SHIB 6 is filled by accreditation medical provider when member of NSSF visit that hospital. Reason for visit is shown as well as amount of medicine and medicine taken. I learned that fee per visit is a pre determination fixed amount to be paid to a medical provider for each visit a beneficiary makes to the facility regardless of the individual services the beneficiary will receive. Form SHIB 7 is for beneficiaries who referred to another hospital and reason for referral must be shown. Beneficiaries will be referred only to a selected SHIB referral hospital in each region or known referral hospital. I learned that the referral system of patients from one unit to another shall therefore follow the skills that are required to address the clinical problems of the patient or ministry of health protocol. In this case all referral cases shall be processed though dully filled form SHIB 7. Form SHIB 8 is given to a member who travels from his or her own residence. This allows him or her to get services. From this task I learned that emergence services for members travelling on duty, inpatient is not more than two times per year. Secondly, I learned that only beneficiaries of NSSF are allowed to join SHIB and enjoy benefits services covered. Also I learned that some other medical services shall not be covered by the scheme because they are covered by other national vertical programs. They are considered as self-inflicted or considered as luxuries. Thirdly, from all the tasks I undertook I learned how to prepare and file the document that need to be stored in the file and also I learned that this disease Diabetes Mellitus (DM) is one of the services/treatment provided by the government free of charge. Therefore SHIB collect data on that in order to know how many beneficiaries suffered from Diabetes Mellitus.

Fourthly, SHIB use two agreements (contracts) which are capitation and fee per visit. These two contracts are used in making payment for health services rendered to SHIB beneficiaries. Fifthly, from the activity of arranging the cards in the shelf, help me to understand that there is shelf of each region. That shelf shows all hospital of that region which provides services under contract with NSSF. Member's cards are stored to that shelf with regard to region and hospitals. Furthermore, from the task I undertook I leaned that form SHIB 4 allow members to add or reduce number of dependants also form SHIB 5 is filled by beneficiaries who need to change the accredited medical provider with different reasons. More than that, I learned that the fee per visit system shall only be used for designated SHIB referral hospitals or facilities having less than 50 beneficiaries registered with them. Also capitation payment system consist the fee itself, the time period for capitation fee and the amount of the capitation. The accredited medical providers must have full information about the name of the hospital, allocation designation, date that established area, fax and telephone number in order to be successfully registered in to the system. I learned how to write the letter for those who requesting refund for spectacles and how to file that letters

PART D CONCLUSION NSSF is a good Fund in Tanzania because of its larger extent and level of the coverage, large number of members, and many number of benefits given under the fund. Also NSSF have good workers who help me during the field work without any collision and harvest a lot of work experience, advanced knowledge, and deserved skills in social security.

PART E RECOMMENDATIONS The fund must take importance steps to recover the funds status so as to straight the management system, to influence its workers to improve and show good and quality services within the funds operations, to processes the benefits faster, even motivation on the workers things may help workers to show fully participation in funds activities, increase number of fund workers as to defeat the members population relatively.

PART F REFERENCE NSSF OPERATIONS GUIDE, Issue No.2, 2010. NSSF Parliament Act No.8 of 1997 of United Republic of Tanzania