Zambia Universal Health Insurance
Country of Operation
- Zambian GovernmentGovernment
SummaryThe Zambia Universal Health Insurance merges three compulsory schemes already in existence: a scheme for the formal sector, medical assistance for local populations, and mutual health organizations for the informal sector.
The scheme will initially cover the formal sector employees (public and private) who are estimated to be 495,277 in 2009 and projected at 739,337 in 2023. This includes (i) Central Government (ii) Local Government (iii) Parastatal Organizations, and (iv) Private-sector Employees. The number of beneficiaries per single contributor will 6 (principle member, spouse & four children/dependants) From the above, the total population covered initially will be 2,971,662 (22%) and increase to 4,436,024 (35%) by 2023.
Key program components
All beneficiares pay a flat fee that is subsidized by the government. The scheme offers an extensive benefits package. Outpatient care includes medical consultations, nursing care, dental care, medical imaging, laboratory tests, and minor surgery. Hospitalization and inpatient care includes the cost of a hospital stay, medical procedures, surgery and medical techniques, and transportation expenses. Maternity benefits include medical and drug costs, tests, hospitalization for pregnancy, delivery, and its effects up to week eight. Pharmaceuticals can be obtained from a list of approved drugs. For mutuelles, benefits include preventative and promotional health including pre- and post-natal consultation, monitoring healthy infants, vaccinations, family planning, health education and sanitation. Curative care benefits include consultations, nursing care, drugs, laboratory testing, chronic diseases, malnutrition and nutrition rehabilitation. This program covers 3,021,128 people.