Reshaping Healthcare Financing – Part I – The Mast Online
[By Brian Muwanei Kabika]
In today’s article, I will try to explain how the Zambian government funded its health care delivery system. In doing so, I will examine the roles of the Ministry of Health (MoH), the Zambian Medicines and Supplies Agency (ZAMMSA) which was previously known as Medical Stores Limited (MSL) and National Health Insurance Management Authority (NHIMA).
I will also compare the roles of NHIMA and ZAMMSA in the health care delivery system in Zambia. This will be followed by a discussion of the reasons and method of realigning the life of NHIMA for the betterment of the public good and a conclusion will be made.
Health care financing
Since 1964 and possibly even before that, Zambia has relied solely on taxpayer resources (including levies, fines, etc.) to finance its provision of health care. The tax that citizens pay to the Zambia Revenue Authority (ZRA) is in turn funneled to the government to purchase drugs, medical equipment, other medical supplies, build health facilities and train health personnel. health.
The church has also been a mainstay in delivering health care to the population, especially in the deep rural areas of the country where the central government may not have a visible presence.
Cooperating partners, non-governmental organizations and some people also have the lion’s share in ensuring that the citizens of this republic have access to decent medical care.
In short, the government, the Church, non-governmental organizations, cooperating partners and certain individuals have been the main players in the health system for a very long time.
Ministry of Health
The Ministry of Health has many facets in the health care delivery system in Zambia. It formulates health policies, implements government directives and annual budgets, and generally oversees general health matters in the country.
The part of the tax that the government allocates to the health sector goes to the Ministry of Health for expenditure. The most common expenses in most cases are the purchase of drugs, medical equipment and other pharmaceutical supplies.
FYI, ZAMMSA was previously known as MSL. MSL was established in 1976 as a semi-commercial limited liability company under the Companies Act. It was 100% owned by the government, with the Ministry of Finance being the major shareholder (98%) and the Ministry of Health the minor shareholder (2%).
Although MSL was originally intended to play a pharmaceutical manufacturing role to complement the importation of pharmaceuticals, this was not fully realized for many reasons. The government has used it in most cases for the storage and distribution of drugs, medical equipment and other pharmaceutical supplies to health facilities.
According to tradition, the Ministry of Health purchased drugs, medical equipment and other pharmaceutical supplies, and MSL’s role was to store and distribute them to government health facilities.
In 2019, the government, after pressure from cooperating partners who provide budget support to the health sector, agreed to enact a law, the Zambia Medicines and Medical Supplies Agency Act No.9 of 2019. of Zambia (ZAMMSA Act) to rename MSL to ZAMMSA and continued its existence.
Under the ZAMMSA Act, ZAMMSA was empowered to purchase drugs, among other things. This was in addition to its mandate to store and distribute drugs and other pharmaceutical supplies to health facilities.
Section 5 of the ZAMMSA ACT reads as follows:
âThe functions of the Agency (ZAMMSA) are to:
a) purchase, store and distribute drugs and medical supplies; (b) repackage and re-label drugs and medical supplies;
(c) develop, maintain and manage an efficient and cost-effective system for the procurement, storage and distribution of drugs and medical supplies;
(d) ensure the timely availability of drugs and medical supplies in public health facilities;
(e) establish and maintain strict inventory management systems and security protocols within the Agency and other storage facilities under the control and supervision of the Agency;
(f) facilitate the selection, forecasting, quantification and planning of the supply of drugs and medical supplies for health facilities;
g) establish a network of storage, packaging and distribution facilities for the supply of drugs and medical supplies to health facilities;
(h) enter into agreements or establish frameworks with the government and other local and international institutions for the manufacture of drugs and medical supplies as the Council may determine;
i) Provide regular information and reports on the status and cost-effectiveness of the procurement, storage, distribution and value of drugs and medical supplies to the ministry responsible for health to assist appropriate planning and decision making;
(j) cooperate and exchange information relating to drugs and medical supplies with relevant stakeholders at district, provincial, national and international levels; (k) establish and maintain an internal quality assurance system for efficient operations, regulatory compliance and the quality of drugs and medical supplies;
(l) assist health facilities to establish and maintain appropriate systems for the management of stocks of drugs and medical supplies; and
(m) advise the Minister on policies relating to the procurement, storage and distribution of drugs and medical supplies.
Mismanagement of public resources at the Ministry of Health delayed the birth of ZAMMSA
Although the ZAMMSA law was enacted in November 2019, this law could not become operational for reasons known to officials at Ndeke House, Ministry of Health. However, the delay in operationalizing the ZAMMSA law may have been the desire of health ministry officials to continue procuring drugs, medical equipment and other pharmaceutical supplies for personal benefit. It is no secret that over the past eight years the Ministry of Health has been engulfed by mismanagement and misuse of public resources. This information is in the public domain through the Auditor General’s reports.
Despite the prolonged delay in operationalizing the ZAMMSA law, the scandals that rocked the Ministry of Health regarding the distribution of substandard drugs and related substances to public health facilities forced the government to create ZAMMSA. Thus, on Wednesday February 3, 2021 through Statutory Ordinance No. 8 of 2021 (entry into force) 2021 of February 3, 2021 by virtue of Gazette Notice No. 125 of 2021, the Ministry of Health stopped procuring drugs and other pharmaceutical supplies, and the function moved to ZAMMSA.
This development meant that part of the resources allocated to the Ministry of Health for drugs and the budget for other pharmaceutical supplies went to ZAMMSA, in addition to the support of cooperating partners. However, it seems that the procurement of medical equipment still remains the responsibility of the Ministry of Health.
I will end here and wish to say that every Zambian deserves decent health care regardless of their social status.
For any comments, please email: [email protected]