The National Health Insurance Management Authority (NHIMA), led by Director General Michael Njapau, today presented its operations report to the Committee on Health, Community Development, and Social Services at Parliament. The report highlighted progress, challenges, and plans aimed at enhancing access to health services across Zambia.
NHIMA revealed its commitment to expanding services to underserved rural areas by accrediting new healthcare facilities in districts that currently lack access. This initiative seeks to ensure nationwide availability of NHIMA services. Additionally, the Authority has accredited 52 public mini hospitals to bring the scheme closer to communities, particularly in remote regions.
In an effort to optimize the benefit package offered to members, NHIMA announced amendments that came into effect on January 1, 2025. The changes include the removal of cosmetic services or restricting them to public healthcare providers, which have lower reimbursement costs. Furthermore, the Authority is working on a differentiated benefit package that will allow members to contribute at varying levels based on the services they wish to access.
However, NHIMA raised concerns about several operational challenges. The Authority cited instances of Ministry of Health staff referring patients to private healthcare facilities where they work, resulting in increased costs to NHIMA as private facilities are reimbursed at higher rates compared to public institutions.
NHIMA also highlighted the financial strain caused by a lack of capital injection from the government since its inception in 2019. The Authority has relied solely on 10% of collected contributions to sustain operations, with no additional funding from the Treasury to support its activities.
Meanwhile, the Zambia Ophthalmology Society (ZOS) appealed to NHIMA not to eliminate eye health services from its benefit package, despite the financial constraints faced by the scheme. ZOS President Kangwa Muma emphasized that the solution lies in a comprehensive restructuring of NHIMA’s management and the implementation of the National Health Insurance Scheme (NHIS). He urged NHIMA to address its challenges with a rational and professional approach through constructive dialogue rather than cutting essential services.
NHIMA’s presentation underscores its efforts to expand access to healthcare while grappling with financial and operational difficulties. The call for collaboration between stakeholders and the government remains critical to resolving these issues and ensuring the sustainability of Zambia’s National Health Insurance Scheme.
NHIMA covering both public and private providers will always be problematic and unfair to the majority poor. Let those attending private hospitals carry separate health insurance. People who attend private hospitals can afford private insurance outside of NHIMA.
This system must be restricted to and only cater for primary health care. Cosmetic therapy shouldn’t be part of it at all. Private institutions have always abused the NIHMA; another conduit for organised theft. They sometimes surcharge the Authority even claim when the services were not offered. It is a blank cheque.
Mini Hospitals Meaning clinics ???
Also why no mention of the intended increase of contribution from Net wage to gross wage
this is going to affect a lot of us
I’m asking whether the medicines for diabetic and BP patients are not covered by NHIMA? On 100%?
Employees of NHIMA can’t find a sensible solution to its woes. It’ll be easier to implement user fees or localized schemes as done before. NHIMA was targeted at workers, no wonder it initially sat at the Ministry of Labour and unions were the main stakeholders. Now that it’s embraced everyone its model must definitely be changed. These are the consequences of rushing matters.
Further, people without any business acumen are appointed to run these important institutions merely on political patronage. Apart from being loyal to the party in government what else make these people’s CV? So far we have seen that this man is fond of wrong appointments. Now he’s relying on image builders from Kenya to explain away his failures. It’s a disaster