Inequality in Public Health Spending and Access to Healthcare Services in Zimbabwe: A Cross-Sectional Study.

Background and Aims: Access to healthcare services is a public health challenge worldwide. Although governments continue to channelscarce resources to enhance service provision, the World Health Organization estimates that about half the world's population lacks essential access. This global context underscores persistent gaps even where investments are made. Public health spending often fails to achieve its aim of helping poor and vulnerable people, creating a critical disconnect between resource allocation and actual service reach. This study examines inequality in public health spending and access to healthcare services in Zimbabwe. Methods: The study achieves the objective using 2017 government health expenditure from the Ministry of Health and Child Care and data from the 2017 Prices, Income, Consumption, and Expenditure Survey. To ensure consistency between spending patterns and household experiences, the empirical model is based on the concentration index and re-centered influence functions. The study estimates inequality in public health spending using the standard concentration index, while Erreygers concentration index measures the inequality in access to healthcare services. Oaxaca-Blinder-RIF decomposition is also used to decompose the differences in the concentration index between urban and rural populations. Results: The results show that, on average, public health spending in Zimbabwe is pro-poor for public clinics and pro-rich for public hospitals. This divergence reflects how different tiers of the health system serve different socioeconomic groups. Despite benefits from government health spending, inequality in the availability and affordability remains a problem, with the affluent continuing to benefit from well-resourced facilities. Affordability and availability of healthcare services are pro-rich, much greater in urban than in rural areas. Moreover, the decomposition analysis highlighted that inequality in the affordability and availability between urban and rural populations is largely not explained by the traditional variables, suggesting the influence of deeper systemic and institutional factors. Conclusion: Zimbabwe needs to aim for universal health coverage, with good quality, affordable care for all, regardless of geographical location or socioeconomic status. Achieving this requires not only sustaining but strategically strengthening current efforts. There is room to improve and augment efforts to achieve universal health coverage without leaving anyone behind. Broader health financing mechanisms and infrastructure investments should be explored to bridge the gap in access to services. Policymakers should, therefore, improve resource allocations in the health sector to achieve equality in government spending and access to healthcare services, ensuring that investment translate into equitable health outcomes for all.