Zimbabwe’s public health financing is facing increasing pressure as the country continues to depend heavily on external funding and out-of-pocket contributions, creating a system that experts warn is highly unsustainable in the long run.
This growing dependency has led to concerns that the government is using the influx of external aid as an excuse to allocate fewer domestic resources to the sector, undermining efforts to create a self-sustaining healthcare system.
During a post-budget seminar in Harare on Monday, Minister of Finance, Economic Development and Investment Promotion, Professor Mthuli Ncube, acknowledged that Zimbabwe’s health budget falls short of the Abuja Declaration target, which calls for African governments to allocate at least 15 percent of their national budgets to the health sector, but highlighted how the same health sector receives “quite a lot” of external funding.
The 2025 National Budget has allocated ZiG28.3 billion to the Ministry of Health and Child Care, which Prof Ncube said amounts to 13 percent of the national budget.
“The Abuja target is 15 percent, we are about close to that but just below. Almost there. The health ministry receives quite a lot of resources from outside, mainly through the Global Fund for the HIV,AIDS programme, GAVI. We also have a credit fund, which is heavily funded. We also take that into account…,” said the finance minister.
While he acknowledged the importance of these external sources, Prof Ncube warned the government must eventually take on a larger share of health financing as international partners may not be able to sustain their support indefinitely.
“We are aware that over time, we as a government have to take over the bulk of that. I can’t imagine that partners will continue supporting…,” he added.
The 2025 health budget includes significant allocations for infrastructure improvements, including ZiG3.5 billion for the construction and rehabilitation of hospitals and clinics, as well as ZWL 290 million for the procurement of medical equipment.
ZiG 150 million has been earmarked for ambulances and utility vehicles.
The budget also targets funding for essential health programmes, including procurement of medicines and medical supplies, as well as enhanced assisted medical treatment orders (AMTOs).
Despite these efforts, the health sector continues to rely heavily on foreign aid.
In 2025, the finance minister said the “sector is projected to receive an estimated US$461 million in external development assistance, primarily from donors supporting HIV, AIDS, Malaria, Tuberculosis prevention and maternal and child health programmes.”
“In addition, the resources will go towards procurement of hospital equipment, family planning programmes and digitalisation,” Prof Ncube said.
A prominent analyst and Director of the Zimbabwe Women’s Resource Centre and Network (ZWRCN), Thokozile Ruzvidzo, criticised the government’s ongoing dependence on external financing for the health sector.
“The inadequate public financing of health has resulted in an overreliance on out-of-pocket and external financing, which is highly unsustainable,” she said.
“The health sector is expected to receive development assistance support amounting to US$461 million, which will go towards HIV, AIDS, Malaria and Tuberculosis prevention, maternal and child health programmes.”
Ruzvidzo pointed out that the heavy reliance on foreign aid has led to a distortion in government spending priorities.
“In countries that are highly dependent on external aid, health priorities in government spending tend to fall in line with the increased aid. Development assistance for health has crowded out government resources and created donor dependence.”
A political analyst, Mxolisi Ncube further weighed in that this dependence on external funding has contributed to a cycle where the government is less motivated to allocate sufficient domestic resources to the sector, relying instead on donor funding to meet basic healthcare needs.
“This reliance not only leaves the country vulnerable to shifts in donor priorities but also compromises the sustainability of the health system,” he said.
Zimbabwe’s health sector faces critical challenges, including a lack of adequate infrastructure, outdated equipment, shortage of essential medical accessories and shortage of medical personnel.
“We also note the pressure put on families and households to finance healthcare through out-of-pocket payments. This has placed a significant burden on the most vulnerable, making it increasingly difficult for them to access quality healthcare. Few can afford private healthcare providers, who are often expensive and inaccessible to the majority,” Ncube lamented.
