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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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In the community

Foot and mouth disease outbreak in Mat North

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BY NIZBERT MOYO

The provincial Veterinary Department has urged farmers to comply with livestock movement regulations following an outbreak of the Foot and Mouth Disease (FMD) in some parts of Matabeleland North.

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Acting provincial veterinarian Gwinyai Zhandire confirmed the outbreak to Southern Eye, saying the government has instituted movement controls, vaccination and active surveillance in the affected areas.

“There are some dip tanks affected in the Nyamandlovu area,” Zhandire said.

“The government has instituted movement controls and vaccination, and we are conducting surveillance.

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“Farmers are encouraged to observe and comply with livestock movement regulations to prevent further spread.”

He highlighted that the rainy season increases the risk of other livestock diseases.

With tick populations on the rise, farmers should be vigilant against tick-borne illnesses such as Anaplasmosis (Gall Sickness), Theileriosis (January Disease), Ehrlichiosis (Heartwater) and Babesiosis (Redwater).

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“Weekly dipping is encouraged to prevent transmission between animals,” Zhandire said.

He emphasised the importance of routine vaccination against other seasonal threats, including anthrax and lumpy skin diseases.

The outbreak has also affected farmers in the Umguza area, who have similarly been directed to adhere to animal movement restrictions.

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Foot and mouth disease is a highly contagious viral disease that affects cloven-hoofed animals, including cattle, sheep and goats.

The disease is characterised by fever and the development of painful sores or blisters in the mouth and on the feet, often leading to severe lameness and a drop in productivity.

The virus spreads easily through direct contact between animals, as well as via contaminated equipment, vehicles and feed.

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The disease can result in significant economic losses in the livestock industry due to trade restrictions and animal health costs.
Source: Southern Eye

 

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In the community

Brother-in-law jailed for repeated rape of mentally incompetent 16-year-old

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BY WANDILE TSHUMA

The Hwange Regional Magistrates’ Court has convicted and sentenced a 41‑year‑old man to 20 years’ imprisonment for the repeated rape of his 16‑year‑old sister‑in‑law, a mentally incompetent juvenile.

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The court heard that the victim was staying at the offender’s homestead in Lupane. Between November 2024 and May this year, the offender exploited her mental incapacity and his position of trust to rape her on multiple occasions.

In the first incident, the offender’s sister pushed the victim into a bedroom where the offender was waiting, locked the door, removed the victim’s clothes and raped her. He threatened the victim and ordered her to remain silent when she tried to cry out for help.

The abuse continued on various occasions. In May, a community member discovered the abuse and reported it to the Zimbabwe Republic Police in Lupane.

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Medical and psychiatric examinations confirmed the victim’s mental status and the ordeal. The offender and his sister assaulted the victim with a sjambok and a stick and threatened her not to disclose the matter.

 

 

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Inside South Africa’s lion breeding debate: A field visit to Mabula Pro Safaris

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BY NOKUTHABA DLAMINI

At the heart of Bela-Bela’s Driepdrift area lies Mabula Pro Safaris — a private predator breeding facility that, to many outsiders, represents one of the most controversial aspects of South Africa’s wildlife industry. But for the Zimbabwe Parks and Wildlife Management Authority (ZimParks) delegation, which recently toured the facility together with myself as a journalist from Zimbabwe, the visit provided an unusual opportunity: to see the behind-the-scenes reality of a commercial hunting lion breeding operation, far from the images often circulated in global media.

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Led by Stephen Palos, Vice-Chair of the Sustainable Use Coalition Southern Africa (SUCo-SA) and CEO of the Confederation of Hunters Associations of South Africa (CHASA), the tour included a close look at lions bred under the South African Predator Association (SAPA) standards.

Inside the sanctuary, the group viewed 52 lions — including 12 adult males and 11 cubs — living in structured social groups within medium-sized enclosures. The animals walked freely, with access to shade, water, and open space.

An earlier visit to a predator sanctuary was, as pointed out by Palos, a stark contrast. Those were used to people whereas these would eat you in a heartbeat.

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“These are breeding animals specifically, not pets,” he emphasized. “This is a breeding unit with the express purpose of producing lions for hunting. What you’re seeing here is very different from the popular ‘puppy farm’ narrative.”

Debunking the ‘puppy farm’ image

For years, global campaigns have depicted South African lion breeding as cruel and exploitative — with constant forced pregnancies, cubs immediately snatched from mothers, and animals confined in cramped cages. Palos argued that the facility before the delegation told a different story.

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“Each enclosure functions as a pride,” he explained. “A male, a few females, different ages of cubs — just like in the wild, but within an enclosure. Look at the cleanliness, the condition of the animals, their behaviours. These animals are at ease.”

He stressed that cubs were not routinely separated from their mothers for tourism activities, and that animals destined for hunting were relocated to separate facilities to be raised with minimal human imprinting.

A fractured industry

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Despite the orderliness observed at Mabula Pro, Palos admitted that the predator breeding industry suffers from fragmentation. Although SAPA prescribes standards for its members, adherence is voluntary.

“There are around 340 facilities in the country, but only about 43 are members of the association,” he said. “We cannot speak about those who choose to operate outside of these standards. That’s where the problems arise.”

What can African countries learn from each other?

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After the tour, l asked what lessons Southern Africa can share across borders, including Zimbabwe.

Palos responded with a regional, long-term view.

“Every African country has something to teach and something to learn,” he said. “Wildlife is a renewable natural resource — but only if it’s managed properly.”

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He contrasted South Africa’s fenced wildlife model with Zimbabwe’s largely open systems.

“South Africa relies heavily on fencing — from Kruger National Park to private ranches. But in Zimbabwe, Tanzania, Namibia, and elsewhere, you have vast open landscapes. Both systems work in their own contexts.”

Palos warned against “fortress conservation”, where communities are excluded from wildlife spaces — a model he says has failed people and wildlife alike.

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Toward shared learning and mentorship

One of the strongest points he emphasized was the need for honest exchange between countries.

“It’s wonderful for us to learn from your challenges and successes,” he told the delegation. “But it’s even more important for us to show what works here, openly, and address our own challenges.”

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He suggested that exchanges like this should evolve into:

Formal mentorship programmes
Boots-on-the-ground technical exchanges
Shared management experiments
Cross-border policy innovation

Economic lessons from a controversial industry

Palos acknowledged that South Africa has become a global leader in game farming and wildlife production systems — but insisted this does not invalidate the strengths of other countries’ models.

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“There is economic success here,” he said. “But it’s not the only way. Zimbabwe already has strong systems. A blend of your models and ours could be even better.”

For the Zimbabwean delegation, the visit provided an opportunity to observe a facility that challenges both critics and defenders of the captive breeding industry. Whether South Africa continues down this path or phases it out — as many activists demand — facilities like Mabulapro Safaris remain central to the debate.

The tour served as a reminder that wildlife management in Africa is varied, complex, and always evolving — shaped by history, ecology, economics, and human needs.

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