Understanding NHIMA’s K600M Debt and Its Impact on Retirement Health Plans

munyumba mutwale
Feb 1
4 min read

Updated: Mar 31

A few weeks ago, ZNBC published a story revealing that the National Health Insurance Management Authority (NHIMA) is already K600 million in debt—less than five years after its launch. While NHIMA has assured the public that it remains solvent and capable of financing patient care, this early financial strain raises concerns about its long-term sustainability.

Understanding NHIMA's Challenges

How will this debt affect private health institutions' willingness to accept NHIMA? What does this mean for hospital congestion, wait times, and the overall quality of healthcare services under NHIMA—not just today but in the future?

If you’re planning for retirement and relying on NHIMA for your healthcare, these are critical questions you need to consider.

Who Benefits from NHIMA?

NHIMA plays a vital role in providing healthcare coverage, especially for Zambia’s economically inactive and informally employed populations. For many, it is a much-needed lifeline.

However, just as I often advise people to save for their child’s university education instead of relying on student loans, I extend the same advice for healthcare. If you are financially capable, it’s wise to explore better healthcare options rather than depend entirely on NHIMA.

NHIMA’s Financial Strain: The Numbers Tell a Story

NHIMA’s financial difficulties are partly due to its growing pool of non-contributors. According to their report:

Over 13% of NHIMA members are non-contributing retirees (Zambians aged 65+), yet this group makes up less than 2% of the total population and less than 4% of the adult population.
Despite their smaller numbers, this group consumes over 20% of NHIMA’s healthcare services.

Now, let’s factor in Zambia’s changing demographics. By 2050, those aged 65 and above will make up 4.5% of the total population and 9% of the adult population. If NHIMA is already struggling financially today, what will it look like in 20 years, when many of us who are 35 to 40 years old today will be in that age bracket?

The Rise of Chronic Illnesses: A Growing Healthcare Crisis

Another major strain on NHIMA is Zambia’s increasing burden of chronic illnesses. A Washington University Institute of Health Metrics report (2009–2019) revealed that Zambia’s fastest-growing causes of death are:

Hypertension
Heart disease
Cirrhosis (liver disease)
Stroke

Additionally, the leading causes of disability in Zambia are linked to lifestyle choices:

Obesity/overweight
Alcohol consumption
Smoking

These chronic illnesses aren’t treated with one-time interventions—they require long-term medication, expensive treatments, and, in many cases, costly surgeries. For instance, since 2013, Zambia’s per capita sugar consumption has risen by 80%, contributing to lifestyle diseases like diabetes. With more people leading sedentary lives and consuming processed foods, chronic illnesses will likely increase, placing even greater pressure on NHIMA.

If NHIMA is already struggling today, what will happen when the number of retirees needing medical care doubles in the next 25 years?

Have You Thought About Your Retirement Healthcare Plan?

When I sit down with people for retirement consultations, many tell me they’ll rely on NHIMA. But have you thought about what NHIMA will look like in 20 years?

You’ll likely develop a chronic illness by the time you retire—if you aren’t already dealing with one now.
We’ve all seen ageing parents struggle with medical expenses—frequent hospital visits, long wait times, and the rising cost of medication.
NHIMA’s financial situation is already shaky. If it collapses or cuts services, will you have an alternative?

Retirement isn’t just about financial freedom—it’s also about physical freedom. What good is financial independence if your golden years are spent battling health issues without proper care?

How to Secure Your Retirement Healthcare Plan

We plan our finances 20 years ahead—why don’t we do the same for our health?

Prioritize nutrition and exercise now to reduce the risk of chronic illnesses later. Making small changes today will reduce healthcare costs later.
Screening and Avoiding preventable lifestyle diseases that will burden you (and NHIMA) in retirement
Commit to regular health check-ups (at least twice a year). Many of us service our cars more often than we visit a doctor!
I’m saying this as someone who also needs to do better—I know I need to improve my health to truly enjoy retirement.

NHIMA might be acceptable today, but it may not be sustainable in the future.

Look into private health insurance options. While Zambia currently limits access to employer-based schemes, some market solutions allow you to save for post-retirement health insurance.
Start saving for retirement healthcare costs now, just as you would for your child’s education.

Where you retire matters because access to healthcare will be crucial.

If NHIMA weakens, Lusaka and the Copperbelt will likely face increased congestion in government hospitals.
Consider smaller towns that are investing in premium healthcare facilities to attract retirees.

I always emphasize the difference between financial security and financial independence:

Financial security: Your retirement income covers at least 1.25x your essential expenses (housing, food, transport, utilities).
Financial independence: Your passive income covers 2x to 3x your essential expenses, giving you a safety buffer for unexpected health costs.

Why does this matter?

You won’t have to choose between food and medicine in retirement.
You’ll experience less financial stress, which reduces health risks—many illnesses are caused or worsened by stress.

Policy Reforms Needed for a Healthier Retirement

Beyond personal responsibility, Zambia needs urgent healthcare reforms to make retirement healthcare sustainable:

Expand Private Health Insurance Access

Currently, you can only access private health insurance if you work for a company with more than 10 employees.

We need health insurance options for individuals and small business owners.

Improve Healthcare in Small Towns

More investment in premium healthcare facilities in smaller towns can reduce congestion in Lusaka and the Copperbelt.

This will also encourage retirees to settle outside of major cities.

Encourage Routine Health Check-Ups

Chronic illnesses are easier (and cheaper) to manage when detected early.

NHIMA (or a new policy) could incentivize check-ups. For example:

If you don’t get two check-ups per year, your NHIMA rate increases from 1% to 2-3%.

Make check-ups convenient. If we get mandatory annual car check-ups, why not do the same for our health?

Final Thoughts: Retire Wise, Retire Well

Relying solely on NHIMA for retirement healthcare is a risky gamble. While it plays a vital role today, its future is uncertain.

If you want to truly enjoy retirement, start planning for:

✔️ Better health habits
✔️ Alternative healthcare financing
✔️ Strategic retirement location
✔️ Financial independence

Your future self will thank you.