-From Breadbasket to Beggar — The Paradox of Zimbabwe’s Resource Wealth and Healthcare Crisis

By Dorrothy Moyo | ZimEye | Seventy years ago, Zimbabwe—then Southern Rhodesia—was wealthy enough to send financial aid to the United Kingdom, its colonial master, during Britain’s post-war recovery. Boasting a diversified economy, fertile lands, and rich mineral deposits, the country was once the industrial and agricultural hub of the region. Today, that same Zimbabwe is struggling to afford essential medicines for its citizens, including third-line antiretroviral drugs (ARVs) needed to manage HIV.

This contradiction between staggering natural wealth and chronic healthcare shortages exposes the tragic irony of Zimbabwe’s modern crisis. The country is home to vast reserves of platinum, gold, lithium, and rare earth minerals—key ingredients in both industrial manufacturing and pharmaceutical production. It also possesses the agricultural base and scientific potential to produce medicines domestically. Yet, decades of misgovernance, corruption, and economic mismanagement have reduced it to a state where it cannot even provide life-saving treatment to just over 600 people without financial strain.

Zimbabwe’s leaders frequently tout the nation’s mineral wealth and its role in the global energy transition, but that wealth has failed to translate into functional public health infrastructure. Instead of being a producer of medicines, Zimbabwe is a dependent importer—vulnerable to fluctuating global prices, donor fatigue, and logistical hurdles.

How can a country that boasts some of the world’s richest platinum and lithium reserves be unable to guarantee consistent access to ARVs for its citizens? How does a nation rich enough to give aid in 1950 now plead for drug access in 2025? The answers lie not in scarcity, but in political choices. And unless those choices change, Zimbabwe will continue to mine wealth for others while its people die waiting for medicine.I’m

Zimbabwe is facing a significant financial strain as it is allocating thousands of US dollars monthly to secure third-line Antiretrovirals (ARVs) for 603 individuals.
This escalating expenditure is occurring against a backdrop of dwindling global donor support, placing immense pressure on the nation’s healthcare resources.

The exorbitant cost of drug resistance tests, required to determine suitable third-line treatment, further exacerbates the financial strain.

While first-line treatment remains relatively affordable, rigorous adherence is crucial to mitigate the catastrophic expenses associated with advanced regimens, which divert funds from other vital treatment programmes.

Dr Owen Mugurungi, Director of Aids and Tuberculosis (TB) Unit in the Ministry of Health and Child Care, underscored the substantial financial burden of third-line treatment.

“The challenge with third-line treatment is that it is expensive to manage. First-line costs US$6 to US$8 per month, while the third line goes into hundreds of US dollars and even thousands per month per person.

“It means you have to go by resistance; if you are now resistant to the drugs that we use on you in the first and second line and that drug is not registered here in Zimbabwe or it is not available here, it means we have to source it for you.

“Considering the three-in-one combination (TLD) that we use for first-line treatment is US$8, treatment for the third line is US$86-US$90 per month, which is 10 times higher and that’s expensive. So, we try as much as possible to limit or reduce the chances of people getting to the second line and third line of treatment,” said Dr Mugurungi.

Dr Mugurungi said that while it is easy to determine the cost of treatment for those in the first and second line of therapy, it is not the same for the third line.

“We have a standard cost for ARVs because it is a three-in-one combination for the first line, but for the third line, they are separate treatments. The biggest cost is with the drug resistance testing; it entails that we test, which drugs you are resistant to and, which drugs your infection is sensitive to and so on. So, it is not standard and it is very expensive to do these processes that can spill into thousands.”

Dr Mugurungi said the 603 patients on third-line medication is too large a number, considering the associated costs of their treatment, and noted that the availability of the drugs is also a challenge and is not always guaranteed.

“It is important to note that the less a drug is used, the less it is also produced, making it extremely expensive to buy. If we had one million people on a particular drug, manufacturers also lower costs as there is a huge demand, but producing special drugs for a very small population also increases the costs significantly, and that is why third-line drugs are very expensive to buy. Their availability is also not guaranteed, always looking at small numbers required,” he said.

Dr Mugurungi revealed that people are developing resistance to first and second lines of treatment due to myths and misconceptions.

“One of the most obvious reasons is knowledge and behaviours. We have had people who have been told it is not HIV they are suffering from but something else to do with spiritual and traditional things. They are told to stop taking their ARVs. That misinformation is dangerous, and we know that the media can assist in addressing some of those myths and misconceptions, which will make it difficult for people to continue taking their medication,” he said.

Dr Mugurungi further revealed how resistance to ARVs comes about.

“If you have a headache or malaria, which you are supposed to get treated for, get treated. However, in a few days, some people stop taking medication because they have side effects or they forget or they have challenges in getting medication.

“For people with diabetes, hypertension and others, there are days that one can forget and you can be forgiven because once you take your medication for diabetes your sugar levels go normal. But for HIV, when you forget or are unable to get your medication or the medication gets lost, the virus changes its morphology. At the end of the day, the virus becomes resistant to the medication that you are taking,” he