By Michael Gwarisa
Funds for Zimbabwe’s soon-to-be-implemented National Health Insurance (NHI) will be drawn from existing taxes and various sectors to minimize the financial burden on citizens, a senior government health economist has revealed.
The principles of Zimbabwe’s NHI Fund have been approved by the Cabinet. This fund will pool resources from multiple sources into a single account, which will then finance the essential health services package.
Targeted funding sources include local authority contributions, earmarked levies, health bonds, the Assisted Medical Treatment Order (AMTO), state contributions, portions of the War Veterans Fund, mineral export taxes, community-based health insurance schemes, voluntary organization and NGO contributions, diaspora remittances, portions of social security funds like the Women’s Compensation Fund, and investments from the NHI fund itself.
Mr. Chengetedzai Gota, a prominent health economist in the Ministry of Health and Child Care’s Policy and Planning Department, assured stakeholders during a consultative meeting on domestic family planning funding that no new taxes would be levied on citizens for the NHI.
A progressive approach is going to be utilized such that the more you earn, the more you are required to pay, and the more you buy, the more you will contribute,” said Mr. Gota.
“We are not saying there will be new taxes. No! Instead, we will take a proportion from existing taxes. For example, a portion of the Value Added Tax (VAT) will go to the NHI. The same applies to remittances and bank charges. It’s not an additional burden on the people but a reallocation of existing funds pooled into the NHI.”
He emphasized that the NHI aims to protect citizens from catastrophic health costs, which occur when out-of-pocket healthcare expenses exceed 10% of a household’s total spending.
“We want to ensure there is no impoverishment or catastrophic spending. Everyone should be able to visit healthcare facilities and receive the care they need without suffering financial hardship,” he explained.
The NHI’s foundational principles—transparency, ownership, and accountability—have already been approved by the Cabinet. The remaining steps involve finalizing the framework and other components. However, certain organizations, such as churches and selected charities, will be exempt from contributing to the NHI.
In preparation, the City of Harare has launched a Community-Based Health Insurance initiative, where individuals contribute $2 per month to a fund designed to support healthcare costs. Community structures have already been established in areas like Mbare and Hopley. However, this program will be integrated into the NHI once it becomes operational.
In neighboring South Africa, the National Assembly passed the National Health Insurance (NHI) Bill on June 12, 2023. Its primary objective is to ensure universal access to quality healthcare for all South Africans, in alignment with the country’s Constitution, which recognizes healthcare as a fundamental human right.
South Africa’s NHI seeks to reduce health inequalities by making healthcare services available to all citizens, regardless of income or social status. However, challenges like funding gaps and resource allocation remain key hurdles in its full implementation.
Other African countries have also introduced successful national health insurance programs. Rwanda, for instance, has gained global recognition for its Community-Based Health Insurance (CBHI), known locally as Mutuelles de Santé.
This program covers over 80% of the population and has significantly improved access to healthcare, particularly in rural areas. By pooling resources and offering an equitable contribution structure, Rwanda has ensured that even low-income households can afford basic healthcare services.
Similarly, Ghana implemented its National Health Insurance Scheme (NHIS) in 2003. The scheme is funded through VAT, contributions from formal and informal workers, and donor support. Today, Ghana’s NHIS provides health coverage to millions, reducing out-of-pocket spending and improving healthcare outcomes nationwide.
Kenya has also made strides with its National Hospital Insurance Fund (NHIF), which serves as a pillar for its universal health coverage agenda. Initially limited to formal sector workers, the NHIF has been expanded to include informal workers, allowing broader access to healthcare services. Subsidized premiums for low-income households have further boosted coverage.
Zimbabwe’s planned NHI has drawn from these examples to establish a sustainable, inclusive, and transparent system. The integration of existing community-based health initiatives, such as the City of Harare’s program, into the national framework demonstrates a commitment to building on existing successes.
However, experts emphasize the importance of addressing challenges such as administrative inefficiencies, equitable resource distribution, and stakeholder buy-in to ensure the program’s success. By leveraging lessons from regional leaders like Rwanda, Ghana, and Kenya, Zimbabwe has a unique opportunity to develop an NHI that meets its citizens’ healthcare needs without overburdening them financially.
