Health In Zimbabwe

Getting the Zimbabwe health care system moving again: health action plan for the first 100 days. March --June 2009.
Source: The Ministry of Health and Child Welfare, Zimbabwe, 9th March 2009

In Zimbabwe, the public health system is the largest provider of health-care services, complemented by Mission hospitals and health care delivered by non-governmental organisations (NGOs). However, years of economic decline, political instability and a reduction in development aid have resulted in a significant decrease in funding for social services. The country's health sector is operating in an environment characterized by humanitarian crises which have been exacerbated by the worst cholera epidemic the country has ever experienced.

Following the recent formation of the Government of National Unity the government has developed a health-sector recovery plan (the first 100-Day Action Plan starting 10th March 2009) that will contribute to the restoration of basic health services to a functional state. The plan seeks to set in motion a reversal of the decline in the performance of the country's health delivery system.

Central to the recovery plan is the need to protect vulnerable populations through the development and implementation of social mechanisms that will consolidate the policy on universal access to primary health care by vulnerable populations. The goals of the plan are to:

• Tackle the levels of health financing by both the government and its development partners with the view to improving the availability of basic medical equipment and access to essential medicines.
• Improve the remuneration and conditions of services to attract, motivate and retain health workers in the public health sector.
• Provide, in the medium to long term, the ground work for an investment policy for the rehabilitation and construction of health-services infrastructure and the restoration of utilities such as electricity, reliable water reticulation and improved communications at all levels of the health delivery system.

Health status of the population

Zimbabweans continue to experience a heavy burden of disease dominated by preventable diseases such as HIV infection and AIDS, malaria, tuberculosis, diarrheal diseases, nutritional deficiencies, vaccine preventable diseases and health issues affecting pregnant women and neonates. It is estimated, for example, that of the 500,000 people in need of antiretroviral drugs for AIDS, only 110,000 have access to them. In other words, 78% of persons living with HIV infection who are in need of antiretroviral treatment are not receiving such treatment. Tuberculosis remains a leading cause of morbidity and mortality with a notification rate of 434 per 100,000 population.

Human resource shortage

Although Zimbabwe has the capacity to train the majority of its health professionals to the highest level of competency both at graduate and post-graduate levels, currently the health training institutions are not producing sufficient health professionals to fill vacant posts, while at the same time the quality of training has deteriorated as a result of scarcity of qualified trainers. According to the World Health Organization, in order to achieve its Millennium Development Goals, Zimbabwe needs at least 250 doctors, nurses and midwives per 100,000 population. In the current situation, this equates to more than doubling the present numbers of health staff.

Health infrastructure

The health-system infrastructure in Zimbabwe is in a state of severe disrepair as a result of underfunding and a lack of maintenance. Hospital equipment such as laundry machines, kitchen equipment and boilers are also non-functional. Thus most institutions are not able to sterilize theatre and maternity equipment, to cook, or to provide clean linen. The hospitals have not even been able to provide hot water for patients.

Plans for recovery

The Ministry of Health and Child Welfare's first 100-Day Action Plan starting 10th March 2009, proposes a number of activities and policy reviews to accelerate and restore access to quality basic health services in Zimbabwe. The salient features are summarized as follows.

• In terms of access to services, the recovery plan proposes the re-examination of the user fees or cost recovery policies, especially given that in the current environment the poor and vulnerable populations have no access to foreign currency that public health institutions charge (the Zimbabwe dollar is currently not in use or in circulation in the country).
• To adopt a human resource health policy that will contribute to the retention of health workers within the country and the public sector. The plan proposes that the government commits to improving the conditions of service for health workers, based on regional salary scales that take into account the country's level of development.
• A rationalization of the services of provincial and central hospitals through combining service delivery within and between service departments as well as within geographical areas until such a time the situation of resource input normalizes. Closure of hospitals is not a policy option.
• In order to strengthen partnerships in the provision of health services by local government institutions, NGOs and Missions, the plan proposes the development of Memoranda of Understanding between these organizations and the Ministry of Health and Child Welfare to deliver an agreed package of services of defined quantity and quality which are appropriately paid for by the Ministry.
• To improve corporate management principles at central and provincial hospitals.
• To adopt a Sector Wide Approach to health development. It is envisaged that in the current environment such a policy will send a strong signal to development partners that the government is committed to the principles of partnerships in health development, transparency and accountability in the utilization of its own resources and those flowing as development assistance.