Struggles for Healthcare Entrepreneurship in Zimbabwe

The expected quality of healthcare in Zimbabwe is aimed at providing accessible, affordable, and effective healthcare services to all individuals within the country. However, it is important to note that Zimbabwe’s healthcare system has faced numerous challenges, including limited resources, infrastructure deficiencies, and changes in tax regimes, continuous changes in local currency, an unstable economy, changes in regulatory policies, and a shortage of medical personnel. These challenges have adversely affected the overall quality of healthcare in the country.  This article intends to close the gap between ideal and reality as far as this issue/matter is concerned.

Healthcare systems should strive to ensure that services are accessible to all individuals, regardless of their geographic location or socioeconomic status. This includes having healthcare facilities and services available in both urban and rural areas. Efforts should be made to minimize out-of-pocket expenses or financial assistance for vulnerable groups to ensure equitable access to healthcare. Healthcare services should be affordable and within reach of most of the population. In developing countries, such as Zimbabwe, healthcare facilities in rural areas must be fully functional using natural resources such as solar energy, and drilling of boreholes for clean water supply and sanitation. Well-trained, with enough healthcare professionals, including doctors, nurses, and allied health personnel, are essential for delivering high-quality care. Investments in medical education, training, and retention strategies are crucial to address the shortage of healthcare professionals in Zimbabwe. Efforts should be made to ensure a consistent supply of affordable and high-quality medications, as well as robust systems for drug procurement, distribution, and quality control.

The general provision of healthcare facilities across the world is constrained by economic, social, technological and political setbacks. A study by the World Health Organization (WHO) found that low- and middle-income countries spent, on average, only 6% of their GDP on healthcare, compared to 12% in high-income countries. This limited funding hampers the ability of healthcare facilities to invest in infrastructure, equipment, and staffing. A review by the World Bank highlighted the potential of digital health technologies to improve healthcare access and quality, but also noted the challenges in scaling up these innovations, especially in resource-constrained settings.

Drawbacks for Zimbabwe’s Healthcare System:

Procurement processes: Local suppliers for healthcare facilities in Zimbabwe heavily depend on foreign manufacturers because there are no functional industries that manufacture medical consumables and medical equipment in the country. The process of importing medical consumables and equipment requires foreign currency whereas practicing healthcare providers are required to accept both currencies. Furthermore, there is also a high demand for foreign currency from local domestic suppliers. During 2020-2023, an auction system was implemented to access foreign currency. The process was not a walk in the park for both big players and small players. The process could take months for the foreign currency to be released from the central bank. The small players, such as small business practices or individuals, would face difficulties in accessing auction systems. Auction participation required certain criteria or thresholds, such as minimum transaction sizes or documentation requirements, which can pose barriers for small players with limited resources or capacity. In the year 2024, the new currency ZIG was introduced with effect on 5 April 2024. The new currency also comes with its monetary policy. To access foreign currency the auction system has been replaced by a refined interbank foreign exchange market under a willing-buyer-willing-seller (WBWS) trading arrangement. All these changes will require changes on the administration side and accounting systems and come with a cost.

In the public sector at some of the large hospitals, in terms of procurement procedures for medical consumables and equipment, the Surgeons/Physicians are not involved nor consulted for specifications in the procurement process yet they are the end users.

Price Regulatory: The Association of Healthcare Funders of Zimbabwe, popularly known as AHFoZ, is the only recognized, skilled, and credible representative body for the medical funders industry in Zimbabwe. There are the ones with the mandate of controlling and regulating medical tariffs that are being used in the country. Zimbabwe has experienced an unstable economy over the years, so sometimes the AHFoZ takes so long to adjust their tariffs and many of the service providers end up charging copayments for their patients and some are not charging depending on where you get the service. AHFoZ’s role as a regulatory body in the healthcare funding sector has been compromised as the healthcare providers are partially following their guidance. For example, medical health funders are now approaching health care providers to be their preferred service provider for their members. The selection is also not fair to existing players, to the new players, and to the members as well. To the members when you pay for your monthly subscription fees the healthcare funder is not obliged to choose the service providers for anyone. In this country, the healthcare funders are doing it because they do not want their members to pay copayments so they channel their members to the ones that they have an arrangement with. This will compromise the quality of service because they are not guaranteed if that service provider has the experience and skills to manage that condition. For example, when someone has problems with the eyes from a layman’s perspective you will not be sure whether the member has retina or cornea issues.

Conflicts of Interest: Over the years the healthcare funders have been indented into the territory of the healthcare providers. Health funders now have shares in some of the major clinics, dental, pharmacies, and many other health facilities. The young players will find it difficult to compete and penetrate the market.

Unavailability of Service in the Public Sector: Because of the unstable economy that the country has experienced over the years, the healthcare sector has also experienced a brain drain for medical professionals from public healthcare.  For those who are not on medical aid or not funded to access healthcare services in public hospitals, there are many drawbacks that they face and for some surgeries, you are required to go on a waiting list for the operation to be performed due to the limited healthcare professionals and strained resources.

But it’s not all doom and gloom, there is hope! Here are a few ideas for African entrepreneurs in the health industry:

a) Develop Affordable Medical Devices and Technologies:

• Identify unmet needs in the Zimbabwean healthcare system and design innovative, cost-effective medical devices and technologies.
• Focus on solutions that address common health challenges, such as diagnostic tools, medical equipment, or telemedicine platforms.

b) Establish Primary Healthcare Clinics and Mobile Clinics:

• Set up primary healthcare clinics in underserved rural and urban areas of Zimbabwe.
• Implement a sustainable business model that combines affordable patient fees, government subsidies, and social impact investments.

c) Enhance Supply Chain and Logistics:

• Identify inefficiencies in the medical supply chain and logistics in Zimbabwe.
• Develop innovative solutions to improve the distribution and availability of essential medicines, medical equipment, and supplies.
• Facilitate the import and distribution of high-quality, affordable medical products.

d) Provide Healthcare Financing Options:

• Explore innovative healthcare financing models, such as microinsurance, community-based health insurance, or crowdfunding platforms.
• Increase access to affordable healthcare services by providing financial assistance or payment plans for patients.

e)  Invest in Healthcare Infrastructure and Capacity Building:

• Partner with the government or healthcare institutions to invest in the construction, renovation, or expansion of healthcare facilities.
• Provide training and skill development programs for healthcare professionals, including nurses, community health workers, and laboratory technicians.

Partnerships in the healthcare sector in Zimbabwe can be successful by considering several key stakeholders. The government alone will not be able to fix the problems without the involvement of the private sector. Here are some success factors for partnerships that can be considered

Successful partnerships are built on a shared vision and common goals among the partnering entities. It is essential to align the objectives of the partnership and ensure that all parties involved have a clear understanding of the desired outcomes. The vision must be centered on providing quality healthcare services in the country and not self-centered. In Zimbabwe, African entrepreneurs need to engage in partnerships and collaborations with healthcare providers, clinics, hospitals, and other healthcare institutions. By working together, entrepreneurs can gain valuable insights, access existing infrastructure, and ensure that their solutions align with the needs of the healthcare industry. I was inspired by the initiative by Tsitsi Masiyiwa, Co-Founder of the Higherlife Foundation. She has collaborated with Mbuya Nehanda Maternity Hospital to resuscitate the maternity ward. This kind of collaboration will bring sanity to the management of the systems and the culture. Furthermore, it brings confidence and trust in public hospitals when patients know that the government is also working with the private sector. Some of the patients even prefer to go to other countries for surgeries because locally it will be expensive or they are not trusting the system.

Partnerships in the healthcare industry can be facilitated and encouraged by a regulatory and policy framework that is receptive such as MDPCZ, HPA, ZIMA, AHFoZ, and other regulatory bodies that have direct influence in the healthcare sector. Collaboration, creativity, and sustainability are encouraged by well-defined rules, structures, and guidelines, and these factors can make partnerships more successful. Monitoring and feedback mechanisms should be in place to assess the partnership’s effectiveness and ensure that it remains aligned with its goals. African entrepreneurs can develop innovative solutions for supply chain management in the healthcare sector. This can involve creating efficient systems for the procurement, storage, and distribution of medical supplies, medicines, and equipment, ensuring their availability in healthcare facilities. At the same time, the government must also relax the tax brackets that encourage the resuscitation of the sector.

What can entrepreneurs learn from Zimbabwe’s medical system?

To come together and request for the health stakeholders to partner together is not going to be an easy walk as some of the problems are deeply rooted both in government and in the private sector. In the Private sector instead of the healthcare funders entering into service providers’ territory, they must work together with the medical regulatory bodies such as ZIMA, MDPCZ, HPA, and AHFoZ :

The AHFoZ number must desist from issuing AHFoZ numbers to individuals but must encourage group practicing for the service providers to open a practice.

• This will reduce pressure on paying the service providers. Currently, healthcare funders have thousands of service providers that they are supposed to pay every month and it’s not sustainable in the long run.
• Will bring sanity to the sector
• Promoting good quality for patient healing

Patients’ information is not accessible easily thus the proposal is to establish a central healthcare dispensing system by private entities to improve the quality of healthcare. Here are some key advantages of implementing such a system:

• Improved Coordination and Efficiency: A central healthcare dispensing system would enable private entities to coordinate and manage patient care more effectively. By consolidating patient information, medical histories, and medication records in a central location, healthcare providers can avoid duplication of services, reduce errors, and ensure better continuity of care.
• Avoidance of Medication Duplication: With a centralized system, private healthcare entities can track the medications prescribed to patients across different providers. This helps prevent the unnecessary repetition of prescriptions and reduces the chances of patients receiving multiple doses of the same medicines.
• Enhanced Patient Safety: Centralizing healthcare dispensing can contribute to improved patient safety. A comprehensive system that tracks medications and patient information can help identify potential drug interactions, allergies, and contraindications, reducing the risk of adverse drug events and ensuring safer healthcare delivery.

Conclusion

To bridge the gap that is currently there in the healthcare system in Zimbabwe there is a need for serious collaboration between government institutions, healthcare providers, non-governmental organizations, and other stakeholders in advancing the quality of healthcare in Zimbabwe. Effective governance, reviewing of policy development, and regulatory frameworks are essential for monitoring and improving healthcare standards. The policies that must be formulated are supposed to be centered toward patients and have a heart of compassion. The government institute must pay their employees competitive salaries to retain professional employees and there is a serious need to revisit the administration department to ensure that the resources and the infrastructure are well maintained and managed. The government must look into ways of resuscitating the medical manufacturing industry to reduce the demand for basic medical consumables.