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Table 4 Background on health care provision and financing in Zimbabwe

From: The political economy of results-based financing: the experience of the health system in Zimbabwe

The public sector is the main provider of health care services [19]. Health care in Zimbabwe is delivered through 1848 facilities, most of which are public health care facilities (the largest category being the rural district council-run primary facilities). The rest are non-profit and church affiliated facilities (referred to as mission facilities), private for-profit facilities and company operated clinicsa. Municipalities also fund and provide primary health care services in their areas. These health facilities are separate from those directly administered by the MoHCC. Local councils generate revenue through local taxes, levies and other fees. During the crisis, health financing collapsed, resulting in 0.02% of GDP in 2009 for MoHCC expenditure [20]. User fees picked up the gaps, rising from 23% in 1999 to 62% of total health expenditure in 200531. Over the same period, health insurance payments are reported to have collapsed from 20% to less than 1 % of total health expenditure. However, by 2010, out of pocket payments had reduced to 39%, which was still well above the 20% maximum level prescribed by the World Health Organisation [21]. In 2015, government expenditure on health as a proportion of total government expenditure was approximately 8%, an increase on previous years but still low for the region [19]. Household payments accounted for around 25% of total health expenditures in 2015, of which 95% were out of pocket. In Zimbabwe, 7.6% of all households incurred catastrophic health payments in 2015; the incidence of catastrophic health payments was highest among households in the poorest quintile [19]. Donor funds provided roughly a quarter of total health expenditure, according to the 2015 national health accounts data. However, pooled funding comprised only 7% of donor funding while non-pooled funding made up the bulk of funding [22] and 90% of external aid to the sector came from ten partners, which creates risks [23]. Estimated costs for a medium-scenario package of care were $94 per capita in 2018, as against expected public resources of $52 per capita [23]. There is evidence of internal pressure for increased public commitments to health – Parliament held up the 2018 budget until the health allocation was increased - however, it remains low, with only one third of the amount needed by the sector funded [24], at around $27 per capita. Health’s allocation as a share of total government budget has remained within the range of 7–10% since 2010 [24].
  1. aThere are 101 private health facilities and 87 mission facilities. Mission and private health facilities provide only primary and secondary care. Mission facilities are partly funded by the MoHCC through salary, administration and capital grants. 68% of services in rural areas and 35% nationally are delivered by mission facilities