THERE is a curious reasoning which is unfolding in Harare.
The Government of Zimbabwe is considering a statutory instrument that would bar medical aid societies from owning the clinics and pharmacies through which they provide care to their members.
The stated purpose is to restore fairness in the health sector and protect independent practitioners from what is described as unfair vertical integration.
Yet this measure would not create genuine competition. It would dismantle one of the few parts of Zimbabwe’s health system that still manages, against extraordinary odds, to function with some measure of coherence.
At a time when public health services remain under strain and private care is often beyond the reach of ordinary citizens, medical aid societies have stepped in to bridge a critical gap.
Their clinics and pharmacies are not merely commercial assets. They are part of the delicate machinery that keeps members connected to treatment, medicine and continuity of care.
To separate ownership from service in the name of reform may sound progressive, but in practice it risks weakening access, increasing costs and punishing patients for a problem they did not create.
A policy meant to cure distortion should not end up inflicting deeper harm on the very people it claims to protect.
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To understand why this matters, one must first understand what medical aid societies have actually done.
They have not merely sold insurance premiums and reimbursed claims in the conventional fashion.
They have, in a country where currency has repeatedly collapsed and where the real value of any monetary instrument can easily be halved in a matter of weeks, found an ingenious way to honour their obligations to members without depending on the stability of money.
By owning clinics and pharmacies, they have shifted their primary transaction from the financial realm into the physical one. A member does not receive a claim settlement in a currency of uncertain value, instead, they receive a consultation, a prescription and a filled bottle of medication. The service itself becomes the unit of account. It is, in its own way, a masterpiece of adaptation under conditions of extreme monetary dysfunction.
This is the context that the proposed statutory instrument entirely ignores.
The problem that gave rise to vertical integration by medical aid societies is not a secretive board decision made in a comfortable boardroom.
It was a direct response to hyperinflation and currency instability. It is the decades-long erosion of trust in Zimbabwe’s monetary system, an erosion so thoroughgoing that it rendered conventional insurance economics nearly unworkable.
When a medical aid society cannot be certain that the premiums it collects today will retain sufficient purchasing power to reimburse a claim filed three months later, it must find another mechanism of honouring its promises, without compromising the going-concern status of the business.
Ownership of the point of care is that mechanism. To prohibit it, without first resolving the underlying monetary instability is to remove the bandage without healing the wound.
The comparison with the pension sector is not merely rhetorical. It is a warning written in recent history.
Zimbabwean pension funds were, for decades, among the most trusted repositories of long-term savings on the continent.
Then came hyperinflation and with it the wholesale destruction of retirement savings that workers had diligently accumulated over entire careers.
The damage was not only financial. It was reputational and psychological.
An entire generation of Zimbabweans concluded, not unreasonably, that formal financial institutions could not be trusted to protect them against the state’s monetary recklessness.
Confidence, once destroyed, takes entire generations to rebuild.
If the government now proceeds to dismantle the structures that have allowed medical aid societies to remain solvent and functional, it risks triggering an identical collapse of confidence in the medical insurance sector.
Policyholders will not wait to see whether the experiment succeeds. They will simply leave.
And when they leave, where will they go?
This is the question that the doctors and pharmacists lobbying for this statutory instrument have not adequately answered.
Their argument, expressed plainly, is that vertically integrated medical aid societies are crowding out independent practitioners by directing patient flows to their own facilities.
The grievance has some surface plausibility. But the remedy they propose rests on a fatal assumption: that the patients who currently use medical aid facilities would, in the absence of those facilities, migrate seamlessly to private consulting rooms and independent pharmacies.
The evidence from comparable contexts across Africa suggests precisely the opposite.
When medical aid systems collapse, patients do not redistribute themselves among the remaining providers. They exit the formal health system altogether. They turn to informal medicine, to traditional practitioners, to self-medication, or to nothing at all.
The doctors lobbying for this measure may imagine that they are fighting for market share. They are, in fact, fighting for a market that may cease to exist if they prevail. It is worth pausing on this irony because it deserves to be stated without equivocation.
The independent practitioners who are pressing the government for this regulation are acting against their own long-term economic interests.
A thriving medical aid sector, even one that includes vertically-integrated providers, sustains a culture in which people regard formal healthcare as normal and affordable. It keeps insurance penetration rates meaningful. It ensures that a significant portion of the population continues to seek medical attention rather than delay or avoid it.
Destroy that ecosystem and the entire private healthcare economy, including independent doctors and pharmacies, will contract.
There will be fewer insured patients, not more. There will be less fee revenue, not more. The winners of this regulatory battle will find that the prize is worthless.
A far more constructive response would be for the disaffected practitioners to exercise precisely the commercial creativity that they are demanding from others.
If independent doctors and pharmacists believe that the vertically-integrated model is so advantageous, then the most logical thing to do is for them to form their own medical aid societies. Let them pool capital, attract members and compete. Zimbabwe does not lack entrepreneurial energy.
What it lacks is the policy environment that would make such ventures worthwhile, which is to say, a stable currency, predictable regulation and a government that is genuinely open for business rather than merely deploying the phrase as a slogan.
The proposed statutory instrument is not a pro-business measure. It is the opposite. It is the state intervening to suppress a successful adaptation to the state’s own policy failures.
Zimbabwe has been here before. It has watched governments reach for regulatory instruments in moments of frustration with market outcomes, only to discover that the markets they were attempting to discipline were the last ones functioning well enough to discipline. The pension sector collapse, the foreign currency crisis, the collapse of formal retail during the hyperinflationary years, in each case, the regulatory response either accelerated the deterioration or prevented the recovery.
The medical aid sector is one of the few arenas in which Zimbabwean private enterprise has demonstrated genuine resilience. It has done so by innovating in response to adversity.
To punish that innovation now and to do so in the name of competition, would be an act of institutional self-harm that future policymakers will spend years trying to reverse.
The government should withdraw this proposed statutory instrument. If genuine concerns exist about anti-competitive conduct, the appropriate response is to strengthen the regulatory framework for competition, to empower the relevant authorities to act against specific abuses and to address the currency instability that drove the vertical integration model in the first place.
one of that is simple. But simplicity is not what the moment demands. What it demands is clarity about causes and consequences and the wisdom to resist the temptation to solve a structural economic problem with a stroke of the regulatory pen.
Irrigation schemes also depend on reliable electricity supply, well-maintained canals and pumping systems and the technical capacity of farmers to use water efficiently. Without these supporting systems, the existence of dams does not automatically translate into higher agricultural productivity.
There is also a broader lesson embedded in the idea of global water bankruptcy. The warning from the United Nations is not simply about scarcity. It is about sustainability. Many of the regions now facing water crises reached that point through decades of over-extraction, inefficient irrigation practices and poor water governance. If Zimbabwe and other African countries seek to expand irrigation, they must do so carefully to avoid repeating these mistakes.
Modern agricultural technologies provide a pathway forward. Precision irrigation systems such as drip irrigation do reduce water use dramatically while increasing yields. Soil moisture monitoring, improved watershed management and drought-resistant crop varieties further improve water productivity. These approaches allow farmers to produce more food with less water, aligning agricultural expansion with environmental sustainability.
Beyond technology, governance will be critical. Transparent water allocation systems, effective management of dam infrastructure and long-term planning for climate adaptation will determine whether Zimbabwe’s water resources become a driver of prosperity or a missed opportunity.
The broader geopolitical implications should not be overlooked. As global water scarcity intensifies, the geography of food production will shift. Nations with reliable freshwater and available farmland could emerge as central pillars of global food security. Investment flows, agricultural partnerships and supply agreements may increasingly gravitate toward regions capable of sustaining large-scale food production under conditions of growing environmental stress. Africa and Zimbabwe within it, could play a crucial role in that emerging landscape.
But given the current US/Israel war against Iran, future wars might play out in Africa, as those who believe they have more rights and entitlement to world resources, start wars, so that they could occupy Africa’s farm land for cheap, whilst utilising the freshwater resources for agricultural production for export to their water-starved societies offshore.
But natural endowment alone is never enough. History shows that resources only translate into prosperity when they are matched with institutions, infrastructure and long-term vision. The United Nations’ warning about global water bankruptcy should therefore be understood not only as a crisis but a signal. It highlights the growing importance of water as a strategic resource in the global economy.
Conclusion
For Zimbabwe, the presence of many dams and substantial freshwater reserves represents more than a legacy of past engineering projects. In an increasingly water-constrained world, it may represent one of the country’s most important strategic assets.
The challenge now is to transform that asset into sustainable agricultural growth and in doing so, help feed a world that is rapidly approaching the limits of its water account.
Ndoro-Mkombachoto is a former academic and banker. As a Systems Transformation Strategist, she helps multilateral agencies, such as the UN, IFC/World Bank, DANIDA, CIDA, GTZ, etcetera, future-proof their operations in markets where the rules are still being written. She also assists private and public sector companies in volatile emerging markets and constrained ecosystems, solve the complexity of institutional alignment by using frameworks that turn systemic constraints into growth engines. Gloria is the current Chairperson of NetOne Financial Services PLC, a subsidiary of NetOne Telecomms. Follow Gloria on YouTube @ HeartfeltwithGloria or contact her on [email protected]
