Michael Gwarisa
Zimbabwe’s already fragile medical aid coverage could fall even further below the current 8 percent if proposed amendments to Statutory Instrument 330 of 2000 force medical aid societies to divest from healthcare service provision, stakeholders have warned.
The proposed changes to Section 14 of SI 330 of 2000 are currently under scrutiny and would prevent medical aid societies from owning or operating healthcare facilities such as hospitals, clinics, and pharmacies.
With more than 90 percent of Zimbabweans already uninsured and relying on out-of-pocket payments for healthcare, healthcare funders fear the move could worsen access to affordable services and push even more people out of medical aid schemes.
Chairperson of the Parliamentary Portfolio Committee on Health, Honourable Decent Bajila, said while the law has played an important role in regulating medical aid societies, any amendments must be approached carefully to avoid unintended consequences.
“This statutory instrument has over the years played an important role in regulating the conduct, financial management and accountability of medical aid societies. However, like many regulatory frameworks, it must evolve in response to emerging realities,” said Bajila.
“These include rising healthcare costs, changing disease burdens, concerns around transparency and governance, and the need to strengthen consumer protection in the medical aid sector.”
He said Parliament’s responsibility is to ensure the proposed amendments strengthen accountability and transparency while protecting contributors, practitioners and beneficiaries from unfair practices.
“The proposed amendments must be carefully examined to strengthen accountability and transparency in the medical aid sector, protect contributors and beneficiaries from unfair practices, enhance financial stability of healthcare funders, and improve efficiency in management and service delivery under broader health sector reforms and universal health coverage aspirations,” he said.
However, the Association of Healthcare Funders of Zimbabwe says forcing medical aid societies to separate from healthcare provision could weaken the very system many Zimbabweans depend on.
Association for Healthcare Funders Chief Executive Officer Ms Shylet Sanyanga said the current model allows medical aid societies to offer members both funding and access to actual healthcare services, and removing that option could lead many to cancel or downgrade their cover.
“The move to force medical aid societies to divest from healthcare provision will affect a lot of things. With medical aid already at only 8 percent coverage, the number of people currently on medical aid may actually go down,” said Ms Sanyanga.
She said many members value access to society-owned facilities as part of their medical aid package.
“The issue of medical aids running health facilities is actually a major component of the products that medical aid societies have been offering. When that is taken away, some people may decide there is no longer value in staying on medical aid.”
She added that some people whose cover is paid for by employers may also question the value of remaining on schemes if they can no longer access those facilities at affordable rates.
“They may decide either to downgrade or to come off medical aid completely. If that happens, the current 8 percent coverage may actually go down,” she said.
The public healthcare sector continues to face serious challenges including medicine shortages, long waiting times, equipment breakdowns and pressure from growing patient numbers. For many Zimbabweans, private healthcare remains the only practical alternative, but the cost is often unaffordable without medical aid support.
Mrs Thando Kembo, Chief Operating Officer of Cimas Health Group, told legislators that the debate should not focus on institutions, but on ordinary Zimbabweans’ right to affordable healthcare.
“This issue is not about institutions. It is about access, affordability, and the rights of ordinary Zimbabweans to healthcare,” said Mrs Kembo.
She argued that medical aid societies were created by citizens voluntarily pooling their resources to secure healthcare when needed, especially in a system where the public sector is overstretched and private healthcare is beyond the reach of many.
“People join by choice because the public system is overstretched and private care is unaffordable for many. They join to benefit from solidarity in seeking services as a collective rather than as isolated consumers,” she said.
Mrs Kembo said medical aid societies invested in hospitals and clinics because the healthcare market had failed to provide affordable and predictable services.
She said many private providers withdrew from schemes during economic instability, tariffs became unpredictable, and patients were left exposed to catastrophic healthcare costs.
“In response, societies invested in service provision as a last resort access strategy, not as a commercial power play,” she said.
“It was a response to medicine shortages, tariff inflation and capacity gaps, not an attempt to dominate the market.”
She noted that even among the small insured population, average monthly contributions range between US$55 and US$65 per member, with employers already struggling to absorb higher healthcare costs.
“Employers are already squeezed. There is almost no room for notable premium increases, yet utilisation is high and claim ratios are often above 90 percent,” she said.
Mrs Kembo warned that removing society-owned facilities would likely result in higher contributions, fewer benefits and reduced access to healthcare, especially for lower-income contributors.
“Society-owned facilities act as price stabilisers. They reduce shortfalls and protect members from excessive charges. Removing them does not fix tariff inflation. It removes one of the few effective tools keeping costs in check,” she said.
She added that international best practice does not support blanket bans on vertical integration, but rather stronger governance, transparency and regulation of conflicts of interest.
“Even in highly developed markets such as the United States and the United Kingdom, organisations like Kaiser Permanente and Bupa are vertically integrated. They regulate conduct, not structure,” she said.
Healthcare funders are now urging Parliament to pursue targeted regulation instead of forced divestment, warning that a blanket prohibition could deepen Zimbabwe’s healthcare access crisis.
For a country already struggling to achieve universal health coverage, stakeholders say the decision could determine whether more citizens gain access to care or lose it altogether.
