A qualitative study of stakeholders' perceptions towards the implementation of the National Health Insurance Scheme in Zambia : Equity and financial sustainability in question
Kazibwe, Joseph LU ; Sundewall, Jesper LU ; Masiye, Felix ; Owusu, Lucy ; Tran, Phuong Bich ; Chama-Chiliba, Chitalu M ; Ekman, Björn LU
and Svensson, Pia
LU
(2026)
In Health Policy and Planning
p.1-14
- Abstract
Low- and middle-income countries are expanding health insurance to enhance financial protection. However, there is scarcity of evidence on the stakeholder perceptions towards health insurance. This study explores stakeholders' perceptions towards the implementation of the National Health Insurance Scheme in Zambia. This qualitative study is based on 21 in-depth interviews with key stakeholders involved in the NHIS implementation in Zambia. We used qualitative content analysis to describe and interpret the manifest and latent meaning of transcribed interviews. The analysis yielded three overarching themes: i) Politics can make or break the scheme, ii) Equity in question: winners and losers and iii) Pointing at the need for financial... (More)
Low- and middle-income countries are expanding health insurance to enhance financial protection. However, there is scarcity of evidence on the stakeholder perceptions towards health insurance. This study explores stakeholders' perceptions towards the implementation of the National Health Insurance Scheme in Zambia. This qualitative study is based on 21 in-depth interviews with key stakeholders involved in the NHIS implementation in Zambia. We used qualitative content analysis to describe and interpret the manifest and latent meaning of transcribed interviews. The analysis yielded three overarching themes: i) Politics can make or break the scheme, ii) Equity in question: winners and losers and iii) Pointing at the need for financial sustainability of the National Health Insurance Scheme. The themes are supported by six subthemes and 18 data categories. Participants perceived the scheme as having contributed to improved quality of care and offering a generous health benefit package. However, implementation is perceived to be hindered by political interference, limited use of empirical evidence, weak institutional coordination, and exclusion of key stakeholders from decision-making processes, low enrolment, operational inefficiencies, inequities and a benefit package misaligned with available resources. The Zambia National Health Insurance Scheme is perceived as a promising initiative for expanding access to health and enhancing financial protection. However, it faces numerous challenges ranging from limited enrolment among the poor, vulnerable and informal sector populations to concerns about financial sustainability. Addressing these issues is essential to realize the scheme's potential benefits.
(Less)
- author
- Kazibwe, Joseph
LU
; Sundewall, Jesper
LU
; Masiye, Felix
; Owusu, Lucy
; Tran, Phuong Bich
; Chama-Chiliba, Chitalu M
; Ekman, Björn
LU
and Svensson, Pia
LU
- organization
- publishing date
- 2026-05-25
- type
- Contribution to journal
- publication status
- epub
- subject
- in
- Health Policy and Planning
- article number
- czag074
- pages
- 1 - 14
- publisher
- Oxford University Press
- external identifiers
-
- pmid:42178854
- ISSN
- 0268-1080
- DOI
- 10.1093/heapol/czag074
- language
- English
- LU publication?
- yes
- additional info
- © The Author(s) 2026. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.
- id
- fddefb8a-aea1-416c-80f0-3d877de7b1ad
- date added to LUP
- 2026-06-30 11:51:13
- date last changed
- 2026-06-30 13:47:08
@article{fddefb8a-aea1-416c-80f0-3d877de7b1ad,
abstract = {{<p>Low- and middle-income countries are expanding health insurance to enhance financial protection. However, there is scarcity of evidence on the stakeholder perceptions towards health insurance. This study explores stakeholders' perceptions towards the implementation of the National Health Insurance Scheme in Zambia. This qualitative study is based on 21 in-depth interviews with key stakeholders involved in the NHIS implementation in Zambia. We used qualitative content analysis to describe and interpret the manifest and latent meaning of transcribed interviews. The analysis yielded three overarching themes: i) Politics can make or break the scheme, ii) Equity in question: winners and losers and iii) Pointing at the need for financial sustainability of the National Health Insurance Scheme. The themes are supported by six subthemes and 18 data categories. Participants perceived the scheme as having contributed to improved quality of care and offering a generous health benefit package. However, implementation is perceived to be hindered by political interference, limited use of empirical evidence, weak institutional coordination, and exclusion of key stakeholders from decision-making processes, low enrolment, operational inefficiencies, inequities and a benefit package misaligned with available resources. The Zambia National Health Insurance Scheme is perceived as a promising initiative for expanding access to health and enhancing financial protection. However, it faces numerous challenges ranging from limited enrolment among the poor, vulnerable and informal sector populations to concerns about financial sustainability. Addressing these issues is essential to realize the scheme's potential benefits.</p>}},
author = {{Kazibwe, Joseph and Sundewall, Jesper and Masiye, Felix and Owusu, Lucy and Tran, Phuong Bich and Chama-Chiliba, Chitalu M and Ekman, Björn and Svensson, Pia}},
issn = {{0268-1080}},
language = {{eng}},
month = {{05}},
pages = {{1--14}},
publisher = {{Oxford University Press}},
series = {{Health Policy and Planning}},
title = {{A qualitative study of stakeholders' perceptions towards the implementation of the National Health Insurance Scheme in Zambia : Equity and financial sustainability in question}},
url = {{http://dx.doi.org/10.1093/heapol/czag074}},
doi = {{10.1093/heapol/czag074}},
year = {{2026}},
}