How is Zambia improving Universal Health Coverage? We asked a local parliamentarian

Zambian Member of Parliament Hon. Given Katuta Mwelwa spoke to VaccinesWork about the country’s national health insurance scheme, her work as a parliamentarian and the country’s progress towards Universal Health Coverage (UHC).

  • 14 December 2022
  • 6 min read
  • by Hamzah Zekrya
Hon. Given Katuta Mwelwa, Member of Parliament for Chienge Constituency in Luapula Province, Zambia
Hon. Given Katuta Mwelwa, Member of Parliament for Chienge Constituency in Luapula Province, Zambia


Gavi has recently partnered with the Inter-Parliamentary Union (IPU) – the global organisation of national parliaments – to help improve immunisation rates and universal health coverage across the globe. Following this week’s Universal Health Coverage (UHC) day Gavi and the IPU spoke to Hon. Given Katuta Mwelwa, Member of Parliament for Chienge Constituency, Zambia, and a member of the IPU Advisory Group on Health, to get her views on UHC and the role of Zambia’s parliamentarians in improving access to health care.

More campaigns on HPV vaccination similar to those that were launched for COVID-19 are needed.

What does UHC mean in Zambia and your day-to-day work? Why is it important?

Universal health coverage is very important in Zambia as it has enabled the population who cannot afford primary health care services to access high-quality health care. Since 2017 the government of Zambia has been improving universal health coverage through the National Health Insurance Scheme (NHIMA), which seeks to facilitate member access to quality health services. NHIMA has enabled most civil servants and average persons who could not access proper health care before. UHC is particularly important in rural areas where we can find the most vulnerable groups.

What have been some of the country’s achievements towards the UHC agenda?

Public hospitals have limited capacity to accommodate patients, which creates the need for people to make use of private hospitals. In the past, private health care was perceived as a service for the elites, but now, with the implementation of NHIMA, patients can have access to both public and private hospitals. Likewise, through this scheme now one member of a family (who is registered by his/her employer) can give access to health care services to other members of his/her family unit, helping to extend universal health coverage.

What have been the challenges you’ve faced in realising UHC both before and after the pandemic?

Zambia struggles nationwide with inadequate access to medicines and health care services and health personnel, hampering the universal health coverage objective of leaving no one behind. Most health facilities do not have enough health staff. During the pandemic, most of the hospital staff got infected with COVID-19. Additionally, the health personnel working in public hospitals often quit their jobs to seek opportunities in private hospitals that used to offer better salaries.

Furthermore, the pandemic underscored the elevated dependency on donors and the lack of emergency preparedness in the country. Discussions took place in the Parliament that this situation has to come to an end; we need to find other solutions, be more prepared for future pandemics. All these aspects have contributed to the limited progress on universal health coverage.

Could you tell us more about how parliamentarians are working to generate political commitment for UHC?

Parliamentarians in Zambia are going on recess on Friday and each of them has the duty to reach out to their constituents to create awareness on the importance of UHC and how  people can register in order to get health insurance. Health insurance is still perceived as an elite benefit in Zambia. Therefore, the government needs to convince people of the advantages of joining the NHIMA scheme, as private insurance tends to be much more expensive.

How have parliamentary structures and citizen participation ensured accountability for UHC in your country?

Parliamentarians can assess the government’s compliance with bilateral agreements through budgetary allocations. In line with Zambian regulations, 10% of the national budget needs to be allocated to health and it is the role of parliamentarians to verify that funds are not diverted from health.

As Zambia heavily relies on donors, the government signs bilateral agreements aimed at extending universal health coverage and parliamentarians exercise oversight powers to monitor compliance with these agreements. The government needs to seek solutions to cover citizens who cannot afford health insurance under NHIMA in order to ensure that no Zambian is left behind. Special attention must be paid to people living in rural areas who don’t have access to health services.

Immunisation is a key pillar of Primary Health Care, towards realising the UHC ambition. How did your country maintain routine immunisation during the pandemic?

The Zambian government has recently achieved 75% of COVID-19 immunisation. However, reaching this rate was challenging because the COVID-19 vaccine came with a lot of misunderstanding. At the beginning of the emergency, many Zambians believed that they could die by getting the vaccine. The president got vaccinated publicly to encourage citizens to use the vaccine and a massive vaccination campaign was launched nationwide in shopping malls to vaccinate every citizen. Within a year the vaccination rate increased from 20% to 75%.

Parliamentarians were required to get vaccinated in order to continue working in the parliament and rapidly after they became champions in the promotion of vaccination in their constituencies. The involvement of parliamentarians in awareness campaigns with their constituents was important to raise vaccination rates, as many people don’t believe in medical staff. Vaccination campaigns were also spread through radio and television, and parliamentarians even made use of religious leaders to convey messages in church on the importance of getting the COVID-19 vaccine.

Could you tell us about HPV vaccination in Zambia?

There are many women in Zambia who suffer from cervical cancer. HPV vaccination has been proven effective for tackling this type of cancer. However, there are many misperceptions regarding the vaccine as Zambian women believe that the virus will enter their bodies via the vaccine, and they show reluctance to get the HPV vaccine. The situation is even more difficult in rural areas where there are even more misconceptions among women. More campaigns on HPV vaccination similar to those that were launched for COVID-19 are needed.

Zambia needs support to ensure that everyone is covered by the national insurance scheme. In this regard, the Inter-Parliamentary Union could deliver a document on the challenges to implementing UHC at the national level, partnerships need to be enhanced on information campaigns and attention needs to be paid to other diseases that are silently killing people, such as cervical cancer.

How could a partnership between Gavi, the Vaccine Alliance and IPU help improve UHC worldwide?

Cooperation between Gavi and IPU is important. Gavi can produce policies and strategies and the IPU can turn Gavi’s input into policy recommendations for parliaments to improve universal health coverage. The recommendations produced by the IPU are considered during parliamentary debates and can be turned into legislation and national policies. Gavi could also help to advocate for timely vaccination. Finally, Gavi and the IPU could work together to produce recommendations on how parliaments can increase vaccination in their countries to leave no one behind.