BUSINESS WRITER 12 September 2017
HARARE – Despite the dwindling formal sector that has traditionally been
the anchor of the country’s economy, government, through the ministry on
Health and Child Care, is determined to soon introduce a National Health
Insurance Scheme (NHIS).
Stakeholders have, however, warned that introducing the scheme at a time
when the economy is highly-informalised would be futile given the
difficulties government is currently facing in taxing the informal economy
whose activities are not included in the country’s gross national product
and gross domestic product.
The Zimbabwe Revenue Authority has been struggling to get the fluid
informal sector to pay taxes.
“Government has committed itself to introducing a National Health
Insurance Scheme in order to ensure that all our people have access to
affordable health services,” said Health minister, David Parirenyatwa in a
speech read on his behalf by his deputy, Aldrin Musiiwa, at an Association
of Healthcare Funders of Zimbabwe conference in Victoria Falls last week.
“It is our hope that such a scheme will be established soon. It is
important that such a scheme should benefit not only those who are
employed and so able to contribute to such a scheme but those in the
informal sector and those who are unemployed. As government, our priority
is to protect vulnerable members of society,” he added.
Government’s eagerness to provide universal health access comes as the
healthcare sector is barely being able to keep its head above the water.
For example, of the $300 million allocated to the health sector in 2015 by
the State, through Treasury, nearly 70 percent of it was gobbled up by
salaries leaving 30 percent for drug, equipment purchases and other
Past experience also shows that the ministry has hardly received full
amount of what it is allocated in the National Budget.
The introduction of the NHIS also comes at a time when the health sector
is experiencing a major decline in membership due to the shrinking formal
sector with membership at 1,3 million in a population of around 16,5
Stakeholders in the sector have also been at loggerheads over tariffs for
many past years.
“Medical aid societies say that if health service charges are higher than
health funders can afford, then the health funders may either have to
increase membership subscriptions or limit the benefit payable, resulting
in payment shortfalls that the member has to meet.
“This is a situation we have faced for a while now, as healthcare service
providers and funders have failed to agree on fees. Each side gave its
strong arguments in support of their preferred fee structures.
“Healthcare funders say they cannot afford the increased charges of
doctors and other service providers without increasing membership
subscriptions or premiums and that they do not believe their members could
afford such increases.
“Service providers would naturally like their charges to be paid in full
by funders. Patients too would like funders to pay the charges in full,
although they would also not want their medical aid subscriptions
increased,” Parirenyatwa said.
HFoZ chief executive officer, Shylet Sanyanga expressed hope that a new
tariff would soon be in place following a scientific study into the thorny
“The scientific study on tariffs was commenced on July 4, 2017. It is due
to be completed October 4, 2017. The exercise was agreed to by AHFoZ and
ZiMA (Zimbabwe Medical Association) and was given a nod by the minister of
Health and Childcare. The objective was to come up with a scientifically
recalibrated tariff that is relevant to the economic environment within
which the healthcare ecosystem exists, as well as to restore fee
relativity,” said Sanyanga.
Meanwhile, government’s plans to establish a Medical Aid Societies Act,
which seeks to, among other things, provide for the establishment of a
Regulatory Authority for medical aid societies to register the medical aid
societies and control and coordinate their functioning in a manner that
would complement national health policy and protect the interests of
members of medical aid societies.
Allaying fears abound in the sector, Parirenyatwa said: “Some of you may
be apprehensive about the introduction of such an authority. I would like
to assure you that, while regulation does imply rules that have to be
complied with and penalties for non-compliance, the proposed regulatory
authority is not intended to be an oppressive overseer of medical aid
societies, but rather an agent for the creation of a conducive environment
for all players in the ecosystem.
“A law cannot be passed for the sole objective of punishing. We are
cognisant of the fact that any drastic action taken against a medical aid
society, such as suspension or deregistration, will adversely affect the
patients belonging to that medical aid society.
“Our desire as a ministry is that such drastic action should not be used
as the first option in resolving issues of compliance. As the old saying
goes: `You do not burn an entire homestead because you have seen a snake
therein.’ It is in our interests as government to nurture what we have,
not destroy it.”
The medical aid societies paid out to service providers a collective $324
365 937 in 2016 compared to the 2016 ministry of Health budget allocation
of $330 million from the National Budget, highlighting the important role
they are already playing in the country’s health sector.