Roll Out of Low-Cost Mandatory Health Insurance in Zambia
Download the Full PaperExemplar Overview
This exemplar examines Zambia's roll-out of affordable mandatory health insurance through the National Health Insurance Management Authority (NHIMA), emphasizing the integration of partner subsidies and the SmartCare digital register.
Zambia enacted its National Health Insurance Act in 2018, launching NHIMA in 2019. It set employee/employer contributions at a low rate (1% each) to ensure political acceptability. To expand equity, Zambia partnered with the Global Fund to subsidize premium payments for poor and vulnerable populations. The scheme is supported by SmartCare, Zambia's electronic health record platform, which links clinical care with insurance membership data.
Policy Recommendations
Setting premium rates at a politically acceptable level (such as 1% salary contributions) accelerates early registration.
External donor resources (like Global Fund) can be integrated directly into national insurance pooling to fund equity subsidies.
Digital health registers (SmartCare) are critical for checking eligibility, tracking claims, and preventing fraud at the facility level.
Sustaining health security requires active cross-border disease surveillance, as demonstrated by Zambia's leadership in SADC cholera response.
Key Numbers
Registered members under NHIMA by November 2024
Total beneficiaries covered by the NHIMA scheme
Health share of the national budget achieved
Healthcare facilities accredited under the NHIMA program
Key Findings
Zambia registered 3.4 million members (representing 4.6 million beneficiaries) under NHIMA by November 2024.
The country integrated Global Fund resources to subsidize premiums for vulnerable informal-sector groups.
The health share of the national budget grew from 8% to 12%, moving closer to the 15% Abuja target.
Zambia's SmartCare electronic register was deployed across accredited facilities, connecting clinical and insurance data.