MASHONALAND WEST, ZIMBABWE — When Dube was diagnosed with gallstones in 2013, Zimbabwe’s public hospital recommended surgery costing nearly US$4,000. She couldn’t afford it.
A friend suggested he go to Zambia, about 150 kilometers (94 miles) to the north. There, the friend said, the treatment would be cheaper.
Over the past decade, Dube has traveled to Zambia several times for medical treatment. His last trip took place in June. The treatment there is cheaper, she says, but the level of care is also much better than what she would get at home. Dubé asked the Global Press Journal to use his totem name, a symbolic representation of ancestral lineage, out of concern for Zimbabwe’s Patriotic Bill, which discourages criticism of the government.
In the 1980s, Zimbabwe had one of the best health systems in sub-Saharan Africa. But over the years, this glory has faded. A persistent economic crisis that has lasted for more than two decades has left the health care system scrambling to meet the needs of its population. Qualified healthcare workers have left in droves, lured by opportunities abroad. More than 4,000 health workers have left Zimbabwe in 2021 and 2022 alone, according to government statistics. At the end of 2022, Zimbabwe had around 1,700 doctors and around 17,200 nurses to serve a population of 15 million.
Just as healthcare workers are leaving the country, patients are also leaving the country.
Over the past decade, Zimbabweans have spent more than US$4 billion on cross-border medical migration. Every year, more than 200,000 Zimbabweans spend around US$400 million on specialist medical care abroad. India, China, Singapore and South Africa are the main destinations.
But an increasingly popular choice is neighboring Zambia. In April alone, the International Organization for Migration interviewed more than 260 people migrating from Zimbabwe to Zambia. When asked why they travel, 42% said it is to access better services, with health being the top priority.
Precise data is difficult to obtain, but anecdotal evidence from sources interviewed by the Global Press Journal, including border officials, indicates a growing trend, raising questions about Zambia’s ability to manage the influx and on the future of healthcare in Zimbabwe.
The choice of Zambia
Zambia and Zimbabwe have allocated almost the same amount to their health sector in 2024, even though Zambia is home to 4 million more people. With this budget, it is an unlikely alternative to the Zimbabwean health system. And in Africa, South Africa and Kenya are the main destinations for medical tourism.
But the border with Zambia is not far for many Zimbabweans, making the cost of travel low and the process of crossing the border generally simple. A person needs either a passport or a pass issued at the border for just US$1, says Morgen Moyo, assistant regional immigration officer at the Chirundu border post.
Even without papers, immigration officials sometimes let those seeking health care pass. “Zambians prioritize life,” says Moyo.
It’s not just about convenience. Zambia provides free primary health services, including basic treatment, preventive care, immunizations and maternal health care services, in line with the Zambia National Health Strategic Plan 2022-2026.
Although these free services are not available to foreigners on a long-term basis, they can access them in case of emergency within the first 24 to 48 hours in the country, says Dr. Kennedy Lishimpi, permanent secretary of the Zambian ministry’s administration of Health. Foreigners would have to pay for Zambian health care after this period.
In practice, however, Zambian health workers rarely charge foreigners, according to a 2019 study funded by the U.S. Agency for International Development, known as USAID.
“You wouldn’t want to see someone from Zimbabwe, for example, arrive in Zambia without access to a service and end up dying. It’s not good. In the same way, we expect our sister countries to do the same to their citizens when they are there,” says Lishimpi.
Dr Mwanza, a Zambian doctor who chose to use only his last name for fear of reprisals, says the availability of surgical and specialist services in Zambia is boosting medical migration. In Zimbabwe, these services are rarely available outside of major provincial and central hospitals. In 2019, for example, about 10% of district hospitals could offer basic surgical procedures, compared to 83% of provincial and central hospitals, according to an assessment by Zimbabwe’s Ministry of Health.
When Mary Chipfuvamiti’s son broke his arm in June, she said she chose a hospital in Zambia, about 93 kilometers from her home, over local options. She suspected that the X-ray machine at the local hospital would not work and that they would probably refer her to a private facility where an X-ray would cost her US$40.
“I only had $30 on me,” she said. In Zambia, the total cost was approximately US$12.50.
A case for Zimbabwe
Things have not always been this way in Zimbabwe. Before the country’s economy experienced a downturn, the country offered free health services in the 1980s to low-income people. Around 90% of the population falls into this bracket.
In the early 1990s, the government introduced user fees at public health facilities as part of austerity measures imposed on the government by the International Monetary Fund to reduce public spending. Currently, free health services are offered only to pregnant and lactating women, children under 5 years old and adults over 60 years old.
The economic crisis continues to strain what remains of the health system. Hospitals are faced with obsolete infrastructure. Shortages of medications and supplies in public health facilities are the norm.
And although Zimbabwe and Zambia have similar health budgets, Zimbabwe’s Treasury sometimes delays disbursement of funds, says Norman Matara, general secretary of the Zimbabwe Association of Physicians for Human Rights.
This was the case in 2021, when the Ministry of Health had only used 46% of its budget allocation for the financial year as of September due to late disbursement of funds, according to a 2024 status report from the Zimbabwe Coalition on Debt and Development, a non-governmental organization. organization that advocates for socio-economic justice.
“There is a gap between the money entered in the budget and what is received by health institutions,” explains Matara. The reasons include hyperinflation and exchange rate fluctuations, he adds.
Comparing health services between countries is unfair, says Donald Mujiri, spokesperson for Zimbabwe’s health ministry. “Each country has its standards and its prices. »
He does not think this migration of patients reflects badly on Zimbabwe’s health system. “We have all the services in the country, and they are adequate to serve the population,” he said, adding that people are free to seek treatment wherever they want.
Mujiri did not respond to questions regarding the late disbursement of funds.
The cost of the trip
These trips to Zambia come with challenges.
Dube remembers his travels along the bumpy Harare-Chirundu highway that connects the two countries, where every bump caused searing pain.
In 2019, six years after her first treatment in Zambia, she started experiencing severe pain. She went to a hospital in Harare for treatment, but a few months later the pain returned. At that time, a healthcare strike took place at home, forcing her to return to Zambia for treatment. Then, in 2023, Zambian doctors discovered that metal clips from his previous operation in Zimbabwe were piercing his liver. She returned to Zambia in January this year for corrective surgery and then again in June.
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Health care experts warn that such trips can be particularly risky for patients undergoing surgery. If surgery is performed in Zambia and there is no proper follow-up, complications can arise if doctors in Zimbabwe ignore previous procedures or tests, says Mukanya, a health expert working in a hospital Zimbabwean who chose to use his totem. fearing that speaking to the media could cost him his job.
In the event of a diagnosis error or professional misconduct in a foreign country, it is difficult to obtain recourse. “In most cases, you are helpless because you don’t know the (reporting) process and contacting a lawyer may require money,” he says.
Medical migration also comes at a cost to Zambia. The influx of patients complicates health care planning, leading to shortages of essential medicines and making it difficult to allocate resources efficiently, according to USAID. The agency’s report recommends that the Zambian government create a fee-for-service system to discourage foreigners from seeking free health care, but Zambian doctors do not appear to agree.
“Most health care providers surveyed said they would continue to provide services for free if a foreign patient was unable to pay,” according to the USAID report.
Lishimpi, the Zambian health ministry official, made no comment on the concerns raised by the report.
Dube, who is recovering at home, is unsure of the solutions. But she believes the Zimbabwean government must prioritize repairing her country’s health system. “I don’t know how we can best help our hospitals, but if there was another way, I think they would have to consider the health sector more than anything else, because we are talking about human life,” says -She.