FRANCIS LUNGU, Lusaka
FOR those who follow international politics, they would be familiar with the debate involving what is commonly known as Obamacare or the Affordable Care Act.This was one of former United States President Barack Obama’s signature domestic achievements.
The Obamacare, which was signed into law by Mr Obama in 2010 to ensure that all Americans have access to affordable health insurance, pitted the Republicans against the Democrats in the United States.
In fact, the bill passed the United States Senate without a single Republican vote. In Congress, all the Republicans voted against the bill although 34 supported it.
There have been attempts by current United States President Donald Trump to entirely repeal the Obamacare despite indications that it is growing in popularity.
Anyhow, that is for the United States.
Back at home, there is the National Health Insurance (NHI) Act which President Edgar Lungu recently assented to.
But the process leading to that was clouded with controversy.
The view advanced by those against the National Health Insurance Act No. 2 of 2018 is that it is just aimed at overstretching the population financially through their tax contributions.
The contributions to the NHI would be by way of monthly deductions from the formally employed workers who, according to labour statistics, are around 800, 000 against the estimated country population of 16 million.
Economist Lubinda Haabazoka believes that the National Health Insurance Act is a good way of financing the health system in Zambia. His concern, though, is that it will create another body larger than even the National Pensions Scheme Authority (NAPSA), according to his understanding.
“We have only about 800,000 formally working employees with a population of around 16 million people. Yet, again, 800,000 people have been called upon to fund health care services for 15.2 million people,” Dr Haabazoka wrote online.
He says the country should also take into account that only about 500,000 of these formally employed workers are paying pay as you earn (PAYE) with some paying as high as 37.5 percent.
In 2017, when the bill was first announced, Insurers Association of Zambia (IAZ) executive director Nkaka Mwashika said the country was ready for health insurance.
“If the pricing is structured well, and options are offered for basic and advanced cover, then such a model would provide an affordable, reliable and quality health service option for all Zambians,” Mr Mwashika said.
Issues of tax are contentious anywhere, and very few people like the taxman.
Felix Mwenge, a researcher at the Zambia Institute for Policy Analysis and Research (ZIPAR), is one of those who offered their views on National Health Insurance.
“NHI is one way of financing a country’s health care services using mandatory financial contributions by citizens as a primary source of funds. NHI works in the same way as private health insurance except that the former is established by the Government and obliges all eligible citizens to contribute. Currently, Zambia finances public health care through appropriations from the national budget based on various sources of government revenue,” Mr Mwenge said.
“One main reason for considering NHI to finance healthcare is that current financing to health is insufficient.
“[But] it is also important to realise that the NHI may have implications on the general well-being of the economy. The main source of NHI funds, according to the bill, will be employer and employee contributions through payroll deductions. This means NHI will primarily rely on the formal sector, which accounts for only 16 percent of total employment.
“It is well known that Zambia already has a narrow tax base, which limits general revenue collection. As the base for NHI will be even narrower, the rates may have to be very high in order to raise enough resources, thus potentially overburdening citizens already bearing numerous other taxes.”
Understandably, no one favours paying tax.
But President Lungu explained that the whole essence of the NHI Act No. 2 of 2018 which he signed into law on April 25, 2018, is to provide equitable and quality health care for all.
President Lungu, after signing the bill into law, noted that bringing into force the NHI is in line with one of the Patriotic Front (PF)’s most significant socio-economic reforms since it took power in 2011.
He said the NHI Act was actualising the country’s long held aspiration to provide quality universal health care.
“Zambians have yearned for a robust, equitable and quality health care system that ensures equality for all without imposing high financial costs on citizens,” President Lungu said.
He said the healthcare reforms the country had embarked on through the Act were aimed at achieving the dream Zambians have held for the past 54 years.
“Since independence from British colonial rule in 1964, successive Zambian governments have sought to provide universal access to quality health care, but this has been hampered by a lack of health insurance, which currently stands at a meagre five percent of the population,” he said.
The President said the low 0level of health insurance cover is unacceptable and that the country could not have low healthcare utilisation rates on account of lack of health insurance by the poor majority.
“We can’t have limited access to health on account of one’s economic status in society,” the head of State said.
He said through the National Health Insurance Act, under the guiding principles of solidarity and inclusivity which are strongly embedded into the law and no Zambian will ever have to suffer to access health care because they have health insurance.
He said despite the opposition from some quarters when the bill was proposed to Parliament in 2017, the NHI Act in force must now work towards the full implementation of the law to ensure that 95 percent of Zambians that have no health insurance cover are insured.
“This progressive law can no longer be viewed with partisan lenses for it is about promotion of life cover illnesses. It is about social justice because it brings about unprecedented equity in the provision of health care. This is an important moment not just for those of us in the PF who have delivered on this great promise, but for all Zambians,” the President said.
President Lungu said the attainment of universal health coverage is the lighthouse that is guiding the PF government health reforms agenda and through the NHI Act, saying he is confident of significant delivery on the health manifesto promises.
“We embark on this progressive, yet ambitious, health reform agenda as guided by the PF’s manifesto, which is premised on being a party that is concerned with the livelihoods of the people, particularly the majority poor. Zambia cannot develop without healthy citizens, and so access to quality health care is a top priority,” President Lungu said. With the assurance from the head of State on the viability of the National Health Insurance Act, Zambians will now wait for the fruits of the new law to address many of their challenges in accessing good health services.
FRANCIS LUNGU, Lusaka