Zimbabwe’s debate over the proposed amendments to Statutory Instrument 330 of 2000 has reached a critical stage. The central question is not whether the healthcare sector needs stronger regulation. It does. The question is whether reform will correct genuine abuses or unintentionally weaken the capacity patients depend on.
The proposed restrictions on medical aid societies owning, managing or operating healthcare facilities — including hospitals, clinics, pharmacies and laboratories — raise important questions about conflicts of interest, market power, pricing and accountability.
Those concerns deserve scrutiny. But a legitimate concern does not automatically justify the most restrictive remedy.
A blanket prohibition on integrated healthcare models could discourage investment, destabilise existing facilities, disrupt employment, reduce access to specialist services and place further pressure on an already stretched public health system. Removing existing capacity before replacement capacity is secured would risk turning a governance problem into an access crisis.
Zimbabwe needs reform that strengthens accountability while protecting the infrastructure and investment required to deliver care.
Regulation must support healthcare expansion
Health and Child Care Minister Dr Douglas Mombeshora’s recent speeches provide a useful framework for this debate.
At the Cimas Healthathon 3.0 grand finale, Mombeshora emphasised innovation, collaboration and private-sector participation, saying:
- Calls grow for medical aid regulations overhaul
- SI 330: Regulate healthcare without destroying capacity
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“Government sets policy, provides public health leadership and regulates the sector. But Government cannot, and should not, work alone.”
He also called on private players to invest, build and participate more boldly in healthcare transformation.
That message is directly relevant to SI 330. Zimbabwe needs more hospitals, clinics, laboratories, pharmacies, diagnostic centres and specialist services. It needs modern equipment, skilled professionals, technology and investment that can reduce waiting times and bring quality care closer to underserved communities.
Any regulatory measure that creates uncertainty around existing healthcare investments or makes future projects less attractive must therefore be assessed against that national requirement.
The test of reform should be whether it improves healthcare delivery — not simply whether it changes ownership structures.
Target abuse, not ownership
The most important distinction in this debate is between ownership and misconduct.
Ownership, by itself, is not proof of abuse. The regulatory focus should be on whether a particular arrangement is transparent, properly governed and operating in the public interest.
Are related-party transactions disclosed? Are procurement decisions transparent? Are referrals clinically justified? Are patients given meaningful choices? Are tariffs and co-payments clearly explained? Are clinical decisions independent of commercial interests? Are complaints investigated? Is competition being distorted?
These are the questions that regulation must answer.
Where risks exist, Government can impose enforceable safeguards, including independent governance structures, audited financial reporting, transparent procurement, disclosure of related-party interests, separation of clinical and financial decision-making, independent referral mechanisms and effective consumer protection.
Proven abuse should attract meaningful penalties.
But the existence of a potential conflict should not be treated as proof that every integrated healthcare model is inherently harmful. Regulation should target harmful conduct, not automatically dismantle functioning capacity.
Tariffs require evidence, not confrontation
The dispute over SI 330 also reflects a broader weakness in the healthcare system: the absence of a trusted and predictable mechanism for resolving disagreements over tariffs, co-payments, delayed settlements and service costs.
These disputes do not remain confined to medical aid societies and healthcare providers. They eventually affect patients through higher out-of-pocket expenses, delayed treatment, restricted services and uncertainty over what their policies will cover.
Mombeshora was right to insist:
“Doctors and medical aids are not adversaries. You are partners serving the very same patient.”
That principle should underpin the proposed National Tariffs Liaison Committee.
The committee should be a practical, technically supported platform bringing together Government, medical aid societies, healthcare providers, professional bodies, actuaries, economists and patient representatives.
Its work should be based on transparent and evidence-based costing. Tariffs must reflect the actual resources required to deliver safe, quality and sustainable care, including staffing, medicines, consumables, equipment, infrastructure, maintenance, technology, quality standards and geographic differences.
Affordability matters, but a tariff cannot be sustainable merely because it is imposed. It must also allow providers to maintain quality, retain staff, replace equipment and continue operating.
A credible tariff mechanism would help resolve commercial disputes before they escalate into wider conflicts over contracting, ownership and access.
Reform should be phased and tested
If aspects of the current framework require structural change, the process should be consultative, phased and supported by a comprehensive impact assessment.
That assessment should examine the likely effects on existing facilities, investment, employment, specialist services, patient choice, tariffs, co-payments, rural access and the public health system’s ability to absorb displaced demand.
It should also determine whether targeted safeguards could address identified risks more effectively than an outright prohibition.
Where change is necessary, transitional arrangements must protect patients and prevent service disruption. Functioning healthcare capacity should not be dismantled before replacement capacity is funded, available and operational.
This is particularly important in a country that needs more healthcare infrastructure, not less.
A consistent investment message
President Emmerson Mnangagwa’s call for barriers to the establishment of specialist healthcare facilities and services to be removed provides an important policy backdrop.
It would be contradictory to invite greater private investment in healthcare while introducing reforms that create uncertainty, undermine existing projects or narrow the space for legitimate private participation.
That does not mean private healthcare should be exempt from regulation. It means regulation must be predictable, proportionate, transparent and aligned with the national objective of expanding access.
Mombeshora’s own message is consistent with that balance. He has called for greater investment and innovation while also demanding discipline, accountability and the protection of public resources.
The same approach should guide SI 330.
Parliament must pursue a workable settlement
With the issue now before Parliament, the opportunity exists to replace confrontation with structured scrutiny and negotiation.
The objective should not be victory for medical aid societies, healthcare providers or Government. It should be a regulatory settlement that protects patients, preserves capacity and addresses genuine conflicts of interest.
That requires meaningful engagement among Parliament, Government ministries, regulators, medical aid societies, healthcare providers, professional bodies and patient representatives.
The proposed National Tariffs Liaison Committee could provide an immediate platform for resolving the tariff and payment disputes that continue to strain relationships across the sector.
A credible settlement should rest on five principles: protect patients from abuse; preserve existing capacity and employment; encourage investment and innovation; regulate conflicts through targeted safeguards; and resolve tariffs through transparent, evidence-based processes.
These objectives are not mutually exclusive. They are interdependent.
A healthcare system cannot be affordable if it is financially unsustainable. It cannot be accessible if investment is discouraged. It cannot be trusted if abuse is ignored. And it cannot be reformed successfully if patients bear the cost of regulatory uncertainty.
Zimbabwe does not need reform that merely redistributes ownership. It needs reform that expands capacity, improves affordability, strengthens accountability and makes the healthcare system work better.
SI 330 should regulate healthcare without destroying capacity.
Aaron Nyatanga is a public health expert whose profile highlights his pioneering research in preventive care, his clinical experience, and commitment to improving community health outcomes.
