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December 2017
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s i n i e r e h t d e n i a t n o c k r o w e h t f o y t e ri t n e e h t t a h t e r a l c e d I , y ll a c i n o rt c e l e s is e h t si h t g n it ti m b u s y B y lt i c il p x e t n e t x e e h t o t s s e l n u ( f o e r e h t t h g ir y p o c e h t f o r e n w o e h t m a I t a h t , k r o w l a n i g ir o , n w o y m n i y ls u o i v e r p t o n e v a h I t a h t d n a ) d e t a ts e si w r e h t o ti sentrietyori npatrs ubmitted tif o robtaining . n o it a c if il a u q y n a A N A Y O M I Y A R A F : d e n g i S Faray iMoyana Date: December 2017Copyright © 2017 Stellenbosch University All rights reserved
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e y i n a h D e is l E , r e h t o m d n a s u r a z a L , r e h t a f e t a l y m o t k r o w s i h t e t a c i d e d I Gapara( whopassedon n i Ap ir l1993)-sadly beforemyf ris tuniverstiydegree .Thi swouldbe my if tfhdegree ,myt hrid s ’r e ts a M degree-thanks t o botht heri con tsan tencouragemen tdu irngmy chlidhood .My mother , s a w e is l E iconwhobarelywen tbeyond tsandard3bu thadallt hehallmark sandcharactersiitc so f y r e v a intelilgen twoman ,ageniuspa rexcellence. Re tsi npeace .Youwouldbeproudt os eet hi .sS
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n i s y a w s u o ir a v n i e m d e ts is s a o h w e l p o e p l a r e v e s f o s n o it u b ir t n o c e h t e z i n g o c e r o t e k il d l u o w I o it a r a p e r p e h t nandw iritngoft hsit he is st(hel si tbelowi sno tnecessarliyi norde rofi mpo trance) : Ifee lgrealty indebted to Professo rKeymanthr iMoodley fo rproviding guidance and e b d n a e c n e it a p , e c n a r e l o t r e h r o f d n a , k r o w s i h t f o g n it ir w e h t g n ir u d n o is i v r e p u s ilef i n o c r e h d n a r e h t i d e r c I . o s o d o t t o n n o s a e r t n e i c if f u s d a h e h s n e h w n e v e y ti li b a p a c y m -e h t t a s r e t n e s e r p d n a s r o s s e f o r p “Cenrte fo rMedica lEthic sand Law ,Depa trmen tof y ti s r e v i n U h c s o b n e ll e t S , s e c n e i c S h tl a e H f o y tl u c a F , e n i c i d e M ”,f ori nrtoducingmet ot he f o d lr o w Heatlhresearchethic .s Staf fa tthe Uni tfo rBioethic sand Cen rte fo rAppiled Ethic sin the Depa trment fo n a v n o t n A r o s s e f o r P f o p i h s r e d a e l e l b a e h t r e d n u , y ti s r e v i n U h c s o b n e ll e t S t a y h p o s o li h P n a t n e u q o l e n a s i l e e f I m o h w , . k r e k e i N dgi tfedphliosophyt eache ro fal litme. D rPat irckGold tsonef orl anguageediitngo fmyearile rdra tf .s Mesdame /sMmesKesleyEngelbrech tandMeaganLeuke ,sf ort he itmelycommunicaiton . u o y k n a h T . y e l d o o M r o s s e f o r P d n a f l e s y m n e e w t e b Myf amliy :wfie rIeneKuda ,andmych lidrenPerseverence ,P irnceandt hei rcou isn sEl ise y d o l e M d n a a si L -fo rputitng up wtih all t he i nconvenience sand all t he encouragemen,t .t r o p p u s d n a , g n i d n a ts r e d n u Allt hosebehindt hes cene ,st oonumeroust omenitonbyname.Y
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ts o p n i s e c i v r e s e r a c h tl a e H -independen tZimbabwehave undergone t urbulence wtih pe irod so f s is e h t si h T . e n il c e d e ti n if e d f o s d o ir e p r e h t o d n a s t n e m e v o r p m i t n a c if i n g is y l g n i m e e s look sa t h tl a e h -caresy tsems i ngenera land inparitcular ,the wayi nwhich t heyare r e lfected through the h tl a e h -caresy tsem fo Zimbabwean. Ethica l sisue sand challenges i nheatlhcare cant akemany h tl a e h e h t n i f o e r e h t k c a l e h t r o s s e n ri a f e h t n o s n o is s u c si d d n a s e t a b e d m o rf g n i g n a r s m r o f -care r e t n i f o s c i h t e e h t ,s s e c o r p m r o f e r -profes isona lrelaitonship ,s t he ethica lproblem swtih doctor s e v it c e p s r e p l a c i h t e ,s t h g ir t n e it a p d n a ,s r e tt a m h tl a e h n i y c a c o v d a f o e t a ts e h t ,s p i h s n o it a l e r t n e it a p h tl a e h f o s c i h t e e h t ,s m e ts y s h tl a e h n o s e s r u o c si d g n i c n e u lf n i -caref unding ,anddebate sonacces s m r o f e r d n a s d e e n , s e g n e ll a h c e h t f o s e it i x e l p m o c e h t n o s t c e lf e r s is e h t s i h T . e r a c h tl a e h o t . n o it a u ti s n a e w b a b m i Z e h t f o s t n e m e ri u q e r l a c it ir c A analy is soft hee thica lp irnciples, thei rimpac tontheZimbabweheatlhc ares y tsem ,u isng y l e g r a l thep irnciplsi tapproacha senunciatedbyBeauchampandChlidress( 2013 ,)i sconducted . f o e s u a c e b l i a t e d e m o s n i d e s s u c si d o sl a s i y r o e h t t c a rt n o c l a i c o s e h t s a h c u s s e ir o e h t l a r o m r e h t O e l o h w A . e r a c h tl a e h o t d e t a l e r s e u s si o t n o it a c il p p a t n a tr o p m i s ti chapte ri sdedicated to the n i s m e ts y s e r a c h tl a e h e h t r o f s n o it a c il p m i d n a e c n a v e l e r st i d n a e c it s u j e v it u b ir ts i d f o e l p i c n ir p . e w b a b m i Z n i n o it a u ti s e h t o t e c n a v e l e r r a l u c it r a p h ti w o sl a t u b , l a r e n e g Lack o for i nadequate t si e c n a r u s n i hebigge tseconomichurdleinaccessingheatlhcarei nmanylowi ncomecount ires . o w t e r a e r e h T m ainargumen st ,whichappeart osuppo trs omesor tofmora l irghtt oaheatlhcare t n e m n r e v o g e h t y b d e d n u f – “thec ollecitves ocia lproteciton” andt he“fai roppo truntiya rgumenst ” B . ) 3 1 0 2 , s s e r d li h C & p m a h c u a e B ( othoft heseargument saredsicussedi ndetali .Rightt oheatlh d n a irgh theatlhcareare t woconcept swhichconfuse al o tof r eader sbecause t heyareclosebu t e h T . h tl a e h f o t p e c n o c e h t f o s n o is n e m i d t n e r e f fi d o t r e f e r y are dsicussed wtih a paritcula r f o g n it t e s d n a g n i n o it a r , s e c r u o s e r h tl a e h f o n o it a c o ll a g n i v l o v n i s e u s si l a c i h t e e h t n o s is a h p m e n i s is ir c h tl a e h e h t o t s n o it u l o s e l b is s o p e h t t a g n i k o o l y b p u s d n i w s is e h t s i h T . s e it ir o ir p h c u m e h T . e w b a b m i Z - lfaunted Naitona lHeatlh Insurance ,amongs tothe rpos isble remedie ,s i s , d e n il t u o s i s n o it a d n e m m o c e r f o t si l A . d e z y l a n a int hel as tchapte .rG
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ts o p n i e ts n e i d g r o s d i e h d n o s e G -onafhankilke Zimbabwe het t urbulen ise ondergaan me tpe irode s k il n y k s n ë o n a v beduidendeverbete irngeenandert ydperkevande ifniiteweafname .Hierdiet e is s d e e lt n o gesondheidsorg tseslel s in die algemee , me t spe isale verwy isng na die n a k g r o s d i e h d n o s e g n i s g n i g a d ti u n e s e is s e w k e s e it E . e s e i w b a b m i Z n a v l e sl e ts g r o s d i e h d n o s e g r o v e i a b me van debatte aanneem ,byvoordeeld bespreking soo rdie r egverdigheid o fdie gebrek e l e n o is s e f o r p r e t n i n a v k e it e e i d , g r o s d i e h d n o s e g r i v s e s o r p s g n i m r o v r e h e i d n i n a a r a a d r o t k o d t e m e m e l b o r p e s e it e e i d , s g n i d u o h r e v -pa isëntverhoudinge ,die tsaa tva n voorspraak in , e k a s d i e h d n o s e g pa isënt-regte,e iteseperspek itewewa tdsikoerseopgesondheid tseslel sbeïnvloed , e g t o t g n a g e o t r o o e tt a b e d n e g n is d n o f e b g r o s d i e h d n o s e g n a v k e it e e i d sondheidsorg .Hierdiet e is s k e e r p s e b die komplekstiei t van die utidagings ,behoe tfes en hervormingsverei tse s van die . e is a u ti s e s e i w b a b m i Z n‘ K iritese analsie van die eitese beginsel sen die i mpak daarvan op die d r u e d k i u r b e g k il k a a s f o o h d r o w , l e sl e ts g r o s d i e h d n o s e g e s e i w b a b m i Z iebeginsel-benade irngvan p m a h c u a e B en Chlidres s(2013) .Ande rmorele t eo ireë soo sdie so isale konrtakteo ire word ook e v t a w e m e l b o r p p o n a v r a a d g n is s a p e o t e k ir g n a l e b e i d n a v g l o v e g s a k e e r p s e b rband hou me t y w e g d r o w k u ts f o o h e l e H n' . g r o s d i e h d n o s e g aa n diebeginse lvandi ts irbuitewe geregitgheiden e e is n a v e l e r e i d n i mpilka ise sdaarvan vi rdie gesondheidsorg tseslesl i n die algemeen ,maa rook e i d s i g n ir e k e s r e v e d n e o d l o v n o f o n a a k e r b e G . e w b a b m i Z n i e is a u ti s e i d t o t g n i k k e rt e b t e m e a l e i a b n i g r o s d i e h d n o s e g n a v g n i g y r k r e v e i d n i k o l b l e k i u rt s e s e i m o n o k e e ts t o o r g -inkom tsel ande . g n ir e g e r e i d r u e d t a w g r o s d i e h d n o s e g n' p o g e r e l e r o m n' r a a b k y l b t a w e t n e m u g r a f o o h e e w t si r a a D d r o w s d n o f e b - "die kollekitewe so isale beskerming "en die "bliilke geleentheidargumente " ) 3 1 0 2 , s s e r d li h C & p m a h c u a e B ( - onder tseun . Albe ihierdie argumente word breedvoe irg i a b t a w e t p e s n o k e e w t si g r o s d i e h d n o s e g e t g e r n e d i e h d n o s e g p o g e R . k e e r p s e b e l eser sverwa r t n a w r e v e s si n e k e t e b e ll u h t a d m o si ,maar hulle tog onderskeideilk verwy sna verskillende w e ll u H . d i e h d n o s e g n a v p e s n o k e i d n a v s e is n e m i d ordbespreekmets pe is ifekeklemopdieeitese ti r o ir p n a v l e ts p o e i d n e g n ir e n e o st n a r , e n n o r b s d i e h d n o s e g n a v g n i n n e k e o t e i d t a w s e is s e w k etie k o o k u r d s is e t e i d r e i H . ti u ls n i deu r na moontilke oplos isng svi rdie gesondheidsk ir is sin w o l e b l e e v e i D . e w b a b m i Z endeNa isonaleGesondheidsverseke irng ,wordonde randereonlteed .n' .t is e g n e e ti u k u ts f o o h e ts a a l e i d n i d r o w s g n il e v e b n a a s y LS
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N O I T A R A L C E D ........................................................................................................................................................ 2 N O I T A C I D E D ............................................................................................................................................................ 3 S T N E M E G D E L W O N K C A ....................................................................................................................................... 4 Y R A M M U S ................................................................................................................................................................. 5 G N I M M O S P O ............................................................................................................................................................ 6 S T N E T N O C F O E L B A T ........................................................................................................................................... 7 1 R E T P A H C ...............................................................................................................................................................11 N O I T C U D O R T N I .....................................................................................................................................................11 0 . 1 INTRODUCTION............................................................................................................................................11 2 . 1 PROBLEMSTATEMENT..............................................................................................................................12 3 . 1 FOCUSOFEACHSUCCESSIVECHAPTER.............................................................................................13 5 . 1 ACRONYMS ,ABBREVIATIONSANDDEFINITIONS ............................................................................15 2 R E T P A H C ...............................................................................................................................................................16 H T L A E H -CARESYSTEMSANDMODELS ........................................................................................................16 1 . 2 INTRODUCTIONTOTHECHAPTER .......................................................................................................16 2 . 2 “HEALTH-CARESYSTEM”DEFINED? .................................................................................................. 6..1 1 . 2 . 2 ALLOPATHIC/WESTERNHEALTHSYSTEMSANDMODELS... 9..1 2 . 2 . 2 TRADITIONAL,COMPLEMENTARYAND/ORALTERNATIVEMEDICINE...24 3 . 2 THEHEALTH-CARESYSTEMOFSOUTHAFRICA..............................................................................26 1 . 3 . 2 THESOUTHAFRICANNATIONALHEALTHINSURANCE...29 2 . 3 . 2 THEWHITEPAPERANDLEGISLATIVEPROCESSONN HI ...304 . 2 THEUNITEDKINGDOMHEALTH-CARESYSTEM..............................................................................30 5 . 2 THEUNITEDSTATESOFAMERICA( USA )HEALTH-CARESYSTEM ............................................32 6 . 2 THEZIMBABWEHEALTH-CARESYSTEM............................................................................................36 1 . 6 . 2 ORGANIZATIONOFHEALTHSERVICESI NPRE-INDEPENDENTZIMBABWE...36 2 . 6 . 2 ORGANIZATIONOFHEALTHSERVICESI NPOST-INDEPENDENTZIMBABWE...37 3 . 6 . 2 MAJORPOST-INDEPENDENCEHEALTH-POLICYI NTERVENTIONS...38 4 . 6 . 2 ZIMBABWE’STRADITIONAL,COMPLEMENTARY/ALTERNATIVEMEDICINE:ISI TACINDERELLAOF ALLOPATHIC/WESTERNMEDICINE? ...42 L A E H H C I H W , O S 7 . 2 THSYSTEMORMODELI STHEBEST? .................................................................. 44 8 . 2 CHAPTERSUMMARY:................................................................................................................................. 74 3 R E T P A H C ...............................................................................................................................................................48 R P L A C I H T E INCIPLES..........................................................................................................................................48 1 . 3 INTRODUCTION............................................................................................................................................48 1 . 1 . 3 PRINCIPLISM ...48 2 . 1 . 3 PRINCIPLISMHASI TSCRITICSTOO ...49 2 . 3 THEPRINCIPLEOFAUTONOMYI NHEALTH-CARESYSTEMS .....................................................50 3 . 3 THEPRINCIPLEOFBENEFICENCEI NHEALTH-CARESYSTEMS.................................................53 4 . 3 NON-MALEFICENCEI NHEALTH-CAREDELIVERYSYSTEMS ......................................................55 5 . 3 THEPRINCIPLEOFJUSTICEI NHEALTH-CARESYSTEMS.............................................................56 6 . 3 THESOCIALCONTRACTTHEORYANDHEALTH- AC RESYSTEMS .............................................58 9 . 3 CHAPTERSUMMARY .................................................................................................................................. 06 4 R E T P A H C ...............................................................................................................................................................61 E C I T S U J E V I T U B I R T S I D ......................................................................................................................................61
1 . 4 INTRODUCTION............................................................................................................................................61 2 . 2 . 4 JUSTICEI NHEALTHCAR E ..................................................................................................................67 3 . 4 PROTECTIONFORCONSUMERSOFHEALTH-CARESERVICES ...................................................68 1 . 3 . 4 STATUTESPROTECTINGTHERIGHTTOHEALTH ......................................................................68 1 . 1 . 3 . 4 TheAf ircanBanju lCha tre ronHumanandPeoples ’Righst ......................................................69 2 . 1 . 3 . 4 TheUniversa lDeclaraitono fHumanRighst( UDHR) ................................................................69 3 . 1 . 3 . 4 Con tstiuitono fZimbabwe..............................................................................................................69 4 . 1 . 3 . 4 Heatlh-Consume rProtecitoni ngeneral .......................................................................................70 4 . 4 DISCUSSION...72 5 . 4 CHAPTERSUMMARY .................................................................................................................................. 47 H T L A E H -CARERATIONING,PRIORITYSETTINGANDFINANCING ...75 1 . 5 INTRODUCTIONTOTHECHAPTER .......................................................................................................75 2 . 5 ACCOUNTABILITYFORREASONABLENESS .......................................................................................75 3 . 5 ALLOCATIONOFHEALTHBUDGETS ,PRIORITIESANDRATIONING.........................................77 4 . 5 HEALTHFINANCING................................................................................................................................. 9..7 1 . 4 . 5 HEALTH-FINANCINGFUNCTIONS...80 2 . 4 . 5 THEABUJADECLARATION...81 5 . 5 ZIMBABWE :HEALTH- NFI ANCINGSCENARIO ...................................................................................82 6 . 5 ETHICALI SSUESONHEALTH-CARERATIONING,PRIORITYSETTINGANDFINANCING ... 48 7 . 5 CHAPTERSUMMARY .................................................................................................................................. 68 6 R E T P A H C ...............................................................................................................................................................87 N E M M O C E R , N O I S S U C S I D DATIONSANDSUMMARY.................................................................................87 1 . 6 INTRODUCTION............................................................................................................................................87
2 . 6 SUGGESTEDPOLICYOPTIONSANDRECOMMENDATIONS ...........................................................87 1 . 2 . 6 INTRODUCTIONORSTRENGTHENINGOFAHUMANRIGHTSANDETHICSCOMPONENTI NTRAINING .... 88 2 . 2 . 6 REGULATIONOFEXISTINGANDPROMOTIONOFNEWMEDICALAIDSOCIETIESANDPRODUCTS...89 3 . 2 . 6 INNOVATIVEFUNDINGAPPROACHES...91 1 . 3 . 2 . 6 NATIONALHEALTHINSURANCE...91 2 . 3 . 2 . 6 PUBLIC-PRIVATEPARTNERSHIPS ...93 3 . 6 SUMMARY ......................................................................................................................................................94 S E C N E R E F E R ..........................................................................................................................................................97 .s m e ts y S e r a C h tl a e H n a e w b a b m i Z d n a n a c ir f A h t u o S , A S U , K U : n o si r a p m o C : 1 e l b a T ... 64 y ti u q e , g n il o o p k si r f o s m r e t n i s d o h t e m g n i c n a n if f o s e p y t e v it a n r e tl A f o n o si r a p m o C : 2 e l b a T y c n e i c if f e d n a ... 18 a c i r f A n i e w b a b m i Z f o n o it a c o L g n i w o h s p a M : 1 e r u g i F ........................................................ 83
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” . n a m u h n i d n a g n i k c o h s ts o m e h t si e r a c h tl a e h n i e c it s u j n i , y ti l a u q e n i f o s m r o f e h t ll a f O “ 1 s e ir u t n e c d n a s e is r e v o rt n o c , s e t a b e d g n ir u d n e e h t s e z i m o ti p e g n i h t o N -oldagoniess u rroundingt he , ) A S U ( a c ir e m A f o s e t a t S d e ti n U e h t n I . t n e m e t a ts e v o b a e h t n a h t e r a c h tl a e h d n u o r a s c it il o p , e v o b a t n e m e t a ts s u o m a f s ’ g n i K r e h t u L n it r a M r D f o e m it e h t d n u o r a there were arleady some h tl a e h r o f s e r u s s e r p d e t n e d e c e r p n u -carer eform( Ho ffman ,2003 .) Fo rexample,i nt he1950’ ,st he s ’ 0 6 9 1 y lr a e e h t n i g n i n e s r o w , d e l b u o d e r a c l a ti p s o h f o e c ir p – and l eaving t hose out isde t he a g n is s e c c a n i y tl u c if fi d h ti w e c a l p k r o w nd a ffordingmedical insurance cover .A sexpected,t he y k s e c n a r u s n i h tl a e h g n il l e s s e i n a p m o c f o r e b m u n e h T . d e t c e f f a t s r o w e h t e r e w y lr e d l e -rocketed d n a a challenge emerged : A concern abou ta docto rsho trage forced a rethink abou theatlh . s d e e n r e w o p n a m Thsil edt of edera lgovernmen tmeasurest oexpandeducaitoni nt he rtainingo f sl a n o is s e f o r p h tl a e h .Sitlli n t he1960’ ,st hemajo rmedical i nsurancef rim swereseen t oendorse h g i h -cos tmedicines .Thi si sthe same pe irod ,which saw Pre isden tLyndon Johnson isgning w a l o t n i d i a c i d e M d n a e r a c i d e M (Centersf o rMedicareandMedicaid) . , e m it e m a s e h t t a , e p o r u E n i n a e c O c it n a lt A e h t s s o r c A heatlh-care reform swere focused on n e tl A ( n o it a l u p o p l a r e n e g e h t o t e l b is s e c c a e r o m t i g n i k a m d n a e r a c h tl a e h g n i z il a i c o s tsetter ,2003 ; .) 8 9 9 1 , s a r e u g i F & n a m tl a S ; 6 0 0 2 , n o x i D & n o s m o h T ; 0 1 0 2 , e s s u B & h ti m S n r e h t u o S d e ll a c ( e w b a b m i Z d e ll a c y rt n u o c l l a m s a , a c ir f A n r e h t u o S n i , a c ir f A n i e m it e m a s e h t t A ) e m it t a h t t a a is e d o h R – heatlh service swere l argely organized ,according t o r acial-segregaiton . s e i c il o p P -o ts independencet heheatlhpoilcie sandi ntervenitonsi nZimbabwet ookani nteresitng . e w b a b m i Z y a d t n e rr u c n i e r a c h tl a e h n i si si r c e h t n o s u c o f ll i w s is e h t si h T . n r u t 1 (“ D rMaritnLuthe rKingJr)¹ ,.i nas peechi nChicagoonMarch25 ,1966,t ot hesecondconvenitonoft he . ” s t h g i R n a m u H r o f e e tt i m m o C l a c i d e M2
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ts o p n i s e c i v r e s e r a c h tl a e H -independen tZimbabwehave undergone t urbulence wtih pe irod so f t n a c if i n g is y l g n i m e e s improvement sand othe rpeirod so fde ifntie decilne .Heatlh service sin a k o o t t u b e c n e d n e p e d n i r e tf a y l e t a i d e m m i s r a e y e h t n i m o o b r o j a m a d e s s e n ti w e w b a b m i Z e h T . ) 9 0 0 2 , e w b a b m i Z r o f y g e t a rt S h tl a e H l a n o it a N ( 9 0 0 2 d n a 0 0 0 2 n e e w t e b e v i d e l b a e c it o n y r e v o c e r wtinessedj us ta tfert hei nrtoducitonof a m -ulit cu rrencyr egimei n2009appearst ohave n i d e tl u s e r s a h s e c i v r e s h tl a e h e h t n i n o it a r o ir e t e d e h T . s r a e y t n e c e r g n ir u d n i a g a t s o l n e e b v il e d e m o h d e si v r e p u s n u d e s a e r c n i y b d e si m o ti p e h tl a e h l a n r e t a m g n i n e s r o w e ires ,majors ho trage s o t d e u n it n o c s a h e l a r o m f f a ts d n a h r e h t o e h t n o e li h w r e t a w d n a s e il p p u s , s g u r d , l e n n o s r e p f o s t n e d i c n I .) 7 1 0 2 , e j n a b M ; 4 1 0 2 , a r e r e h N ; 5 1 0 2 , a r u b m a n u K ; 7 1 0 2 , o y o M ; 5 1 0 2 , S H D Z ( e n il c e d e r a c h tl a e h d n a l a ti p s o h y b n o it p u rr o c d e g e ll a f o insuranceexecuitve shaveconitnuedt ograbt he e h t o t e r u s o p x e d i o v a o t tr o ff e n a n I .) 5 1 0 2 d n a 4 1 0 2 , a z n u p i h C ( s r e p a p s w e n l a n o it a n n i s e n il d a e h o t r o s a e s r e v o g n i y lf e b o t d e tr o p e r e r a e ti l e y ll a c it il o p d n a h c ir e h t s e c i v r e s h tl a e h g n it a r o ir e t e d A h t u o S f irca t o enjoy tsate- fo - et -h ar theatlh care ;whlie t he poo rmajortiy are l e tf t o wallow i n r e tt e b k e e s o t d e c r o f e r a s n e z it i c r o o p e h t f o e m o S . ) 6 1 0 2 , a v a h s u M ; 6 1 0 2 , a h z a g n a h Z ( y r e si m r i e h t h tl a e h -cares ervicesa crosst hebordersi nMozambiquea ndSouthAf irca( Crushe ta .l ,2012 ;Crush . ) 7 9 9 1 , r a m u k j a R d n a j a r a h a M ; 1 1 0 2 , a r e z d o w a T d n a Governmen’t sfreeze on recrutimen to f r o t c o d e l b a k r o w n u n a n i d e tl u s e r s a h , s r o t c o d g n i d u l c n i ,s l a n o is s e f o r p h tl a e h -paitentr aitoo f0.8 a s u s r e v n o it a l u p o p 0 0 0 1 r e p s r o t c o d n i deal r aito o f3:1000 ( Katongomara ,2016 .) The doctor -d i o h p y t f o e c n e g r u s e r e h T . ) 8 0 0 2 , a d n a k i h C ( s 0 9 9 1 e t a l e h t e c n is g n i n e s r o w n e e b s a h o it a r t n e it a p a e b d l u o c e w b a b m i Z f o s e rt n e c n a b r u n i ) 6 1 0 2 , e d n e w u R & o b m u G ; 9 0 0 2 , tt o c s u r T ( a r e l o h c d n a f o t l u s e r theundsiputedmas isvebreakdowni npubilcuitilitess ucha swaterr eitculaiton,s antiaiton , . c t e r e t a w e l b a t o p f o n o is i v o r p , l a s o p si d e s u f e r d r a g e r h ti w s n r e c n o c d n a s n o it s e u q l a c i h t e r o j a m d e si a r s a h r o t c e s h tl a e h e h t n i s ri a ff a f o e t a ts s i h T e h t o t expectaiton sofheatlhservice sconsumers ,guarantee sofaccesst oheatlh a sexpounded in . h tl a e h r o f s e c r u o s e r l a n o it a n f o n o it u b ir ts i d e l b a ti u q e d n a n o it u ti ts n o c l a n o it a n n a e w b a b m i Z e h t “Heatlh si r ecognized a sone o fa r ange o fsocio-economic irght ,s i ncluding hou isng ,educaiton , r e v e w o H . e r a C h tl a e H y r a m ir P n o n o it a r a l c e D a t A a m l A e h t y b h c u s s a d e m a rf s i d n a r e t a w d n as i h tl a e h o t t h g ir e h t . … s u t a ts h tl a e h e t u l o s b a s ‘ e n o y r e v e e e t n a r a u g n a c t n e m n r e v o g o n e s u a c e b g n it a e r c f o s m r e t n i d e b ir c s e d y ll a u s u oppo truniitesf o rpeoplet or eacht herif ul lheatlhpotenital , s n o it i d n o c g n i y lr e d n u e h t o t s t h g ir h g u o r h t r o , e r a c h tl a e h o t s s e c c a f o t h g ir a h g u o r h t r e h ti e o it a g il b o y ll a c i p y t e r a st h g ir n a m u H . d o o f e t a u q e d a d n a r e t a w n a e l c s a h c u s , h tl a e h r o f y r a s s e c e n n s ” .s e t a ts n o d e c a l p (London ,2006p. 21 .)The tsateha sar espon isblitiyf o rmeeitnga irgh tatl eas t s u o ir e s e r a e r e h T . st h g ir e t o m o r p d n a l if l u f , t c e t o r p , t c e p s e r t s u m e t a ts e h t :) d i b i( s y a w r u o f n i s ti g n it e e m s i e t a t S e h t t a h t st b u o d respon isbiilitesinupholdi “ng the irghtt oheatlh” .Therefore,i t n a c fu trherbe argued t ha taccess t o heatlh care and t he whole heatlh care sy tsem of Zimbabwe e b y a m facing majo rethica lchallenge sand t hi s tsudy ,aims t o as is ts i n conducitng ou ta deep e h t f o s is y l a n a sisue swtihaviewt opropo isngr ecommendaiton .s
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o w t r e t p a h C kloo s ta heatlh-cares y tsemsingeneralandt hewayi nwhicht heyarer e lfectedi nt he f o m e ts y s y r e v il e d h tl a e h Zimbabwea . n Ethical i ssue so rchallenges i n heatlh caresy tsemscan s n o is s u c s i d d n a s e t a b e d m o rf e g n a r y e h T . s m r o f y n a m e k a t o nthef arines sorlack thereofint he h tl a e h -carer eformproces ,s et h ethic sofi nter-profes isonalr elaitonship ,s et h ethica lproblem swtih r o t c o d -paiten trelaitonship ,s t he tsate o fadvocacy i n heatlh matters, and paiten t irghst ,ethica l g n i c n e u lf n i s e v it c e p s r e p dsicourse son heatlh system ,s et h ethic so fheatlh-care funding ,and s e t u ti ts n o c t a h w n o s e t a b e d “the irghtt o”and“accesst oheatlhcare” .Fullunder tsandingoft hes e s e it i x e l p m o c o rchallenges ,needsa ndr eformr equriement soft heZimbabweans tiuaitonc anno tbe d n a s m e ts y s h tl a e h e h t , e r o f e r e h T . si s y l a n a e v it a r a p m o c f o m r o f e m o s t u o h ti w d e p s a r g y ll u f n i sl e d o m theUntiedState so fAme irca( USA) ,Brtiain(UK )andSouthAf irca( SA )arei ncluded . o ir a n e c s n a e w b a b m i Z e h t f o s is y l a n a e v it a r a p m o c d e c n a l a b a r o f w o ll a o t e r a c h tl a e h e w b a b m i Z e h t r o f s n o it a c il p m i ri e h t d n a s e l p i c n ir p l a c i h t e e h t t a s k o o l e e r h t r e t p a h C h c a o r p p a t si l p i c n ir p e h t y l e g r a l g n is u , m e ts y s (Beauchamp andChlidress ,2013) .Thep irnciplsi t e v l o s o t st p m e tt a ethica ldliemmasa ndha sphliosophicalt hinking isncet hel ate1970s( McCa trhy , . ) 3 0 0 2 The p irnciplsi tapproach wa sushered i nto f amein t he 1970 sand 1980s ,throughbu tno t o t d e ti m il famou sBelmon tRepo tr, whichenunciatedethica lp irnciple swhichhavecomet obea f o e n o ts r e n r o c the regulaiton o fbiomedica lresearch i nvolving human beings i(bid) .The socia ld e s s u c si d o sl a s i y r o e h t t c a rt n o c in some detai lbecause of i st i mpo tran tappilcaitons t o sisue s . e r a c h tl a e h o t d e t a l e r e r a c h tl a e h e h t r o f s n o it a c il p m i d n a e c n a v e l e r st i d n a e c it s u j e v it u b ir ts i d n o s e s u c o f r u o f r e t p a h C b a b m i Z e h t o t e c n a v e l e r r a l u c it r a p h ti w o sl a t u b , l a r e n e g n i s m e ts y s we scena iro .Atlhought here s m e l b o r p h ti w y ti s r e v i d t a e r g a e b o t r a e p p a y a m regardingheatlhdeilverys ystems,t hemajo rbone : d n u o r a s i n o it n e t n o c f o whoshould ge t‘wha tshareo fasociety’sr esources’? Themajo rhurdle g n is s e c c a o t theheatlhdeilverysy tseminmanycount ire ssit heinadequacyora bsenceo fifnancial s e c r u o s e r fo rsuch people t o enablet hem t o afford care .There aret wo major argumenst ,which e h t tr o p p u s “mora l irght” to pubilcly-fundedcare – “thecollecitve socia lproteciton and t hefai r st n e m u g r a y ti n u tr o p p o ” (Beauchamp&Chlidress ,2013) .Theseargument saredsicussedi ndetai.l t n i o j e h t , n o it i d d a n I “Wo lrd Heatlh Organsiaiton /Ofifce oft he HighCommsi isoner f o rHuman t n e m e t a ts s t h g i R ” (WHO/OHCHR )(2007 )i sdiscussed .Thi s tsatemen tembodie sthe irgh tto y ti li b a t p e c c a ; y ti li b a li a v a ; y ti li b is s e c c a l a s r e v i n u : s r e t e m a r a p n e v e s g n i w o ll o f e h t n o d e s a b h tl a e h . y ti li b a t n u o c c a d n a y c n e r a p s n a rt , n o it a n i m ir c si d o n , y ti l a u q d o o g , s r e m u s n o c e h t o t y ti n g i d d n a o g n ir a e b a e v a h s e u s si e s e h t ll A nt heanaly is sandappreciaitono fchallengesr elatedt ot heheatlh . e w b a b m i Z n i m e ts y s e r a c e h t s e r o l p x e e v if r e t p a h C sisue saround “the irgh tto heatlh” versus “irgh tto heatlh care” .A s u c o f e t a r e b il e d regarding ethica lsisues i nvolving the di ts irbuiton fo heatlh r esources,r aitoning d n a setitng o fp iro irites i sdone .Zimbabwe , ilke many Af ircan count ires ,ha sbeen faced wtih h tl a e h s ti f o g n i d n u f r e d n u c i n o r h c -cares y tsem (Murwria ,2016 ;AlJ azeeraEnglsih ,2014 ;Tawona , , a r e r e h N ; 6 1 0 2 , a ri g n u h m a K ; 5 1 0 2 2014) .Th sir asie skeyethica landvalue-judgmenta lsisuesi n f o n o is i v o r p d n a g n i c n a n if s ti heatlhc are,e vent houghina r esource-consrtainede nvrionment .The ll i w r e t p a h c oa sl dsicuss t hef ollowingt opic swhenre lfecitngon t he sisue so fethic sandhealt -h e r a c deilveryf unding :ethicalapproachest oheatlh- ec ar deilverys etitngo fp iro irites ,bes tpracitces h tl a e h n i -care budgetary provi isons ,heatlh-care ifnancingand ethica lapproachest o di ts irbuiton h tl a e h f o resources andmedica lcare. w x is r e t p a h C ind sup thi sthe is sby looking a tthe pos isble soluiton sto the heatlh c ir is sin h c u m e h T . e w b a b m i Z - lfaunted Naitona lHeatlh Insurance ,amongs tothe rpos isble remedie ,s i s A . d e z y l a n a numberofr ecommendaiton saremadeatt heendoft het he is .s
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UNESCO :“UntiedNaiton sEducaitonal ,Scienit ifcandCutlura lOrganizaiton” MOHCC :“ nMi sirtyo fHeatlhandChlidCareo fZimbabwe” ZIMASSET: Zimbabwe Agenda fo r Su tsainable Socio-Economic Transformaiton o r p c i m o n o c E ( gramme,s tatredi n2013) TM & CAM :Tradiitona lmedicine (TM) ,complementary and Atlernaitve medicine ) M A C ( . NHI :Naitona lHeatlhI nsurance OBAMACARE: Atlhough now referred to a sObamacare in contemporary ilngo ,the : si e m a n l a i c if f o “The Paiten tProteciton and A ffordable Care Ac t(PPACA )o rthe ) A C A ( t c A e r a C e l b a d r o ff A ” ,dubbed the larges toverhau lo fthe Ame ircan (USA ) .s 0 6 9 1 e h t e c n is m e ts y s e r a c h tl a e h Of ifcia ldata show tha t“i twa s isgned into law by a m a b O t n e d is e r P ” in2010( Hal l&Lord ,2014 .)Sincetheni tha smadeahugei mpac ton .s n a c il b u p e R e h t m o rf y l e g r a l n o it is o p p o h ti w e r a c h tl a e h2
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e t a u q e d a n i , e r a c h tl a e h o t s s e c c a n i st i m il m o rf e g n a r l a r e n e g n i e r a c h tl a e h g n it c e ff a s e u s si l a c i h t E h tl a e h c il b u p n i s e u e u q g n it i a w g n o l ,r e w o p n a m e t a u q e d a n i , y ti li b a li a v a d n a n o it a c o ll a e c r u o s e r r d , e g a tr o h s e c a p s o t e u d y c a v ir p d e si m o r p m o c , s e it il i c a f ugs ho trage setc. Thi schapte rwilll ook h tl a e h e h t t a -cares y tsem ,st hemodesl ,andt hewayi nwhicht heyarer e lfectedi nt heZimbabwean n o p u n o it a d n u o f a g n i h si l b a ts e s a d o o ts r e d n u e b t s e b n a c r e t p a h c s i h t , e r o f e r e h T . m e ts y s h tl a e h n i e r o m h c i h w -depth dsicus ison son t heethica l sisue saroundheatlh-care deilveryi nZimbabwe m r o f e r d n a s d e e n , s e g n e ll a h c f o s e it i x e l p m o c e h t f o g n i d n a ts r e d n u l l u f A . tl i u b e b n a c f o m r o f e m o s t u o h ti w d e p s a r g y ll u f e b t o n n a c n o it a u ti s n a e w b a b m i Z e h t f o s t n e m e ri u q e r t a r a p m o c iveanalyssi .Theheatlhs y tsem sandmodel soft heUntiedState so fAme irca( USA ,)t he e v it a r a p m o c d e c n a l a b a r o f w o ll a o t , d e d u l c n i e r a ) A S ( a c ir f A h t u o S d n a ) K U ( m o d g n i K d e ti n U t s d r a g e r h ti w s li a t e d o t n i o g e w e r o f e B . o ir a n e c s n a e w b a b m i Z e h t f o s is y l a n a ot hevairou sheatlh . m e ts y s h tl a e h a f o n o it i n if e d l a u t p e c n o c e h t t a k o o l ll i w e w s l e d o m.
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h tl a e H -care sy tsems ,the need fo rreforms ,thei ref ifciency and e ffecitvenes s– ea r topics fo r d n a s t n e m e e r g a si d , s e t a b e d y a d y r e v e evenac irmony .However ,wtihou ta clea rde ifniiton oft he d e s u f n o c a g n it a e r c d n a n o it c e ri d g n is o l k si r s n o si r a p m o c e h t d n a s e t a b e d e h t , ” m e ts y s h tl a e h “ m r e t s e g n a r o d n a s e l p p a g n ir a p m o c o t n i k a e b d l u o w s i h t s a ; s n o is u l c n o c g n i d a e ls i m d n a e s r u o c si d o a is H ( ,2003) .A con is tsen tand adequate de ifniiton o fthe concep to fa heatlh sy tsem help s r o s n o it n e v r e t n i h c i h w d n a t a h w d n a ts r e d n u d n a y fi t n e d i o t s r e k a m y c il o p d n a s r e h c r a e s e r , t n e m e v o r p m i e h t h ti w d e t a i c o s s a e r a s t n e m u rt s n i su tsainenance ro demsie o fa paritcula rheatlh . m e ts y s h tl a e h a m r o f e r o t d e s u n e h t si n o it a m r o f n i si h T . m e ts y ss m e ts y s h tl a e H can be explained and de ifned i n so many d fiferen tway s(H isao ,2003) .In t he n o d e s a b n e e b s a h s m e ts y s h tl a e h f o n o it p ir c s e d e h t , g n it t e s l a n o it i d a rt indicaitono fcapactiyand y r e v il e d acitviite ,ss uchast henumbe ro fadmsi isonbeds ,numbe ro fheatlhcareprofe isonasl,t he f o e p o c s d n a y ti t n a u q pubilcly funded heatlh programmes ,and so fo trh (Ra ffel ,1997) .An s i h t f o t n e m e v o r p m i e h t r o f e d a m n e e b s a h t n e m u g r a rtadiitona lconceptuailzaiton andde ifniiton : st n e m e l e l a c it ir c e v if f o n o is u l c n i e t a r o b a l e e r o m a f o n o it a e r c e h t y b “ rp oducitver esource ;st he c i m o n o c e ; s e m m a r g o r p f o n o it a z i n a g r o -suppor tmechansims ;managemen tmethods ;andservice y r e v il e d ” (Roemer ,1993 1p ). . Butt heweaknes so fRoeme ’rsconcep tsit hati tdoesn’ t tsatewhy n o it a r u g if n o c ri e h t fi e c n e r e ff i d a s e k a m t i r e h t e h w r o , n o it i n if e d e h t n i ts o m r e tt a m s e it i v it c a e s e h t . d e g n a h c s i a s e n if e d t I . r e m e o R r e v o n o it i n if e d d e v o r p m i n a s r e ff o n o it a si n a g r O h tl a e H d lr o W e h T heatlh m e ts y s “ast hecolleciton,s rtuctu irngandorgansiaitono fallr esource sneededf ort hedeilveryo f s e c r u o s e r e s e h T . n o it a l u p o p d e t e g r a t a o t s e c i v r e s e r a c h tl a e h comprsie rtained providers , st n e m e g n a r r a g n i c n a n if d n a s n o it u ti ts n i ,s r e m u s n o c ” (WHO ,2007p. 2) . “Aheatlhs ystemconsist so fal lorganisaitons ,peopleandaciton swhoseprimaryi ntenti s o t s t r o ff e s e d u l c n i s i h T . h tl a e h n i a t n i a m r o e r o t s e r , e t o m o r p o t inlfuencedeterminant so f h tl a e h t c e r i d e r o m s a l l e w s a h tl a e h -improvingacitviites .Aheatlhs ystemi st hereforemore t I . s e c i v r e s h tl a e h l a n o s r e p r e v il e d t a h t s e it il i c a f d e n w o y l c il b u p f o d i m a r y p e h t n a h t k c i s a r o f g n i r a c r e h t o m a e l p m a x e r o f , s e d u l c n i chlid a thome ;private providers , n o it a l s i g e l y t e f a s d n a h tl a e h l a n o it a p u c c o , s n o it a s i n a g r o e c n a r u s n i h tl a e h .. .. .. .. .. .. ......” ) 2 . p ( t n e m il p m o c o t s r a e p p a n o it i n if e d e v o b a e h T an earile rWHO de ifniiton ,which de ifned heatlh s m e ts y s basedontheacitviitestheyencompass( Wo lrdHeatlhOrgansiaiton ,2000) .Thes rtength si h t f o improved de ifniiton l ays i n ti sfocu son t he ‘pe frormance (ulitmate outcomes )o fheatlh s m e ts y s ’ and thei r‘measurement’ . Thi simproved de ifniiton aslo add saddiitona l focu son ‘function so f tsewardship,r esourcecreaiton,s erviceprovi ison ,and ifnancing’ .However ,whliei t y b t r o h s ll e f o sl a t i , p i h s d r a w e ts t n e m n r e v o g f o e l o r e h t g n i z is a h p m e f o t n e m e l e w e n a d e c u d o rt n i e h t n i a l p x e o t g n il i a f interconnectedness fo majorplayer sandoutcome .s I , n o s a e r t a h t r o F ifndt hec haracte irzaitono f“heatlhs y tsemsa sa se ire soff und lfowsa ndpaymen t s n o it u ti ts n i d n a s p u o r g n o it a l u p o p n e e w t e b s d o h t e m ” qutie usefu l(O fheatlh Care ,1992) .In
p o r p s a w s t n e n o p m o c l a n o it c n u f f o m e ts y s a , n o it i d d a osed by Londono and Frenk (1997) , t n e w s r o h t u a e s e h T . n o it a l u c it r a d n a n o it a l u d o m , y r e v il e d , g n i c n a n i F : s n o it c n u f r u o f g n is ir p m o c o t y g o l o p y t ri e h t y l p p a o t n o ‘heatlhsy tsem s ifnanced t hrough social i nsurance’ ;andt heyeven l e d o m a d e s o p o r p which they argued can as iss tin fuflliilng these specia lfuncitons .Thi s n i ,) 1 0 0 2 ( n o s n a R d n a s ll i M y b d e s o p o r p e n o e h t m o rf t n e r e ff i d h c u m t o n s i n o it a z il a u t p e c n o c : d e si r p m o c e s e h T . d e s o p o r p s a w s n o it c n u f d n a s r o t c a f o k r o w e m a rf e s o o l a h c i h w financing , r , g n it a l u g e r esourceallocaitonands erviceprovi ison. p l e h e v o b a d e b ir c s e d s m e ts y s h tl a e h f o s n o it i n if e d d n a s k r o w e m a rf l a u t p e c n o c e h t f o t s o m e li h W r o j a m r i e h t ,s n o it c n u f l a n r e t n i st i y b m e ts y s h tl a e h a y fi s s a l c d n a e z y l a n a o t s u sho trcoming sit ha t i a l p x e t’ n o d y e h t n clea lrywh ichgoaslt hesef unciton stargetf o rachievement ;thes rtategyt hrough e s e h t h c i h w funciton ssitmulate t he achievemen tof t hese goasl ;how t hese f uncitons i nte rrelate e r w o h d n a ; r e h t o h c a e h ti w -a rrangingt hesef unciton swoulda ffectt hei ntendedoutcomes( H isao , I . ) 3 0 0 2 ifnd t hefollowing “ isxbuliding block so fa heatlhsy tsem” a senunciatedbyt heWHO 3 1 0 2 ( p .vi )a smore comprehen isve and are c iritca lfo ra successfu,l ef ifcien tand e ffecitve y r e v il e d e r a c h tl a e h sy tsem: “Goodheatlhs ervices :theymus tdeilvers afe ,e ffecitve ,qualtiyandnon-persona lheatlh f o e ts a w m u m i n i m h ti w d e d e e n e r e h w d n a n e h w , m e h t d e e n o h w e s o h t o t s n o it n e v r e t n i .s e c r u o s e r Awel lperformingheatlhworkforce: whoarer espon isve,f ari ,andefifcientt oachieve b e h t es theatlhoutcome spos isblegivenavaliabler esource sandcricum tsance .s A well-func itoning heatlh informa iton system : ensure s the produciton , analyssi , h tl a e h , st n a n i m r e t e d h tl a e h n o n o it a m r o f n i y l e m it d n a e l b a il e r f o e s u d n a n o it a n i m e s si d m r o fr e p m e ts y s anceandheatlh tsatu .s Awell-func itoningheatlhs ystem :ensurese qutiablea ccesst oe ssenita lmedica lproducst , d n a , s s e n e v it c e ff e t s o c d n a y c a c if f e , y t e f a s , y ti l a u q d e r u s s a f o s e i g o l o n h c e t d n a s e n i c c a v ts o c d n a d n u o s y ll a c if it n e i c s ri e h t -effecitveuse. A good heatlh ifnancing system :rasie sadequate fund sfo rheatlh,i n ways t ha tensure r o e h p o rt s a t a c l a i c n a n if m o rf d e t c e t o r p e r a d n a , s e c i v r e s d e d e e n e s u n a c e l p o e p e d i v o r p t s u m m e ts y s e h T . m e h t r o f y a p o t g n i v a h h ti w d e t a i c o s s a t n e m h si r e v o p m i s e v it n e c n i fo rprovider sanduserst obeef ifcien.t
Leadership and governance: to ensure t ha tsrtategic poilcy rfamework sexsi tand are m e ts y s o t n o it n e tt a , n o it a l u g e r , g n i d li u b n o it il a o c , t h g is r e v o e v it c e ff e h ti w d e n i b m o c -y ti li b a t n u o c c a d n a n g is e d ”. s e p y t c if i c e p S o fheatlhsystemswli lbedsicussedi nt hef ollowingparagraph .s
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y n a m g n is ir p m o c d lr o w e h t f o e v it c e p s r e p a m o rf d e t a u l a v e d n a d e z y l a n a e b t s u m s m e ts y s h tl a e H . s e ir t n u o c TheUntiedNaitonsi stel fha s193members .Thi sdiverstiyhasi mp ilcaiton sf or tsudying , d e e n e w , tl u s e r a s A . d lr o w e h t f o s l e d o m r o s m e ts y s h tl a e h t n e r e ff i d e h t g n i y fi s s a l c d n a g n is y l a n a o t g n i d r o c c a ,s e ir o g e t a c e l b a e g a n a m o t n i s m e ts y s h tl a e h y fi s s a l c o t thei rmainc haractersiitcs .Thi s e h t t e e m t s e b y e h t w o h o t g n i d r o c c a , m e h t n o s t n e m e g d u j l a c i h t e r o e u l a v s s a p o t s u s p l e h l a n i d r a c t n a tr o p m i g n i w o ll o f crtie ira: “Keeping peopleheatlhy ; rteaitng t he isck ;and protecitng o rf n i u r l a i c n a n if t s n i a g a s e il i m a f m medica lbills” (Wallace ,2013). The following fou rba isc s m e ts y s h tl a e h n r e ts e w / c i h t a p o ll a o rmodel swere chosen f or t hei r ismpilctiy and clartiy .These : e r a “ eT h Beve irdge mode;l t he Bsimarck Mode;l t he Naitona lHeatlh Insurance mode land t he t u O - fo - oP cke tModel” i(bid) . d e s u y l e d i w l li ts s i ti e c n is ; d e s s u c si d o sl a s i e n i c i d e m e v it a n r e tl A / y r a t n e m e l p m o C r o l a n o it i d a r T d n u o r a thewo lrd,i ncludingAf irca,I ndiaa ndmanyEa tserncount ire ,ss ucha sChina,J apan ,Korea . m a n t e i V d n a x TheBeveridgemodel o s e h t si s i h T -called“socialsied-medicinemodel”o rSingle-Paye rNaitona lHeatlhService( UK ) l e d o m ,nameda tfe rLord WliilamBeve irdgewho wa saf amou sBrtisihsocial r eforme rcredtied t a h t si l e d o m s i h t f o t n e m e g n a rr a c is a b e h T . e c i v r e S h tl a e H l a n o it a N h si ti r B e h t g n i n g is e d h ti w “heatlh care i sprovided and ifnanced by government t hrough t ax payment ,s ismliar t o how t he d e c n a n if e r a e c il o p d n a y m r a e h t e k il s d o o g c il b u p r e h t o ” (Ninane ,1983 ;Musgrove ,2000) .Mos t t n e m n r e v o g y b d e n w o e r a s e it il i c a f h tl a e h e h t f o – wtih some doctor sbeing employed by y l e t a v ir p e t a r e p o s r o t c o d r e h t o h g u o h tl a ; t n e m n r e v o g – whlie collecitng thei r fee s rfom s r e ff o c t n e m n r e v o g (Wallace ,2013). Thebes texampleoft hsis y tsemi sBr tiain ;whlies omeothe r, m e ts y s d e if i d o m a e s u s e ir t n u o c such as Spain, New Zealand, mos tScandinavian count ires , n e s e r p e r a b u C . g n o K g n o H d n a a d a n a C stt hewors tcaseoft hsis y tsem i(bid .) n o it a t p m e t e h t e c u d e r y a m t i e c n is y ll a c i h t e r o ir e p u s si t i t a h t e u g r a l e d o m s i h t tr o p p u s o h w e s o h T .s e c i v r e s h tl a e h f o n o it a si ti d o m m o c e h t r o f Thegoe sproceedasf ollows… “Inas y tsemo fheatlh o d e r e h w , g n i c n a n if ctor sare paid on a f - ree f -o service ba is s(a s si t he case w tih t he Bsimarck r e v o o t s r o t c o d r o f s ts i x e n o it a t p m e t e h t ,) l e d o m -service and even t o over-charge, i n order t o st if o r p r i e h t e s a e r c n i ” (RoweandMoodley ,2013 .)Inordert obutrtesss uppo trf or ht eBeve irdge l e d o m i ti sargued tha t ti may o ffe rsome “form o fsafety ne tfo rthe poore rseciton so fthe n o it a l u p o p ” .Howeve,rt hemaindrawbackoft hes ystem sit helacko fcompeititon ,becauseoft he t a h t m e ts y s l a n o it a si n a g r o e l g n is t n a n i m o d e r p a f o e s u include s ifnancing bodie sandproviders , h c u m g n ir e ff o t u o h ti w “choice between i nsurers” (Cloughe try ,2011) .“Thi sgenerally t ends t o r n u l a r e n e g a d n a y c a r c u a e r u b y d l e i w n u , y c n e i c if f e n i e t a e r c espon isveness t o consume rneeds” (ibid) .Someaspect soft hi sheatlhmode lappeart obef oundi nt heZimbabweanheatlhsy tsemco -y a w e h t n i ,s t n a ir a v r e h t o h ti w g n it si x e the governmen town smanyhosptial sand cilnics ;andi t f t n e m y a p y n a m i a l c t o n o d s r o t c o d e t a v ir p , r e v e w o H . s e s r u n d n a s r o t c o d d e ir a l a s s y o l p m e o sl a rom m o rf r e h t a r t u b s r e ff o c t n e m n r e v o g p irvate heatlh-insurance frim sand medica laid socieites . h tl a e H l a n o it a N a h ti w p u g n i m o c n i ts e r e t n i g n i v i v e r e w b a b m i Z f o t n e m n r e v o g e h t f o s tr o p e R y b t p m e tt a n a e b y a m , )I H N ( e m e h c S e c n a r u s n I t hegovernment t o b irng someuniversaltiyand h tl a e h o t n i y ti u q e -careprovi ison( Gumbo ,13Novembe r2015 ;Matarie ,2015 .) x TheB simarckmo del n o n e h t d e ll a c o sl a s i l e d o m s i h T -profti “ iscknes sfund” o r the “social-insurance model” t I .) y n a m r e G ( i sbasedon a “n insurances y tsem” fundedjoinltyby hb ot employer sandemployee s , y ll a e d I . s e ir a l a s r o s ll o r y a p r i e h t m o rf s n o it c u d e d h g u o r h t i ti snon-proif tmaking ,and mus t e d u l c n i a smanyciitzen sa spos isble(Kutzin ,2011;Atlen tsette ,r2003 .)Conrtaryt ot heAme ircan a ir a v e c n a r u s n i nt ,thsi t ype of heatlh-insurance d oes no tmake a profti ;and ti i smandatory t o e d u l c n i thewholepopulaiton .Heatlhcareprofes isonal sand medicalf aciilitestendt obe p irvate ; s i t n a n i m o d e r p s i l e d o m s i h t d n a we tsern countire ssuch a sGermany ,France ,Belgium ,the d n a lr e z ti w S d n a n a p a J ,s d n a lr e h t e N (Wallace ,2013) . tI take sti sname rfomahi tso irca lGermany
d e ll a c r o ll e c n a h C Otto v on Bsimarck ,whose type o fWeflare State wa sinsrtumenta lin the e h t g n ir u d y n a m r e G f o n o it a c if i n u 91 thCentury. h tl a e h e h t e s u a c e b ; l e d o m k c r a m si B d e if i d o m a e s u o t s r a e p p a e w b a b m i Z -insurancecont irbuiton s . y r a t n u l o v s i n o it u b ir t n o c s ’r e y o l p m e e h t h g u o h tl a ;s e e y o l p m e d n a s r e y o l p m e h t o b m o rf y l e g r a l e r a e f a y l n o t a h t si l e d o m n a e w b a b m i Z e h t h ti w k c a b w a r d t s e g g i b e h T wpeoplearecovered ,duet o e k a m o t d e t c e p x e e r a e w b a b m i Z n i s e it e i c o s d i a l a c i d e m , n o it i d d a n I .s e t a r t n e m y o l p m e n u h g i h e h t l a c i d e m a f o t n e v e e h t n i m e h t n o i h s u c o t s e v r e s e r y r o t u t a ts e v a h o t d e t a g il b o e r a t u b ; ti f o r p a t c A s e c i v r e S l a c i d e M ( e h p o rt s a t a c ,1998 ,2001 ,2002) .The Bsimarck mode lappear sto have l e d o m e g d ir e v e B e h t r e v o s e g a t n a v d a – fort he ismpler easont ha tgovernmen tplay samajorr ole h ti w s ts is s a , n o it a l u g e r n i funding ;bu tdoe sno tgobeyondt hat . ll a r e n e g e r a s m ri f e c n a r u s n i g n it e p m o C ybetterf o rpaitenstt hrougho ffe irngcompeititon ,ensu irng l a m i n i m d n a e c i o h c r e m u s n o c beauracracy .An added advantage of t he Bsimarck mode l si t he e r a c o t s s e c c a l a s r e v i n u f o y ti li b is s o p and equtiy (Cloughe try ,2011) .The Bsimarck model i sa it l u m -layeredmode landno tnecessarliya isngleheatlhi nsuranceovershadowingeverythingesle . h tl a e h /s d n u f t n e r e f fi d 0 4 2 r e v o s a h y n a m r e G , e l p m a x e r o F -insurance players ,bu twtih itgh t ts o c f o t n e l a v i u q e e h t si h c i h w , t n e m n r e v o g y b n o it a l u g e r -conrto lo radvantage;as i nt he isngle . ) d i b i( l e d o m e g d ir e v e B e h t s a h c u s ,s m e ts y s r e y a p l e d o m k c r a m si B e h t r e h t a r t u b , e g d ir e v e B e h t g n is u t o n e r a n e v e s , e p o r u E n i s e ir t n u o c 0 1 p o t e h t n I .) m u i g l e B d n a g r u o b m e x u L , a ir ts u A , d n a lr e z ti w S , e c n a r F , y n a m r e G , s d n a lr e h t e N e h t( e h T rea reproblemst obea nitcipatedwhenpoilitciansa rea llowedt obecomei nvolvedi nt hedriec t y e h t fi s n a i c it il o p g n i v l o v n i ts e r e t n i f o s t c il f n o c d i o v a u o y o d w o H . e c n a r u s n i h tl a e h f o g n i n n u r e h t n i y l p e e d d e v l o v n i e b o t d e w o ll a e r a fundingandr egulaitono fheatlhinsurances?Thsia ppear s f o t n e m e v l o v n i e h t g n i d r a g e r sl a d n a c s d e g e ll a s u o ir e s e r e h w , e w b a b m i Z n i e s a c e h t n e e b e v a h o t s a w h tl a e H f o r e ts i n i M e h T . a i d e m e h t n i d e tr o p e r n e e b e v a h h tl a e H f o r e ts i n i M l a n o it a N e h t s e i n o m d e v i e c e r e v a h o t d e g e ll a undert hegu sieof“ captiaiton”( Chipunza ,2015) .Thet henGroup l a c i d e M s e c i v r e S r e i m e r P ( s e m e h c s e c n a r u s n i h tl a e h r o j a m s ’ y rt n u o c e h t e n o f o e v it u c e x E f e i h C y t e i c o S d i A – PSMAS )wa sallegedt obeearningamonthlys alaryo fove rUS5000 – 00 beforehe s a w reileved o fhi sduites .Thi swa sa naitona lscanda lo fcon isderable proporiton s(Chipunza , . ) 4 1 0 2
x TheNa itona lHeatlhI nsuranceMode l g n i e b s e l p m a x e t s e b h ti w , e c n a r u s n i h tl a e h l a n o it a n r e y a p e l g n is a o t s d n o p s e rr o c l e d o m s i h T i a T d n a a d a n a C n i d n u o f wan.I tappearst ocomp irseacombinaitono fbotht heBeve irdgeandt he d n a ; sl e d o m k c r a m si B i sbasedonpirvate-secto rproviders ;whlier -e imbursementi sprovidedvia a government-run insurance programme funded by the whole populaiton in a counrty via a premiumt ax .Thi ssit hes o-calleduniversali nsuranceprogram ,whicht heproponensta rgue sil es s r e w o l h ti w , e v is n e p x e running cosst ,than the Ame ircan-vairant rf -o pro if tinsurance plan s (Wallace ,2013) . Zimbabwe’ sneighbort o t he south ,SouthAf irca i scu rrenlty i nt he proces so f g n it c u d n o c plio t tsudiesont hi smodel( SouthAf ircaDepatrmen to fHeatlh ,2011) .Zimbabweha s 3 1 , o b m u G ; 5 1 0 2 , e ri a t a M ( e m e h c S e c n a r u s n I h tl a e H l a n o it a N e h t e c u d o rt n i o t s n a l p d e t o o m . ) 5 1 0 2 r e b m e v o N st n e n o p o r P oft hsis chemearguet hatt heremaybeout irgh tadvantagesi nt hsis y tsem ,byhaving t n e m n r e v o g a -admini tseredinsurances cheme ,paidf o rbyeveryci itzen ,wtihou tanyrequriement r o f promoitonandadverit isng ,no ifnancia lincenitve torefuseclaims ,and no ifnanciali ncenitve y lt n e u q e rf s ts o c f o g n il l o rt n o c e h t e b d l u o c k c a b w a r d r o j a m e h t ,r e v e w o H . e m e h c s e h t g n i n n u r r o f s e c i v r e s l a c i d e m e h t g n it i m il y b d e t c e ff e paidf o rbytheNaitona lHeatlh I nsurance ,and/thel ong t n e m t a e rt r o f s d o ir e p g n it i a w .Thi s qu -a is raitoning o fmedica l service scan create ethica l e h t o t e l b a li a v a s e c i o h c d e ti m il e h t f o e s u a c e b y m o n o t u a g n is i m o r p m o c y l b is s o p y b s e g n e ll a h c . r e m u s n o c Whlie Naitona lHeatlh Insurance may create an obviou sadvantage through the e k r a m f o n o it a si l a rt n e c tpowe r(which may help lowe rp irce so fpharmaceuitcasl) ,i ti sno ta s r e m u s n o c h tl a e h y b s e r u d e c o r p r o f s d o ir e p g n it i a w g n o l e l b is s o p r o f n o it a c if it s u j t n e i c if f u s . ) 6 7 9 1 , n a i d e b a n o D ( t , % 0 9 r e v o f o s l e v e l t n e m y o l p m e n u h ti w , e w b a b m i Z s a h c u s , y rt n u o c a n I hsis y tsemmayno tbe n e d r u b x a t e h t y rr a c o t d e ri u q e r e b d l u o w e l p o e p d e y o l p m e w e f a y l n o e c n is e l b a i v unles s ti i s , s r o d n e v , s r e v ir d i x a t e k il r o t c e s l a m r o f n i e h t n i e s o h t d n a d e y o l p m e n u e h t o t n e v e y r o t a d n a m e d a m . c t e s r e ll e w d l a r u r
x TheOut- fo -Pocke tMode l t e k r a m “ e h t d e ll a c o sl a s i si h T -d irvenmodel”.I tsif oundi nt hemajortiyo fcount iresi nt hewo lrd , d n i k y n a e d i v o r p o t s e ir t n u o c r o s t n e m n r e v o g r o f h g i h o o t si y tr e v o p h c i h w n i o fa srtuctured y r e v il e d h tl a e h l a n o it a n system( Wallace ,2013).I nt hi sstiuaiton ,peoplewtihmoneypayf o rand ti t e g heatlhc are ;butt hosewtihou tmoneymayr emain isck ,or neve diea thome .Thi ssit heorder -f o - et -h dayi nmos toft her uralr egion so fconitnent ,ss ucha sAf irca,I ndia ,China ,SouthAmeirca – wheremliilon silvet hei rilve swtihou teve rbeings eenbyadoctor( Macinkoe tal ,2003) .Whlie c it r a p t c e ri d f o m r o f e m o s ipaitonbygovernmensti na nyheatlhs y tsem sii mpo tran,ti tsie venmore t s e r a b e h t t A . l e d o m h tl a e h g n i c n a n if t e k c o p f o t u o t n a n i m o d e r p a h ti w y t e i c o s a n i t n a tr o p m i m r o f n i s e d u l c n i t a h t e c i v r e s h tl a e h c il b u p f o m r o f e m o s e d i v o r p t s u m s t n e m n r e v o g m u m i n i m aiton a n e s k a S ( s h t a e d e l b a d i o v a e c u d e r o t e r a c l a c i d e m y c n e g r e m e f o m r o f e m o s ll e w s a n o it n e v e r p r o f .) 0 1 0 2 , l a t e There are count ire sw tih mixed modesl ,such a sSweden ,which ha sfeature so fa e c i v r e S h tl a e H l a n o it a N andt hoseo fanaitona lheatlhs ervice.I tha sgovernmentr unhosp tial sa s g n i e b s r o t c o d r -e imbursedonaf ee- rf -o servicebassi( Wallace ,2013). y d a e rl a e s o h t g n i d u l c n i ,l e d o m s i h t n o g n i y l e r n o it a l u p o p s ti f o n o it r o p t n a c if i n g is a s a h e w b a b m i Z e h c s e h t f o t s o m e s u a c e b ; s e m e h c s d i a l a c i d e m n o me shavegapsi nt heproceduresi nsured. x Emergingheatlh-caremodel s s d n e rt w e n e r a e r e h t , e v o b a d e s s u c si d s l e d o m h tl a e h l a n o it i d a rt e h t n i s n o it a ti m il e h t f o e s u a c e B s e c n e i c s e fi l n i e g d e l w o n k w e n g n i g r e m e y b y lt r a p n e v ir d s i si h T . sl e d o m y r a t n e m e l p m o c s d r a w o t e n i c i d e m d n a – bothi nc ontenta ndi ns rtucture( Swan ,2009) .Example soft hes o-called‘emerging t n e it a p -d irvenheatlhmodesl’ include :“heatlh-socia lnetworks” ,whicha rewebs tie-basedr esource r e m u s n o C ; tr o p p u s l a n o it o m e d n a g n ir a h s n o it a m r o f n i d n if o t e l b a e b y a m s t n e it a p e r e h w , s e rt n e c -c i h w , e n i c i d e m d e si l a n o s r e p h use s“an i ndividua’l sspeci ifc biologica lpredsipo isiton” to t alio r r o f t n e m t a e rt c if i c e p s h ti w p u e m o c tha tperson ,a swel la squanit ifed “ fls -e rtacking” ,which g n is ir p m o c fo “ ye - oas t -usedata-enrtys creens” fo rcondiiton ,ss ymptoms ,rteatmenttherapiesa nd d e t a l e r biologicali nformaiton– resul itngi na graphica ldsiplayofr esulst .Example sincludes ocia l s a h c u s s k r o w t e n PaitentsLikeMe ,CureTogether ,MedHelp ,andSugarStat s i(bid .)