To allow NHIMA to lapse into bankruptcy is to sleep-walk into collective suicide.
By Dr. Chitalu Chilufya.
Lusaka, January 18 – Letting NHIMA collapse is sentencing Zambians to permanent ill-health, poverty and eventual death. Allowing NHIMA to sink and drown, is sentencing a nation to a slow painful death; a betrayal of the aspirations of achieving Universal Health Coverage that is aimed at ensuring that all Zambians, for the first time in our lifetime, access quality insured healthcare services without suffering financial hardship, increasing the quality of health outcomes, reducing morbidity and mortality, and ultimately, eliminating inequality and poverty arising from ill health.
Also Read: Dr. Chilufya commends government’s movement of NHIMA back to MoH! Says the decision is a correct and highly progressive move; critically vital as an initial step to realign NHIMA to its original design and purpose as an innovative health care financing strategy to propel the country’s UHC!
If NHIMA is to die, the latent economic dividends wrought out of a productive and vibrant citizenry are lost forever. It is unfortunate that the financing and solvency situation at NHIMA has deteriorated to levels where the Scheme is unable to meet its financial obligations, as and when they fall due, particularly the claims.
This, however, should have been expected, given the structural constraints of NHIMA on revenue collections, currently pegged at 2% of Basic Income, split 1% between employer and employee.
The current NHIMA financing mechanism is inadequate to meet the needs of keeping the Scheme sustainably solvent, and it was expected that key reforms would be implemented after two years of NHIMA’s creation. Sadly, five years down the line, there have been no reforms on NHIMA financing arrangements, and what we see today is a result of policy, strategic and management inaction.
The 2022 NHIMA Actuarial Valuation, which is publicly accessed by all, warned that if nothing was done to reform the NHIMA financing model, NHIMA would be insolvent by 2024. And true to these warnings, the Scheme is now insolvent because nothing has been done to correct the situation by those in whose hands this national jewel has been entrusted.
It is time for serious policy and strategic introspection on what we want to achieve collectively as a people particularly where access to health is concerned. If allowed to collapse due to continued policy inaction, Zambia would have eroded all the dividends gained and progress made so far towards achieving Universal Health Coverage and the Vision 2030.
Allowing NHIMA to collapse is akin to Zambians willfully choosing ill health over wellness; squalor and poverty over wealth; and death over life. We must all come together to forestall this national pending, but avoidable, calamity. Because when history is recorded, posterity will judge our generation harshly and rightfully so. This must not happen under our watch!
What then should be done? The following are the key policy steps that must urgently be implemented to salvage NHIMA:
1. Immediately address the governance failure at NHIMA by resconstituting the Board to bridge the gap between management and policy makers. NHIMA is collapsing under the watch of the board and their failure is reflecting badly on otherwise competent technical staff in management.
2. Equally, the reconstituted board must ensure that management implement a solid contribution and membership expansion program to increase compliance levels.
3. Bail out NHIMA with a one-off deficit financing, for say one year, to immediately plug the hole in outstanding claims. To avoid recurrence of this scenario, we need to trigger immediate financing reforms.
3. Implement the December 2023 Tripartite Consultative Labour Council Resolutions that unanimously agreed to support government’s proposal to move the NHIMA contributions from Basic Income to Gross Incomes. This will not only raise additional income but will also ensure that employers contribution avoidance is curbed. Triangulation with other institutions that collect contributions will be an obvious mode of checking compliance.
4. Introduce a Statutory Mandatory Minimum Contribution for both the Formal and Informal Sector to ensure that the NHIMA collections do not fall below an acceptable minimum. This is the global practice in the implementation of such schemes.
5. NHIMA Capital Injection and Appropriation for Operations: The NHIMA reports show that government has not provided the needed Capital Injection and appropriation as stipulated in the Act. This is an anomaly that must be corrected if the Scheme is to serve its public role.
6. Invest in Public Service Delivery; We can do this by ensuring public hospitals have adequate human capital, comprehensive laboratory and diagnostic services, and sufficient drugs and medical supplies. This will ensure that demand for services drift from the private to the public sector. NHIMA must contribute to the drug fund at ZAMMSA to ensure availability of safe and efficacious drugs for ALL.
7. NHIMA should standardize the prices for services for both the public and private sector to contain costs. The Quality Assurance & Accreditation Department must double down in monitoring over servicing risks from private sector partners, who, otherwise, are key to the UHC agenda.
Further, the sustainability of NHIMA lies in ensuring that demand for curative healthcare services are reduced through investment in health promotion and preventive healthcare interventions. NHIMA must forge a stronger partnership with the Ministry of Health and the media to empower people with knowledge to prevent Non Communicable Diseases such as:
1. Hypertension, with the common consequence of cerebrovascular accidents, commonly called strokes. These cases are common and have contributed to the rise in mortality or expensive clinical care, through prolonged hospital stays.
2. Diabetes.
3. Cancers.
4. Chronic respiratory disorders.
Also Read: Prescription for Progress: Zambia’s Policy Cure Lies with Dr. Chitalu Chilufya! Dr. Chitalu Chilufya, the former Minister of Health, has been honored with the prestigious Zambia Medical Association (ZMA) Lifetime Achievement Award for 2024. Zambia’s ailing development needs policies that put its people first, not foreign interests.
Further, NHIMA must work with the Ministry of Health to eliminate common infectious diseases that account for high outpatient attendance and expensive inpatient stay, culminating in higher claims. A case in point is the rise in Malaria cases will put a strain on the NHIMA funds. Yet, if NHIMA worked with the Ministry of Health and the National Malaria Elimination Programme, in funding Indoor Residual Spraying and other preventive interventions, huge savings would be realized.
The last five years of NHIMA have proven beyond doubt that if properly governed, managed and supported, access to quality insured health for Zambia is possible in our lifetime. It is prudent, therefore, that government seriously looks into the NHIMA situation and urgently institute reforms needed to save the Scheme to save the lives of Zambians.
Government must seriously look into the NHIMA situation to fix only that which is broken. Policy makers must urgently institute reforms needed to preserve and improve on those parts that are functional because we should not throw out the BABY with the proverbial bath water.
Universal health coverage is only sustainable under the auspices of a viable health care financing mechanism!
NHIMA MUST BE SAVED; NHIMA SAVES LIVES!
About The Author: Dr. Chilufya, a PF presidential candidate, is a public health physician, Mansa Central Member of Parliament and former Minister of Health who led the radical transformation of the Zambia national health system in pursuit of Universal Health Coverage.
About Our Advocacy: Woodpecker’s Digest provides in-depth analyses and commentary on issues of national importance, alongside articles on personal development and health. We believe journalism can be a force for socio-economic change.
About Our Advocacy: Woodpecker’s Digest provides in-depth analyses and commentary on issues of national importance, alongside articles on personal development and health. We believe journalism can be a force for socio-economic change.
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