THE health sector is being crippled by budget underutilisation, procurement challenges and stalled infrastructural projects that are threatening service delivery in the country, a new report has revealed.
A report by Transparency International (TIZ) titled, Trend Analysis Report: Procurement Performance in Zimbabwe’s Health Sector (2020-2024), revealed persistent challenges jeopardising health service delivery in Zimbabwe.
The report said the sector’s performance was dependent on transparent, efficient and accountable procurement processes.
“In an economically-constrained environment like Zimbabwe, the timely and cost-effective acquisition of essential medicines, equipment and services is not merely an administrative task, but a life-saving imperative,” TIZ said.
According to the report, the health sector has been struggling to fully utilise allocated budgets from 2020 to 2024, leaving 20,3% unspent in 2020, 22,8% in 2021, 10,4% in 2022, 5,5% in 2023 and 21,4% in 2024.
“The AG [Auditor-General] also flagged unreconciled direct payments and arrears in all years, with 2024 highlighting an unexplained US$3,1 million variance between Treasury and ministry records.
“Despite a temporary improvement in 2023, the issue resurfaced in 2024, showing that financial efficiency remains weak.”
The corruption watchdog said procurement planning remained a major concern for at least three years, while compliance breaches peaked in 2021 before gradually improving.
“The absence of approved procurement plans was a major issue in 2020, 2021 and 2022, when the ministry conducted procurement without valid annual approval.
“The situation slightly improved in 2023 and 2024, when the ministry obtained procurement authority and registered its evaluation and disposal committees. However, planning gaps persisted at provincial and district levels, suggesting incomplete compliance across the health system.”
TIZ said non-compliance with procurement regulations was most severe in 2021, when the Auditor-General recorded a peak in irregular purchases and unauthorised procurement.
“Compliance gradually improved thereafter, with rates increasing from 40% in 2020 to 73% in 2024; however, isolated breaches — especially in 2023 and 2024 — still occurred, including delayed tenders, overpayments and inadequate documentation for supplier contracts. Thus, although formal compliance improved, operational compliance remained weak,” it said.
TIZ said consistent documentation failure provided an environment where more serious non-compliance and corruption risks could continue unchecked.
“Weak internal controls and governance failures were repeatedly raised from 2020 through 2024. Issues such as lack of segregation of duties, under-banking and unsupported expenditures were noted particularly at Government Analyst Laboratory, Harare Dental Centre and Gweru Hospital,” it said.
Public health economist Tendayi Chipango said the health sector continued to mirror broader governance shortcomings.
“The health sector is not insulated from governance challenges; its performance is interdependent with the broader governance and public administration ecosystem.
“Persistent concerns remain regarding the rigidity and bureaucratic nature of procurement systems. The current structure of approvals, though presented as decentralisation, functions more as administrative delegation without genuine devolution,” she said.
She said minimal reference to Health Management Information Systems (HMIS) utilisation was particularly troubling.
“Strengthening and leveraging on HMIS could substantially improve documentation, accountability and evidence-based decision-making.
“The report does not reflect the expected efficiencies or system management improvements anticipated from results-based financing (RBF) implementation. The sustainability and institutionalisation of RBF gains require review,” she said.
Meanwhile, in a position paper on the 2026 national health budget, Community Working Group on Health executive director Itai Rusike said the prevailing macroeconomic situation had negatively impacted the health sector.
“Government allocations to the health sector have been affected by limited fiscal space, hence the government has failed to meet the Abuja target of 15% of the national budget to the health sector and ultimately the US$84 per capita World Health Organisation threshold in demonstration of its commitment to the health of its population.
“In 2021, the health budget allocation was 10% of the national budget, increased to 12% in 2022 and subsequently the 2025 budget for Health was about 10,2% of the total national budget,” he said.
He said about 90% of Zimbabweans lacked health insurance, forcing them to pay for services and medication with cash, contributing to high out-of-pocket costs, where spending is below regional and peer group averages, reflecting high rates of insurance.
“In per capita terms, out-of-pocket costs in health spending in Zimbabwe was US$10,66 in 2018 and Zimbabwe is among the four low- and lower-middle-income countries, with out-of-pocket costs spending representing less than 10% of their total health spending,” he said.
Rusike said the 2026 national budget must provide resources that enable oversight institutions to effectively execute their mandates, be more transparent and responsive in addressing societal concerns regarding such issues as corruption, tenderpreneurship and resource leakages.-newsda
