Budget underspend leaves health sector in doldrums

Zimbabwe's health sector is being severely undermined by budget underutilisation, weak procurement systems, and stalled infrastructure projects, posing a serious threat to the country's healthcare delivery, a new report by Transparency International Zimbabwe (TIZ) has revealed.

The report, titled "Trend Analysis Report: Procurement Performance in Zimbabwe's Health Sector (2020–2024)," paints a worrying picture of persistent inefficiencies, poor financial management, and widespread non-compliance within the Ministry of Health and Child Care.

According to the report, the sector has repeatedly failed to fully utilise its allocated budgets over the past five years - leaving 20.3% unspent in 2020, 22.8% in 2021, 10.4% in 2022, 5.5% in 2023, and 21.4% in 2024.

"In an economically constrained environment like Zimbabwe, the timely and cost-effective acquisition of essential medicines, equipment and services is not merely an administrative task, but a life-saving imperative," TIZ said.

The Auditor-General's Office also flagged unreconciled payments and arrears in every financial year, with 2024 showing a US$3.1 million variance between Treasury and ministry records - highlighting continued weaknesses in financial efficiency and accountability.

TIZ said procurement planning remained one of the health sector's biggest challenges, with major compliance breaches recorded between 2020 and 2022 when the ministry conducted purchases without approved procurement plans.

While compliance improved marginally in 2023 and 2024 - as the ministry registered evaluation and disposal committees - significant gaps persisted at provincial and district levels, indicating incomplete compliance across the health system.

Non-compliance peaked in 2021, when irregular purchases and unauthorised procurements were at their highest. Compliance rates have since improved from 40% in 2020 to 73% in 2024, but TIZ noted that "formal compliance improved while operational compliance remained weak."

"Delayed tenders, overpayments and inadequate documentation for supplier contracts continued to occur in 2023 and 2024. Consistent documentation failures create an environment where corruption can thrive unchecked," the report warned.

TIZ also cited weak internal controls and governance failures at major health institutions such as the Government Analyst Laboratory, Harare Dental Centre, and Gweru Hospital. Issues included lack of segregation of duties, under-banking, and unsupported expenditures.

Public health economist Tendayi Chipango said the findings reflected broader governance deficiencies in the public sector.

"The health sector is not insulated from governance challenges; its performance is interdependent with the broader governance and public administration ecosystem," she said.

Chipango urged government to strengthen the use of Health Management Information Systems (HMIS) to improve documentation, accountability and evidence-based decision-making.

"The report does not show the expected gains from results-based financing (RBF). Its sustainability and institutionalisation require review," she added.

In a related analysis, Community Working Group on Health (CWGH) executive director Itai Rusike said the government's limited fiscal space had crippled the sector's ability to meet key funding benchmarks such as the Abuja Declaration target of allocating 15% of the national budget to health.

"In 2021, health received 10% of the national budget, rising to 12% in 2022. However, the 2025 budget fell again to 10.2%. The government has also failed to meet the World Health Organisation's threshold of US$84 per capita," Rusike said.

He noted that about 90% of Zimbabweans lack health insurance, forcing them to rely on out-of-pocket payments for healthcare. This has worsened inequalities and limited access to essential services.

"Out-of-pocket health spending in Zimbabwe was just US$10.66 per capita in 2018, one of the lowest among low- and middle-income countries," he said.

Rusike called for the 2026 national budget to prioritise transparency, resource efficiency and stronger oversight to curb corruption, tender manipulation and financial leakages.

"The upcoming budget must empower oversight institutions to act decisively and restore public trust in how health resources are managed," he said.

The TIZ report concludes that without urgent reforms in procurement, financial governance and budget execution, Zimbabwe's health system will remain underperforming, underfunded and vulnerable to corruption, undermining national development and public health goals.