Overview
Zimbabwe has a health care system that is divided into two – the private sector and the public sector. People who cannot afford to visit a private General Practitioner (GP) or go to a hospital or clinic are in most cases forced to go to public hospitals. People can also use their Medical Aid (medical insurance) instead of paying cash when they go to the doctor’s rooms and it often offsets the cost of medicine and supplies. Most people get Medical Aid through their work places and a certain fee will be deducted from their monthly salary.

What happens if you need to see a doctor?
If someone is on Medical Aid, they can easily go to their Medical Aid clinic. For example, CIMAS medical aid has clinics all over the country and if one has a valid medical licence they can go to any CIMAS clinic and get tended to by a GP who is employed by the Medical Aid. This applies to all Medical Aids in the country. Some people prefer to go visit their Physicians or Specialist Physicians instead of going to clinics.

When someone gets a prescription from a Medical Aid clinic they will go get the prescribed drugs from the pharmacy which is usually located at the clinic. They will not pay for the drugs if they are getting them from the clinic. If someone gets a prescription from their private doctor, they would have to go to any pharmacy to collect the new prescription, and also pay a shortfall for the drugs or the full amount if they are not on Medical Aid.

Who decides what doctors can prescribe?
The Medicines Control Authority of Zimbabwe (MCAZ) decides what medicines a doctor can prescribe to patients. It also authorises what kind of drugs enter and exit the country. The MCAZ also makes decisions about medical technology. For example, it recently approved of some advanced insulin into the country. The MCAZ provides guidelines for pharmacies and doctors to follow when prescribing drugs to patients.

Practically, what is like to live with type 1 diabetes in Zimbabwe?
In Zimbabwe, type 1 diabetes has been labelled the “wealthy man's disease’’ because of the high costs of living that it comes with. Most people still cannot afford to buy test strips as well as insulin because of the incredible costs of basic supplies. If someone wants to buy insulin over-the-counter in pharmacies, the average cost per vial would be between USD$9 and USD$12 as compared to the price when someone uses Medical Aid, the shortfall would be USD$3 at most.

Living with Type 1 diabetes can be a real burden in Zimbabwe because sometimes insulin, besides being expensive, can also become scarce. Most times, diabetic patients are seen by GPs and not Specialist Physicians or Endocrinologists, mainly because Physicians are expensive and there are not a lot of Endocrinologists in the country. Some people cannot even afford to go to eye specialists or to get a simple HBA1C test, let alone visit a dietician, because of the expenses. Sometimes diabetic people are discriminated by members of the society, which is caused by ignorance not only by the societies, but also by the authorities.

What about getting admitted to the hospital?
Before a person is admitted into hospital, they must pay a hospital fee. When they are in hospital, they are sometimes told to buy their own latex gloves for use during their stay. Doctors can prescribe drugs for patients while they are in hospital and then the patients would have to buy the drugs from pharmacies.

How does diabetes care vary throughout Zimbabwe?
Diabetes care varies a lot from place to place. The prices of insulin changes drastically from city to city; this also goes for the prices of test strips. Insulin and test strips are not available in some parts of the country in some cases and people have to travel great distances in order to get insulin and other supplies.

Yemurai Machirori was kind enough to provide much of this information for us - thank you!