Is this health justice or state overreach?

In the swiftly evolving drama of Zimbabwean healthcare, a new bill in Parliament has stirred both hope and alarm. The Medical Services Amendment Bill, championed by Justice and Parliamentary Affairs Minister Ziyambi Ziyambi, seeks to align private hospital practices with constitutional guarantees. It empowers the health minister to cap fees, regulate pricing, and mandates that private institutions admit and stabilize emergency patients for at least 48 hours, regardless of their ability to pay.

This legislation strikes at the heart of a dilemma now familiar in Zimbabwe, and indeed around the world. Is it a mandate toward universal justice, a necessary bulwark against medical profiteering? Or is it a dangerous overreach, threatening to collapse a fragile private healthcare sector already on its knees?

In this moment, we must look clearly at both potential and peril.

The political and human stakes are obvious. Zimbabwe's public health system, was ravaged by economic collapse and underfunding. Private hospitals now charge fees out of reach for ordinary citizens.

In emergencies, stories of patients turned away at gates, unable to pay entry fees, are lifelines severed. This bill seeks to make that impossible - no one may be refused emergency care under Section 76 of our constitution.

The optics are undeniably powerful. A constitutional right made real. A state reasserting its duty. Justice framed not in broken hospitals or bureaucratic promise, but in tangible half‑life lines drawn in the corridors of care.

In many parts of the world, such legislation would be lauded as overdue, essential. The phrase "healthcare as a human right" would not to most readers sound radical.

But the Golden Rule of law says: Those with gold make the rules. If private hospitals become compulsory 48‑hour clinics, no institution will absorb that at cost without compensation. Though the bill allows for ministerial cost‑recovery agreements, there is scant clarity on timeliness, rates, or guarantees  .

Doctors' associations and human‑rights groups have cautioned that this "reimbursement model… is vague and may need further clarification"  . They note public hospitals owe large arrears; private hospitals cannot sustain bloated bills without guaranteed payment.

A senior physician told journalists - bluntly - that private hospitals would be overwhelmed. Running out of food, medicine, oxygen, and with staff stretched thin, this could collapse the very system it hopes to rescue  . Indeed, facilities founded on rapid turnover and revenue per patient are suddenly tasked with open‑ended guarantees. The question becomes: can a hospital sustain a business model built on profit under these constraints?

If not profit, perhaps regulation can fill the gap. The bill grants sweeping powers to cap fees and price increases - even overriding previously established charges  . Again, early reactions raise concern. Should the Health Minister, a political figure, dictate bedside rates? Doctors warn this amounts to micro‑management, unwisely binding health delivery to bureaucratic fiat  .

Zimbabwe's medical sector, like those elsewhere, requires agility. A sudden shortage of critical drugs or a spike in imports costs must be absorbed. Setting fixed price ceilings - with no adjustment mechanisms - could choke innovation, stifle investment, and shrink capacity just as demand burgeons.

There is another hidden dimension: equity. Who benefits and who gets left behind? If private hospitals can no longer raise fees, their board decisions may include cost‑shifting or prioritization of lucrative cosmetic, dental, or elective services. Those who can pay may be diverted to circumvent price controls. Emergency care, in practice, might become a symbolic principle rather than a lived guarantee.

Worse, if private institutions begin refusing non‑emergency patients to allocate resources to mandated emergencies, the general public may suffer.

The designations of what is "emergency" versus "routine" are vulnerable to manipulation - patients may show up in true crisis and be denied care on technical grounds. In systems where triage protocols are already weak, this could create a two-tier that benefits none.

Yet, it's vital not to mistake critique for cynicism. Zimbabwe's private healthcare crisis didn't emerge overnight - it is the product of years of public underinvestment, currency collapse, and structural rot. The bill must be judged on its structural merits, not just its risks. It addresses a moral failing: healthcare should not be a luxury to finance or a gamble on one's luck.

For Zimbabweans, the question isn't whether the state should intervene - it has to. It's whether this intervention is sufficiently nuanced, financed, enforceable, and paired with a plan to revitalize public health so that dependence on private lifelines can ease, rather than deepen.

International comparisons offer mixed lessons. In the United States, coercive "emergency treatment regardless of ability to pay" exists on paper - but in practice, hospitals bill uninsured patients at staggering rates after evacuation orders expire. In South Africa, private hospitals dominate serious healthcare provision - yet cost schedules are hardly transparent and access remains politically contested.

In Kenya and Nigeria, recent bills criminalize refusal to treat, but compliance remains structural, not legal. Penalties for non-compliance are vague and enforcement weak. Zimbabwe's version now leads in constitutional alignment - but must learn from its neighbors' failures in implementation and funding.

The absence of public finance strategy is the bill's gravest flaw. The state must estimate the load this imposes and prepare to move resources accordingly.

Will the Health Ministry run reimbursement processes within 30 days, or limp through six months of delays?

Will there be trauma units, ICU surfaces, nursing cadre supplements? Or will the bill remain a "mythic promise" while facilities deteriorate?

As one doctor argued, the state should "fix public hospitals before placing that burden on private sector". This echoes the Africa‑Press critique, which objects that constitutional alignment alone is not enough; rehabilitating health infrastructure and expanding workforce capacity is."

If it passes with these ambiguities unresolved, the bill may amount to a band‑aid on a bleeding institution. Worse, if hospitals collapse underneath it, emergency care could be even less accessible. We could end up with a leggiero system in which both public and private wards fail patients and see two siloed zones of neglect.

But this disaster is not inevitable. Zimbabwe can pivot the bill into a transformational moment, embedding it within a strategy that raises standards, finances rescue, and builds accountability.

First, clarify the reimbursement. The Minister should issue regulations with clear timelines: maximum 30 days turnaround, standard kilometric rates, and penalties for arrears. A trust fund backed by global donors, diaspora bonds, or dedicated levies could ensure liquidity.

Second, establish triage protocols with civil society oversight. Define "emergency" clearly. Ensure patients stabilised under the law are physically referred to public facilities when needed - not left to rot.

Third, support private‑public partnerships to expand capacity. Zimbabwe's governorate system already pools resources - this reform could channel collaboration not coercion.

Fourth, invest in regeneration. The bill should be paired with a 10‑year national health recovery plan, remitting investment in training, clinics, mental health, rural outreach, supply chains and digital health architecture.

Finally, activate the Consultative Health Forum Spiritually, public trust hinges on participation. The bill establishes this forum. It can be used to elevate patient voices - including those previously turned away.

There is a philosophical danger that merits reflection. When states intervene in justice as raw power, they risk eroding the virtue they intend to enforce. Zimbabwe's government must avoid the temptation to rely solely on statutes to fix systemic decay. For rights to mean anything, hospitals must not fear the state as punitive overlord - they should view it as partner. Otherwise, access could worsen under political terror, rather than improve under rational bureaucracy.

At its core, this bill reveals the collapse of two visions. The neoliberal worldview said privatisation plus competition would ensure quality and access. That meme now lies in tatters in front of under‑funded hospitals. On the other side, the authoritarian state worldview insists that power vested in ministries can overcome neglect. But alone, that handbook cracks under inertia.

Zimbabwe's future lies somewhere in between - a hybrid of rights, regulation, resilience. The health ministry must prove that legislation can be more than coercive - it can be catalytic.

International donors, African Union and diaspora communities must also lean in. The world cannot applaud constitutional benchmarks from Harare and then leave Zimbabweans wandering back into ration queues. Zimbabwe's struggle stands as a signal testbed for a new global compact: what happens when a post‑colonial democracy tries to administer emergency justice under economic collapse.

If we fail, this bill will be seen as symbolic theatre for the privileged. If we succeed, it will become a model for what health justice looks like in broken societies.

The questions before Zimbabwe are not just legal -  they're moral. Do we believe that lives are more precious than ledgers? Do we trust that institutions can deliver as well as legislate? Can we walk beyond bill‑signing into the hard, tired work of caregiving?

As the amendments head back for debate and potential passage, these questions must be asked out loud - not whispered during committee meetings. If we cannot demand better, we cannot claim to care at all.

Zimbabwe is at a crossroads. Either the Medical Services Amendment Bill becomes the start of a journey - toward shared infrastructure, sustainable care, and human dignity - or it becomes the last gasp of a failing system, solar‑powered by political will and nothing else, just like the Zig. In the half‑life between the law's promise and the loud sirens in hospital wards, we will find out which path Zimbabwe takes. We will learn if this is health justice - or state overreach in the guise of Compassion.
 
Kumbirai Thierry Nhamo || Social Justice Activist
kumbiraithierryn@gmail.com 
+263780022343