Tanzania's National Medical Stores Let TZS 18.74 Billion in Medicines Expire. The National Health Insurance Fund Enrolled 39 Percent of Its Target. These Are Not Health Statistics. They Are Economic Ones.
The health sector findings in the CAG's 2024/25 audit are typically analysed through a public health lens. Uchumi360 is analysing them through an economic one, because workforce health is a direct input into the labour productivity that Tanzania's industrialisation agenda requires. A country that cannot deliver medicines to its population without losing TZS 18.74 billion to expiry, and whose national health insurance system has enrolled less than half its membership target, is a country whose productive workforce is being constrained by health system failures that show up not only in hospital statistics but in manufacturing output, in absenteeism rates, and in the human capital quality that attracts or deters investment.
TZS 18.74 Billion in Expired Medicines
Medical Stores Deparment, Tanzania's national medical stores authority, allowed medicines and medical supplies with a combined value of TZS 18.74 billion to expire during the audit period, with an additional TZS 707.82 million in supplies spoiling through improper storage. The CAG documents this as a consequence of inadequate storage and distribution management systems rather than a supply funding failure. Tanzania purchased and received these medicines. It then failed to distribute them before their expiry dates.
The economic analysis of this failure goes beyond the direct financial loss. Every TZS of medicine that expires in a warehouse is a TZS that was not deployed to maintain the health of a worker, a farmer, a teacher, or an entrepreneur. The compound effect of systematic medicine expiry is a population that is less healthy than the medicines already purchased to serve it would allow, with all the downstream consequences for labour productivity, school attendance, and household economic capacity that population health directly determines.
The 39 Percent Enrolment Problem
The National Health Insurance Fund enrolled 553,447 members in 2024/25 against a target of 1,407,918. This is 39 percent of its planned membership. The fund also has TZS 20.15 billion in outstanding claims from employers of supplementary package beneficiaries who have not paid despite contractual requirements to do so.
Universal health insurance coverage is a development economics prerequisite, not simply a social policy goal. Workers without health insurance coverage make employment decisions based partly on the risk of catastrophic health expenditure that uninsured medical events create. Employers who cannot offer credible health coverage face recruitment and retention challenges in a competitive regional labour market. Investors evaluating manufacturing location decisions include workforce health infrastructure in their assessment of operational risk. Tanzania's target of 1,407,918 NHIF members was set because the government understood these relationships. The 61 percent gap between target and achievement is a gap in Tanzania's economic infrastructure as much as in its health infrastructure.
The employer non-payment problem, TZS 20.15 billion in outstanding claims from employers who have contracted to pay, is a governance failure with a specific mechanism. Employers who deduct health insurance contributions from workers' salaries and do not remit them to NHIF are engaging in precisely the same behaviour documented in the pension fund findings: extracting legally mandated contributions from workers and retaining rather than remitting them. The workers who experience this practice are workers who believe they have coverage and discover otherwise when they need it.
The Structural Connection to Investment
Tanzania's investment surge is generating employment. Manufacturing facilities, logistics infrastructure, and commercial real estate development all require workers. The quality of the health infrastructure those workers can access is a direct input into their productivity, their reliability, and the operating risk profile of the enterprises that employ them.
Investors who are evaluating Tanzania's investment environment alongside Kenya's, Rwanda's, and Uganda's, the comparison that every location decision for East African manufacturing or services investment involves, are evaluating health infrastructure quality as part of that comparison. A national medical stores authority that expires TZS 18.74 billion in medicines and a health insurance system at 39 percent of its target are not compelling competitive differentiators.
The health sector CAG findings are an accountability document. They are also an investment environment document. Tanzania's Vision 2050 ambition of becoming a USD 1 trillion economy requires a productive, healthy workforce. The CAG's health sector data describes the gap between that requirement and the current delivery capacity of the institutions responsible for meeting it.
Uchumi360
Business Intelligence
Source: Ripoti ya Mwaka ya Mdhibiti na Mkaguzi Mkuu wa Hesabu za Serikali kuhusu Ukaguzi wa Mashirika ya Umma kwa Mwaka wa Fedha 2024/25. March 30, 2026.
Uchumi360 covers business, investment, and economic policy across East, Central, and Southern Africa.
