Health in Zimbabwe

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 organizations (NGOs). In recent years, economic decline and political instability have led to a reduction in health-care budgets, affecting provision at all levels. In the past five years, the country’s poorest have suffered the most, with a 40 per cent drop in health- care coverage (1).  Chronic malnutrition limits the life prospects of more than one third of the country’s children (2).  Zimbabweans continue to experience a heavy burden of disease dominated by preventable diseases such as HIV infection and AIDS, malaria, tuberculosis and other vaccine-preventable diseases, diarrhoeal diseases and health issues affecting pregnant women and neonates. Every year, one in every 11 children in Zimbabwe dies before his or her fifth birthday. In other words, 35,500 Zimbabwean children under the age of five die every year (3).

The challenges

The country’s health sector faces numerous challenges: a shortage of skilled professionals and health-care staff; an eroded infrastructure with ill-equipped hospitals, many lacking functional laundry machines, kitchen equipment and boilers; and a lack of essential medicines and commodities. The system breakdown has been exacerbated by humanitarian crises such as the cholera and measles epidemics between 2008 and 2010, by poor maternal and child health services and by consistently falling but nevertheless still-high numbers of people living with HIV.
One of the leading causes of mortality of children aged under five in Zimbabwe, HIV and AIDS account for more than 20 per cent of the deaths in this age group (4).  In 2009 it was estimated that more than 1 million children in Zimbabwe had been orphaned by AIDS and 1.2 million people were living with HIV (5).  An updated estimate suggests that 100 000 of this number are children (6).
Tuberculosis remains a leading cause of morbidity and mortality with a prevalence in 2009 of 431 per 100,000 population (7).

Access to health care

The deterioration in Zimbabwe’s health-care services coincided with a fall in demand for services, following the introduction of user fees. These fees, which are often applied in an ad hoc way and so vary from provider to provider (8), act as a barrier to basic health services for many of the most vulnerable people in Zimbabwe. Government policy is to provide free-of-charge health services for pregnant and lactating mothers, children under five and those aged 60 years and over, but the policy has proved to be difficult to implement. Currently, in the absence of substantial government financial support, user fees provide the main income for many health care facilities, enabling them to provide at least the minimum service.
Giving birth in a government or municipal facility costs between US$3 and US$50 (9).  These costs are often prohibitive, leaving some women to give birth outside the health system. It is estimated that more than 39 per cent of women are delivering at home (10).
In his 2012 National Budget, presented to Parliament on 24 November 2011, the Minister of Finance, Tendai Biti, proposed an allocation of US$10 million to help eliminate user fees for maternal and child health-care services. He reported to Parliament that the maternal mortality ratio was 790 per 100 000 live births, compared with 390 in the 1990s. The under-five mortality rate was 94 per 1 000 live births, up from 78 in 1990. These statistics reveal that on average, pregnancy-related complications lead to the deaths of eight women per day and about 100 children die every day from common and preventable diseases.
The Zimbabwe Government, UNICEF and international donors have formulated a five-year plan titled the Health Transition Fund to reduce high maternal and child mortality rates. Abolishing health-care user fees is one of the plan’s key goals.

Investing in health

Following the formation of the Government of National Unity in February 2009, the government developed The National Health Strategy for Zimbabwe (11).  A health-sector recovery plan, it sought to reverse the decline in the performance of the country’s health delivery system, especially as it impacted on universal access to primary health care by vulnerable populations.
The goals of the plan included tackling levels of health financing and thus improving access to basic medical equipment and essential medicines; taking steps to attract and retain health workers in the public health sector; and laying the foundations for an investment policy to fund the rehabilitation and development of the health-services infrastructure.
In the 2012 Budget, some progress towards these goals was reported. Recognising that further investment was required, the government allocated US$63.4 million for infrastructure rehabilitation, equipment, the purchase of ambulances and service vehicles. In line with the National Health Strategy, it was stated that primary health-care needs would be prioritised. The support of the Government’s partners in the Health Transition Fund was also acknowledged. The fund, for its next phase from 2011 to 2015, has received pledges of US$435 million to reduce high maternal and child mortality rates, to strengthen health systems and abolish health-care user fees.

Strategy for recovery

In the period since the formation of the Government of National Unity in 2009 and the Ministry of Health and Child Welfare’s National Health Strategy, the Ministry has instituted further policy developments, targeted financing and introduced programmes to address inequity in the health-care system. During the decade 2000 – 2010, state investment in health varied from 4.2% of the state budget in 2001 to 8.5% in 2009 and 2010.
However, as acknowledged to Parliament in the 2012 Budget address, budget performance below the 15 per cent threshold stipulated by the Abuja Declaration of 2000 (which says the health budget must be 15 per cent of total expenditure) compromises the speed at which the country can attain its Millennium Development Goals (MDGs) targets. A march in Mutare to mark World Aids Day on 1 December 2011, attended by advocacy groups, church and youth organizations as well as members of the Zimbabwe National Army and Zimbabwe Republic Police, highlighted the need for at least 15 per cent of the national budget to be spent on the health sector.
MDGs 4 and 5, on child survival and maternal survival respectively, are among the goals that Zimbabwe has made least progress towards achieving, as Zimbabwe’s Deputy Prime Minister, Thokozani Khupe, points out in her foreword to a Situational Analysis on the Status of Women’s and Children’s Rights in Zimbabwe, 2005 – 2010: A call for Reducing Disparities and Improving Equity (12).  “As the world turns to 2015 when all countries will be evaluated against their progress on the Millennium Development Goals, it is increasingly clear that women and children are central to the achievement of the majority of these goals,” she writes. Describing women and children of Zimbabwe as the “most pressing development priority of our times”, she adds: “… it is increasingly clear that the success of the Inclusive Government will be measured, not just by improvement in the political and economic situation, but by how successful we have been in helping women and children, especially the poorest and most vulnerable …”

1 http://www.unicef.org/infobycountry/zimbabwe_56573.html (viewed 15/03/12, see paragraph headed Closing the gaps)
2 A Situational Analysis on the Status of Women’s and Children’s Rights in Zimbabwe, 2005 – 2010 (page ix) see http://www.unicef.org/zimbabwe/SitAn_2010-FINAL_FINAL_01-02-2011.pdf (viewed 15/03/12)
3 National Child Survival Strategy for Zimbabwe 2010 – 2015, (page 12) see http://www.unicef.org/zimbabwe/Young_Child_Survival_Doc-Complete.pdf (viewed 15/03/12)
4 National Child Survival Strategy for Zimbabwe 2010 – 2015 (page 12)
5 http://www.unicef.org/infobycountry/zimbabwe_statistics.html (viewed 15/03/12)
6 National Child Survival Strategy for Zimbabwe 2010 – 2015 (page 9)
7  http://www.who.int/gho/countries/zwe.pdf (viewed 15/03/12)
8 Health Transition Fund, A Multi-donor Pooled Transition Fund for Health in Zimbabwe, December 2011, see Chapter 2, page 14
9 http://www.unicef.org/infobycountry/zimbabwe_60380.html and http://www.unicef.org/esaro/5440_investment_in_health.html (viewed 16/03/12)
10  http://www.unicef.org/zimbabwe/education.html (see final paragraph)
11 http://www.unfpa.org/sowmy/resources/docs/library/R174_MOHZimbabwe_NatHealthStrategy2009-2013-FINAL.pdf
12 A Situational Analysis on the Status of Women’s and Children’s Rights in Zimbabwe, 2005 – 2010 (page vii) see http://www.unicef.org/zimbabwe/SitAn_2010-FINAL_FINAL_01-02-2011.pdf (viewed 15/03/12)