Zanzibar is undergoing a major healthcare financing reform, shifting from fee-free healthcare to a sustainable Social Health Insurance (SHI) model. At the heart of this transformation is Kadi ya Matibabu, a digital health card that uniquely identifies citizens and connects them to healthcare facilities, enabling real-time tracking of healthcare utilization and costs. By embedding a Unique ID, this system enhances transparency, improves efficiency, and informs data-driven decision-making in health financing.

With 92% of the population enrolled, Kadi ya Matibabu has been integrated into the national Matibabu Information System, linking all Ministry of Health (MoH) electronic medical records (EMR) systems. This integration supports the government in resource allocation, service equity, and evidence-based policymaking for Universal Health Coverage (UHC).
In partnership with the MoH, PharmAccess introduced a digital quality improvement model based on SafeCare principles. Deployed across 268 health facilities in all 11 districts of Zanzibar, this system allows facilities to access digital Quality Improvement Plans (QIPs), an online knowledge library, and benchmarking tools to track progress.

https://publications.pharmaccess.org/progress-report-2023/

• United Republic of Tanzania

• Older persons
• Women
• People with disabilities
• The unemployed
• The poor
• Remote and rural communities

The Matibabu Card ID system in Zanzibar serves as a highly replicable model for low-and middle-income countries(LMICs) aiming to strengthen their digital health ecosystems. Its success is attributed to several key factors that, with proper adaptation, can be applied in other regions.A primary enabler of replication is strong government commitment and a clear policy framework. PharmAccess played a crucial role by providing technical expertise,facilitating partnerships, and developing tools such as the healthcare utilization dashboard. This allowed healthcare facilities to link performance with patient outcomes, ensuring measurable and sustainable impact.The Zanzibar Ministry of Health demonstrated leadership by adopting the Matibabu Card as a universal patient identifier. Other governments can replicate this by establishing policies that mandate unique health IDs and ensure interoperability within national health systems.The Matibabu Card is integrated with digital health systems and interoperable with key Electronic Medical Records(EMRs), such as SHAMS-EMR, NSK-EMR, ZanEMR, and Jamii ni Afya, all enabled by the Zanzibar Health Interoperability Layer(ZHIL).This data exchange improves patient tracking & care coordination. Community Health Workers(CHWs) have been instrumental in the uptake of the Matibabu Card. By recognizing, training, and equipping CHWs to register patients at the household level, Zanzibar has improved grassroots data collection.This approach can be replicated by other countries by integrating CHWs into their national health systems and providing them with mobile tools and targeted training.The scalability and phased implementation of the Matibabu Card further enhance its replicability.After piloting, the system expanded to over 180 public health facilities, with plans to link it to national IDs for better data accuracy and sustainability.This approach allows for continuous learning and adaptation, making it easier for other countries to replicate without overburdening their health infrastructure.

In January 2024, the Ministry of Health launched the Strengthening Digital Health Ecosystem initiative to accelerate healthcare digitalization, with the Matibabu Card as a key pillar. The card, a unique patient identifier, has enrolled 92% of Zanzibar's population (around 1,739,390 people) and facilitates electronic registration, medical history storage, and health information exchange across facilities. To ensure interoperability, the Ministry mandated all digital systems integrate with the Zanzibar Health Interoperability Layer (ZHIL).

PharmAccess collaborated with the Ministry’s ICT Unit and stakeholders like UNICEF Tanzania, Saifee Hospital Zanzibar, NSK Tanzania, and ZEDCo to integrate Matibabu Card data with health facility EMRs. By December 2024, the Matibabu Information System was integrated with district, regional, and ZanEMR systems, with ZanEMR being piloted and set to expand to 170 public facilities. District and regional EMRs operate in 10 and 2 facilities, respectively.

The government identified key use cases for the Matibabu Information Mobile App within the Jamii ni Afya system, formally recognizing and training Community Health Workers (CHWs) to enroll community members into the digital health system during household visits. Adopting the Matibabu Card as a universal patient identifier has transformed Zanzibar’s digital health landscape, ensuring seamless patient identification, registration, and data storage. Future plans include linking the Matibabu Card with ZanID and birth certificates to improve credibility and interoperability. The government, in collaboration with PharmAccess, customized openIMIS for health insurance management, supporting the Zanzibar Health Services Fund (ZHSF) and ensuring long-term sustainability and improved healthcare delivery.

AL C2. Information and Communication Infrastructure - Building information and communication infrastructure by integrating various health data systems and ensuring connectivity between healthcare providers, government bodies, and patients. This enables more efficient management of healthcare services. AL C3. Access to Information and Knowledge - Improving access to information by enabling dissemination of critical health data to both healthcare providers and the public. They empower healthcare workers with up-to-date knowledge and tools to make informed decisions, while patients gain better access to their health records, educational resources, and support networks. AL C7. ICT Applications: Benefits in All Aspects of Life — E-health - E-health applications help to streamline healthcare delivery, improve service accessibility, and enhance patient engagement. Examples of e-health applications include telemedicine, electronic health records, and mobile health apps. These applications improve efficiency, reduce waiting times, and provide patients with remote access to healthcare services. AL C11. International and Regional Cooperation - Fostering international and regional cooperation by creating shared platforms for data exchange, knowledge sharing, and collaboration. AL C7. ICT Applications: Benefits in All Aspects of Life — E-science - E-science in healthcare enables better research and data analysis, which can lead to improved health outcomes. Through digital tools, researchers can collaborate globally, and conduct studies that influence policy and healthcare practices, hence driving evidence-based improvements in health systems.