It’s time to advocate for national health insurance

BY Johannes Marisa THE health sector in Zimbabwe has been facing numerous challenges which continue to threaten its viability in the face of ravaging outbreaks in the form of COVID-19, measles, monkeypox.

HIV is still wreaking havoc with many people testing positive to the deadly virus.

At least 60% of our citizens cannot access healthcare, a phenomenon which is quite unfortunate.

Many lives are being lost on a daily basis, yet better medical services can be offered to salvage the horrendous situation.

Medical access is now a pie in the sky in Zimbabwe as people are struggling on a daily basis to make ends meet.

Public health institutions have infrastructural standing, but the quality of service has been annihilated by worker shortages, lack of resources, maladministration, lack of motivation and general disregard of the health sector by policymakers.

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The Abuja Declaration of 2001 called upon all African governments to allocate at least 15% of the national budget towards the health sector if sound health delivery service is to be realised.

In Zimbabwe, the cost of living has miserably sky-rocketed, especially in the last three months and many people have been reduced to beggars.

Inflation is now nauseating, sitting at more than 140% against stagnant salaries that cannot even purchase half of breadbasket requirements.

Of note is the price of bread which has gone beyond the reach of many.

I wonder how boarding schools that pegged their tuition fees in local currency, are faring. Poverty is now at its worst in Zimbabwe.

The health sector has not been spared from the effects of the economic quagmire as healthcare workers are leaving Zimbabwe in droves.

There is high staff turnover from public health institutions, while worker morale is at rock bottom.

The healthcare workers cannot afford to send their children to school while the cost of health is beyond many.

Admitting patients in private health institutions is a nightmare as the charges are beyond the affordability of many.

Zimbabwe has a population of close to 16 million people, of which only about 10% are on medical aid cover.

With lack of disposable income in Zimbabwe, many citizens are vulnerable, thus putting their lives in danger.

Both morbidity and mortality have potential to balloon to unprecedented levels.

For real, medical access should be made easy and according to the World Health Organisation constitution of 1946, the highest attainable standard of health is envisaged as a fundamental right to every human being.

The right to health for all means that everyone should have access to the health services they need, when and where they need them, without suffering financial hardships.

Is this what is happening in developing countries like Zimbabwe, Zambia, Malawi, et cetera?

Is it not the right time to advocate for national health insurance (NHI)?

NHI is a financing system that is designed to pool funds together to provide access to quality and affordable personal health services to everyone based on health needs and irrespective of the socio-economic status.

There are usually no fee charges at the health institutions because NHI will cater for all the costs.

This entails that the health insurance will cover every citizen whether employed or unemployed, high or low-income.

The socio-economic status of members of the public will not influence the type of healthcare one receives, but will be influenced by the condition of one’s health.

Both public and private healthcare practitioners will be paid on exactly the same basis and the same standard of care is expected from both.

Zimbabwe is currently making use of two main health financing models, the private insurance and the out-of-pocket systems.

These models are not sustainable in poor economies where many people have insignificant disposable income.

The adoption of the NHI will at least move the nation towards universal health coverage. Every citizen deserves better value from healthcare spending.

As it stands today, healthcare has become a burden for almost everyone in Zimbabwe except for the elite who can fly outside Zimbabwe.

Some are flown to Canada, Singapore, the United Kingdom, Italy et cetera to seek medical attention, yet many cannot even afford to buy a month’s course of anti-hypertensive drugs.

The increased out-of-pocket payments are draining the disposable incomes of many Zimbabweans.

Those who boast of being on expensive medical aid cover are also feeling the heat as health service providers are demanding cash upfront because of delayed payment.

I think this is the time to consider NHI. A healthy nation has great potential for development.

Government should consider the merits and demerits of NHI. South Africa implemented it successfully, why not us?

•  Johannes Marisa is president of the Medical and Dental Private Practitioners Association of Zimbabwe. He writes here in his personal capacity.