BY TENDAI MAKARIPE
ACROSS Zimbabwe, millions of citizens—particularly the elderly and marginalised—find themselves excluded from the country’s health insurance system.
This systemic problem leaves many vulnerable to financial ruin when they fall ill. Edward Chitsike, a 62-year-old diabetic retiree from Dambudzo village near Sese Business Centre in Chivi District, Masvingo Province, epitomises this predicament.
Sitting outside his mud-brick home, he clutches a pile of medical bills he can no longer afford to pay.
“I worked as a farmhand my whole life,” he says.
“Now that I’m retired and can’t get insurance, every illness feels like a death sentence.”
In addition to managing diabetes, Chitsike suffers from diabetic neuropathy, which causes persistent pain and numbness in his legs. His condition requires regular medication, check-ups, and kidney function tests to monitor for diabetic nephropathy, a serious complication of diabetes. His modest earnings as a farmhand were insufficient to afford medical aid coverage.
Unfortunately, his three children, reliant on low-paying odd jobs in and around Masvingo, cannot afford the premiums required to secure a health insurance policy for their father.
Chitsike does not qualify for state assistance because the Medical Service Amendment H.B.1 of 2022 stipulates that only people over 70 are entitled to health care and medical assistance from the state.
Widespread Exclusion
Edward’s case is far from unique.
From urban workers to retirees in remote villages, countless Zimbabweans face exclusion from health insurance coverage due to age discrimination, administrative inefficiencies, and high premiums. This exclusion undermines their Constitutional right to healthcare and impedes Zimbabwe’s commitment to universal health coverage (UHC) under the Sustainable Development Goals (SDGs).
Zimbabwe’s National Development Strategy 1 (NDS1), which runs from 2021 to 2025, emphasises the need for equitable and affordable healthcare services to promote economic development and improve livelihoods.
The strategy prioritises UHC, highlighting the importance of expanding health infrastructure, ensuring accessibility for all, and fostering public-private partnerships in healthcare delivery. However, the exclusionary practices currently rampant in Zimbabwe’s health insurance sector directly contradict the goals outlined in NDS1.
The lack of inclusive insurance options undermines the government’s ability to achieve these targets, perpetuating inequalities that NDS1 seeks to eliminate. Health insurance, as defined by the World Health Organisation (WHO), promotes equity by enabling the healthy to subsidize those who fall ill and by maintaining low prepayments accessible to the poor.
Zimbabwe’s current health insurance system fails to meet these principles, perpetuating inequities.
Age Discrimination in Health Insurance
A significant barrier is the cut-off age for health insurance coverage. Most insurers refuse to enroll individuals over 59, forcing the elderly to pay out-of-pocket or forgo care entirely.
“We are considered high risk,” says Chipo Gunda, a 63-year-old retired housemaid from Marondera’s Dombotombo suburb. “
After leaving my job, I had to rely on my meager savings to cover medical costs because no insurer would accept me. It feels like being abandoned when you need help the most.”
This discriminatory policy affects a demographic that requires more medical attention. Article 25 of the Universal Declaration of Human Rights guarantees everyone adequate healthcare without discrimination.
Zimbabwe’s practices also contravene regional treaties like the African Charter on Human and Peoples’ Rights, whose Article 16 obligates member states to ensure access to healthcare and protect public health.
“By failing to provide equitable healthcare access, Zimbabwe undermines its constitutional commitments and breaches international frameworks aimed at UHC and health equity,” says human rights lawyer Zororai Nkomo.
Neighbouring South Africa demonstrates a more inclusive approach, offering specialised health plans for senior citizens despite higher premiums. However, Zimbabwe’s Association of Health Funders argues that excluding the elderly protects contributors’ funds.
“As people age, their health declines, requiring more care,” says AHFoZ CEO Shylet Sanyanga. “Joining earlier allows for consistent contributions, preventing unsustainable premiums in old age.”
Analysts argue that policymakers must introduce age-inclusive health insurance policies to ensure the elderly are not excluded from coverage. Economist Mike Zvandasara said establishing a national health insurance scheme specifically for senior citizens, with subsidies provided by the government, could alleviate the financial burden on this vulnerable demographic.
“This approach has been successful in neighboring South Africa and could be tailored to Zimbabwe’s context, ensuring affordable premiums for retirees while maintaining the financial sustainability of insurance providers,” he said.
“Additionally, public-private partnerships could incentivise insurers to create plans that cater to low-income and rural populations by offering tax breaks or grants for inclusive health schemes.”
Administrative Inefficiencies and Systemic Failures
Administrative failures compound these challenges.
Investigations reveal that insurers often suspend medical aid accounts despite timely payments, leaving patients unable to access care. “I paid on time, but the hospital told me my account was inactive,” says Tatenda Munyaka, a frustrated policyholder.
These inefficiencies violate Section 76 of Zimbabwe’s Constitution, guaranteeing healthcare access. Dr. Shingi Marange, a healthcare policy analyst, attributes the problem to outdated systems.
“Real-time digital record-keeping is crucial,” he said. “Delays in updating transactions unfairly penalise patients and erode trust in the system.” Dr. Marange advocates comprehensive reforms, including digital record systems, risk-pooling mechanisms, and subsidized plans for low-income populations to achieve UHC.
Tech analyst Fortune Nyamusa added that administrative inefficiencies must also be addressed by adopting modern digital systems for real-time account management.
“A centralised database accessible to healthcare providers and insurers would reduce errors and ensure patients can access care without unnecessary delays,” he said.
“Training for insurance personnel and hospital administrators on the effective use of these systems would further enhance service delivery.”
Penalising Frequent Users
Another troubling practice is increasing premiums for frequent users of health insurance, effectively penalising those who fall ill.
“Why should we be charged more for using our insurance?” asks Caroline Matema from Rusape. “This defeats the purpose of having coverage.”
The essence of insurance is to pool risk. Penalising frequent users discourages care-seeking, undermining health outcomes and the insurance model. Additionally, some Zimbabwe’s premiums, which often exceed $100 per month, exclude low-income and rural populations.
Group discounts for corporate clients widen this disparity, leaving the uninsured—especially in rural areas—to choose between healthcare and essentials like food.
“Many in our community can’t afford health insurance,” said village head Rodwell Kufandada Musonza of Goromonzi.
“Affordable rural options are essential.”
Economist Benedict Marufu adds, “Economic instability raises operational costs, forcing insurers to rely on corporate clients. Subsidised rural schemes, like those in Botswana, could address these disparities.” To combat the high premiums and rural exclusion, the government could introduce community-based health insurance (CBHI) models in underserved areas.
These schemes allow individuals and families to pool resources locally, with additional funding provided by government subsidies or development partners. CBHI programs have proven successful in other low-income countries, offering affordable coverage while promoting community ownership.
The Path Forward
Zimbabwe’s exclusionary practices hinder progress toward UHC and SDG Goal 3 on good health and well-being. Addressing systemic barriers is critical to achieving equitable healthcare access. Policymakers must consider reforms such as subsidised rural schemes, inclusive policies for the elderly, and administrative modernisation to ensure no one is left behind.
