MASHONALAND WEST, ZIMBABWE – When Dube was diagnosed with gallstones in 2013, Zimbabwe’s public hospital recommended surgery that cost nearly $4,000. She couldn’t afford that.
A friend suggested she go to Zambia, about 150 kilometers north. There, the friend said, the treatment was cheaper.
Over the past decade, Dube has traveled to Zambia several times for medical treatment. Her last trip was in June. The treatment is cheaper there, she says, but the care is also far better than at home. Dube asked the Global Press Journal to use her totem name, a symbolic representation of her ancestral lineage, out of concern about Zimbabwe’s Patriotic Law, which discourages criticism of the government.
In the 1980s, Zimbabwe had one of the best health systems in sub-Saharan Africa. But over the years this fame has faded. An economic crisis spanning more than two decades has left the healthcare system struggling to meet the needs of its population. Healthcare professionals have been leaving in droves, drawn to opportunities abroad. According to government statistics, more than 4,000 healthcare workers left Zimbabwe in 2021 and 2022 alone. By the end of 2022, there were about 1,700 doctors and about 17,200 nurses in Zimbabwe to serve a population of 15 million people.
As healthcare workers leave the country, so do patients.
Over the last decade, Zimbabweans have spent more than $4 billion on cross-border medical migration. Every year, more than 200,000 Zimbabweans spend around $400 million on specialized medical treatments abroad. India, China, Singapore and South Africa are the main destinations.
But an increasingly popular choice is neighboring Zambia. In April alone, the International Organization for Migration surveyed over 260 people who migrated from Zimbabwe to Zambia. When asked why they traveled, 42% said it was to receive better services – with health being the top priority.
Exact data is hard to come by, but anecdotal reports from sources who spoke to Global Press Journal, including border officials, suggest a growing trend raising questions about Zambia’s ability to handle the influx and the future of health care in Zimbabwe raises.
The election of Zambia
Zambia and Zimbabwe allocated almost the same amount of money to their health sectors in 2024, even though Zambia has 4 million more people. With this budget it is an unlikely alternative to Zimbabwe’s healthcare system. And in Africa, South Africa and Kenya are the top destinations for medical tourism.
But the border with Zambia is not far away for many Zimbabweans, which makes travel costs low and crossing the border usually uncomplicated. A person needs either a passport or a passport issued at the border for as little as $1, said Morgen Moyo, assistant regional immigration officer at the Chirundu border post.
Even without documents, immigration officials sometimes let through those seeking medical care. “Zambians value life,” says Moyo.
It’s not just about convenience. Zambia provides free primary health services, including primary care, preventative care, immunizations and maternal health care, according to the National Health Strategic Plan 2022-2026 for Zambia.
While these free services are not available to foreigners in the long term, in emergencies they can access them within the first 24 to 48 hours in the country, says Dr. Kennedy Lishimpi, permanent administrative secretary of the Zambian Ministry of Health. Foreign nationals are expected to pay for healthcare in Zambia after this period.
However, in practice, Zambian health workers rarely charge fees to foreigners, according to a 2019 study funded by the U.S. Agency for International Development, known as USAID.
“For example, you don’t want to see someone from Zimbabwe come to Zambia, not use any service and then end up dying. This is not good. Likewise, we expect our partner countries to do the same with our citizens when they are there,” says Lishimpi.
Dr. Mwanza, a Zambian doctor who has chosen to use only his last name for fear of retaliation, says the availability of surgical and specialist services in Zambia is driving medical migration. In Zimbabwe, these services are rarely available outside of major provincial and central hospitals. For example, in 2019, about 10% of district hospitals could offer basic surgeries, compared to 83% of provincial and central hospitals, according to an assessment by Zimbabwe’s Ministry of Health.
When Mary Chipfuvamiti’s son broke his arm in June, she says she chose a hospital in Zambia – about 93 kilometers (nearly 58 miles) from her home – rather than the local options. She suspected the local hospital’s X-ray machine wouldn’t work, and she would likely be referred to a private facility, where an X-ray would cost her $40.
“I only had $30 on me,” she says. In Zambia the total cost was about US$12.50.
A case for Zimbabwe
This was not always the case in Zimbabwe. Before the country’s economy experienced a downturn, the country offered free health services to low-income earners in the 1980s. About 90% of the population fell into this group.
In the early 1990s, the government introduced user fees in public health facilities as part of austerity measures imposed on the government by the International Monetary Fund to reduce government spending. Currently, free health services are only offered to pregnant and nursing mothers, children under 5 years old and adults over 60 years old.
The economic crisis continues to strain what is left of the healthcare system. Hospitals struggle with aging infrastructure. Shortages of medicines and supplies in public health facilities are the norm.
And although Zimbabwe and Zambia have similar health budgets, Zimbabwe’s treasury sometimes delays disbursing funds, says Norman Matara, secretary general of the Zimbabwe Association of Doctors for Human Rights.
This was the case in 2021 when, as of September, the Ministry of Health had used only 46% of its budgetary allocations for the financial year due to late disbursement of funds, according to a 2024 situation report by the Zimbabwe Coalition on Debt and Development, a non-governmental organization , which advocates for socioeconomic justice.
“There is a mismatch between the money that is paid into the budget and what the health facilities receive,” says Matara. The reasons for this are hyperinflation and exchange rate fluctuations, he adds.
Comparing the health services of different countries is unfair, says Donald Mujiri, a spokesman for the Zimbabwean Ministry of Health. “Every country has its own standards and prices.”
He does not believe this patient migration reflects poorly on Zimbabwe’s healthcare system. “We have all the services in the country and they are sufficient to serve the people,” he said, adding that people are free to seek health care wherever they want.
Mujiri did not respond to questions about the late disbursement of funds.
The cost of the trip
These trips to Zambia come with challenges.
Dube recalled their journeys on the bumpy Harare-Chirundu Highway that connects the two countries, when every bump caused sharp pain.
In 2019, six years after her first treatment in Zambia, she began experiencing severe pain. She went to a hospital in Harare for treatment, but the pain returned a few months later. At that time, there was a health strike at home that forced her to go to Zambia for treatment. Then in 2023, Zambian doctors discovered that metal staples from her previous surgery in Zimbabwe were piercing her liver. She returned to Zambia for corrective surgery in January this year and again in June.
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Health experts warn that such trips can be particularly risky for patients undergoing surgery. When surgery is performed in Zambia and proper follow-up care is not provided, complications can arise if doctors in Zimbabwe are unaware of previous procedures or tests, says Mukanya, a health professional who works in a Zimbabwean hospital and advocates the use of his totem has decided. fearing that speaking to the media would cost him his job.
In the event of a misdiagnosis or malpractice abroad, it is difficult to seek legal redress. “In most cases, you are powerless because you don’t know the (reporting) process and contacting a lawyer may require money,” he says.
Medical migration is also associated with costs for Zambia. According to USAID, the influx of patients complicates health planning, creates shortages of essential medicines and makes effective resource allocation difficult. The agency’s report recommends that the Zambian government introduce a fee-for-service system to discourage foreigners from accessing free healthcare, but doctors in Zambia appear to disagree.
“Most health care providers surveyed said they would continue to provide their services free of charge if a foreign patient was unable to pay,” the USAID report said.
Lishimpi, the Zambian health ministry official, did not comment on the report’s concerns.
Dube, who is recovering at home, is unsure about the solutions. However, she believes the Zimbabwean government must prioritize overhauling her country’s health system. “I don’t know the best way to help our hospitals, but if there was another way, I think they should consider the healthcare sector more than anything else because lives are at stake here,” she says.