Harnessing the Capital of the Poor: Assessing the Acceptability of Community Based Health Insurance in Zimbabwe

Abstract

Most people in Zimbabwe face financial risk when seeking healthcare. Similar to other low- and middle-income countries, the population is largely informally employed or unemployed, with only 10% covered by private health insurance or limited government programs. Without health insurance or strong financial risk pooling mechanisms, both rural and urban populations must pay out-of-pocket, and the government collects insufficient tax revenue to fund equitable healthcare and achieve its goal of Universal Health Coverage (UHC). Community-based health insurance (CBHI) has been proposed as a viable path toward providing high quality health services and financial protection for the population in low- and middle-income countries like Zimbabwe. CBHI involves forming local risk pools through community-managed insurance schemes that rely on voluntary contributions and social capital—trust and solidarity within communities. This social capital is essential for CBHI’s success. Faith-based organizations (FBOs), long trusted within communities, have been identified as well-positioned to help organize CBHI programs. This project aimed to assess the acceptability of FBO-led CBHI in predominantly rural communities near mission hospitals in Zimbabwe. The Old Mutare community, surrounding the United Methodist Church’s Old Mutare Mission Hospital, was selected for the study. Using a qualitative design, researchers conducted focus group discussions and key informant interviews. The Adapted Cooperative Healthcare framework was used to identify enablers and barriers to CBHI acceptance. Findings suggest that CBHI is indeed acceptable to the Old Mutare community. FBOs can play a critical enabling role by offering financial and technical support. However, the study found that those interviewed felt the church should not lead the initiative outright. When CBHI is perceived solely as an FBO initiative, it may trigger mistrust in the community that could undermine success. Instead, strong community ownership and oversight will be essential. Acceptability studies like this one are an important first step in CBHI development. Early community engagement and buy-in can build the foundation for long-term sustainability and contribute meaningfully to Zimbabwe’s progress toward UHC.