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Zambia offers health care to Zimbabweans — but for how long?

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Illustration Credit: Wynona Mutisi for Global Press Journal

BY GAMUCHIRAI MASIYIWA

Summary: Zambia is as generous with patients from neighboring Zimbabwe as it is with its own citizens. That could mean problems for both countries.

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This story was originally published by Global Press Journal.

MASHONALAND WEST, ZIMBABWE — When Dube was diagnosed with gallstones in 2013, the public hospital in Zimbabwe recommended surgery costing close to 4,000 United States dollars. She couldn’t afford that.

 

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A friend suggested she go to Zambia, about 150 kilometers (94 miles) to the north. There, the friend said, treatment would be cheaper.

 

Over the past decade, Dube has gone to Zambia multiple times for medical treatment. Her most recent trip was in June. Treatment is cheaper there, she says, but the level of care is also far better than what she would get at home. Dube asked that Global Press Journal use her totem name, a symbolic representation of ancestral lineage, out of concern about Zimbabwe’s Patriotic Bill, which discourages criticism of the government.

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In the 1980s, Zimbabwe had one of the best health care systems in sub-Saharan Africa. But over the years, this glory has faded. An ongoing economic crisis spanning over two decades has left the health care system scrambling to meet the needs of its population. Skilled health care workers have left in droves, drawn to opportunities abroad. More than 4,000 health care workers left Zimbabwe in 2021 and 2022 alone, according to government statistics. By late 2022, Zimbabwe had about 1,700 doctors and about 17,200 nurses to serve a population of 15 million people.

 

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Just as health care workers are leaving the country, so are patients.

 

Over the past decade, Zimbabweans have spent more than 4 billion US dollars on cross-border medical migration. Annually, more than 200,000 Zimbabweans spend around 400 million US dollars on specialized medical treatment abroad. India, China, Singapore and South Africa are the main destinations.

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But an increasingly popular choice is neighboring Zambia. In April alone, the International Organization for Migration surveyed over 260 people migrating from Zimbabwe to Zambia. When asked why they were traveling, 42% stated that it was to access better services — health being the top priority.

 

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Precise data is hard to come by, but anecdotal evidence from sources who spoke to Global Press Journal, including border officials, points to a growing trend, raising questions about Zambia’s ability to manage the influx, and the future of health care in Zimbabwe.

 

The choice of Zambia

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Zambia and Zimbabwe allocated nearly the same amount of money to their health sectors in 2024, even though Zambia is home to 4 million more people. With that budget, it’s an unlikely alternative to the Zimbabwean healthcare system. And in Africa, it’s South Africa and Kenya that are top destinations for medical tourism.

 

But the border with Zambia isn’t far for many Zimbabweans, making the cost of travel low and the process of crossing the border usually straightforward. A person needs either a passport or a pass issued at the border for just 1 US dollar, says Morgen Moyo, assistant regional immigration officer at the Chirunduborder post.

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Even without documentation, immigration officials will at times let those seeking health care pass through. “Zambians prioritize life,” Moyo says.

 

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It’s not only about convenience. Zambia offers free primary health services, including basic treatment, preventative care, vaccinations and maternal health care services, according to the 2022-2026 Zambia National Health Strategic Plan.

 

While these free services are not available to foreigners long-term, they can access them in emergencies within the first 24 to 48 hours in the country, says Dr. Kennedy Lishimpi, permanent secretary of administration for the Zambian Ministry of Health. Foreigners are expected to pay for Zambian health care after that timeframe.

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In practice, though, Zambian health workers rarely charge foreigners, according to a 2019 study paid for by the US Agency for International Development, known as USAID.

 

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“You wouldn’t want to see somebody from Zimbabwe, for instance, getting to Zambia and not accessing a service and then they end up dying. That is not good. Similarly, we expect that our sister countries do the same to our citizens when they are there,” Lishimpi says.

 

Dr. Mwanza, a Zambian doctor who chose to use only his last name for fear of retribution, says availability of surgical and specialist services in Zambia drives medical migration. In Zimbabwe, these services are rarely available outside of the large provincial and central hospitals. In 2019, for example, about 10% of district hospitals could provide basic surgeries, compared to 83% of provincial and central hospitals, according to a Zimbabwe health ministry assessment.

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When Mary Chipfuvamiti’s son broke his arm in June, she says she chose a hospital in Zambia — about 93 kilometers (nearly 58 miles) from her home — over local options. She suspected the local hospital’s X-ray machine wouldn’t be working, and they would likely refer her to a private facility where an X-ray would cost her 40 US dollars.

 

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“I only had 30 dollars on me,” she says. In Zambia, the total cost came to about 12.50 US dollars.

 

A case for Zimbabwe

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Things haven’t always been like this in Zimbabwe. Before the country’s economy took a downturn, it offered free health services in the 1980s to low-income earners. About 90% of the population fell in that bracket.

 

In the early 1990s, the government introduced user fees in public health facilities as part of the austerity measures imposed on the government by the International Monetary Fund to reduce government expenditures. Currently, free health services are offered only to pregnant and lactating mothers, children under age 5 and adults over 60.

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The economic crisis continues to strain what remains of the health care system. Hospitals struggle with obsolete infrastructure. Shortages of medicines and supplies in public health facilities are the norm.

 

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And although Zimbabwe and Zambia have similar health budgets, Zimbabwe’s treasury sometimes delays funds disbursement, says Norman Matara, secretary general for the Zimbabwe Association of Doctors for Human Rights.

 

That was the case in 2021, when the health ministry by September had used just 46% of its budget allocation for the fiscal year due to late disbursement of funds, according to a 2024 situational report by the Zimbabwe Coalition on Debt and Development, a nongovernmental organization that advocates for socioeconomic justice.

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“There is a mismatch between the money that is put on the budget and what is being received by the health institutions,” Matara says. Reasons include hyperinflation and currency rate fluctuations, he adds.

 

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Comparing health services across countries is unfair, says Donald Mujiri, a Zimbabwe health ministry spokesperson. “Each country has its set standards and pricing.”

 

He doesn’t think this migration of patients reflects poorly on Zimbabwe’s health care system. “We have all the services in the country, and they are adequate to serve the people,” he says, adding that people are free to seek health care where they want.

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Mujiri did not address questions regarding the late disbursement of funds.

 

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The cost of the journey

These journeys to Zambia come with challenges.

 

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Dube recalled her trips along the bumpy Harare-ChirunduHighway that connects the two countries, when every bump caused piercing pain.

 

In 2019, six years after her initial treatment in Zambia, she began experiencing severe pain. She went to a hospital in Harare for treatment, but a few months later the pain resurfaced. By that time, there was a health care strike at home, forcing her back to Zambia for treatment. Then in 2023, Zambian doctors discovered metal clips from her earlier surgery in Zimbabwe were piercing her liver. She returned to Zambia in January this year for corrective surgery, and again in June.

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Health care experts warn that such journeys can be especially risky for patients who undergo surgery. If a surgery is performed in Zambia and there is no proper follow-up, there can be complications if doctors in Zimbabwe are unaware of previous procedures or tests, says Mukanya, a health expert working in a Zimbabwean hospital who chose to use his totem, fearing that speaking to the media would cost him his job.

 

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In the case of misdiagnosis or malpractice in a foreign country, it’s difficult to get recourse. “In most cases you are powerless because you don’t know the [reporting] process and approaching a lawyer may require money,” he says.

 

Medical migration also comes at a cost to Zambia. The influx of patients complicates health planning, leading to shortages of essential medications and making it difficult to allocate resources effectively, according to USAID. The agency’s report recommends the Zambian government create a fee-for-service system to discourage foreigners from seeking free health care, but doctors in Zambia don’t seem to agree.

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“Most health care providers interviewed stated that they would continue to provide services free of charge should a foreign patient be unable to pay,” according to the USAID report.

 

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Lishimpi, the Zambia health ministry official, had no comment on the report’s concerns.

 

Dube, who is recuperating at home, is uncertain about the solutions. But she thinks the Zimbabwean government needs to prioritize fixing her country’s health care system. “I don’t know how best we can help our hospitals, but if there was any other way, I think they should consider the health sector more than anything else because we are talking of human life,” she says.

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Gamuchirai Masiyiwa is a Global Press Journal reporter based in Harare, Zimbabwe.

 

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Global Press is an award-winning international news publication with more than 40 independent news bureaus across Africa, Asia and Latin America.

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National

Inside the ‘bondage’ of Zimbabwe’s contract tobacco farming

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BY LINDA MUJURU

Zimbabwe’s tobacco sector was once on the brink of collapse. Now, it’s booming again. Last year alone, it earned the country close to US$1 billion in revenue.

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But though the crop is one of the country’s top exports and production has soared, small-scale contract farmers say they see little profit due to restrictive financing agreements.

The tobacco boom, farmers say, is keeping them in debt.

Gift Ngoma is among them. When he lost his clerk job eight years ago, tobacco farming was the only way he could feed his family. But fertilizer, seeds and labor proved expensive. Even money from the few cows he sold wasn’t enough.

Like many rural Zimbabweans, he’d gotten land — about 3.5 hectares (9 acres) — through traditional tenure. But those who secured land that way often lack a title deed. For Ngoma, formal credit was out of the question.

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Ngoma knew of local farmers who had entered agreements with private companies. The deals looked good at first: Each planting season, a company provided farmers with seeds and fertilizer on credit. They’d offer technical support throughout the season. In return, farmers sold enough of their crop to the company and used part of the revenue to cover what they owed.

Ngoma signed on with Premium Leaf Zimbabwe, a subsidiary of Premium Tobacco — a global company headquartered in Dubai.

The company provided him with seeds and some money for labor. Once harvest came, he sold enough tobacco to the company to pay off his debt. But over time, he says, this agreement came to feel like a trap. The seeds and other inputs are overpriced, he says, and there’s little money left over to find true success as a farmer.

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Thin rewards

More than 100,000 small-scale tobacco farmers in Zimbabwe have entered into contracts with tobacco companies, according to data from the Tobacco Industry and Marketing Board, a statutory body that oversees tobacco production in the country.

The contracts — heavily financed by companies such as British American Tobacco and Tian Ze (China Tobacco) — now support over 95% of Zimbabwe’s tobacco production.

The five largest importers of Zimbabwe’s raw tobacco are China, South Africa, Mozambique, United Arab Emirates and Indonesia.

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But smallholding farmers don’t feel that success. In December 2024, the government announced plans to issue title deeds to beneficiaries of the land reform program, which would give farmers a chance to use their land as collateral and rely less on contract farming. But for now, many still rely on tobacco contracts.

“We are in a cycle of oppression,” Ngoma says. “There is poverty in contract farming. It’s as if we are laborers on our farms.”

When Global Press Journal reached out to Premium Leaf Zimbabwe for comment, they said it was the company’s policy to “protect the privacy of our farmers and operational integrity.” Tian Ze and British American Tobacco did not respond to several requests for comment.

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The land link

Zimbabwe’s shift to contract farming has roots in a wider story of land reform.

At independence in 1980, white Zimbabweans — who made up less than 2% of the population — controlled nearly half of all agricultural land. The majority black population was confined to degraded, overcrowded communal areas.

In 2000, then-President Robert Mugabe launched the controversial Fast Track Land Reform Programme. The government redistributed millions of hectares of land from about 6,000 large, white-owned farms to more than 168,000 black-owned farms, according to a Human Rights Watch report.

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The reforms were rushed, controversial and violent, but they brought a new agrarian structure. Tobacco, at the time one of the most valuable crops and dominated by white-owned farms, shifted to small-scale operations by the new landowners.

But the new generation of farmers didn’t have access to traditional bank credit since they didn’t hold deeds to their land. Tobacco production dropped dramatically, from over 197,000 tons in 1998 to about 44,000 tons in 2006.

Farmers needed support, and into the vacuum stepped contract schemes, mostly by Chinese agribusinesses such as Tian Ze. They supplied seeds, fertilizers and technical support in exchange for crop guarantees, price control and access to global markets. Ultimately, those contracts played a key role in the post-reform tobacco boom.

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‘We continue to be dependent’

Contract schemes now dominate Zimbabwe’s tobacco farming, says Emmanuel Matsvaire, acting chief executive officer of the Tobacco Industry and Marketing Board. In the 2024-25 season alone, the board recorded a total of 106,555 small-scale growers, he says, and about 89% of these are contract farming. In the 2025 season, the board licensed 43 companies to contract tobacco farmers.

The country’s economy has long struggled and “local financing is generally limited,” Matsvaire says. These companies fill the gap.

But farmers say the fine print works against them.

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Seeds and fertilizer are overpriced, Ngoma says. For half a hectare, he receives seven bags of fertilizer for US$65 each. At the shops, the same bag costs about US$40. Many farmers don’t have ready cash to buy directly from shops, so they rely on private companies to provide fertilizer and other inputs, even if it means paying more when harvest comes.

“Because of poverty, we continue to be dependent,” Ngoma says.

Once contract farmers pay back the debts, very little is left. In some cases, the total earnings don’t even cover the debt, Ngoma says, which forces them to grow tobacco for the same company the next season.

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The companies control the whole process, including land use, Ngoma says, adding that at times they bring in agricultural experts who dictate seed types, planting times and farming methods, completely disregarding local farming knowledge.

Peter Neshumba, 36, began contract farming for Premium Leaf Zimbabwe in 2024. He says these companies go as far as controlling whether farmers can plant anything else. They want full devotion for their crops, he says. “Until harvest, the land essentially belongs to them.”

If a farmer doesn’t stick to the rules, the company might refuse to buy their crop or leave them without a contract the next season, he says.

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A contract analyzed in a 2023 study in Oikos, a journal published by Zimbabwe Ezekiel Guti University, shows just how tobacco contracts lock small-scale farmers into risky debt. The 2019-20 Tian Ze contract required farmers to repay loans before seeing any profit, even requiring some to put their property on the line as collateral.

Undoing land reforms

These arrangements undermine Zimbabwe’s land reforms, says George Seremwe, the president of the Zimbabwe Tobacco Growers Association. The reforms were meant to redress colonial imbalances, but contract farming introduces new vulnerabilities for small-scale farmers as they cede control of their land to contracting companies.

But Nelson Marongwe, an independent land expert who has researched tobacco farming and land rights, doesn’t think so. The contracts are valid, he says, and address a production gap.

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But it needs to be for a limited period, he says, as there is a risk of farmers losing autonomy and companies abusing their bargaining power.

‘I feel used’

The tobacco board is trying to make these arrangements fairer to farmers, Matsvaire says. The government is implementing a framework to ensure farmers receive a fair share of profits, receive inputs in time and aren’t burdened with overpriced or substandard inputs. The framework will also set a minimum input package for farmers.

Matsvaire adds that this farming season, the Reserve Bank of Zimbabwe has mandated that tobacco farmers retain 70% of their earnings, in US dollars to protect them from exchange-rate losses.

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But Ngoma says other issues, like land control and alternative financing methods, still need to be addressed.

One solution, Marongwe, the land expert, says, is to secure rural land rights for all farmers, which would expand access to other financing options.

Seremwe says farmers need fairer terms, but the solution is not to abandon contract farming, since the country needs the foreign investment.

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Despite the challenges, Neshumba plans to keep contract farming. He doesn’t have financing alternatives. When he started, he hoped for better returns. “Now that I’m in it,” he says, “I feel used.”

For farmers like Ngoma, the goal is self-financing.

“Contract farming,” he says, “is a bondage.”

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The story was originally published by the Global Press Journal 

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National

Government discord over tinted vehicle directive

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BY WANDILE TSHUMA

In a surprising turn of events, President Emmerson Mnangagwa’s spokesman, George Charamba, has dismissed a recent directive mandating the removal of tinted windows from vehicles across Zimbabwe, labeling it as lacking legal grounding and urging the public to disregard it.

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Charamba, who is currently accompanying the president in China, issued this clarification on Wednesday, distancing Mnangagwa’s office from the controversial announcement made by Tafadzwa Muguti, the Secretary for Presidential Affairs and Devolution.

“Kindly note: There is no basis in fact or law to the accompanying announcement attributed to Secretary Muguti. Kindly ignore this miscommunication from an unauthorized office and officer!” Charamba stated on X, further attaching a video of Muguti.

Muguti’s original directive, announced during a press conference in Harare on Tuesday, required all private and public motorists to “immediately” strip their vehicles of tinted windows due to a purported increase in crime involving obscured vehicles.

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The announcement notably exempted government and VIP transport, as well as vehicles manufactured with standard shades of tint.

The directive quickly sparked confusion, as previous laws do not impose an outright ban on tinted windows. Statutory Instrument 129 of 2015 mandates that windows must provide “a clear, undistorted vision” and a “safe degree of visibility,” indicating that there are conditions under which tints are permissible.

Legal experts have raised concerns over the authority and validity of Muguti’s statement, cautioning that the police could engage in unlawful actions if they attempted to enforce the measure. Lawyer Obey Shava emphasized, “Police should be careful not to make costly decisions based on a statement which is not fully supported by the law. Tint is allowed on condition certain requirements are met,” as reported by ZimLive.

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In the community

Victoria Falls Junior Council urged to propose projects for 2026 budget

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BY STAFF REPORTER

In a significant push to empower the youth and encourage community development, Kholwani Mangena, the Chamber Secretary of Victoria Falls City Council, has urged the Junior Council to identify and propose projects they wish to see funded in the 2026 budget.

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This call to action was made during a recent budget consultation meeting held at Chinotimba Clinic, where concerns about the lack of support for the Junior Council and local youth from the council’s livelihoods program were raised.

Mangena highlighted an opportunity, revealing that the council has earmarked a piece of land specifically for youth-led initiatives, particularly in agriculture.

“Otherwise, on the other projects you have proposed such as poultry in this coming budget, for 2026, we have earmarked some piece of land so that if you want to do poultry, you can do that,” she stated. Her message was clear: youth and women, as well as people with disabilities, must take the initiative to define their projects and funding needs.

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The Secretary brought attention to previous efforts made by the council to support marginalized groups, mentioning, “We gave them a piece of land somewhere about three months ago,” referring to the land allocated for various community projects. She encouraged the Junior Council to be proactive in outlining their desired projects, saying, “Identify your projects. Be clear about the projects that you want to do and the funding. And then we can ask the council to fund those.”

Mangena also offered support for fundraising efforts, suggesting that the council could provide initial funding for activities like a talent show to help raise funds for their proposed initiatives. “Before the end of the year, we can do that. For example, maybe you want to do some fundraising. We can give you the money to start that fundraising,” she continued, emphasizing the importance of grassroots efforts in driving change and development.

 

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