Johannes Marisa Tax at the heart of health inequalities
HEALTH and development are symbiotic in nature and no country can boast of development when its nationals are not healthy.
A healthy individual is productive and can contribute significantly to the country’s gross domestic product.
Many poor countries are still miles away from solving the issue of health inequalities and twisted equity and the consequences can be so dire that there is high morbidity and mortality.
Crude death rate, maternal mortality, peri-natal mortality, neonatal mortality and child mortality can all be on the rise if primary healthcare is not as robust as expected.
The health sector is touted as one of the most important sectors in the world and in 2001, African countries convened in Abuja, Nigeria where they recommended that for countries to stand firm in terms of health service delivery, at least 15% of the national fiscus should be allocated to the health sector.
This means about 1/7 of the entire national budget and that stance showed how significant the health sector is to any country.
Zimbabwe has, however, failed to reach the 15% mark for the past many years and in 2022, 2023 and 2024, the budgetary allocations were 10,6%, 11,2% and 10,8%, respectively.
With the emergence of COVID-19 and post-COVID syndrome, the menacing HIV and Aids, a malaria, tuberculosis and a cholera outbreak, the 10,8% allocation for 2024 is significantly little.
The year 2024 is riddled with taxes as the country attempts to increase revenue domestically.
There has been reduced foreign direct investment and the country has been under financial sanctions from international monetary institutions.
The creditworthiness of the country has been under scrutiny, it is grossly indebted with more than US$15 billion on the debt calendar.
The macro-economic factors are against the smooth sailing of the country with high inflation rate, high interest rates, painful taxation and high unemployment rate which render the country unattractive to investment.
The health sector is not spared from the harsh macroeconomic environment and recently, there was an outcry from health practitioners when medical commodities started to attract unbearable taxes.
It caught many citizens by surprise that medical commodities like spectacles, wheelchairs, crutches and ambulances are now attracting unbearable taxes.
Ambulances are now having a surcharge of 35%, 5% duty and 15% value-added tax, figures which are not only extortionate, but will weaken our health service delivery.
It remains a pipe dream for us to achieve universal health coverage in a short time to come.
Whoever buys the heavily-taxed ambulances will be forced to transfer the costs to patients, thus further aggravating the already dire health service delivery situation.
It may result in increased consultation fees, higher admission charges at clinics and hospitals; higher ambulance charges; increased drug costs et cetera.
If a country is to have an affordable health service, obvious cost-drivers should be nipped in the bud and taxation is one of those which should be given special consideration among interest rates, levies and drug costs.
It is impossible to achieve health equity in our country where many people are unemployed and are not insured.
The out-of-pocket health financing mechanism is not brawny when many people are not liquid as de-industrialisation takes centre stage in a country like Zimbabwe.
The country’s public health system is not as strong as expected because many factors continue to hamper progress.
There is massive brain drain at the moment with thousands of healthcare workers flocking to Europe to seek greener pastures.
Understaffing in clinics and hospitals is a serious cause for concern, yet many citizens cannot afford to access private healthcare.
Our health service delivery needs serious attention and should be user-friendly such that national policies do not suffocate the already incapacitated health sector.
Taxation is one area that needs serious consideration.