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Health Insurance Disparities Expose Low Income Families

By Tariro Guwira


Mutare- As she was preparing for the rainy season, Mary Chadzingwa (50) a subsistence farmer in Munyarari Village under Chief Zimunya still recalls how she was involved in an accident on her way to the farm on an ox-drawn scotch cart.


On this fateful day in November 2019, Chadzingwa woke up early as usual and left for the farm in an ox-drawn scotch cart.


On her way the scotch cart hit a big stone in the middle of the road and overturned and

Chadzingwa was thrown out of the scotch cart and fell into the bushes.


She had a severe leg fracture and was rushed to the nearest clinic.


Chadzingwa was referred to Victoria Chitepo Provincial Hospital in Mutare (formerly known as Mutare Provincial Hospital), about 25 kilometers from Munyarari Village, for treatment.


But she failed to make it to the referral hospital because she didn’t have money to settle for the bills that she would incur at the hospital.


Chidzingwa narrated her ordeal in the midst of pain and struggled with the fracture, she told Post On Sunday that, the bills were her most worrying factor.


“When I was told to go to the referral hospital, l thought of the medical bills and other expenses, and decided to let ignore and endure the pain,”


“The excruciating pain kept me awake every night, to a point l got used to it and forced myself  to walk using it in that state of pain.”


To reduce the excruciating pain, Chadzingwa says she would buy painkillers from a local store.


Chadzingwa, a widow and a mother of a 12-year-old son, said she needed 4 000 Zimbabwean dollars (Z$) (USD49) for her to get treatment


“There is nothing much l can do at the moment until l raise about Z$ 4000 to go for further medical examination at the referral hospital,” she said.


Chadzingwa is part of the 92 percent of health uninsured Zimbabweans.


About 8 percent of the southern African nation’s population are on health insurance and the rest rely on out of pocket spending.


Out of Pocket (OOP) expenses are the costs of medical care that are not covered by insurance and that one needs to pay for on their own.


The Total Consumption Poverty Line for an average family of five is Z$17 244 (USD215), according to the Zimbabwe National Statistics Agency.

Grace Muradzikwa


Government and other insurance players have made significant expansion of social protection programs under various schemes like Accident Prevention and Workers compensation offered by National Social Security Authority (NSSA) and other benefits.


In Zimbabwe, a number of people are in the informal sector and  are low paid  and vulnerable including children, women, men, ethnic minorities and persons with disabilities.


The uninsured various groups of people have insufficient health insurance coverage or none at all and have to use out of pocket money to cater for medical bills and basic living expenses including food, housing.


Spending OOP money comes with a burden for those who cannot afford private health institutions as they will have to use public health facilities that are less equipped from human resources to medicine.


Health insurance monthly subscriptions in Zimbabwe vary from Z$4 000 (USD49) up to Z$19 000 (USD234) which is beyond the reach of many.


John Mundamumwe (40) from Chikanga, a high density suburb in Mutare, said he was being insured by Commercial and Industrial Medical Aid Society (CIMAS) medical aid but he ditched in 2019 after losing his job.


“I could not keep up with the monthly subscriptions. Now that I am in the informal sector having medical insurance is a luxury,” says Mundamumwe.


Chadzingwa told this publication that her situation could have been different if she had medical insurance cover.


“I would not have been enduring this pain since that day If I had medical insurance,”says  Chadzingwa.


Tambudzai Jongwe, National Social Security Authority Chief Social Security officer speaking at a journalism mentorship virtual program in September stated implications of one not having social security coverage drive people into poverty.


“There is an increased risk, with people falling into poverty as they use OOP (money) and to cater for contingencies when they do not have any social security cover is highly impossible, “states Jongwe.


Jongwe explains that many Zimbabweans have been left vulnerable due to social security exclusion.


“The majority of Zimbabweans are without cover against life cycles such as old age, invalidity, health care and injury (at work). Absence of insurance cover against these risks does not only trap them in endless poverty but leads to social exclusion as well”.


Grace Muradzikwa, Commissioner of the Insurance and Pensions Commission speaking at the same virtual meeting in August revealed that there has been low confidence in subscribing to any insurance mainly owing to loss of value as a result of hyper inflationary legacy issues.


“In a recent Baseline Survey by the commission, we revealed, only 34% of the population in Zimbabwe have insurance of some sort, 76% of which are in respect of funeral assurance policies,” said Muradzikwa.


Joseph Kauzani, National Association of Non-governmental Organizations, Manicaland  eastern region coordinator in  an interview said the high health insurance subscription fees has seen most people preferring  spending their money buying groceries other than subscribing to any health insurance.


This is due to low disposable income and subscribing to any of the insurance becomes luxury though necessary.


“At this rate it is almost impossible for the majority to survive on their pockets because almost everything is now priced in USD (at a time) monthly salaries have been eroded by hyperinflation,” says Kauzani.


Walter Chikanya, Zimbabwe Community Health Intervention Research programs manager, speaking at a Southern African Development Community People’s Summit in August highlighted that OOP expenses for medical needs is an infringement of basic human rights.


“There is reduced government control and costly medical services where there is no universal health insurance. The limited access to services by ordinary citizens shows that the system is not fair for everyone,”highlighted Chikanya .


Lloyd Dembure, a Zimbabwe focal person for Partnership to Inspire, Transform and Connect the HIV Response, in an interview at the sidelines of a universal health coverage (UHC) provincial call meeting in September said there was need to strengthen domestic health financing and abide by the 15 percent Abuja Declaration if nations were to move towards universal health coverage.


“Zimbabwe is behind in meeting the Abuja Declaration of allocating 15 percent of the Government’s budget towards health and as you see the country’s population on medical insurance is decreasing and it shows that we are doomed somehow, “says Dembure..


OOP spending plays a significant role in financing the health system in Zimbabwe, according to The World Bank 2020 report.


Per capita health allocation in Zimbabwe is below the World Health Organisation recommended threshold of US$86 (Z$7 000).


Zimbabwe’s per capita allocation, which had, in 2017, improved to US$57 (Z$4 600) is estimated to have sharply declined to US$21 (Z$1 707) in 2020.


Harare based economist Prosper Chitambara, in late 2019, at a socio-economic rights meeting said over the years, social spending has not been able to match the social deficits in the economy leaving the area of humanitarian assistance to international partners.


“Under these circumstances it is imperative to adopt a human centered approach to development and a pro poor inclusive national budget should be adopted,” he stated.


Chadzingwa who is still suffering from the leg fracture said she is hopeful that she will raise enough money to have her medical examination at Victoria Chitepo Provincial Hospital in Mutare.


“l hope l will be able to cover all expenses and have my leg examined. Perhaps I will be able to walk properly,” says Chadzingwa, holding back tears.