NHIMA: An excess to Zambia’s health service delivery that must be abolished – Part I

[By Brian Muwanei Kabika]


A good and prosperous economy thrives on an organised, well-funded and functioning health care system. In the absence of this, it is almost impossible to have an economy that meets the demands of the population such as the creation of employment.

In providing health care services, it is the sole duty and responsibility of a government to provide the best heath care service to its people, no matter how costly it may be. This is because it is the citizens that contribute to socio-economic development of a nation through their skills, innovations and labour.

Additionally, it is the citizens that establish governments through the Constitution and so, no citizen should plead for medical care. No citizen should go to a hospital or health facility and be told that Panadol or any other medication required for their treatment is not available.

This article will, therefore, discuss and analyse whether the ‘New Dawn’ Government requires to keep the role that National Health Insurance Management Authority (NHIMA) is currently playing in Zambia’s health care system or completely do away with it.

To someone who may lack critical thinking, NHIMA may seem to be attractive and the greatest thing that has ever happened to Zambia’s broken and ailing health system. However, this is far from the truth. Although it is a baby of the government (Patriotic Front government to be precise), NHIMA is not any different from a private insurance company incorporated under Patents and Companies Registration Agency and providing health insurance cover to its clients.

It can be recalled that the proponents of NHIMA rode on the ignorance of the public and their arrogance to bring NHIMA into existence through the National Health Insurance Act No. 2 of 2018 of the Laws of Zambia. The proponents of NHIMA did not entertain opposing views because the majority of the stakeholders were against the idea of establishing NHIMA as a health delivery system. Various reasons were advanced for the objection, but they are not a subject of the discourse of this article.

Operations of NHIMA

There is nothing unique that NHIMA does that cannot be done by any of the government entities or Ministry of Health (MoH) allied institutions. Presently, NHIMA simply collects monthly employer and employee’s contributions from persons and institutions registered with NHIMA and pays to institutions that are accredited to it (hospitals, clinics and pharmacies).
Collection of contributions by NHIMA can be done by the Zambia Revenue Authority (ZRA) which, in turn, can channel the same to Zambia Medicines and Medical Supplies Agency (ZAMMSA) for onward procurement of medicines and other medical equipment.

If ZRA was to collect the contributions, the existence of NHIMA would become irrelevant, thereby saving the costs on expenses such as staff emoluments, office accommodation that NHIMA is incurring.

ZAMMSA under Section 5 of the Zambia Medicines Medical Supplies Agency Act No. 9 of 2019 of the Laws of Zambia appears to have an adequate legal framework that may accommodate some of the responsibilities that NHIMA is currently undertaking.

Inequality in Health Care Service Delivery Initially, and before NHIMA became an institution, Zambians were told by the government officials from MoH that the monthly contributions that the members of NHIMA would make would benefit the poor, and that shortages of medicines and lack of equipment would be a thing of the past.

Alas, this is not what is happening. Health facilities still have no medicines, and no proper and reliable medical equipment. Poor people are not allowed to access services of NHIMA.
If one is not a member, they cannot access the services of NHIMA. This means that the poor people who go to these hospitals that have no drugs simply pick up prescriptions and look for money to buy medicines.

What is even astonishing is that both members and none members of NHIMA all use same pharmacies, but if one is not a member, they cannot get medicines that are under NHIMA yet they are accessing a government health facility.

In an ideal situation, there should have been no membership for NHIMA so that the monthly contributions that are made by employers and employees go to purchase drugs and equipment that benefit the poor and the rich. This is what is expected because membership to NHIMA is statutory.


There is need to re-examine the existence of NHIMA in light of the interest of the poor Zambians who are not members of NHIMA. In the next article, I shall further critically analyse if NHIMA is needed and suggest the method of terminating its life for the betterment of public good.

For any comments, please email: muwanei.kabika@gmail.com/SM

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