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It is time to try national health insurance

Opinion & Analysis
Healthcare practitioners

HEALTH financing is critical in each and every country in the world as we endeavour to achieve universal health coverage even in our beautiful country. Out-of-pocket and private health insurance have been dominant in many developing countries. Challenges continue to threaten the healthcare sector in the face of unpredictable and fluid determinants of health in Zimbabwe where the rate of unemployment is indisputably high. At least 60% of our citizens cannot access healthcare, a phenomenon which is quite unfortunate.

Many lives are being lost on a daily basis yet better medical services can be offered to salvage the horrendous situation. Medical access is now a pie in the sky in Zimbabwe as people are struggling daily to make ends meet.

Public health institutions have infrastructure but the quality of service has been annihilated by worker shortages, lack of resources, maladministration, lack of motivation and general disregard of the health sector by policymakers. The Abuja Declaration of 2001 called upon all African governments on allocate at least 15% of the national budgets towards health if sound health delivery service is to be realised.

The cost of living has sky-rocketed, especially in the last few months and many people have been reduced to beggars. Inflation is now nauseating, sitting at more than 200% against stagnant salaries that cannot even purchase half of the food basket. The health sector has not been spared from the effects of the economic quagmire as healthcare workers are leaving Zimbabwe in droves, there is high staff turnover from public health institutions while worker morale is at its lowest. Health worker migration has worsened in the last two years with more than 5 000 workers leaving for the so-called greener pastures.

Many of our citizens have flocked to the United Kingdom as healthcare workers, but their euphoria quickly dies down after facing unprecedented ill-treatment overseas. Britain is facing numerous economic challenges today and our fellow citizens should realise that all that glitters is not gold. Brass, copper or silver can also glitter.

The economy is slowly picking up but liquidity remains a challenge. Government is working hard to establish more health centres but staff concerns still linger. Issues of maladministration, corruption, inadequate financing, worker demotivation have dominated the delicate health sector in our country. Government should address these issues once and for all.

Admitting patients in private health institutions is a nightmare as the charges are beyond the reach of many. Zimbabwe has a population of close to 16 million people of which only about 10% are on medical aid cover. With lack of disposable income in Zimbabwe, many citizens are vulnerable to the medical catastrophe, thus putting their lives in danger. Both morbidity and mortality have potential to balloon to unprecedented levels.

For real, medical access should be made easy and according to the World Health Organisation constitution of 1946, the highest attainable standard of health is envisaged as a fundamental right to every human being. The right to health for all means that everyone should have access to the health services they need, when and where they need them, without suffering financial hardships. Is this what is happening in third world countries like Zimbabwe, Zambia, Malawi et cetera?

Is it not the right time to advocate for national health insurance (NHI)? NHI is a financing system that is designed to pool funds together to provide access to quality and affordable health services to everyone based on health needs and irrespective of socio-economic status.

There are usually no fees charged at the health institutions because NHI will cater for all the costs. This entails that the health insurance will cover every citizen whether employed or unemployed.

The socio-economic status of members of the public will not influence the type of healthcare they receive, but it will be influenced by the condition of one’s health. Both public and private healthcare practitioners will be paid on exactly the same basis and the same standard of care is expected from both.

Zimbabwe is currently making use of two main health financing models, the private insurance and out-of-pocket. These models are not suitable for poor economies where many people have insignificant disposable incomes.

The adoption of the NHI will at least move the nation towards universal health coverage. Every citizen deserves better value from healthcare spending. As it stands today, healthcare has become a burden for almost everyone in Zimbabwe except for the elite who can afford to fly for treatment outside the country. Some fly to Canada, Singapore, UK, Italy et cetera to seek medical attention, yet many cannot even afford to buy a one-month course of anti-hypertensive drugs.

  • Johannes Marisa is president of the Medical and Dental Private Practitioners Association of Zimbabwe. He writes here in his personal capacity.

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