By Youlanda Changata
Community Psychology Intern
Zimbabwe is just months away from launching its National Health Insurance (NHI) scheme
in June 2026 — a landmark promise to bring universal health coverage to millions. But there
is a gaping hole in that promise: mental health is barely mentioned.
Universal health coverage with a significant gap
The NHI policy, steered by the Ministry of Health and Child Care, aims to achieve universal
health coverage for all Zimbabwean citizens. Its primary objective is to eliminate high
outofpocket expenses by pooling resources from workers, employers, and government. The
benefits package currently offers full coverage at primary and community levels, with tiered
coverage at district (80%), tertiary (60%), and quaternary (40%) facilities. For the estimated
90% of Zimbabweans who lack any form of medical aid, the scheme represents a potential
lifeline.
However, mental health has been largely excluded from the policy framework. Despite
growing evidence on the burden of mental illness and the effectiveness of communitybased
interventions, the NHI’s current design emphasises hospitalbased treatment – consultations,
surgeries, and medications – while overlooking counselling, psychotherapy, and psychosocial
support.
The hidden burden of mental illness in Zimbabwe
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According to the 2022 Zimbabwe Mental Health Survey, published in the Zimbabwe Journal
of Health Sciences, approximately 13% of Zimbabweans – nearly two million people – live
with a common mental disorder such as depression, anxiety, or posttraumatic stress disorder.
The same study found that fewer than one in five affected individuals receive any
professional care. Rates of mental distress are significantly higher in rural and economically
marginalised communities, where poverty, unemployment, food insecurity, and genderbased
violence amplify suffering. Substance use disorders, including alcohol dependence, are also
prevalent yet remain largely untreated under existing health financing mechanisms.
Evidence from Zimbabwe and beyond
Zimbabwe is home to an internationally recognised mental health innovation: the Friendship
Bench. This programme trains lay health workers to deliver problemsolving therapy in
primary care clinics. Peerreviewed studies, including a 2016 trial in JAMA, demonstrated a
reduction in depression and anxiety of up to 40% at six months. Similar communitybased
interventions in Uganda and Kenya have shown that integrating mental health into primary
care improves health outcomes and reduces overall system costs.
The World Health Organization (WHO) has consistently called for the integration of mental
health into universal health coverage schemes. In its 2023 Mental Health Atlas, the WHO
stated: “There is no health without mental health.”
What the current NHI framework lacks
Critics point to several specific gaps in the proposed benefits package. First, there is no
explicit coverage for evidencebased psychological interventions, including individual and
group counselling, family therapy, or problemsolving therapy. Second, the framework does
not fund communitybased mental health programmes delivered through schools, rural health
centres, or faithbased organisations. Third, there is no provision for training community
health workers and nurses in basic mental health competencies. Furthermore, the current
policy does not adequately address the social determinants of mental health.
A policymaker’s defence – and a rebuttal
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Some officials defend the exclusion on pragmatic grounds. “We cannot do everything at
once,” said a senior Ministry of Health and Child Care official, speaking on condition of
anonymity. “Cancer treatment, surgical backlogs, and infectious diseases already strain the
budget. Adding mental health would require reallocating resources from other urgent
priorities.”
However, this position overlooks two key facts. First, mental health interventions are among
the most costeffective in healthcare. The WHO estimates that for every US dollar invested in
scaling up treatment for depression and anxiety, there is a return of five dollars in improved
health and productivity. Second, untreated mental illness drives up costs elsewhere – more
emergency visits, complications from chronic diseases, and higher disability payments.
Excluding mental health therefore does not save money; it merely shifts costs to other parts
of the system.
Another concern – that mental health conditions are difficult to measure and verify,
potentially enabling fraud – is a technical challenge, not a justification for exclusion.
Standardised screening tools, referral logs, and outcome tracking have been used successfully
in South Africa’s NHI pilot districts and could be adapted to Zimbabwe.
A roadmap for inclusion
Four concrete actions are recommended. First, the benefits package should be expanded to
cover evidencebased psychological interventions at primary and community levels. Second,
the NHI should fund communitybased programmes building on existing platforms such as the
Friendship Bench, school health services, and faithbased organisations. Third, the policy
must invest in training community health workers, nurses, and peer counsellors in basic
mental health competencies through standardised modules. Fourth, all services must be
culturally sensitive, recognising diverse beliefs about mental health.
Conclusion
Zimbabwe’s NHI represents a historic opportunity to reshape healthcare. But a scheme that
covers the body while ignoring the mind will not achieve universal health coverage. The
Ministry should revise the benefits package to explicitly include mental health services.
Parliament should hold public hearings on mental health coverage. Civil society, professional
bodies such as the Zimbabwe Psychological Association, and citizens must raise their voices.
Mental health is the foundation of a productive, resilient society – and the NHI policy is the
vehicle to make that foundation a reality.
