A New Era of Self-Reliance in Healthcare: Implications for Workforce Productivity, NDS2, and Vision 2030
Published: 25 February 2026
By Tete Getty, Founder, Tete Getty House & TGRI
Zimbabwe has taken two bold, interconnected steps, a twin decision in healthcare policy that signal a clear strategic shift toward greater sovereignty and long-term self-reliance.
First, the country became one of the first in Africa to roll out lenacapavir, a groundbreaking twice-yearly injectable HIV prevention drug (PrEP). Second, the government declined a proposed US$350–367 million US health funding package, citing sovereignty concerns and terms viewed as “lopsided.” These decisions, taken together, mark a deliberate move away from heavy dependence on external aid toward domestic ownership of health outcomes—with profound economic implications for the future workforce, productivity, and the successful execution of National Development Strategy 2 (NDS2, 2026–2030).
Understanding Lenacapavir: A Simple Explanation for Everyone
Lenacapavir is a long-acting injectable medicine administered just twice a year (every six months) that prevents HIV infection in high-risk individuals. It works by blocking the virus from multiplying inside the body before it can establish infection. Clinical trials (PURPOSE 1 and 2 studies) showed it is over 99% effective when taken on schedule — far higher adherence than daily oral PrEP pills, which many people forget or stop using. In Zimbabwe, it is being rolled out at multiple sites nationwide, prioritising high-risk groups: adolescent girls and young women (15–24 years), sex workers, serodiscordant couples. The programme is funded by the Global Fund and remaining PEPFAR resources, but is fully administered through Zimbabwe’s public health system under the leadership of the Ministry of Health and Child Care (Hon. Dr. Douglas Mombeshora) and the National AIDS Council (NAC), led by Executive Director Dr. Tafadzwa Mhonde.
Historical Context: From the 1990s Crisis to Today’s Strategic Choices
Who will forget the 1990s HIV/AIDS crisis devastated Zimbabwe. There was a catastrophic time in our recent history every week there was a funeral in many families, many communities, young working adults plucked out of existence by HIV/AIDS. Adult prevalence peaked above 26%, and life expectancy fell to as low as 37 years. Entire productive generations were lost, leaving behind orphaned children, depleted farms, shuttered businesses, and a severely weakened tax base. The crisis received global attention when Princess Diana visited Zimbabwe in July 1993. During her three-day trip, she toured hospitals, met patients, and publicly embraced people living with HIV/AIDS — actions that helped destigmatise the disease at a time when fear and silence dominated. President Robert Mugabe publicly acknowledged the epidemic’s severity and thanked Princess Diana for shining a global spotlight on Zimbabwe’s struggle. Her visit, and the aid and awareness it generated, contributed to early momentum for international support. Yet the scale was immense: over 1 million Zimbabweans were living with HIV by the late 1990s, and the economy lost billions in productivity.
The Zimbabwe National HIV/AIDS Strategic Plan 2021–2025 and the National AIDS Council’s World AIDS Day 2025 campaign (“Overcoming Disruptions and Transforming the AIDS Response”) marked a turning point. These frameworks emphasised domestic ownership, integration with national development plans, and resilience against external shocks — lessons that directly inform the current decisions.
Comparative African Context: Signed, Declined, and Pending Healthcare Packages
Zimbabwe’s approach is part of a broader continental trend toward more selective engagement with large aid packages:
Countries that signed — Kenya, Uganda, Tanzania, Nigeria, Ethiopia, and South Africa have accepted major PEPFAR/Global Fund packages in recent years, often with parallel structures and heavy reporting requirements. While these have delivered treatment scale-up, critics (including Dambisa Moyo in Dead Aid) argue they have sometimes created dependency and diverted domestic resources.
Countries that declined or renegotiated — Rwanda has consistently pushed for greater local ownership and has declined packages with overly prescriptive conditions. Uganda has renegotiated terms amid policy disagreements. Zimbabwe’s polite but firm decline fits this emerging pattern of African nations asserting sovereignty while remaining open to partnership.
Countries yet to respond — Botswana, Namibia, and Zambia are currently reviewing similar packages, with analysts watching whether they will follow Zimbabwe’s lead in demanding terms that align with national priorities.
This trend reflects a maturing African stance: accept support that respects sovereignty and complements domestic plans, but decline arrangements that risk long-term dependency.
Economic Analysis: Workforce, Productivity, and Fiscal Implications
Positive Impact of Lenacapavir Rollout
● Preventing new infections among young people (especially adolescent girls and young women) preserves the most productive segment of the future workforce. Every HIV infection averted saves an estimated US$10,000–15,000 in lifetime treatment costs (UNAIDS modelling) and preserves decades of economic contribution.
● High adherence (twice-yearly injection) is expected to reduce new infections by 30–50% in targeted high-risk groups within 3–5 years, based on trial data and early African rollout projections.
● Healthier workforce → higher labour participation, increased household consumption, and stronger tax base. This directly supports NDS2’s human-capital pillar and Vision 2030’s goal of an empowered, upper-middle-income society.
Economic Case for Declining the US Package
● The proposed US$350–367 million package carried significant strings: heavy reporting requirements, parallel structures, and policy conditionalities that would have diverted Ministry of Health resources away from NDS2 priorities.
● Accepting it risked creating parallel systems, increasing administrative costs, and reducing policy space. Zimbabwe’s experience with donor-driven programmes in the 2000s–2010s showed that such arrangements often lead to aid dependency rather than sustainable capacity building.
● By declining, the government frees itself to allocate domestic resources and seek more flexible partnerships (e.g., with BRICS nations, the Global Fund on its own terms, and private sector). This aligns with NDS2’s emphasis on ownership, predictability, and reduced transaction costs.
Net Economic Benefit
Short-term fiscal savings from avoiding parallel structures and long-term gains from a healthier, more productive population outweigh the immediate loss of funding. A healthier cohort of young people entering the workforce in 2030–2040 will contribute far more in taxes, innovation, and consumption than any single aid package.
Tete Getty Perspective: A New Dawn – From Lost Generations to Sovereign Health Security
At the Tete Getty Research Institute (TGRI), we see these twin decisions as a defining moment in Zimbabwe’s journey from the dark days of the 1990s and early 2000s — when HIV stole entire generations and life expectancy fell to just 37 years — to a new era of self-determined health security.
From Princess Diana’s invitation to Zimbabwe in 1993, a visit that put a global spotlight on Zimbabwe’s struggle, and President Mugabe’s public acknowledgment at the time helped galvanise early international aid. Yet the scale was immense: over 1 million Zimbabweans living with HIV by the late 1990s, and billions in lost productivity.
Today, by pioneering the rollout of twice-yearly lenacapavir while politely declining a funding package that did not fully respect our sovereignty, Zimbabwe is writing a different story. This is not rejection of partnership — it is assertion of ownership. When external aid comes with disruptive conditions, the rational choice is to focus on one clear pathway, as the Shona proverb teaches: “Kubata mhembwe mbiri panguva imwe chete, unodzishaisa” — if you try to catch two duikers (small antelopes) at the same time, you will lose them both. Lenacapavir protects the next generation of workers. Declining conditional funding protects our policy space. Together, they strengthen the social contract and reinforce the principle that nyika inovakwa nevene vayo — the nation is built by its people.
Africa is transforming and decolonising aid packages where it can and should be supported and celebrated for self-reliance instead of “Dead Aid” (Dambisa Moyo). Zimbabwe’s mature, forward-looking response shows the continent’s growing confidence in charting its own course. For the United States, this decline is ultimately a win-win: it reduces long-term aid dependency, aligns with DOGE efficiency goals and America First priorities by freeing resources for domestic needs, and encourages more effective, sovereign-led partnerships in the future. The West would do well to rethink aid packages — moving from conditional, donor-driven models to flexible, respect-based collaboration that truly supports African ownership.
The economic future looks brighter when our young people — especially our young women — can grow up HIV-free, educated, and economically active. This is how we move from survival to prosperity, from dependency to long-term self-reliance in health security.
Tete Getty, Founder, Tete Getty House & TGRI | February 2026
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