Abstract
Health financing has increasingly become a much-debated concept when it comes to ensuring a healthy nation in recent years. Surprisingly, health financing towards attaining sustainable development has been given scant attention in the development discourse. As such, this calls for extending our understanding of health financing in the context of African countries, especially in the unique context of Zimbabwe. Given this information, this chapter focuses on the health financing challenges. Six health financing challenges were ascertained, that is, fragile economy; corruption; unanticipated health shocks; budget constraints; poor political commitment towards public health; and high-out-of-pocket payments. In order to deal with these serious health financing challenges, a plethora of recommendations were offered herein. The research outcomes of this study could help policymakers and practitioners.
TopIntroduction
Recently, there is growing consensus on the fact that SDGs cannot be efficiently and effectively attained in developing countries without healthy individuals. In this regard, it is necessary to mention that there is a dire need to finance health-related programs, initiatives, and projects so as to create an environment whereby everybody can access health facilities (Chitah, 2022; Doherty, 2019; Liaropoulos & Goranitis, 2015; Ma-Nitu, 2022). This is also captured in SDG 3 which captures to “ensure healthy lives and promote well-being for all at all ages”. This implies that health services must be accessed by all poor people even the financially marginalized members of society. In the Zimbabwean context, the provision of health services is guided by national-level governance frameworks in the form of the Constitution and the National Economic Plan. The National Economic Plan then feeds into the National Health Policy and the National Health Strategy, which govern the health sector. Implementation of all ministries' activities within Zimbabwe is guided by the Results Based Management (RBM) system, which was adopted in 2013 to ensure improved public sector performance and accountability. From the RBM framework, every year the Ministry of Health and Child Care (MOHCC) develops operational plans to coordinate all stakeholder activities required to meet the objectives outlined in the National Economic Plan and the National Health Strategy. Zimbabwe's health services are accessed through several platforms, including public facilities, non-profit-run facilities, religious/mission organizations, and the private sector (for-profit facilities). The public health sector is the major provider of health services in Zimbabwe and is comprised of the Ministry of Health and Child Care, Ministry of Defense, Ministry of Justice and Legal Affairs, Ministry of Local Government, Public Works and National Housing and Mission Health Services. The Poverty, Income, Consumption, Expenditure Survey (PICES) 2011/12 shows that 50.5% of the extremely poor and 43.3% of the non-poor access health through public facilities in comparison to 8% and 18.8% respectively that use private facilities (Zimbabwe Health Financing Strategy, 2017).
The free healthcare policy was put forward in the 1980s whereby the fee schedules were introduced in the early 1980s (Mhazo & Maponga, 2022). Incentives to collect fees for government health services are weak since they all go to the Consolidated Revenue Fund of the Finance Ministry. Few in the health sector believe that Treasury gives credit to ministries for the revenue they collect when considering what proportion of the estimates of expenditure to grant each year in the budget. Administrative costs of collecting fees in rural areas are high and exceed the revenue collected in some cases. More rigorous implementation of the existing fee schedule started with the advent of ESAP in 1990. There are six main sources of health sector financing in Zimbabwe: (i) the Ministry of Health and Child Welfare; (ii) other government departments; (iii) local government, including municipalities and rural district councils; (iv) donors and voluntary organizations, including the members of the Zimbabwe Association of Church-Related Hospitals (ZACH); (v) employers; and (vi) individuals, through both direct payments and private health insurance (Medical Aid Societies).Although significant progress has been made over the last few years, the country still faces a double burden of communicable and non-communicable diseases (Zimbabwe National Healthy Financing Policy, 2016). The top four causes of disability-adjusted life years (DALYs) in Zimbabwe are HIV/AIDS, lower respiratory infections, diarrheal diseases, and tuberculosis (TB). Life expectancy at birth is 59 for males and 62 for females and mortality between the ages of 15 to 60 years per 1,000 of the population is 385 for males and 288 for females and HIV/AIDS remains a significant public health problem in Zimbabwe (Zimbabwe National Health Financing Policy, 2016). The HIV prevalence for adults (15-49 years) has declined by 5.6% from 2011 to 15% in 2014 (UNAIDS, 2018). Mortality has also declined due to increased ART coverage which stands at 72% for adults and 44% for children.
Key Terms in this Chapter
Health Financing: It deals with a set of core financial functions that include revenue pooling, purchasing, raising, and policies with the aim to ensure universal health coverage in a specific country.
Out-of-Pocket Payment: It refers to the medical expense paid from personal coffers whether or not it is reimbursed.
Health Financing Strategy: It is the grand framework that captures the financial approaches to fund healthcare services with the purpose to ensure universal health coverage in a particular country.
Universal Health Coverage: This means that all individuals have the right to access high-quality health services despite their financial status.].
Sustainable Development: It captures the ability to address our current needs and wants without compromising the needs and wants of the next generation.
Risk Pooling: It describes a risk management strategy whereby a group of people whose medical expenses are put together so as to compute premiums.
Public Health Expenditure: This refers to financial resources provided by the government to cater for the provision of quality health services in a particular country.