Hon. Kan’gombe, Context Matters in the NHIMA Debate
By Tobbius Chilembo Hamunkoyo
Hon. Kan’gombe, your comparisons between Zambia’s NHIMA and Rwanda, Kenya, Tanzania, and Ghana may look convincing on paper, but without context they mislead the debate.
Rwanda, with a population of about 14 million and a GDP of about $13.7 billion, collects more because it charges 7% of gross pay, not 2% of basic pay like Zambia, and aggressively integrates informal workers with heavy government and donor subsidies. Kenya, with 52 million people and a GDP of about $131 billion, collects 17 times more by charging 5% of gross pay and deliberately covering informal workers, while also receiving large state contributions.
Tanzania, with 67.5 million people and a GDP of about $86 billion, collects far more because contributions are set at 5% of gross pay matched by employers, effectively 10% per worker. Ghana, with 34.6 million people and a GDP of about $75 billion, funds its NHIS not mainly from worker contributions but through a 2.5% VAT levy, social security funds, and direct state subsidies, explaining why it generates 25 times more than Zambia. These differences highlight scale, structure, and financing models, not simply efficiency.
Zambia, by contrast, has 20 million plus people, a GDP of only $26.33 billion, and a narrow contribution model of 2% of basic pay limited largely to the formal sector, while over 80% of workers are informal. Despite this, NHIMA has paid out K4.7 billion ($180m) in claims since 2020, but arrears of over K950 million in 2023–2024 expose inefficiencies, late Treasury transfers, and weak claims verification. More money without reform will only expand these problems.
Your proposed fixes, diverting 1% of VAT, raising sin taxes, or bailouts, are band-aid solutions.I am sure you know that VAT is volatile, sin taxes are unreliable, and bailouts only delay reforms.
The real solution lies in broadening the revenue base, integrating informal workers, strengthening claims audits, and introducing transparent governance. Hon. Kan’gombe, the debate Zambia needs is not about who collects more, but who manages better. Until NHIMA fixes its structure, comparisons to Rwanda, Kenya, Tanzania, and Ghana will remain misleading.
Let NHIMA fund government facilities only so that their capacity is enhanced to have adequate medical supplies and equipment for public medical care. Private medical facilities should deal with private insurances.