THERE are renewed calls for the government to urgently review Zimbabwe’s Medical Aid Regulations, Statutory Instrument (SI) 330 of 2000, amid concerns that the framework no longer reflects current realities in the country’s healthcare financing sector.
Stakeholders say the more than two-decade-old law has failed to keep pace with economic shifts, changing healthcare delivery models and plans for a national health insurance (NHI) scheme, creating regulatory gaps that they argue are fuelling conflicts of interest, weakening accountability and limiting access to affordable care.
The SI operationalised medical aid societies more than two decades ago, establishing rules for their registration and operations.
However, the healthcare landscape has since undergone significant changes, including prolonged economic volatility, evolving service delivery models and ongoing discussions around the introduction of a national health insurance scheme.
Critics argue that the regulatory framework has not kept pace with these developments. One of the key issues raised is the expansion of some medical aid societies beyond their core mandate of risk pooling and financing healthcare into direct ownership and operation of clinics and hospitals.
Medical and Dental Private Practitioners Association of Zimbabwe president Johannes Marisa said clearer separation between funding and service provision was necessary to restore balance in the sector.
“Medical aid societies were established primarily to pool risk and finance access to healthcare services for their members,” he said.
“When the same entity becomes both the funder and the provider, there is potential for conflict of interest and market distortions.”
Marisa said private practitioners had raised concern over delayed reimbursements, tariff disputes and what they described as limited transparency in contractual arrangements.
“We need a system that is fair, transparent and sustainable. Independent practitioners must be able to operate without fear of exclusion and patients must retain freedom of choice.”
Some stakeholders have proposed structural reforms, including possible divestiture of medical facilities owned by medical aid societies to create functional separation between financing and service provision.
Under such proposals, medical aid societies would focus on funding, while healthcare providers — whether private, public or investor-owned — would focus on delivering services.
Health sector advocates say reforms to SI 330 of 2000 should align with broader plans to introduce a national health insurance scheme aimed at expanding access and improving equity in healthcare financing.
Itai Rusike, the executive director for the Community Working Group on Health, said fewer than 7% of Zimbabweans currently have access to medical insurance, a figure he described as inadequate to guarantee decent public healthcare.
“Raising domestic public funds is essential for universal health coverage (UHC),” he said.
“No country has made significant progress towards UHC without increasing reliance on public revenues.”
Rusike said strengthening domestic tax systems to expand fiscal space would be central to achieving UHC and urged the government to expedite the gazetting of the National Health Insurance Bill.
“We pray that the National Health Insurance Bill will be gazetted this year, given the parlous health situation and the funding gap left by the withdrawal of funding by the United States government and the inadequacy of the national health budget.”
He also called for clarity in the forthcoming Medical Services Amendment Bill, particularly around emergency treatment obligations.
He cited a recent case in which a faith-based private hospital allegedly refused emergency treatment to a security guard who was hit by a car near the hospital while reporting for duty, reportedly because he could not afford treatment.
“Since humanity, conscience and goodwill cannot always be guaranteed, this law needs to effectively cover health and emergency services,” Rusike said.
He stressed the need for clearer guidelines defining the State’s role in healthcare delivery and the circumstances under which responsibilities are delegated to local authorities, faith-based institutions, charities and private providers — including how such entities will be compensated.
Rusike further highlighted gaps in child healthcare services, noting that children are often treated in adult wards due to limited paediatric facilities, inadequate neonatal units and overstretched maternity waiting shelters.
“Children remain very vulnerable and this law needs to better cover their health needs beyond just the ‘child care’ mandate of the Ministry of Health.”-newdda
