Health taxes must save lives, not plug Treasury gaps

ZIMBABWE has a bad habit of taxing citizens in the name of health and making it difficult to track where the money actually goes.

That habit is under scrutiny again. The Community Working Group on Health (CWGH) has warned that millions of dollars raised through health-related taxes can be diverted to competing government priorities — not merely another routine civil society complaint, but a warning that exposes a fundamental weakness in Zimbabwe’s public finance system: money can be raised for a specific social purpose without any guarantee that the intended beneficiaries will ever see it. When government tells citizens that a tax will help to fight cancer, equip hospitals or improve healthcare, it assumes both a moral and fiscal obligation to ensure the money reaches those services. That obligation must be taken seriously.

The sugar tax is a case in point. Introduced in 2024 on sugar-sweetened beverages, the levy was intended to support cancer diagnosis and treatment. If the proceeds are simply absorbed into general government expenditure, taxpayers are entitled to ask a basic question: what exactly are they paying for?

Initially, government appeared reluctant to disclose how much the tax had raised or how the money was being used. It took pressure from Zimbabwe Doctors for Human Rights to push Treasury into providing greater clarity. In June, Health and Child Care minister Douglas Mombeshora disclosed that government had spent US$27 million raised through the sugar tax on the first phase of a major cancer equipment procurement programme. The equipment is expected to improve cancer diagnosis and treatment at public hospitals, including Parirenyatwa Group of Hospitals in Harare and Mpilo Central Hospital in Bulawayo.

That disclosure was welcome. Taxpayers deserve evidence that money collected in their name is being used for the purpose for which it was imposed. But disclosure alone is not enough — the money must be protected.

Ring-fencing health-related revenue provides a stronger guarantee that funds raised specifically for healthcare cannot simply be diverted when government faces competing fiscal pressures. Zimbabweans are already heavily taxed and the controversy that accompanied the introduction of the sugar tax makes transparency even more important. Government must tell citizens how much is collected, where the money goes and what it achieves. A legal instrument providing for ring-fencing would go a long way towards protecting the revenue and rebuilding public trust.

As CWGH executive director Itai Rusike has correctly pointed out, what is allocated on paper is not necessarily what reaches hospitals. A generous health budget means little to a patient lying in a hospital without medicines, equipment or functioning services. A budget allocation is not healthcare. Cash reaching a hospital is.

Zimbabwe urgently needs to move beyond political promises and establish enforceable mechanisms to protect health-related revenue from diversion. Where a tax is explicitly justified on health grounds, the public should be able to track the entire chain — from collection by Treasury to disbursement and expenditure at health institutions. Government should publish regular, accessible reports detailing collections from health-related levies, Treasury transfers and expenditure by beneficiary institutions.

Ring-fencing will not solve every problem in the health sector. It will, however, establish an important principle: money raised for health must be spent on health. This is particularly important as international donor support comes under increasing pressure — Zimbabwe cannot afford to lose external financing while failing to protect the domestic resources it raises.

The sick should not compete with roads, agriculture, salaries, debt obligations and other legitimate government priorities for money raised specifically in their name. Every dollar collected through a health tax represents a promise to the taxpayer and, potentially, a lifeline to a patient. That promise must be honoured.

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