Zim’s healthcare funding: A drop in the ocean?


The story about Medecins Sans Frontierers (Doctors without Borders) — MSF packing its bags from Zimbabwe’s Buhera district after a 12-year tour of duty providing free healthcare for Aids patients, hit the Press at the same time as Zimbabwe’s second largest Medical Aid Society —Cimas — published its end of year financial statements.

Painona with Tapiwa Nyandoro

The Cimas results provide a chilling insight into the financing gap that faces public-funded healthcare services in Zimbabwe.

MSF hopes the clinics it had established in Buhera will be taken over by the Zimbabwe Ministry of Health. The Ministry, however, has no fiscal space for the task outside donations.

For some of the 15 000 plus beneficiaries of MSF services the farewell to their service provider will be their death sentence. They will not afford the fees that they may need to pay to access their life-sustaining Anti-Retroviral medicines.

On his knees, alarmed by the fate awaiting the 15 000 MSF patients, Roland Madondo the Buhera District Administrator, begged the MSF to stay, pointing out [that] he was aware of government’s lack of resources.

(Perhaps the National Aids Council should take over?) It is not “noble”, he pleaded, for MSF to pull out at the moment, stating he “saw no alternative”.

France’s Ambassador to Zimbabwe, from whose country MSF originated, had no kind words for the Zimbabwe leadership at a recently held Southern African Political and Economic Series (SAPES) meeting.

He said Zimbabwe has imposed sanctions on itself because of its failure to deal with corruption and the uncertainty surrounding the indigenisation programme. The sentiments were echoed more or less by other ambassadors, both “frienemy” and assumed friend.

The solution to availing resources in the medium to long term is robust economic growth. Cimas’ chairman, as had many captains of industry before him, had sound advice to government in his chairman report as he presented the Society’s 2013 audited annual results, amid reports elsewhere in the Press of rising maternal mortality and the missing of Millennium Development Goals.

He called for:
Creation of fiscal space;
Formulation and application of enabling industrial policies;
Addressing infrastructure and key sector specific challenges;
Engaging the country’s creditors on the long0standing debt overhang;
Promotion of Foreign Direct Investment (FDI), as domestic resources is inadequate to underwrite meaningful investment.

The Society’s results showed that it collected over US$100 million from its approximately two hundred thousand lives covered. Given this figure Zimbabwe’s 13 million population would require circa US$6,5bn as its annual Ministry of Health budget.

Due to economies of scale and gains in productivity that would come with huge numbers it is conceivable the public sector could provide the same quality of care currently being enjoyed by the few lives covered by Cimas Medical Aid at half the cost per life covered. This would bring the budget down to $3,2bn. That the Ministry gets less than half a billion tells a story.

From the figures, it would appear the nation has a long way to go “to find an equilibrium position or a point of harmony between the need to promote indigenisation and the need for FDI and the ability to synchronise the two”, to quote part of the inaugural speech of the newly-installed Reserve Bank of Zimbabwe Governor, John Mangudya. To afford a $3,2bn Ministry of Health budget, the National budget needs to grow to around $30bn, whilst gross domestic product (GDP) should hover close to the $100bn dollar mark.

At that point unemployment would have been defeated or below 20%, and the GDP per capita would be around $5 000, more or less where China and RSA are today. Yet even those two countries are struggling with healthcare costs.

That said there could be “a missing page” in the Cimas Audited Results for 2013. While it may not be legally or professionally required at the moment, the chairman needs to give a trend analysis from 2009 to date of out-of-pocket expenses — shortfalls and prepayments — accruing to members. According to the chairman’s statement, the gap between what service providers charge and what the Society pays in claims on behalf of members who would have incurred medical bills “continues to widen”.

The regulator and the membership need this analysis to make informed decisions.

The regulator might want to amend his regulations to allow multiple Society membership and the use of two or more medical aid cards to cover one claim, this being more preferable to “ex gracias” requests. Members too might want to insure themselves against shortfalls and prepayments.

A more detailed statistical analysis would also be more useful to the regulator, the service providers and the memberships. It would show the membership how their money is being spent: which branch of the profession is driving medical inflation the fastest, how many lives are claiming and from which scheme, and such information as average payments per provider per profession?

At an average subscription of $500 per life covered the Society’s rates may be half those obtaining in South Africa. From a distance, it would appear that as the Society’s membership has fallen by 50% or thereabouts, its payments, including out-of-pocket expenses to service providers per capita have doubled? This information could be helpful to the Society itself and the regulator in planning a way forward. But there is no denying the need to grow the economy first for a sustained period. As has been said before in this column and elsewhere, “a rising tide lifts all boats”.

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