A Systematic Review of Social Determinants of Health in Harare, Dissecting the Affordability Dichotomy Between Private and Public Healthcare

Introduction: Healthcare affordability in Harare is shaped by social and economic conditions, including income, employment, insurance status, medicine availability and household insecurity. Public care may offer lower entry costs than private care, but shortages, facility-level price variation and payment mechanisms can generate additional expenditure. Methods: The researcher-selected databases and information sources were Google Scholar, PubMed (MEDLINE) and ERIC. The eligibility protocol restricted publication years to 2020–2026. The exact calendar date of search execution was not recorded in the verified identification provenance; this is distinct from the publication-year eligibility range. Google Scholar, PubMed (MEDLINE) and ERIC were searched using a prespecified Boolean strategy for English-language studies published from 2020 to 2026. Results: The direct Harare evidence was concentrated in qualitative diabetes-care research. Public referral care was described as cheaper and more accessible to low-income and generally uninsured households, but local consultation fees, medicine shortages, transport and searching costs, cash co-payments, exchange-rate disadvantages and possible improper charging weakened effective affordability. Household economic insecurity constrained continuity of chronic disease treatment. Information about medicine sources was enabling, while digital infrastructure and network limitations constrained telehealth. Remittances were associated with greater use of private facilities in wider urban Zimbabwe evidence. Discussion/Conclusion: Affordability in Harare is relative and pathway-dependent rather than determined solely by sector. Public care can reduce initial financial barriers, yet system shortages and payment failures shift costs to households. Confidence is moderated by concentrated disease-specific evidence, thin direct comparison of private and public care, contextual transferability limits and incomplete.