• NHIMA services need to be improved and upgraded to satisfactory standards
• Patients can only get syrups in the range of K35 and below.
• NHIMA must put its house in order to satisfy clients or its better they stop deducting money from people.

Protecting families from the risk of high medical bills remains the top priority for both the private and public insurance sectors in Zambia.
Health or medical insurance covers the whole or a part of the risk of a person incurring medical expenses.
According to the 2020 Finscope survey, 90% of Zambian adults have no emergency savings and 77% cannot raise money to cope with unexpected emergency expenses within 3 days, hence without a health insurance scheme, medical bills can put serious pressure on households’ income.
Therefore, the ability to access services on most private health insurance schemes through National Health Insurance Management Authority (NHIMA) is a plus to the insurance industry in Zambia.
Insurance is a means of protection from financial loss and Health Insurance is among the various products currently being offered on the market.
The establishment of NHIMA, a national health care system in 2012 is part of the country’s path to economic development.
Research shows that this scheme provides free medical access for those aged above 65 and below 18. The Scheme had a registration milestone of 1.5 million members in 2022, with over 300 accredited healthcare providers.
Established in 2012 through Statutory Instrument Number 63 of 2019, it was signed by then Minister of Health Dr Chitalu Chilufya but was recently moved to the Ministry of Labour and Social Security by the UPND administration.
The Authority has entered into a Memorandum of Understanding with both private and public healthcare providers, which stipulates a service level of 45 days turnaround time for payment of valid claims and currently, its turnaround time is 35 days.
Despite this development, some beneficiaries on the Copperbelt are calling for an improvement and upgrade in the NHIMA scheme to satisfactory standards.
Victor Kalesha told Money FM News that there are certain medications that are not in the NHIMA package, as patients can only get syrups in the range of K35 and below, a situation that needs to be seriously addressed.
“NHIMA services need to be improved and upgraded to satisfactory standards. I have been to two NHIMA accredited facilities this week in Luanshya, where I have witnessed inefficiencies that are unfair to patients,” Mr. Kalesha stated.
And other beneficiaries, who declined to be named, lamented that there have been some inefficiencies in certain NHIMA-accredited facilities in Luanshya, where services only start after 08hrs to 16hrs, while weekends remain closed for operations, making it challenging for patients to access health services.
“The services for a patient only start after 08hrs to 16hrs and weekends they don’t work and you would wonder what services NHIMA is offering from the money they deduct from us. Secondly, the officers on NHIMA desks or reception are very rude.”
“I think it’s just important that NHIMA puts its house in order to satisfy clients or its better they stop deducting money from people and close it, other than deducting money as an Insurance policy that is not working out,” they said.
But for Vincent Chipanta, a Lusaka resident, the health insurance scheme has been very helpful to him and his household as they are able to access healthcare services without worrying about medical bills, despite long queues at most facilities.
“This scheme has been very helpful to me and my family despite the long queues at most health facilities. All in all, there is need for more advocacy and public awareness on how NHIMA helps in time of need,” Mr. Chipanta said.
However, NHIMA management was not immediately available for a comment.
Meanwhile, Acting Minister of Labour and Social Security Chushi Kasanda recently told Parliament that NHIMA paid out 1, 038, 747 claims valued at K889, 117, 723 in 2022.
Ms. Kasanda, who is also the Information and Media Minister, said government has put in place the electronic data interface where 90 percent of accredited health institutions are submitting their claims to ensure faster turnaround time and reconciliations.
“The Authority has been meeting its obligations to settle claims within the service level agreement. The Authority paid out, 1, 038, 747 claims valued at K889, 117, 723 in 2022.”
“The measures being undertaken to ensure claims are paid on time is the introduction of the electronic data interface where 90 percent of accredited healthcare providers are submitting their claims to ensure faster turnaround time and reconciliations. Accreditation and guidelines of Health Professions Council of Zambia (HPCZ) stipulates that no member or patient shall be denied services,” Ms. Kasanda stated.
She was responding to Kasenengwa Member of Parliament Philimon Twasa who wanted to know whether the government was aware that patients under this Scheme were being denied services by healthcare providers due to delayed payment claims by NHIMA to the health facility and what measures were being put in place to correct the situation.
In a bid to increase insurance uptake which currently stands at 6.3 percent, there is need for industry players to provide products and services that will make the industry relevant to economic growth, and significantly contribute to the country’s Gross Domestic Product (GDP).
According to Pensions and Insurance Authority (PIA) Manager for Market Development Yizaso Musonda, the sector’s contribution to GDP stood at 1.26 percent in 2021 and the Authority would want to see the rate increase to about 3 to 5 percent in the coming years.