Last week, I had the privilege of attending a session at Zambia’s National Assembly as Chairperson of the Lusaka Branch of the Diabetes Association of Zambia (DAZ). I was joined by DAZ President Dr. Kamanga and our Vice Secretary General Mrs. Dorothy Chikampa, to discuss NHIMA (National Health Insurance Management Authority) and its approach to healthcare for diabetics. This conversation highlighted both the promise and the challenges of ensuring accessible healthcare for all Zambians.
NHIMA’s mission to make healthcare affordable is commendable, but it’s clear the system faces significant hurdles. Among the most pressing issues are funding deficits and gaps in the coverage of essential diabetes management tools. These challenges spark an urgent question: how do we create a sustainable healthcare model that serves the needs of all Zambians, particularly those managing chronic conditions like diabetes? By comparing NHIMA to global systems like the UK’s NHS and the US healthcare model, we can draw lessons on what works—and what doesn’t.

NHIMA: Strengths, Challenges, and Missed Opportunities
NHIMA was established to provide financial protection for medical expenses by pooling contributions from employers, employees, and informal sector participants. While this model has great potential, its implementation has faced challenges.
Despite its significance, NHIMA is struggling with severe funding deficits. It raises approximately K100 million per month but spends about K160 million. This shortfall underscores the need for innovative funding strategies. Over-reliance on the national treasury is not a sustainable solution. Experts suggest that expanding preventative healthcare programs could alleviate the financial burden of treating non-communicable diseases (NCDs) like diabetes, which consume a large portion of NHIMA’s resources.
For diabetics, NHIMA was initially designed to cover essentials like insulin, oral medications, test strips, and urine sticks—items critical for effective diabetes management. However, due to severe underfunding, many of these supplies have been removed from NHIMA’s packages, leaving patients to shoulder significant out-of-pocket expenses. This isn’t just an issue in rural areas; it’s happening across Zambia, undermining NHIMA’s mission to provide equitable healthcare.

The NHS:
The UK’s National Health Service (NHS) is a global example of universal healthcare. Funded through taxation, the NHS ensures free healthcare, removing financial barriers for patients. For diabetics, this means comprehensive support, including access to modern insulins, CGMs, and specialists like podiatrists and ophthalmologists. The NHS also invests heavily in prevention through regular screenings and diabetes education programs.
However, the NHS is not without its flaws. Budget limitations and increased demand have led to long waiting times for treatments and specialist consultations. These challenges serve as a reminder that even well-funded systems require careful planning and resource management to meet the needs of their populations.
NHIMA can learn from the NHS by prioritising prevention and expanding access to chronic care services. This would significantly reduce long-term healthcare costs while improving patient outcomes.

The US Healthcare System
In contrast, the American healthcare system operates on a largely privatised model, where access depends heavily on employment-based insurance or personal wealth. For diabetics, this often means paying exorbitant out-of-pocket costs for insulin, CGMs, and other essentials if uninsured. While the US is a leader in medical innovation, including advanced diabetes technologies, the system’s profit-driven nature leaves millions without access to the care they truly need.
NHIMA stands apart by aiming to create an equitable system. NHIMA’s focus on affordability and accessibility is critical, even as it seeks to expand its scope and financial stability.

Bridging the Gaps
From my role within the Diabetes Association of Zambia and our collaborative discussions in Parliament, the following recommendations emerged as critical to NHIMA’s success:
1. Sustainability Through Funding:
NHIMA must address its deficit through innovative strategies. While increasing contribution rates from 1% to 2% could generate additional revenue, this must be balanced with the economic realities of Zambians. Government support remains essential to ensure NHIMA complements the Ministry of Health’s responsibilities.
2. Chronic Care Tools and Coverage:
Reinstate access to critical medications within NHIMA packages. Modern insulins and newer medications for Type 2 diabetes should be undoubtedly included to reflect current standards of care.
3. Improved Healthcare Infrastructure:
Upgraded facilities are vital for managing complications like retinopathy and neuropathy. Diagnostic services for early screenings should be strengthened to support preventative care.
4. Simplified and Automated Processes:
Simplifying registration and claims processes, possibly through automation, would increase efficiency and accessibility. This could encourage more people to enrol and benefit from the system.
5. Awareness and Education:
Launch targeted awareness campaigns to educate the public about NHIMA’s benefits. Leveraging community leaders and mobile messaging can help reach underserved areas. Expanding diabetes prevention and education programs will also empower individuals to take proactive steps in managing their health.
6. Mental Health Support:
Addressing the emotional challenges of diabetes through counselling and mental health services would help combat stigma and improve overall patient confidence.

The Path Forward
NHIMA is at a critical juncture. Imagine a Zambia where healthcare is a right, not a privilege—where diabetics don’t have to choose between buying insulin and paying rent, and where rural and urban healthcare facilities are equally equipped to serve their communities. This vision is achievable, but it requires bold decisions and collaborative action.
Expanding NHIMA’s coverage and addressing its financial challenges will require balance: Drawing lessons from the NHS’s universal model and avoiding the inequities of the US system will be key to creating a robust healthcare system for all Zambians.

A Call to Action
Healthcare isn’t just policy—it’s deeply personal. As a diabetic managing my health every day, I understand the urgency of getting this right. NHIMA must prioritise chronic care, upgrade its infrastructure, and educate communities about its benefits. But responsibility doesn’t rest with NHIMA alone. Policymakers, healthcare providers, and citizens must work together to demand and support a system that prioritises access, quality, and sustainability.
The future of Zambia’s healthcare is still being written. Let’s make it a story of resilience, equity, and innovation.

Kaajal Vaghela is a wellness entrepreneur, sportswear designer, and diabetes health consultant with over three decades of lived experience managing Type 1 diabetes. As the chairperson of the Lusaka branch of the Diabetes Association of Zambia, she is a passionate advocate for breaking down myths and building awareness about diabetes. For more information, check out: www.kaajalvaghela.com and for any feedback: [email protected]