Africa-Press – Zambia. SINCE the early 1990s, successive Zambian governments have considered introducing a Social Health Insurance (SHI) scheme aimed at removing economic barriers for citizens to access basic health care.
By 2012, a consultation process commenced to establish the SHI. It gained momentum over the following few years and was enacted in 2018 and spearheaded by then Minister of Health and former Republican President.
The passage of the health insurance scheme was undoubtedly a very important historical development and marked a huge leap for the country in this direction in achieving universal health coverage (UHC) and quality service delivery. It also affirmed the nation’s pursuit of innovative health financing to support robust and resilient health systems.
The history of Zambia’s health care system
Before the establishment of the National Health Insurance Management Authority (NHIMA), the country’s health care system was based on a mix of private and public provision.
However, the vast majority of the population (85 percent) lacked access to any formal health care, and relied instead on traditional healers and self-medication.
The government and donors where the two biggest sources of health expenditure in Zambia, accounting for about 80 percent of total health expenditure. The government health budget was also very low, at about one percent of GDP or less.
This meant that service provision was very poor, and there was a lack of trained personnel and basic medical supplies. In the late 1990s, the situation began to improve when the government introduced a number of reforms to the health sector.
This included increasing the health budget to about 2.5 percent of GDP, and introducing a number of new policies and programs aimed at improving access to health care.
This included; The intention was to improve the quality and efficiency of the sector, and to reduce waiting times and provide a greater variety of choice to the population. These policies have proven difficult to implement, however, and their effects are controversial.
Challenges faced before NHIMA
Zambia underwent a period of health sector reform from 1993 to 1998. The reform attracted substantial support from the World Bank and other bilateral donors.
While significant achievements were made with respect to decentralisation, increased accountability and donor collaboration, the reform stalled in 1998 without having achieved its objectives, largely because of the handling of hospital reform and the civil servants in the health sector.
With about 88 hospitals in that period, historical legacy from the colonial and post-colonial eras had left the country with an expensive and skewed hospital structure that was rapidly deteriorating and very difficult to reform.
With the referral system not functioning at peak: higher-level hospitals only provided a higher level of care to their immediate catchment populations than what was available to the population in general.
The reality was thus far from the vision of equity of access to cost-effective quality care. Zambian doctors even left the country or where concentrated at the highest referral levels in two provinces, leaving the lower levels and most of the country in the hands of expatriate doctors.
Resources where scarce in the government or the private systems to maintain the current hospital infrastructure and the situation was set for further deterioration unless radical decisions were taken and implemented, hence, the introduction of a new health insurance handled by “NHIMA.
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It was ntroduced as a system of risk-sharing between the government and private providers, and by providing incentives for private providers to participate.
Considering that these health reforms are a political high-risk zone and if the problems are to be dealt with, the Zambian planners must, together with the politicians, work to create a broad national consensus for understanding the situation, its urgency, and the limited options for forward action.
The introduction of NHIMA
NHIMA is an autonomous body mandated by the government to administer the National Health Insurance Scheme (NHIS). Government had established the National Health Insurance Authority under Section 4 of the National Health Insurance Act No. 2 of 2018.
The establishment of NHIMA coincided with the government’s decision to provide universal health insurance to all Zambians. Therefore, NHIMA was aimed to provide high quality products, affordable prevention, treatment, rehabilitation and palliative care services for all Zambians, in line with the government’s vision.
Since then, the Board and Management of NHIMA have worked to operationalise the National Health Insurance System and source to provide funding to meet the government’s health care goals.
Under the scheme, every Zambian is eligible to access a health card which entitles them to free health care services at any public health facility. The scheme is financed through a mix of general taxation and contributions from the formal sector.
Objectives and challenges
The introduction of NHIMA was an answer to the woes faced in the Zambian health care system. NHIMA came with lots of changes to the health care system in the country and an application of change management is very vital.
A few objectives were established to deal with the many issues that encompassed the system. Some of the objectives are; However, the scheme has been facing a number of challenges which have hindered its effectiveness. These challenges include:
Change management and recommendations
The Project Management Institute (PMI), defines change management as “a formal process and set of tools for controlling changes to a project or product.
” Change management is a process that helps organisations deal with the consequences of changes to their products, services, or processes.
It is designed to help organisations control the changes that they make to their products, services, or processes, and to ensure that the changes are made in a controlled and safe manner. Some of the recommendations to deal with challenges and control processes in the system;
Conclusion
The expectation of an effective health insurance system is its ability to bridge the gap between the poor and rich in terms of access to health care, more so like in the case of the Covid-19 pandemic, there seemed to come on board a classless and less segregative health system that served everyone so long they were Zambian citizens – Everyone infected would either go to the University Teaching Hospital (UTH) or Levy Mwanawasa Teaching Hospital and face the same medical care and facilities for alCl.
If the challenges discussed here can be curtailed, and recommendations thereof considered; the objectives would be met and an effective health care system established for good, and would continue to improve in the long run. This, dear citizens, is part of
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