The Zambia Congress of Trade Unions (ZCTU) says the proposed National Health Insurance bill is unlikely to work because the Ministry of Health is simply shoving it down the throats of employers and workers.
Government, through the Ministry of Health, has taken to parliament the National Health Insurance Bill for approval amidst public apprehension and threats from institutions like the Zambia Federation of Employers (ZFE) who plan to drag government to the International Labour Organisation (ILO) if it insists on adopting into law the bill without reaching a consensus with stakeholders.
And in a statement, Thursday, ZCTU deputy secretary general Elaston Njobvu expressed pessimism, saying the bill would not work to the expectation of the beneficiaries.
Njobvu argued that in its current form, the National Health Insurance scheme would also unfairly burden civil servants who were required to pay one per cent of their salary every month to meet health care services of every Zambian.
“The decision by government to implement the National Health Insurance (NHI) Scheme will not yield the expected results because it is being done in a haphazard manner. It is saddening that government decided to start the Health Scheme without addressing concerns raised by stakeholders regarding institutional arrangements and benefit structures. How does government hope to administer this national programme which is expected to benefit every member of society when they are only targeting a limited section of public service workers to contribute towards its operations? How does government expect public service workers to shoulder the huge burden of health care on behalf of all citizens? This shows that the Ministry of Health has literally failed to put a workable system in place and this will eventually render the whole programme a futile exercise,” Njobvu stated.
“The announced deduction of 1% is illegal because the unions have not yet been informed on the benefit package, nor have they signed a collective agreement on the matter. Members representing stakeholders on the NHI Board are supposed to be nominated by their institutions but we have a Board, whose members were hand-picked and their names approved by the minister. The selection lacks transparency and is unprecedented. We cannot recognize such Board members as being representatives of their institutions but rather as self-serving people because they do not represent the interest of their members. We have not been told who will manage the fund, how this Scheme will benefit members and how the fund will be managed. These procedures are supposed to be explained instead of rushing to impose deductions on the workers. The Ministry of Health is also deliberately ignoring the fact that there is currently, existing medical schemes in place, which are doing well. Therefore, caution ought to be taken during this transitional period.”
Njobvu insisted that ZCTU would not support this scheme despite the good intentions behind its creation because of the haphazard approach the Ministry of Health had taken by disregarding institutional frameworks.
“The scheme is supposed to provide for a sound financing of the national health system and ensure universal access to quality insured health care services. The Tripartite Consultation (International Labour Standards) Convention No. 144 of 1976 allows for employers and workers organisations to raise considerations on national policies which directly affect employers and workers. This was not done because the Ministry of Health opted to walk out of the Tripartite meetings, and opted to hijack the process. The scheme is simply being shoved down the throats of employers and workers by the Ministry of Health and we are pessimistic it will work to the expectation of the beneficiaries. Experiences and good practices shared at global level indicate that there is no single perfect model of a national health insurance scheme,” stated Njobvu.
“Nonetheless, the success of any national scheme depends largely on national circumstances mooted by tripartite partners – and not a single ministry imposing its own selfish agenda. Consultations are usually emphasised as necessary and key to the success of any national health insurance scheme. Most importantly, experience has shown that establishing a health insurance scheme is not enough if adequate resources are not allocated to make the scheme viable and sustainable. Zambia has a huge informal economy and a large poor population and this will pose a major challenge to the scheme, hence the need for adequate consultations and learning from good practices elsewhere…The success of the National Health Insurance scheme depends on full contributions from both formal and informal sector. We note and realise that establishing a health insurance scheme is one thing and to achieve universal health coverage is another. In its current form, the National Health Insurance scheme is unfairly burdening Civil Servants to pay 1% of one’s salary every month, to meet health care services of every Zambian. This is unacceptable!”
Njobvu insisted that moving forward, government should conduct consultations in order to build consensus among different players on a number of technical issues in the scheme, such as elaboration of an appropriate design of benefits.