The Zimbabwe Medical Association (ZiMA) wants Parliament to support one of the most far-reaching healthcare reforms in recent years. Yet despite proposing a structural intervention that could affect healthcare access, investment, infrastructure and thousands of jobs, its submission fails the most basic test of public policy: it never proves that the proposed reforms will leave Zimbabweans better off than they are today.
That omission is not a minor flaw.
It is the fatal weakness at the heart of the entire submission.
The document repeatedly warns about conflicts of interest, patient steering, over-servicing and governance concerns. But it never quantifies the alleged harm, never measures the scale of the problem and never presents credible evidence that dismantling Zimbabwe’s integrated healthcare model will improve affordability, access or patient outcomes.
Instead, Parliament is effectively being asked to approve structural surgery without first being shown convincing evidence that the patient is sick — or that the proposed cure will be better than the disease.
That is a dangerous basis for reform.
The submission proceeds from an assumption that separating funders from providers is inherently desirable. Yet assumptions are not evidence.
If lawmakers are being asked to support reforms of this magnitude, several questions should be answered before a single amendment is approved.
- Cars up for grabs in batteries competition
- Africa should be better prepared for Europe’s security funding shift
- Sadc PF wants right to health enforceable
- AG’s report shows growing impunity at the heart of govt operation
Keep Reading
What measurable harm is the current system causing?
How widespread is that harm?
Why are existing regulatory mechanisms incapable of addressing it?
What evidence demonstrates that structural separation will improve outcomes?
And do the benefits outweigh the risks?
The submission offers remarkably few answers.
Throughout the document there are repeated references to concerns, risks, conflicts and potential abuses. Yet there is a striking absence of hard evidence. How many policyholders have suffered measurable prejudice because of vertical integration? How many documented cases of patient harm exist? How many investigations have substantiated the claims being advanced? How much healthcare expenditure can be directly attributed to the alleged abuses?
Parliament is not told.
Instead, lawmakers are expected to infer that because a conflict may exist, significant harm must therefore exist.
That is not evidence-based policymaking.
It is policymaking by assumption.
Perhaps the most revealing omission is the submission’s failure to explain why medical aid societies entered healthcare provision in the first place.
Medical aid societies did not begin operating clinics, pharmacies and laboratories because they suddenly wanted to become healthcare providers. They entered because gaps existed in the healthcare system. Integrated service models emerged as responses to infrastructure shortages, affordability challenges and failures in healthcare delivery.
Whether one supports those models today is beside the point.
Any proposal to dismantle them must first explain why they emerged and what will replace the functions they currently perform.
The submission does neither.
Instead, integration is treated as the problem itself rather than a response to deeper problems within the healthcare system.
That is a critical distinction.
Good policy addresses root causes. Weak policy attacks symptoms.
More concerning is the complete absence of a meaningful economic assessment.
The submission spends considerable time describing the perceived dangers of integration. It spends almost no time examining the consequences of dismantling it.
What happens to clinics currently operated by medical aid societies?
What happens to pharmacies and laboratories built through years of investment?
What happens to healthcare workers employed in those facilities?
What happens to patients who currently rely on integrated healthcare networks?
What happens to investment confidence in a sector already struggling to attract sufficient capital?
These are not side issues.
They are the central issues.
Yet they receive remarkably little attention.
Parliament is being asked to support reforms that could affect healthcare facilities, healthcare workers, patient access and private-sector investment. Yet the submission contains no serious attempt to quantify either the harm allegedly caused by the current system or the disruption likely to result from dismantling it.
Reform without evidence is not reform. It is experimentation.
The submission also confuses governance with outcomes.
It speaks extensively about institutional independence, role separation and conflicts of interest. These are legitimate considerations. But healthcare systems are not judged by organisational charts.
They are judged by outcomes.
Can patients access care?
Can they afford treatment?
Can they obtain medicines?
Will services improve?
Will costs fall?
Will access expand?
The submission never convincingly demonstrates that the proposed reforms will achieve any of those objectives.
Instead, it appears to assume that cleaner governance structures automatically translate into better healthcare outcomes.
That assumption is neither self-evident nor proven.
A perfectly structured system that delivers less care is not an improvement. It is simply a better-organised failure.
There is also a contradiction running through the submission that Parliament should not ignore.
The document repeatedly invokes patient welfare, healthcare access and universal health coverage. Yet it never explains how restricting existing healthcare infrastructure, forcing divestments or disrupting integrated service networks will expand access to care.
The promised benefits are asserted.
They are not demonstrated.
None of this suggests the current system is beyond criticism. It is not. There may well be legitimate concerns about governance, market conduct and conflicts of interest.
Those concerns deserve scrutiny.
But scrutiny is not the same as structural surgery.
Before Parliament endorses reforms capable of reshaping significant parts of Zimbabwe’s healthcare sector, it should demand evidence, not assumptions; outcomes, not theories; and proof, not promises.
The ZiMA submission does not meet that standard.
It asks Parliament to embrace a far-reaching structural intervention without first establishing the evidentiary foundation such an intervention requires.
It makes a determined case for structural separation.
It makes a far weaker case for better healthcare.
And until proponents of these amendments can demonstrate that separation will improve access, affordability and patient outcomes, lawmakers should be wary of embracing a cure whose consequences remain largely unexamined.
