Action Plan To Rebuild The Health-care System In Zimbabwe

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Main Category: Public Health
Article Date: 13 Oct 2009 - 0:00 PDT

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A viewpoint published Online First and a future edition of The Lancet reports the priorities that Zimbabwe must address to improve the current dire state of its health indicators. Once proud for its achievements in health, this country has been undermined over the past twenty years by increasing poverty, deplorable governance, poor economic policies, widespread HIV/AIDS, and a weakened health system. The article is the work of a group of doctors with expert knowledge of Zimbabwe, led by Dr Charles Todd, former chairman, University of Zimbabwe School of Medicine, and Westongrove Partnership, Wendover Health Centre, Aylesbury, UK, and colleagues.

The Government of National Unity (GNU) was established in Zimbabwe on February 13, 2009. It has instigated at 100-day recovery plan. The country's health sector gradually began operating again, with doctors and nurses returning to posts. Health centres are once again operational. Over the past three decades, the decline in health indicators has been enormous:

• Between 1990 and 2006, life expectancy at birth dropped from 62 to 43 years, mostly from increased young adult mortality from HIV-related conditions.

• Mortality rates of children younger than five years and infants rose from 77 and 53 per 1,000 livebirths in 1992 to 82 and 60 in 2003, respectively.

• Maternal mortality rose from 168 per 100,000 births in 1990 to 725 per 100,000 in 2007.

• Tuberculosis incidence increased from 136 per 100,000 in 1990 to 557 per 100,000 in 2006.

These indicators are correlated to the high prevalence of HIV/ AIDS, which was estimated at 26 percent in 2000 in adults aged 15 to 45 years but declined to 15.3 percent by 2007. In 1994, 80.1 percent of children aged 12 to 23 months had received all basic vaccines compared with 74.8 percent in 1999 and only 52.6 percent in 2006-07.

By early 2009, hospitals in the country were barely operating. There were massive shortages of indispensable medicines and supplies. Although most hospitals are now functioning again, shortages are still ordinary and patients usually need to buy medicines, intravenous fluids, and other supplies.

The authors consider the priority must now be directed to the re-establishment of essential services such as effective emergency obstetric care in all districts. This challenge will imply an adjustment in focus in the work of central and provincial hospitals. In addition, in order to restore Zimbabwe's health service and health training institutions, they suggest the following priorities:

• The Ministry of Health, in conjunction with leading civil society groups, UN agencies, and donors, should assess implementation of the 100-day action plan. They should elaborate a budgeted, medium-term health-care recovery plan including priority actions to tackle Zimbabwe's major health issues.

• The Health Services Fund should be re-activated. They were originally established in the 1990s to retain user fees at local level and later used for increased donor support to district health services. This would grant directly accessible funds for district health teams to maintain effective health services.

• The training of specialist mid-level workers, such as clinical officers and nurse anaesthetists should be quickly restored and expanded. Malawi and Mozambique show the way on this matter, where such workers perform key frontline health functions. The existing health workforce cannot meet Zimbabwe's needs so any resistance to specialist mid-level workers from professional associations must be overcome.

• The return of health professionals to Zimbabwe should be encouraged. This should be accomplished without causing disadvantage to those who have remained.

• The Ministry of Health should continue to promote an inclusive and cooperative philosophy. There should be further support for voluntary organisations and missions. Civil society organisations involved in health should be formally recognised. Their advocacy of human rights and monitoring of donor funds should be encouraged.

• The political sector will deal with the deep-rooted culture of violence. Impunity should be nurtured and translated into legislation, including the establishment of a Healing and Reconciliation Commission. Furthermore, human rights' organisations should be permitted to run programmes for community-based mental health care of survivors of organised violence.

The authors write in conclusion: "Success in the 1980s was built on widespread community mobilisation accompanying a protracted struggle for human rights. Since then, Zimbabweans have been systematically deprived of these rights, including the right to health. A new opportunity now exists to rebuild the health-care system; its success will be contingent on firmly re-establishing the principles of social justice, equity, and public participation."

"What is the way forward for health in Zimbabwe?"
Charles Todd, Sunanda Ray, Farai Madzimbamuto, David Sanders
DOI: 10.1016/S0140-6736(09)61498-7
The Lancet

Written by Stephanie Brunner (B.A.)
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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