Zimbabwe has an opportunity to embed health technology assessment (HTA) into its health system as it works towards Universal Health Coverage (UHC) by 2030. Currently, the country provides access to just 55% of the benchmarked essential health services.
The health system in Zimbabwe
In 2019, Zimbabwe adopted the goal of achieving Universal Health Coverage (UHC) by 2030, focusing on equitable access to quality healthcare and financial risk protection. With a current UHC service coverage index of 55 out of 100, the country faces a substantial gap between aspiration and reality. The National Health Insurance (NHI) bill, drafted by the Ministry of Health and Child Care and yet to complete the parliamentary process, aims to bridge this gap. Beyond financing reform, the bill creates a critical window of opportunity to institutionalise health technology assessment (HTA) as a cornerstone of evidence-based healthcare decision-making. HTA can support key decisions on benefit packages, prioritisation and resource allocation as Zimbabwe builds its NHI system.
Zimbabwe’s healthcare system comprises public, private and faith-based providers. The public sector, which serves as the primary provider, operates a four-tier referral system from primary care facilities through to quaternary centres (such as university teaching hospitals). Healthcare funding comes from multiple sources: government budget (10.2% of total public expenditure in 2025, projected at 2.1% of GDP), external donors, private insurance and out-of-pocket payments. Per capita health expenditure in 2024 stood at USD 71.80, according to the Community Working Group on Health.
Zimbabwe’s UHC journey reflects broader trends across sub-Saharan Africa, where countries are increasingly recognising HTA as essential for sustainable health systems. As the region builds collaborative platforms for HTA knowledge exchange, Zimbabwe has the opportunity to engage with networks like the African Health Technology Assessment Network (AfroHTA), which facilitates capacity building across the continent through peer learning and technical support.
A roadmap for new technologies
Currently, Zimbabwe lacks a systematic pathway for evaluating and adopting new health technologies. Decisions are made through fragmented processes across multiple organisations, each operating independently with different criteria and limited coordination.
When a new medicine or medical device seeks entry to the Zimbabwean market, it must first obtain regulatory approval from the Medicines Control Authority of Zimbabwe (MCAZ). For public sector adoption, the National Medicine and Therapeutics Policy Advisory Committee (NMTPAC) then assesses whether to include it in the Essential Medicines List and Standard Treatment Guidelines (EDLIZ), applying criteria of disease burden, safety, efficacy, affordability, accessibility, rational use and potential for local production. Broader resource allocation decisions are guided by the Ministry of Health and Child Care’s five-year National Health Strategy. In the private sector, the Association of Health Funders of Zimbabwe (AFHOZ) independently sets reimbursement tariffs that influence coverage decisions by private insurers.
A formal HTA system would connect these steps rather than replace them. Cost-effectiveness already appears among the EDLIZ criteria, but cost-effectiveness evidence is not currently used to inform which medicines are selected. Introducing HTA would mean giving NMTPAC an explicit evidence framework, extending assessment beyond safety and efficacy, and linking the results to the benefit package the NHI will need to define. Thailand followed a comparable route when its 2008 revision of the National List of Essential Medicines became the first to incorporate economic evaluation formally, using medicines assessment as a manageable entry point institutional capacity developed. Once enacted, the NHI legislation would supply both the mandate and the mechanism, since a scheme that must decide what it covers and at what levels needs a systematic basis for those decisions.
The current challenges
Institutionalising HTA in Zimbabwe faces obstacles common to many low- and middle-income countries. Funding remains a fundamental constraint. HTA requires investment in infrastructure, personnel and processes, yet health budgets are already stretched. Recent reductions in donor support have compounded this challenge.
Expertise is scarce, and critically so. Zimbabwe has few health economists and limited capacity in outcomes research and evidence synthesis, reflecting the absence of academic institutions offering training in these essential fields. Yet this shortage emerges at a potentially fortuitous moment. The government’s plans to expand the healthcare workforce in response to donor funding cuts offer scope to strategically incorporate health economists and evaluators into the system. Paired with investments in establishing formal training programmes, this expansion could lay the foundation for sustained technical capacity that robust HTA demands.
Data gaps undermine evidence generation. Poor data collection on unit costs, epidemiology and health outcomes means assessment teams lack the robust parameters needed for rigorous evaluation. Without reliable local data, HTA risks relying on international studies that may not reflect Zimbabwe’s context.
Conflicts of interest complicate decision-making. Some private health insurance companies also operate healthcare facilities, creating potential conflicts when these same organisations set reimbursement tariffs for services they themselves provide. This dual role raises questions about the independence and objectivity of coverage decisions.
Perhaps most fundamentally, awareness of HTA remains low. Many policymakers and stakeholders are unfamiliar with what HTA entails and the value it could bring to healthcare decision-making. Building understanding and buy-in will be essential for successful institutionalisation.
These challenges mirror those faced by neighbouring countries. Kenya, for instance, has addressed expertise gaps through a bilateral partnership with Thailand’s Health Intervention and Technology Assessment Programme (HITAP), signed in 2019, which provides technical assistance, capacity building and postgraduate scholarships. Tanzania introduced HTA through systematic revision of its National Essential Medicines List between 2014 and 2018, establishing a formal HTA committee in the process. Zimbabwe can learn from these experiences whilst adapting solutions to its own context.
Next steps
The proposed NHI bill gives Zimbabwe an opportunity to move from ad-hoc decision-making to a formal HTA system. The question is no longer whether HTA is needed, but how to introduce it in a practical and sustainable way. Three steps would matter most.
Establishing who decides. Building on the stakeholder analysis, Ministry of Health and Child Care could convene a national HTA steering committee bringing together the Ministry of Finance, MCAZ, NatPharm, medical aid societies, professional associations, universities and patient representatives, with a small technical secretariat within the ministry to coordinate assessments while permanent arrangements are developed. Involving medical aid societies directly also creates a forum in which the conflicts of interests described above can be surfaced rather than left implicit.
Giving it a legal footing. A Cabinet-approved HTA policy would set out who conducts assessments, who decides, how the function is financed and what criteria apply. Without this, HTA risks remaining a project rather than becoming a permanent part of how decisions are made.
Starting where decisions are already being made. The next EDLIZ revision offers the most immediate opportunity, strengthening a process that already exists rather than building a parallel one, and putting to use the cost effectiveness criterion already written into it. Capacity can grow alongside, through partnerships with the University of Zimbabwe and through AfroHTA’s HTA short course, which is aimed at both producers and users of assessments. Routine data collection would need to improve in parallel, since assessments are only as good as the unit cost and outcomes data available.
Zimbabwe stands at a pivotal moment. The convergence of the NHI reform, growing awareness among policymakers, existing decision-making structures and regional support through networks like AfroHTA creates favourable conditions for HTA institutionalisation. With sustained political will, strategic stakeholder engagement and phased implementation, Zimbabwe can transform this opportunity into a functioning HTA system that advances Universal Health Coverage and offers a route others in the region might follow.
