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Outcry over NSSA's health scheme
Dumisani Ndlela & Lucia Makamure, The Zimbabwe Independent
January 19, 2007

http://www.theindependent.co.zw/viewinfo.cfm?linkid=11&id=9861&siteid=1

PLANS by the National Social Security Authority (NSSA) to establish a compulsory national health insurance scheme have sparked an outcry from traditional foes — industry and labour — who have united in denouncing the proposed scheme.

Zimbabwe Congress of Trade Unions (ZCTU) secretary-general, Wellington Chibebe, said the scheme would be a monumental fraud in post-independent Zimbabwe and urged workers to resist it.

"This is another fraud in the making," an angry Chibebe told the Zimbabwe Independent in an interview from his office. "It's a classic example (of fraud)."

Employers Confederation of Zimbabwe (Emcoz) president, Johnson Manyakara, said while business was supportive of a national health insurance scheme, employers "feel strongly that all key stakeholders" must be consulted before establishment of the scheme.

"We are concerned at NSSA's capacity to handle the health scheme over and above the existing social security scheme given that there are still a lot of problems with the management of the pension scheme," Manyakara said.

He said conceptually, the planned scheme was skewed in that it "weighed higher than a pension scheme in terms of contribution".

"Business has, to date, not been consulted on the details of the proposed scheme, including the planned Statutory Instrument. We have since learnt that the plan is for employers and employees to contribute 5% of basic pay towards this scheme per month, capped at $130 000 of monthly salary. This works out to a monthly contribution of $6 500 for each party towards this scheme. The planned monthly contribution is significantly higher than the contributions towards the existing NSSA Pension Scheme," Manyakara said.

Sources indicated that employers were fuming in closed door meetings discussing the issue, although their representatives' public statements appeared coated in diplomatic language.

Chibebe said the ZCTU had engaged in consultations and members resolved to oppose the scheme.

"They are saying this can only be done over their dead bodies. They have been robbed through the NSSA pension scheme and through the Aids levy which has benefited politicians and their cronies," said Chibebe.

The ZCTU leadership has already called for an emergency special general council meeting to discuss "very urgent matters, including the issue of the health scheme".

Already, ZCTU affiliates are understood to be mobilising workers for nationwide industrial action, and industry sources indicated employers were willing to back them.

There were fears the planned scheme was meant to boost government coffers ahead of the presidential and parliamentary elections in 2008 and 2010 respectively. President Mugabe is however pushing to have the presidential election held in 2010.

Chibebe said the ZCTU, which had been invited to set up structures for the planned scheme last year, had baulked after being informed by intelligence sources that the scheme was also meant to benefit politicians and their children.

"Our members are not interested in a new scheme. They have failed to access antiretrovirals through the National Aids Council, which receives its proceeds from the Aids levy. This institution has only benefited politicians (and their cronies)," Chibebe charged.

"This is a way to access affordable health care for themselves and their children. Sources of income are dwindling and they think the workers are their cash cow."

A business executive who requested anonymity said employers were stunned after announcements that NSSA would introduce a new scheme in January. There had been no consultation with stakeholders, he said, and the business community was uninformed about the nature of the scheme.

"They once came up with a maternity scheme but there was no point of unanimity with stakeholders so they abandoned it," the business executive said.

He said the norm is for NSSA to propose possible schemes and present them to stakeholders for support or input before legislation.

However, NSSA has already come up with a statutory instrument for the health insurance scheme even before consultations.

Another business executive said Emcoz had written to NSSA following reports of the impending scheme and had been informed that consultations would only begin once drafting of the statutory instrument was completed.

"This is a back-to-front approach — once there's a statutory instrument, this thing is legislated," a consultant closely following the issue said.

Meanwhile, health insurance providers have said they do not feel threatened by the new health scheme set to be introduced in July this year.

The NSSA Health Insurance Scheme (NHIS) for all taxpayers will become effective three months after members start making their monthly contributions.

Association of Healthcare Funders of Zimbabwe (AHFOZ) chief executive officer Job Chiviro said although the idea was noble NSSA did not make enough consultations. "Noble ideas and intentions can be destroyed if their implementation is not thought out well. And thinking it through includes wide and sober consultations and debate by all stakeholders," said Chiviro.

He said NSSA should have consulted with institutions which were already offering medial aid.

"We have been in the industry for more than 70 years and we have the knowledge and experience of how funding health works," added Chiviro.

AHFOZ also expressed doubt over the success of NSSA's health insurance. NHIS is premised on the centrality of public health institutions that have been run down over the years due to underfunding.

"With NHIS, there will be an influx by those covered by these institutions, which will be ill-equipped to cope with the large numbers of patients, amid shortages of staff, drugs and equipment," Chiviro said.

Joseph Nkani, the sales and marketing officer for the Medical Aid Society of Central Africa, said the NSSA scheme was not a threat to them.

"We don't feel threatened at all as NSSA's product is more of a generic product while we offer diverse products," Nkani said.

"Their product is mainly for low earners while our products cater for both top earners and low earners."

He said the scheme is for use at government medical institutions.

"You will find that some of our top earners prefer private hospitals to government hospitals. So for them to get that service, they have to be on a scheme that offers that service."

A medical doctor who spoke on condition of anonymity said: "In principle this was a good thing but with our unstable economy this system will not work. Instead it is only going to burden taxpayers who are not going to benefit anything as inflation is likely to erode their savings before they use them."

He said he was worried by NSSA's history of bad management and late processing of funds. This could disadvantage beneficiaries who would fail to get financial benefits that cover the cost of treatment at the government institutions.

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