OPINION | Why Zimbabwe needs a subsidised healthcare system

A health worker at Harare's Wilkins Infectious Diseases Hospital (AFP/Jekesayi NJIKIZANA)

By Dr Gift Risinamhodzi

Ahead of the 2023 elections, the opposition Citizens’ Coalition for Change (CCC) presented its manifesto for the 2023 elections. As a doctor, I was particularly interested in their health policy and how it compares to the current situation and other alternatives.

The CCC proposed implementing a universal healthcare system, where healthcare is available freely for everyone at the point of use. Anyone unwell can access a healthcare facility and get help without paying fees or charges. This sounds like a noble and ideal goal, but is it feasible and sustainable? How would it be funded and managed? What are the potential benefits and drawbacks of such a system? In this article, I will try to answer these questions and offer my opinion on what kind of healthcare system Zimbabwe needs.

The current system: free in theory, costly in practice

According to the current policy, healthcare in Zimbabwe is supposed to be free at the point of care for all citizens. However, this is not the reality on the ground. Due to factors such as shortage of funds, lack of political will, corruption, mismanagement, and inefficiency, the public health sector is severely under-resourced and understaffed. As a result, people seeking healthcare often have to pay for various services and supplies that the government should provide. For example, if someone needs an operation, they must buy all the consumables required for the surgery, such as sutures, dressings, antibiotics, and saline. These costs can be prohibitive for many people, especially people with low incomes and those who do not have ready cash or insurance.

The current system is, therefore, unfair and ineffective. It creates a gap between what is promised and what is delivered. It disadvantages low-income people and those who cannot afford to pay for their care. It also breeds resentment and distrust among the public towards the government and the health sector. It undermines the quality and accessibility of healthcare for all.

The proposed system: free for all, but at what cost?

The CCC’s manifesto promises to change this situation by introducing a universal healthcare system that is free for all at the point of use. This would mean that no one would have to pay anything for any service or treatment they receive at a healthcare facility. The government would cover all the costs of providing healthcare to everyone.This sounds like a progressive proposal but raises some serious questions. How would the government fund such a system? Where would the money come from? How much would it cost? How would it affect other sectors of the economy? How would it ensure quality and efficiency? How would it prevent abuse and misuse?

To answer these questions, we can look at some examples of countries that have implemented similar systems or tried to do so. One of the most successful and well-known cases is the National Health Service (NHS) in the United Kingdom, which offers free healthcare to all residents at the point of care. However, even the NHS has its challenges and limitations.

The NHS’s budget alone is over US$180 billion for a population of 67 million. This means that each person costs about US$2,686 per year on average. This is a massive amount of money that has to be raised through taxes and other sources of revenue. Even then, the NHS still faces funding gaps and shortages that affect its performance and quality. Moreover, because the system is free for all, it also encourages overuse and wastage by some people who seek unnecessary or excessive care. This puts more pressure on the design and reduces its availability and efficiency for those who need it.

Another example is the United States of America (USA), which is known for having one of the world’s most expensive and unequal healthcare systems. The USA spends about US$3.8 trillion on healthcare annually, about 17% of its GDP. However, despite this massive expenditure, millions of Americans still lack access to affordable and quality healthcare. Most Americans rely on private health insurance or pay out of pocket for their care. Those who cannot afford insurance or face high deductibles or copayments often delay or forego care altogether. This leads to poor health outcomes and disparities among different groups of people.

The USA has tried to reform its healthcare system by introducing Obamacare (the Affordable Care Act) in 2010, which aimed to expand coverage and reduce costs for millions of Americans. However, Obamacare has faced many challenges and criticisms, such as legal battles, political opposition, technical glitches, rising premiums, and limited choices. It has also failed to achieve universal coverage, as about 28 million Americans remained uninsured as of 2019.

These examples show that implementing a universal healthcare system free for all is not easy or cheap. It requires a lot of resources, planning, management, and regulation. It also involves trade-offs and compromises among different stakeholders and interests. It may not be the best or most suitable option for every country, especially those with limited resources or facing other pressing issues.

The Alternative System: subsidised for all, but with some contribution

I believe that Zimbabwe needs a different kind of healthcare system that is more realistic and sustainable. I propose a subsidised healthcare system, where healthcare is provided at a low and affordable price, but everyone also pays something for their care. The only exceptions would be children, the retired, and people with disabilities, who would receive free care. Everyone else would pay a small fee for each service or treatment they receive, depending on their income and ability to pay. This would help cover some healthcare costs and reduce the burden on the government.

This system would have several advantages over the current or proposed methods.

First, it would make everyone responsible and accountable for their health and care. It would encourage people to seek preventive and primary care rather than wait until they are seriously ill or injured. It would also discourage people from abusing or misusing the system by seeking unnecessary or excessive care.  Second, it would generate revenue for the health sector and improve its financial sustainability. This system would allow the government to allocate more funds to other sectors of the economy, such as education, infrastructure, and security.

Third, it would improve the quality and efficiency of healthcare by creating a competitive and transparent market. It would allow people to choose from different providers and facilities based on their preferences and needs. It also incentivises providers to offer better services and outcomes to attract and retain customers.

Of course, this system would also have some challenges and drawbacks. It would require a robust and reliable system of collecting and managing fees and subsidies. It would also need a strong, independent regulatory body to monitor and enforce quality standards and ethical practices. It must ensure that no one is denied or discriminated against based on their ability to pay or other factors. However, I believe these challenges can be overcome with proper planning, implementation, and evaluation. This system would be more suitable and beneficial for Zimbabwe than the current or proposed systems. I believe this system would offer a fair and effective way of providing healthcare to all.

Healthcare is one of the most important and contentious issues in any society. It affects everyone’s well-being, dignity, and rights. It also reflects the values and priorities of a nation. Therefore, it is essential to have a clear and coherent vision of what kind of healthcare system we want and need.

The CCC’s manifesto offers one vision of a universal healthcare system free for all at the point of use. However, this vision is not feasible or sustainable for Zimbabwe. I propose an alternative vision of a subsidised healthcare system that is affordable for all but with some contribution from everyone. This vision is more realistic and desirable for Zimbabwe.

I hope this article has stimulated debate and discussion on this vital topic. I invite you to share your thoughts and opinions with me and others. Together, we can shape the future of healthcare in Zimbabwe.


Dr Gift Risinamhodzi is a Zimbabwean Doctor working in the United Kingdom. His greatest passion is unleashing the full potential of Primary Care