• Cancer radiotherapy machines worth USD 27 million are installed at major hospitals but not yet operational, ~800 patients remain on the backlog
• Presidential Hospital Renovation Programme has delivered visible upgrades (Parirenyatwa, Mbuya Nehanda, Mpilo, Sally Mugabe) but patient outcome data is still missing
• Health facilities routinely receive less than 50% of allocated operational budgets, renovated rooms still face medicine stock-outs

Harare- She has been waiting for three months.

Not in the queue that forms outside Parirenyatwa Group of Hospitals before sunrise, though she knows that queue.

Not in the administrative corridor where referral letters are sorted and files assembled, though she has spent time there too.

She has been waiting on a cancer treatment list for a machine that the Government of Zimbabwe purchased with Sugar Content Tax revenues, transported to the hospital and installed in a room renovated under the Presidential Hospital Renovation Programme.

The machine is there. It is not working yet.

“The queues are still long,” a woman said in an interview with Equity Axis speaking on condition of anonymity because of the sensitivity of her condition. “You have to wait long, but at least you are not turned away simply because you do not have thousands of dollars requested in private clinics.”

Her experience captures the gap this investigation set out to examine. A patient can enter a public hospital without facing the cost of private treatment while remaining on a waiting list with no clear treatment date. Roughly 800 according to government statistics people remain on the reported backlog that the Government’s US$27 million investment in cancer equipment was intended to reduce, because the clinical benefit begins only when the machines are commissioned, staffed, supplied with consumables and treating patients.

This is the part of the hospital renovation programme that cannot be measured through commissioning photographs alone.

Zimbabwe’s public hospitals have received substantial documented investment commitments between 2025 and mid 2026. The Presidential Hospital Renovation Programme, launched after President Emmerson Mnangagwa conducted surprise inspections of major referral hospitals and found sections affected by infrastructure decay, policy gaps and systemic overload, has delivered visible physical results.

The refurbishment of Adlam House and the Nurses Home at Parirenyatwa Group of Hospitals was commissioned in May 2026. Mbuya Nehanda Maternity Hospital handed over its upgraded maternity wing on 12 May 2026, while rehabilitation works have also been undertaken at Mpilo Central Hospital in Bulawayo and Sally Mugabe Central Hospital in Harare.

Finance Minister Professor Mthuli Ncube toured Mpilo in June 2026 and confirmed that one refurbished block was expected to be completed by August 2026, pledging continued procurement of oncology equipment using Sugar Content Tax proceeds. Treasury approved 8,785 new health worker posts for 2026, building on approximately 3,700 workers recruited from the 5,284 posts approved in 2025.

Government committed approximately USD 1.67 billion toward a Health Workforce Investment Compact over three years. The Global Fund allocated USD 412.9 million for the 2026 to 2028 period to combat HIV, tuberculosis and malaria while strengthening health systems. Between 2021 and 2025, government reported constructing 200 new health facilities, bringing Zimbabwe’s total public health institutions to 1,953.

The investment is real and physically visible. What remains considerably harder to establish from publicly available information is whether the same investment has produced corresponding improvements in treatment access, waiting times, equipment availability and other patient outcomes.

Zimbabwe can confirm renovated blocks at Parirenyatwa, yet there is no routinely published facility-level evidence showing whether dialysis waiting times have fallen. Cancer equipment procurement can be confirmed without corresponding public data showing how many patients have moved from waiting lists into treatment on the new machines. Treasury can confirm 8,785 approved health worker posts without facility-level reporting showing how many recruited workers remain at their stations.

Health Minister Dr Douglas Mombeshora acknowledged at the launch of the National Health Strategy 2026 to 2030 that many public health facilities receive less than 50% of their allocated operational budgets. A renovated facility receiving half of its operational allocation can have cleaner walls and newer machines while still facing shortages of medicines and consumables. Patient care depends on equipment, medicines, clinical staff and operating budgets functioning together.

USD 27 Million, Installed, Not Yet Operational

The Sugar Content Tax model provides a direct connection between a domestic revenue source and a defined clinical need. Revenue raised from sugary drinks has been directed toward cancer equipment, creating a financing mechanism whose expenditure purpose can be publicly identified and tracked.

A health worker familiar with the oncology equipment rollout, who spoke on condition of anonymity because they are not authorised to comment publicly, described the position at the time of this investigation.

“The installation has been done, but the machines are not working yet,” the health worker said. “For now, the old machines are the ones still being used. Maybe when the new machines come into use, they will help decentralise cancer treatment to other facilities, because right now patients are still concentrated at the main referral centres.”

Installation places a machine inside a hospital. Clinical value requires commissioning, treatment planning system integration, trained personnel, consumables and patients receiving treatment. Until that process is completed, the reported backlog of approximately 800 patients remains the clearest test of how quickly capital expenditure is being converted into additional treatment capacity.

Zimbabwe has more cancer patients than its existing functioning public radiotherapy capacity can comfortably absorb. The newly purchased machines can expand that capacity once they become operational. Public reporting would make that progress measurable by showing how many machines are functional, how many patients are waiting, how many begin and complete treatment each month, and how many sessions are lost to machine downtime, staffing shortages or consumable gaps.

Mpilo’s Lesson: What Actually Saves Lives

Before assessing what the renovation programme may deliver, Mpilo Central Hospital provides a documented record of a period in which maternal outcomes improved substantially within Zimbabwe’s public health system.

A peer reviewed study published in 2022 in the Journal of Perinatal Medicine documented that Mpilo Central Hospital’s maternal mortality ratio declined from 655 per 100,000 live births in 2011 to 203 per 100,000 by 2020, a 69% reduction over nine years. The leading causes of maternal mortality across the decade included hypertensive disorders, obstetric haemorrhage, pregnancy related infection and pregnancies with abortive outcomes.

Those conditions place substantial weight on the availability and quality of clinical intervention, medicines, protocols and skilled staff. The study documents the scale of the mortality reduction. It does not, by itself, establish that any single factor was solely responsible for that improvement.

Mpilo’s experience therefore provides an important reference point for the renovation programme. Infrastructure forms part of the treatment environment, while maternal survival also depends on whether medicines such as oxytocin are available, whether skilled personnel are present when complications occur and whether emergency clinical protocols can be implemented consistently.

Then came 2024. Published reports cited by this investigation recorded 280 child deaths over four months at Mpilo amid severe resource shortages. The figure places renewed attention on the relationship between physical infrastructure and the recurrent resources required to sustain clinical services.

A renovated Mpilo therefore still requires dependable operational funding, medicines, functioning equipment and sufficient staff if capital investment is to translate into continuous care.

Equity Axis contacted Mpilo Central Hospital by telephone during the preparation of this investigation and it wasn’t responded to. No response had been received by the time of publication.

The Dialysis Machines at Parirenyatwa

Parirenyatwa Group of Hospitals, Zimbabwe’s largest referral facility with 1,800 beds and a workforce of more than 2,000, presents one of the renovation programme’s clearest potential accountability tests because equipment availability can be measured directly.

Published reports cited by this investigation stated that around 50% of dialysis machines at Parirenyatwa were not working, affecting roughly 130 kidney patients dependent on scheduled treatment. Dialysis is time sensitive because the treatment removes fluid and waste products that failing kidneys cannot adequately clear. Repeated interruption can worsen a patient’s clinical condition.

The renovation programme’s commitment to new beds, theatre tools, X ray equipment and CT scan technology addresses important infrastructure requirements. Dialysis availability also depends on maintenance contracts, spare parts, consumable supply chains and technical staffing.

Parirenyatwa can therefore serve as a machine availability test case for the wider programme. The hospital’s national referral role means equipment failure can affect patients beyond Harare. A regular public dashboard could show how many dialysis machines are installed and functional, how many patients are booked, and how many sessions are missed because of downtime, consumable shortages or staffing gaps.

Improved machine availability and fewer missed sessions would provide measurable evidence of increased treatment capacity. Continued downtime would identify operational weaknesses requiring further intervention.

The Nurse’s Calculation

The largest single workforce commitment in Zimbabwe’s health sector in years was made alongside the infrastructure programme. Treasury approved 8,785 new health worker posts for 2026. Government committed USD 1.67 billion toward a Health Workforce Investment Compact over three years, targeting a doubling of the health workforce by 2030 and a 50% reduction in attrition. A USD 11.8 million retention scheme targeting rural health workers through accommodation support and career development programmes was confirmed at the Human Resources for Health Dialogue Meeting on 28 May 2026.

A female health worker at Parirenyatwa Group of Hospitals, speaking on condition of anonymity, described the calculation confronting health workers across Zimbabwe’s public system. Her decision, and those of thousands of colleagues, will help determine how many approved posts translate into nurses and doctors consistently reporting for duty in renovated wards.

“Competitive salaries, comparable to those in the region, are essential to retain skilled staff and reduce the risk of strikes that disrupt services,” she said. “Improving infrastructure and hiring more nurses will deliver limited results if living conditions and wages are not addressed.”

South Africa and Zambia have periodically adjusted health worker remuneration and employment conditions as part of broader retention efforts. Zimbabwe continues to face pressure over public sector health worker remuneration. That pressure was visible in 2026 when nurses at Parirenyatwa and Sally Mugabe Central Hospitals took industrial action over pay and working conditions.

The Health Workforce Investment Compact commits substantial resources toward workforce expansion and retention. Its effectiveness will be measurable through recruitment, vacancy rates, staff attrition and sustained staffing levels inside public facilities.

The Medicine That Was Not There

A patient receiving treatment at Sally Mugabe Central Hospital described another part of the public hospital experience.

“The doctor attended to me at the hospital, but some of the medicines were not available,” the patient said. “I had to go outside and buy from a private pharmacy, and that is where the cost becomes difficult.”

A medical doctor at the hospital, who separately spoke to Equity Axis and declined to be named, described medicine availability as a structural constraint on the treatment patients ultimately receive.

“Reliable supply of essential medicines in public facilities would reduce the financial burden on households and improve treatment adherence,” he said. “The gap between public and private sector medicine access must be closed if the renovation programme is to change outcomes.”

The patient described how the cost of filling prescriptions outside the public system can affect adherence.

“Sometimes you do not buy everything at once because you do not have enough money. You buy what you can afford first and hope to get the rest later. That affects how you follow the treatment because the doctor gives you a plan, but the pharmacy cost decides whether you complete it.”

Zimbabwe’s households spent 27.8% of their total healthcare costs out of pocket in 2023. For households already under financial pressure, unavailable medicines in a public facility can shift part of the treatment cost directly onto the patient. Diagnostic equipment may identify a condition, while access to the prescribed medicine determines whether treatment can proceed as intended.

What Zambia Shows Zimbabwe and What South Africa Warns

Zambia’s maternal mortality ratio reached 85 per 100,000 live births in 2023. Zimbabwe’s most recently confirmed national figure is approximately 357 per 100,000. The difference provides a regional reference point for Zimbabwe’s health reforms, while differences in data methodology, health system structure and reporting periods must also be considered when making direct comparisons.

Zambia maintains more than 2,900 public health facilities against Zimbabwe’s reported 1,953. In December 2025, Zambia signed a National Health Compact with the World Bank that included commitments around workforce expansion and primary healthcare. In Eastern Province, electronic health record coverage had reached 61% of more than 420 facilities as of 2025. Zambia’s health budget share was 11.8% in 2023 and 10.4% in 2024, both below the Abuja Declaration target.

South Africa provides another regional reference point. Its National Health Insurance became law in May 2024, while implementation subsequently became subject to legal and institutional challenges. During the 2024 to 2025 financial year, South Africa reported substantial refurbishment, maintenance and construction work across public health facilities.

South Africa also spends substantially more per person on health than Zimbabwe, while maintaining major inequalities between its public and private health systems. Its experience demonstrates that higher expenditure, legislation and infrastructure investment still require functioning implementation systems, sustainable operating budgets and effective clinical administration.

Four Decisions That Will Define the Programme’s Legacy

The Presidential Hospital Renovation Programme has delivered visible physical investment, while the Sugar Content Tax has financed major equipment procurement. The next stage is measurable conversion into treatment capacity, from installed equipment to patients treated, approved posts to health workers reporting for duty, and medicines procured to prescriptions dispensed.

Four policy and operational decisions would make that conversion easier to measure and sustain.

The first is the operational budget guarantee. Renovated facilities require predictable recurrent funding capable of supporting the equipment and services installed inside them. The CT scanner at Parirenyatwa needs reagents. The theatre at Mpilo needs anaesthetic consumables. The maternity ward at Mbuya Nehanda needs oxytocin. Capital expenditure and operating resources must reach the facility together if treatment capacity is to improve.

The second is a mandatory quarterly public outcomes dashboard at facility level. The National Health Strategy 2026 to 2030 sets targets including life expectancy of 70 years, a universal health service coverage index of 80 by 2030 against the current 55, and reductions in maternal and under five mortality. Measuring progress requires facility level data on treatment volumes, waiting periods, equipment uptime, medicine availability and selected clinical outcomes.

Zimbabwe’s Impilo electronic health record system has been deployed across a substantial number of health facilities, including major referral hospitals. Publicly available facility-level outcome reporting, however, remains limited. Greater interoperability between electronic systems and routine national health reporting would allow national targets to be tested against what is happening inside individual hospitals.

The third is workforce retention. Industrial action by nurses at Parirenyatwa and Sally Mugabe Central Hospitals in 2026 demonstrated how remuneration and working conditions can directly affect service availability. Recruitment numbers therefore need to be assessed alongside retention, vacancy rates and actual staffing levels inside renovated facilities.

The fourth is predictable health financing capable of reducing the household burden of care. Zimbabwe’s 27.8% out of pocket expenditure share means medicine shortages and service gaps can transfer costs directly onto patients. The Sugar Content Tax demonstrates one model in which a defined revenue stream is linked to a specific health expenditure. Any broader health financing reform will ultimately be judged by whether it improves recurrent funding at facility level and reduces the amount patients must finance themselves.

The programme Zimbabwe’s government has committed to between 2025 and 2026 represents one of the most substantial recent investments in the country’s public hospital infrastructure.

Zimbabwe’s public hospital system is being rebuilt. Its legacy will be measured in what happens after construction and procurement: whether installed machines treat patients, health posts remain staffed, prescriptions are filled and renovated facilities produce measurable improvements in survival, waiting times and continuity of care.

Equity Axis News