By TROY MUKUPA
Lusaka – The National Health Insurance Management Authority (NHIMA) has been grappling with numerous challenges, including financial sustainability. In an exclusive interview, Mr. Zanga Musakuzi, a renowned Pharmacist, Entrepreneur, Innovator, and CEO of Medsearch Zambia, shared his insights on the fundamental differences between an insurance scheme and a public health fund.
Mr. Musakuzi highlighted the importance of distinguishing between an insurance scheme and a public health fund, explaining that an insurance scheme provides specific, limited coverage based on member contributions. In contrast, a public health fund operates on a broader scale, aiming to provide universal health services without tying benefits to individual contributions.
“The primary distinction between an insurance scheme and a public health fund lies in the scope and structure of benefits,” Mr. Musakuzi emphasized. “An insurance scheme provides specific, limited coverage based on member contributions, whereas a public health fund operates on a broader scale, aiming to provide universal health services without tying benefits to individual contributions.”
Mr. Musakuzi cautioned that the absence of defined limits on benefits has disrupted the delicate balance between contributions and payouts, leading to outflows exceeding inflows. “This is unsustainable and risks transitioning NHIMA from an insurance scheme to a public health fund,” he warned.
Using an apt analogy, Mr. Musakuzi illustrated the challenge facing NHIMA: “The current scenario is akin to managing a stream where water trickles in slowly while people drink without restraint. Without controlling how much water can be drawn, the stream risks running dry. Similarly, NHIMA faces the challenge of ensuring its financial resources can sustain its growing obligations.”
To address this challenge, Mr. Musakuzi recommended implementing annual or monthly coverage limits, defining covered services, introducing tiered benefits, providing special provisions for vulnerable populations, enhancing revenue streams, and strengthening governance and monitoring.
In a call to action, Mr. Musakuzi stressed the need for policy-makers, stake-holders, and the public to collaborate and support reforms that will ensure NHIMA’s sustainability and success in the long term.
“NHIMA’s financial struggles underscore the need for reform. By redefining its structure to incorporate limitations and focusing on its role as an insurance scheme, NHIMA can regain its footing. Policymakers, stakeholders, and the public must come together to support reforms that will ensure NHIMA’s sustainability and success in the long term.”