adminPaidamoyo Chipunza Senior Health Reporter
As healthcare costs continue to rise in Zimbabwe, Government’s contribution towards the same remains low, posing a serious challenge to the sustainability of public services — a majority of which are funded by development partners. According to the Zimbabwe National Health Accounts Report for 2010, Government covered only 18 percent of individuals’ healthcare costs while the rest was paid for either by individuals themselves, donors or employers.
In fact, the report shows that individuals met the bulk of the costs, paying for at least 39 percent for them to access health services.
“The healthcare burden on households continues to rise from 36 percent in 2001 to 39 percent in 2010. Government funding has gone down from 39 percent in 2001 to 18 percent in 2010 while donor support increased from 4 percent in 2001 to 19 percent in 2010,” reads part of the report.
Health and Child Care Permanent Secretary Dr Gerald Gwinji acknowledged the fact that donor funding should complement local resources.
“It becomes a challenge when these (donors) becomes the major source of funding. It is unpredictable, always comes with some conditionalities in terms of use. For example, it may be directed to specific programmes or activities, and can be withdrawn at any time, bringing sustainability challenges,” said Dr Gwinji.
He said his Ministry was working on other initiatives for increasing domestic funding for health beyond the traditional budget.
According to the ministry’s policy brief on domestic financing produced in May this year, these proposals include taxing cigarettes, beer, wine and spirits with a potential to raise at least $20 million annually by 2022.
Government is also weighing its options on a once-off five percent addition to the existing fuel levy, which could raise about $14 million in a year — capital that could be invested for emergencies only such as road traffic accidents.
Other international examples proposed include earmarking either one or two percent of Value Added Tax (VAT) for health, which could raise between $100 million to $200 million in 2015 alone.
This initiative is projected to raise sufficient funds to cover all deficits in universal coverage of community, primary care and district services by 2030.
“The evidence and dialogue on the findings raise proposals to increase domestic health financing, with management capacities, systems and measures to use the resources more equitably and effectively,” reads part of the brief.
Government, through the Ministry of Public Service, Labour and Social Welfare is also working on introducing a National Health Insurance Scheme. The scheme is expected to be funded by deductions from all employees’ salaries.
Consultation fees at public health institutions range between $5 and $10, while actual costing by the ministry shows that it costs $74 to be treated at a district hospital and $16 at a clinic. The public sector is the largest health service provider in Zimbabwe but is prone to pressure resulting in overcrowding, drug stock outs, fatigue of health workers and long waiting lists for surgeries.
“Often, there are long queues to consult a doctor and when you eventually see the doctor, most prescribed drugs will not be in stock. If surgery is recommended, it might take months before it is performed,” said Mrs Rudo Mhangwa of Mhondoro.
Mrs Mhangwa said this forced patients to seek health services from private health institutions, whose costs were prohibitive for many.
In May last year, Government allowed general practitioners to charge patients at most $35 per visit and an average of $120 for specialists. Cost of surgeries range between $400 up to $30 000 depending on the procedure.
Of the 13 million people in Zimbabwe, only 10 percent (Association of Healthcare Funders of Zimbabwe) are covered by a health insurance scheme.
Private health insurance schemes cater for costs of treatment at both private and public health institutions.
“Our wish is to have a sound public health system, which is affordable, accessible and efficient to the generality of Zimbabweans so that we do not rely on private health institutions,” added Mrs Mhangwa.
Since 2010, Government has partnered with different development partners to pool financial resources with a view to accelerate some of the country’s initiatives towards achieving its targets under the Millennium Development Goals.
One of these funding mechanisms was the Health Transition Fund which ran between 2010 and 2015 and sought to address particularly MDG 4 on reducing child mortality and MDG 5 on reducing maternal mortality.
According to UNICEF, which was HTF’s fund manager, $158 million was raised in the past five years. Although great strides were made under HTF, UNICEF country representative Mr Rezza Hossain urged Government to assume a greater share of non-wage financing, saying dependence on external funding was not sustainable.
Mr Hossain said the current global economic challenges also affected donor’s ability to mobilise resources.
“This therefore calls for us to think outside the box and see how we can leverage domestic resources, re-look our priorities and expenditure mix, build back confidence and support the full operationalisation and implementation of the ZimAsset,” said Mr Hossain.
The HTF mechanism is coming to an end this year.
Acting director for policy development and planning in the Ministry of Health and Child Care Mr Stephen Banda said the National Health Strategy (2016-2020) which was expected to address some of the country’s funding initiatives should be ready by December.
He said development of the Zimbabwe National Health Financing Policy, which gives direction on how to fund the country’s health sector and the National Health Insurance Scheme, were also at an advanced stage.
Speaking at a recent media workshop held in Addis Ababa, Ethiopia, on the sidelines of the African Union conference on financing for development, AU Commissioner for social affairs Dr Mustapha Sidiki Kaloko said most African countries were reliant on donor funding — a situation he said disallowed ownership and sustainability of health programmes.
“How can you claim ownership of something that you did not pay for?” questioned Dr Kaloko.
He said while most African countries still needed outside financial assistance, they should strive to mobilise the bulk of resources domestically.
“Domestic funding cannot solve all problems in Africa but what we are saying is countries should come up with innovative ways of mobilising more funding for their programmes. The donor community will then come in to complement existing programmes,” he said.
Speaking at the same occasion, Global Fund to Fight Aids, Tuberculosis and Malaria executive director Dr Mark Dybul said efficient use of available resources was important in the whole discussion on domestic financing.
“It is not about how much money has been spent but it is about what that money was used for. It is about the effective use of the money,” he said.
According to the African Union Commission, in the last four years, African countries have increased their domestic resources to fight AIDS by 150 percent and Zimbabwe was cited as one of the countries doing well in domestic funding for HIV through the National Aids Trust Fund.
Speaking at the same AU meeting, UNAIDS deputy executive director Dr Luiz Loures said investment in health saves not only lives but also made business sense. He said in relation to HIV, for every dollar invested, a total of $17 was saved through avoidance of medication, hospitalisation, and human resources for care, among others.
Dr Loures said 30 million HIV infections and 80 million deaths were averted through investments done so far.
“Investing in health makes not only business sense but it is also good for the people,” he said.
Zimbabwe is a signatory to the April 2001 Abuja Declaration which recommends at least 15 percent of country’s national budget be channelled towards health. However, since adoption of the declaration the country has never surpassed the Abuja target with the highest allocation so far being 12,3 percent in 2011. Other allocations range between six and nine percent of the national budget.
These allocations fall far short of the World Health Organisation per capita recommendations of $34 as they range between $12 and $29.
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