Expat insurance and health insurance in Zambia

Zambia's health system is organised in three tiers: health posts, health centres and district hospitals at local level (level 1), provincial general hospitals (level 2), then central and specialised hospitals (level 3). The public sector remains unevenly resourced, with provision concentrated in cities and much more limited in rural areas. The University Teaching Hospital (UTH) in Lusaka, the country's largest hospital with around 1,655 beds, is the national reference and the teaching facility for health professionals; the Levy Mwanawasa University Teaching Hospital, also public, helps ease pressure on the UTH for emergencies, maternity and outpatient consultations. Health financing notably rests on the National Health Insurance Scheme, managed by the National Health Insurance Management Authority (NHIMA), created by the National Health Insurance Act no. 2 of 2018 and operational since 1 October 2019. According to sources specialising in Zambian payroll, the mandatory contribution stands at 2% of gross salary, split equally between employer and employee (1% each), and would cover all formal-sector workers, including foreign employees, subject to a possible exemption for expats already holding comprehensive private insurance; these precise terms of application to non-Zambians could not, however, be confirmed directly on NHIMA's official website and deserve checking with the authority before relying on them. The private sector, concentrated in Lusaka, offers a level of care and waiting times generally better than the public offering: Fairview Hospital (also known as the International Hospital of Zambia) and Medlands Hospital are among the private facilities most used by expats in Lusaka.

France Diplomatie notes that basic care is available in Lusaka, but that serious conditions or major emergencies most often require treatment in South Africa, or even a return to France, as the embassy covers no medical costs. The site also notes, for the recent period, a risk of cholera outbreaks in the rainy season (November to April), particularly in the Copperbelt and Lusaka, as well as severe pollution of the Kafue river linked to the collapse of a mining tailings dam in 2025, with an explicit recommendation not to eat fish caught in that river.

• Free visa on arrival for any French national on a tourist stay of under 90 days, free of charge since 1 November 2022 (visa fee waiver decided by the Zambian government); the authorities in practice most often issue a 30-day stamp, to be extended on the ground before it expires. An e-visa remains available beforehand on the official portal eservices.zambiaimmigration.gov.zm for those who prefer to apply in advance. Passport valid at least 6 months after the end of stay date and with at least two blank pages required.
• Tourist stay capped at 90 days per calendar year; extensions up to this cap remain free, beyond that fees apply. An irregular stay (beyond the granted duration, with no extension) risks a fine of up to 18,000 ZMW and, where applicable, detention until it is settled.
• KAZA Univisa: separate regional visa (USD 50, valid 30 days), available at Lusaka and Livingstone airports as well as certain border posts, allowing unlimited back-and-forth travel between Zambia and Zimbabwe and a day trip to Botswana via the Kazungula post — relevant for a stay combining both banks of Victoria Falls, but of no use for a stay limited to Zambian territory.
• France Diplomatie describes taking out an assistance contract covering medical costs, hospitalisation and medical evacuation as essential, as serious cases are most often referred to South Africa or France and the embassy covers no costs.
• Yellow fever: a vaccination certificate is required for any traveller arriving from a country where the disease is endemic (or having transited through such a country), with vaccination to be carried out at least 6 days before entering the country.
• Malaria: transmission risk present across much of the territory; suitable antimalarial prophylaxis is recommended before departure, alongside protection against insect bites (also useful given the dengue and chikungunya risk noted by France Diplomatie).
• Stay of more than 6 months or professional activity: separate residence and work permits are required, to be applied for beforehand with the relevant Zambian authorities; no visa or permit dedicated to remote workers ("digital nomads") has been identified to date.

No bilateral social security agreement between France and Zambia has been identified. CLEISS lists only 16 African countries and territories that have concluded such an agreement with France (Algeria, Benin, Cameroon, Cape Verde, Congo, Côte d'Ivoire, Gabon, Madagascar, Mali, Morocco, Mauritania, Mayotte, Niger, Senegal, Togo, Tunisia) — Zambia is not among them. Absent any agreement, no coordination exists for health, maternity, old age or family benefits between the two schemes.

• No form maintaining French rights applies in Zambia.
• Affiliation to the CFE or taking out international private insurance are the only routes to cover recognised by a French system, whatever the profile.
• NHIMA affiliation, when open and applicable to foreigners, gives access to the local system but is neither cover recognised in France nor a substitute for medical repatriation.
• Consular services for French residents in Zambia are, depending on the procedure, shared between the French embassy in Lusaka and the French consulate general in Johannesburg (South Africa) — to check case by case with the embassy for the relevant procedure.

• Before departure, whatever the purpose: take out insurance or an assistance contract covering hospitalisation and repatriation, absent any France-Zambia coordination; the visa itself is free and does not require a mandatory online process for a short tourist stay.
• For a stay combining Zambia and Zimbabwe (Victoria Falls): consider the KAZA Univisa (USD 50, 30 days) on arrival in Lusaka or Livingstone rather than two separate visas.
• Before departure: a medical consultation/vaccination centre visit to assess the need for yellow fever vaccination (depending on origin and transit), hepatitis A and B, typhoid fever, rabies, and antimalarial prophylaxis, as malaria risk is present across much of the territory.
• For a stay of more than 6 months or a professional activity: start the residence and work permit process well in advance with the relevant Zambian authorities.
• Formally employed: check NHIMA affiliation and its terms for a foreign employee with the employer, alongside — never in place of — cover recognised in France.
• Voluntary affiliation to the CFE recommended absent any health coordination.
• Within 6 months of arrival: register with the roll of French nationals living abroad, at the French embassy in Lusaka or, depending on the procedure, the French consulate general in Johannesburg.