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It makes sense to tailor-make a medical aid society for the whole agricultural ecosystem making use of rural clinics

Charles Dhewa
Zimbabwe’s summer season is often associated with pests and diseases, not just for crops and livestock but for people as well. Climate change has seen malaria, pneumonia and other ailments increasing in many farming areas like Binga, Gokwe, Guruve, Chipinge and Muzarabani.

While there has been a recent interest by insurance companies to cover crops and livestock against unpredictable weather, those companies have shied away from setting up a medical aid scheme for farmers and other value chain actors. With many smallholder farmers embracing farming as a business, there are untapped business opportunities in the form of a medical aid facility of farmers with predictable income patterns.

A commercial mindset has fully germinated among many farmers who are now getting into horticulture and livestock as all-year round businesses. Like in any other business, it is not enough to provide insurance for the business and commodities without considering the owner’s medical needs. As agribusiness owners, farmers are the custodians and conveyors of knowledge, skills, passion and relationships with the market. Why should crops and livestock be insured without considering the owner who has the expertise and intellectual property that fuel agribusiness growth?

The importance of prioritising the owner ahead of commodities

Ignoring such issues is the main reason why in the event of illness or death of the owner, all risks and pressures associated with agribusiness are exerted on the enterprise. Without medical aid, most farmers who fall sick end up selling crops and livestock at a give-away prices or borrow in order to meet their health challenges yet a medical aid facility would cover such issues and leave the enterprise to continue functioning undisturbed.

A sensible starting point is putting in place a medical aid facility for all farmers and farm workers whose health should be in order if an agricultural enterprise is to remain viable. While you can insure crops or livestock, if something happens to the owner, everything collapses. The owner establishes relationships with the market and when he falls sick or dies, someone else fills his/her gap in the market and his children will have problems rebuilding the market.

Some of the historical facts

In Zimbabwe, medical aid services have traditionally been confined to the formal economy, mainly for formal wage employees. These services were more of a risk mitigation measure by employers than choice by employees. In the case of employees falling sick or dying, companies were caught napping and ended up spending unbudgeted resources to meet challenges related to sickness and death of employees.

To avoid being ambushed by these scenarios, companies set up medical aid facilities to inform their budgetary decisions and resource allocation. For this model to be accepted by employees, it was coined and presented as employment benefit, with part of employees’ salaries going towards medical aid.

While this facility worked for formally employed urban people including civil servants like teachers and nurses in rural areas, most rural people depended on a binding social fabric where death within a community was everyone’s responsibility. Contributions were quick to mobilise and it was also easy to dispose assets like cattle or crops in order to meet costs related to death or illness. The extended family system was also solid. Some of these elements are still available in some rural communities.

Evolution of a new hybrid economy

A few decades ago, we started seeing an adjustment of the country’s socio-economic fabric with the formal economy being transformed into SMEs and the informal economy. The Zimbabwean economy has largely become dominated by SMEs.

This socio-economic transformation has not brought with it medical aid schemes and benefits from the formal economy. For instance, there is no structured medical aid scheme for SMEs. Owners of small enterprises cannot afford medical aid for themselves and their households, let alone their few employees.

That agriculture remains the country’s backbone is beyond question. In the past, smallholder farmers were part of the rural economy with its strong social fabric while commercial agriculture was part of the formal economy where illnesses and deaths of employees were covered by agricultural enterprises such as large scale farming operations.

The advent of the land reform saw a shift from large scale farming to semi-large, medium and small farmers who employ one or two relatives. These small farming businesses cannot afford consistent medical aid contributions. It means, new employees in the agriculture sector have been added to the number of smallholder sector which lacks medical aid.

On the other hand, the rural social fabric has been eroded by the migration of the young generation to urban centres, in pursuit of education opportunities or starting their own SMEs.

This has left rural areas with those aged mid-40s and the old, still participating in smallholder agriculture and non-farming activities like retail trading. However, along the entire agricultural value chain, there has been an increase in the number of young people participating in agro-processing, metal fabrication of agricultural implements and trading of commodities in informal markets.

Since all these activities are not covered by medical aid, it means the major risks are scattered along value chains. The old smallholders cannot cater for their medical needs while the young in SMEs cannot afford it either. For youths who have moved to the diaspora, mechanisms have not been developed for them to provide medical aid to their parents remaining in Zimbabwe. For instance, someone working in SA cannot put his parents on a foreign medical aid scheme.

A big vacuum in terms of enforcement

Just as pension was mandatory, the traditional medical aid model was mandatory so that everyone was covered in the event of unforeseen circumstances. However, in the informal, SME and hybrid economy no one can enforce medical aid. An attractive option is raising awareness of the necessity for such schemes and design appropriate facilities such as an agricultural medical aid society.

The depletion of Government social safety nets has made this initiative more necessary. Government used to provide free health care, especially for rural smallholders. However, such facilities are no longer there due to macro-economic hardships. Where such services continue to exist, related costs are prohibitive for the majority. For instance, patients who are given prescriptions at clinics and hospitals are expected to go and buy drugs and other forms of medication. As a result, rural smallholders have become exposed.

Riding on the democratisation of medical services

On a positive note, medical services are now available at growth points and rural business centres. Previously, farmers who could afford medical aid did not see the need because surgeries and pharmacies were mainly in urban centres.

Since there were no facilities for using medical aid, everyone relied on Government clinics and hospitals. Now, with the proliferation of pharmacies and surgeries in rural business centres, farmers can see the need for medical aid. In the past, they used to wait until they fell very sick from malaria and other diseases before being referred to urban surgeries. Some would visit doctors once a year, usually, after harvesting.

While the temptation is for each organisation to have its own medical aid scheme, in a fluid hybrid economy characterised by diverse interdependencies among value chains, it makes sense to tailor-make a medical aid society for the whole agricultural ecosystem. Benefits of tailor-making an agricultural medical aid scheme include the fact that you get an in-depth understanding of a particular value chain and its risks.

This is critical for planning and investment analysis, demonstrating the impact of wellness interventions on the growth of agriculture and the entire economy. Changing mindsets is not a one-step dance and requires a holistic approach. Most SMEs do not see the importance of health risks until they occur. That is why the Agricultural Medical Aid Society (AGRIMED) and Knowledge Transfer Africa have started collaborating in designing an appropriate medical aid scheme for the agricultural sector.

Harnessing the power of evidence

In order to anchor this far-reaching initiative on solid evidence, both organisations have started conducting a feasibility study in Goromonzi district and selected agricultural markets.

Using a knowledge-intensive methodology, this effort is already generating insights that will facilitate evaluation of the model after it has been rolled out nationally. Land, water, agricultural information, knowledge and inputs are less useful if people are not in good health to fully use exploit them. In addition, serious investors interested in agriculture are keen to know the health status and wellness of farmers, employees and other value chain actors before committing resources.

Existing medical aid societies are still obsessed with providing services to formally employed people yet the cheese has moved. A comprehensive agricultural medical aid scheme is long overdue. This should embrace tobacco farmers, cotton farmers, livestock farmers, horticulture farmers, small grains farmers, irrigation schemes, transporters, agro-dealers, agro-related SMEs like those who produce agricultural implements, caterers, fisheries, agricultural colleges, universities and schools.

• Charles Dhewa is a proactive knowledge management specialist and chief executive officer of Knowledge Transfer Africa (Pvt). He can be contacted on: [email protected] Mobile: +263 774 430 309 / 772 137 717/ 712 737 430.