Expat insurance and health insurance in Tanzania

The Tanzanian health system is structured in several tiers, from community dispensaries to national reference hospitals, with a mixed public, private and faith-based offering. The public sector, on which most of the population depends, remains unevenly resourced across regions; Muhimbili National Hospital in Dar es Salaam, a teaching hospital with around 1,500 beds (nearly 40% reserved for paying patients), is the national reference. Health financing rests on the National Health Insurance Fund (NHIF), originally created for civil servants and extended to the formal sector, funded by a 6% contribution on gross salary split equally between employer and employee (3% each, no identified cap). A universal health insurance law (Universal Health Insurance Act) was enacted in December 2023 on the mainland, aiming to extend coverage to non-employees and, according to some specialist sources, to foreigners residing over 30 days in the country; its implementation remains gradual, however, and the precise terms of application to foreign residents could not be confirmed with certainty in the sources consulted — check directly with the NHIF before relying on it. The private sector, concentrated in Dar es Salaam, offers a markedly higher level of care: Aga Khan Hospital, the country's only Joint Commission International (JCI) accredited facility, and Saifee Hospital, both recommended by France Diplomatie, are the references.

Zanzibar, a semi-autonomous archipelago within the Union, has had its own mandatory universal health insurance scheme since March 2023, the Zanzibar Health Service Fund (ZHSF), separate from the mainland NHIF and adopted before the equivalent mainland law. For foreign visitors and residents, the most concrete specificity concerns tourism: since 1 October 2024, a mandatory travel insurance ("Zanzibar Travel Insurance", managed by the Zanzibar Insurance Corporation, around USD 44 per adult for 92 days) must be taken out to enter the archipelago, in addition to any personal insurance already held. France Diplomatie further notes that this local insurance, sometimes referred to as "ZIC", carries numerous exclusions and is not accepted by serious healthcare facilities in Tanzania — it therefore in no way removes the need for comprehensive health and repatriation cover before departure. On the archipelago, the facility recommended by the French embassy in an emergency is Medexpress; serious cases are most often transferred to Dar es Salaam, or even to Kenya or South Africa.

• Mandatory visa for any stay: e-visa to apply for online on the official eservices.immigration.go.tz portal, or a visa issued on arrival at the international airports of Dar es Salaam, Zanzibar and Kilimanjaro. Tourist visa: around USD 50; business visa: around USD 250. A passport valid more than 6 months after the arrival date is required.
• It is strictly forbidden to enter with a tourist visa when the purpose of the stay is professional or voluntary work, on pain of prosecution — a business visa or work permit is required in that case.
• France Diplomatie describes taking out an assistance contract covering medical costs, surgery, hospitalisation and medical repatriation as essential, as costs are never covered by the embassy.
• Zanzibar: in addition to the formalities applicable to all of Tanzania, a mandatory local travel insurance ("Zanzibar Travel Insurance", USD 44, valid 92 days, via visitzanzibar.go.tz) has had to be taken out since 1 October 2024 to enter the archipelago — it does not replace comprehensive health and repatriation insurance.
• Yellow fever: vaccination is not required for a direct flight from France, but becomes mandatory for any traveller arriving from a country or territory at risk of transmission (or having transited more than 12h through such a country), with presentation of the original international vaccination card.
• Malaria: high risk of transmission across the whole territory, including Zanzibar; suitable antimalarial prophylaxis is recommended before departure.
• Stay of more than 6 months or professional activity: a residence permit is required (Residence Permit Class A, B or C depending on profile), with an associated work permit for employees; the process must be started from abroad, before entering the country. No visa or permit dedicated to remote workers ("digital nomads") has been identified to date.

No fixed fine for lacking health cover has been identified for mainland Tanzania, but Zanzibar's travel insurance is, itself, an entry requirement checked on arrival.

No bilateral social security agreement between France and Tanzania has been identified. CLEISS lists only 16 African countries and territories that have concluded such an agreement with France (Algeria, Benin, Cameroon, Cape Verde, Congo, Côte d'Ivoire, Gabon, Madagascar, Mali, Morocco, Mauritania, Mayotte, Niger, Senegal, Togo, Tunisia) — Tanzania is not among them, unlike a neighbouring Indian Ocean country such as Madagascar (1967 agreement). Absent any agreement, no coordination exists for health, maternity, old age or family benefits between the two schemes, whether with the mainland scheme (NHIF) or the Zanzibar scheme (ZHSF).

• No form maintaining French rights applies in Tanzania.
• Affiliation to the CFE or taking out international private insurance are the only routes to cover recognised by a French system, whatever the profile.
• Registering with the NHIF (mainland) or ZHSF (Zanzibar), when open to foreigners, gives access to the local system but is neither cover recognised in France nor a substitute for medical repatriation.

• Before departure, whatever the purpose: apply for the e-visa on eservices.immigration.go.tz and take out insurance or an assistance contract covering hospitalisation and repatriation, absent any France-Tanzania coordination.
• For a stay including Zanzibar: additionally take out the archipelago's mandatory travel insurance (USD 44, 92 days) via visitzanzibar.go.tz, without relying on it alone for genuine health cover.
• Before departure: a medical consultation/vaccination centre visit to assess the need for yellow fever vaccination (depending on origin and transit), hepatitis A and B, typhoid fever, meningitis ACWY, and antimalarial prophylaxis, as malaria risk is present across the whole territory including Zanzibar.
• For a stay of more than 6 months or a professional activity: start the residence and work permit process (Class A, B or C depending on profile) from abroad well in advance, as these permits cannot be obtained once on the ground.
• Formally employed: check affiliation to the NHIF (mainland) or ZHSF (Zanzibar) with the employer, alongside — never in place of — cover recognised in France.
• Voluntary affiliation to the CFE recommended absent any health coordination.
• Within 6 months of arrival: register with the roll of French nationals living abroad at the French embassy in Dar es Salaam.