This study examines the evolution, challenges, and current realities of hospital service delivery in Zimbabwe from independence to the present. It traces how political, economic, and social transitions have shaped the health system—from post-independence expansion under the Primary Health Care approach to decline during structural adjustment, and subsequent crises marked by underfunding, brain drain, and infrastructure decay. Despite severe constraints, hospitals remain central to Zimbabwe’s healthcare framework, demonstrating resilience and innovation amid adversity. Using the Donabedian Model and the World Health Organization’s Health Systems Framework, the paper analyzes systemic issues such as governance, financing, human resources, and policy implementation. It argues that the crisis in hospital service delivery stems not only from resource scarcity but also from institutional inefficiencies and governance deficits. The study concludes that sustainable improvement requires accountable leadership, equitable financing, and people-centered reforms aligned with Universal Health Coverage goals.