Who benefits from public health financing in Zimbabwe? Towards universal health coverage

ABSTRACT

Zimbabwe's public health financing model is mostly hospital-based. Financing generally follows the bigger and higher-level hospitals at the expense of smaller, lower-level ones. While this has tended to perpetuate inequalities, the pattern of healthcare services utilisation and benefits on different levels of care and across different socioeconomic groups remains unclear. The purpose of this study was therefore to assess the utilisation of healthcare services and benefits at different levels of care by different socioeconomic groups. We conducted secondary data analysis of the 2010 National Health Accounts survey, which had 7084 households made up of 26,392 individual observations. Results showed significant utilisation of health services by poorer households at the district level (concentration index of −0.13 [CI:−0.2 to −0.06; p < .05]), but with mission hospitals showing equitable utilisation by both groups. Provincial and higher levels showed greater utilisation by richer households (0.19; CI: 0.1–0.29; p < .05). The overall results showed that richer households benefited significantly more from public health funds than poorer households (0.26; CI: 0.2–0.4; p < .05). Richer households disproportionately benefited from public health subsidies overall, particularly at secondary and tertiary levels, which receive more funding and provide a higher level of care.

KEYWORDS:

• Health financing
• equity
• inequality
• resource allocation
• cost

Acknowledgements

We would like to thank Dr Rene Loewenson for her input in the initial design and peer review of this work. This work was also carried out to support the Training and Research Support Centre (TARSC) and Ministry of Health and Child Care (MoHCC)’s research agenda on Universal Health Coverage; hence we would like to thank TARSC and MoHCC for providing the necessary support. We would also like to thank Chris Kapp and Associates for professional editing of this work.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This research was supported by funding from the Wellcome Trust, UK and the International Development Research Centre (IDRC), Canada.