The Healthcare System in Zambia: What a French National Should Know

Zambia’s health system combines a public network under the authority of the Ministry of Health and private providers, located mainly in Lusaka and the large towns. France Diplomatie indicates that first-line care is accessible in Lusaka, that some conditions and injuries can only be treated in South Africa, or in France if the patient’s condition allows, and recommends registering with Fil d’Ariane (the ministry’s alert service) giving the details of your assistance company.

On funding, the World Health Organization reports health expenditure of about 80 US dollars per capita, or about 6% of GDP; under-five mortality is about 45 per 1,000 live births. These figures indicate the overall level of the system, without prejudging the quality of a specific facility.

In practice, the expatriate plans for three levels: routine care in Lusaka or the town of residence, specialist care in a more complete facility, and evacuation to South Africa by the assistance provider. The guide healthcare systems of the world offers a comparison method.

The National Health Insurance Management Authority (NHIMA) runs a compulsory health insurance scheme. Its website states that it allows you to enrol your spouse and five children under 18 and describes a benefits package per insured person: generic medicines from the national essential medicines list, hospitalisation (ordinary or private room, intensive care), laboratory tests and imaging (X-ray, CT scan, MRI, ultrasound, mammography), dental care, glasses once every three years, maternity (normal delivery or caesarean), surgery, prostheses, oncology, rehabilitation.

The site describes the arrangement as established for all Zambians and settled citizens; it does not address the case of expatriates. Contribution rates do not appear on the pages read for this guide. A locally recruited employee must therefore ask their employer and the body whether they are covered, and which providers are approved.

No social security agreement binds France and Zambia: the NHIMA opens no right in France, and French social security does not reimburse Zambian care, except for a seconded employee under the conditions of the French scheme. Reimbursements by status are detailed on the page healthcare reimbursement in Zambia.

France Diplomatie names no doctor or facility in particular on its health pages and publishes no local emergency number. It is recommended, before departure, to obtain from the insurer or assistance provider the list of approved providers, then to save the numbers of the assistance provider, of the French embassy in Lusaka and of the Consulate General in Johannesburg (out-of-hours emergencies).

After settling in, locate the nearest health centre, have a first routine consultation, gather your medical file (vaccinations, prescriptions, allergies, blood group) and keep it up to date. In the event of hospitalisation, direct payment by the insurer avoids advancing the costs; see direct payment.

Outside the towns, roads that are sometimes in poor condition and unlit slow down emergency services; night-time travel is discouraged. For an evacuation, the logistics are described in the guide medical repatriation.

France Diplomatie advises keeping medicines in their original packaging, with a prescription giving the international non-proprietary name, checking that they are authorised in Zambia and never buying any on the street. Local legislation is firm on narcotics and psychotropic drugs, including sleeping pills and antidepressants without a prescription: it is better to keep imported medicines to the strict minimum and to keep the corresponding prescription.

For a chronic treatment, a stock for several months when settling in and a discussion with a local doctor about the available equivalents limit the risk of running out. The national essential medicines list applies in the NHIMA scheme for generics.

Dental and optical care fall, depending on the case, under the NHIMA, insurance contracts or the CFE (Caisse des Français de l’étranger, the French social security fund for expatriates); see expat health insurance.

France Diplomatie recommends being up to date with the French vaccination schedule and considering, depending on the length and conditions of the stay, hepatitis A and B, typhoid fever, rabies, chikungunya, dengue and mpox. Yellow fever vaccination is required of people arriving from an endemic country: the vaccine must be given at least six days before entry.

Malaria, transmitted by mosquitoes, can cause severe forms: prevention combines protection against bites and preventive treatment, and any fever during the stay or in the weeks following return calls for a prompt consultation. Cholera is frequent during the rainy season, from November to April, notably in the Copperbelt and the Lusaka region; typhoid fever, hepatitis A and poliomyelitis are transmitted by contaminated water or food.

The prevalence of HIV/AIDS is high in Zambia and justifies avoiding risky behaviour. More limited risks concern anthrax, mpox and trypanosomiasis, with specific preventive measures. The France Diplomatie site publishes occasional alerts: one on measles, and one on Ebola in the Democratic Republic of the Congo and Uganda, with screening at border crossing points in the Northern, Luapula and North-Western provinces; they should be consulted before each departure.

Do not drink tap water: use bottled, filtered, boiled or disinfected water. It is recommended to wash your hands, cook food thoroughly, and avoid raw vegetables, shellfish and cold buffets.

France Diplomatie recommends not eating fish caught in the Kafue River or in the Zambezi downstream of Lake Kariba, because of heavy pollution linked to the collapse of a mining dam, and avoiding any water activity in the Kafue.

Against mosquitoes: covering clothing, repellents, treated mosquito nets and removing stagnant water. On safari, never get out of the vehicle; in the event of an animal bite, clean it immediately and consult a doctor, rabies being almost always fatal once symptoms have appeared.

France Diplomatie describes an insurance or assistance contract covering all medical costs, surgery, hospitalisation and medical repatriation as essential. The embassy cannot under any circumstances cover these costs.

Three routes exist: the CFE (membership before departure or within three months of settling in for immediate cover), international first-euro insurance (with direct payment and evacuation) or the cover of a secondment. The comparison is made on the coverage area, the hospitalisation ceiling, maternity, repatriation and the medical questionnaire; see coverage area.