By Michael Gwarisa
The 2025 National Budget allocation for Zimbabwe’s health sector has raised significant concerns among health advocates and stakeholders, including the Community Working Group on Health (CWGH).
With health expenditure shrinking in real terms, CWGH Executive Director Itai Rusike emphasized that the budget falls short of addressing the country’s critical health challenges, risking further strain on an already fragile system.
Declining Health Expenditure
The Ministry of Health and Child Care has been allocated ZiG28.3 billion (US$785.9 million) in 2025, representing 10.2% of the national budget, a decrease from the 10.6% allocated in 2024. This allocation also represents a mere 2.1% of the Gross Domestic Product (GDP), a significant decline from the 4.0% in 2024. The Abuja Declaration benchmark, which requires 15% of national budgets to be allocated to health, remains unattainable for Zimbabwe.
Rusike highlighted the implications of this decline where he said, “The inadequate financing of the health sector perpetuates overreliance on out-of-pocket spending and external donor support, both of which are unsustainable. No country can achieve Universal Health Coverage (UHC) without prioritizing public investment in health.”
Per Capita Spending and External Aid Dependency
Per capita health spending is projected to decrease from US$71.8 in 2024 to US$65 in 2025, a stark contrast to the US$4,001 in high-income countries and US$531 in upper-middle-income countries, as noted by the World Health Organization (WHO). Zimbabwe’s reliance on external funding, projected at US$461 million for programs such as HIV/AIDS, malaria, and TB prevention, risks creating donor dependency and undermines the government’s autonomy in setting health priorities.
Underfunded Interventions
- The budget outlines allocations for essential interventions, including:
- ZiG3.5 billion for the construction and rehabilitation of health facilities (12.4% of the health budget).
- ZiG290 million for procuring medical equipment (1%).
- ZiG150 million for ambulances and utility vehicles (0.5%).
While these allocations are commendable, Rusike noted their inadequacy in addressing systemic issues. He urged the government to ensure timely disbursement of funds, citing delays in 2024, where only 52.6% of the health budget had been released by September.
Missed Opportunities in Sexual and Reproductive Health
The budget also fails to prioritize sexual and reproductive health services, critical for women and adolescents, particularly in rural areas. Rusike expressed disappointment:
“The failure to allocate sufficient resources for sexual and reproductive health services exacerbates inequalities and limits women’s ability to make informed choices about their health.”
The Role of Village Health Workers
Another glaring omission is the failure to integrate Village Health Workers (VHWs) into the government payroll, despite previous assurances. Rusike emphasized their importance:
“Village Health Workers are the cornerstone of community health systems and critical for achieving UHC. Their exclusion undermines efforts to strengthen primary healthcare delivery.”
Revenue Measures and Accountability
The government expects to raise ZiG4.1 billion through special taxes on sugar and airtime, but CWGH recommends ring-fencing these revenues for health. Rusike also called for improved transparency and stakeholder involvement in resource allocation:
“Involving civil society, trade unions, and other stakeholders is crucial to ensure accountability and optimal utilization of public funds.”
A Call for Action
In conclusion, Rusike urged the government to rethink its approach to health financing:
“Increasing health expenditure in line with population growth and disease burden is non-negotiable. A well-funded health system is essential for improving access to quality services, particularly for vulnerable populations. The current model is unsustainable and does not reflect the urgency of our health challenges.”
