Zimbabwe: Zim Struggles to Contain Primitive Diseases

THE year 2012 has come and nearly gone. And 34 years after the Alma-Ata declaration on health, Zimbabwe is still struggling to contain primitive diseases such as cholera and typhoid.

The Alma-Ata Declaration of 1978 emerged as a major milestone of the 20th century in the field of public health, and it identified primary healthcare as the key to the attainment of the goal of health for all.

However, besides being a signatory to the health declaration and contrary to the hope that was raised by the formation of the current inclusive government in 2009, Zimbabwe has again dismally failed to contain the maternal mortality rate which has remained very high at 790 per 100 000 live births, compared to 390 in the 1990s, which means eight women die every day while giving birth.

In addition, 100 children between 0 and five years die every day, mainly due to preventable diseases, and around one-third of them are stunted. The health sector has remained arrested in a time machine where donor-funded drugs are available but service delivery continues to decline due to understaffing and poor remuneration.

Only a decade ago, Zimbabwe's public health system was ranked among the best in sub-Saharan Africa. But just like the rest of Zimbabwe's economic and social fabric, the health delivery system has frighteningly deteriorated.

The health sector received a major boost in February this year when the United Kingdom announced a contribution of £74 million (around US$120 million) to support maternal and child health.

Around US$80 million is earmarked for supporting the Health Transition Fund (HTF), an innovative multi-donor fund launched in November 2011 and managed by Unicef.

Following the formation of the coalition government, the National Health Strategy for Zimbabwe was adopted. This was a five-year health sector recovery plan, which sought to reverse the decline in the performance of the country's health delivery system, especially as it impacted on universal access to primary healthcare 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 foundation for an investment policy to fund the rehabilitation and development of the health services infrastructure.

Zimbabwe has enjoyed the temporary delirium in which changes within the health sector were notable as drugs were donated by the international community and hospitals revived their day-to-day activities.

However, a shortage of nurses and doctors is throwing the one-time beacon of health in Africa into the doldrums again.

According to a report presented by the Portfolio Committee on Health and Child Welfare chaired by former Health minister and Zanu PF Murehwa North legislator, David Parirenyatwa, there is a decline in service delivery especially on child health.

The report also states that as a result of the dire situation in the health sector, Zimbabweans continue to suffer from a high burden of diseases and conditions, most of which are preventable and treatable.

"Child health status indicators are worsening with infant mortality and under-five mortality rising from 53% to 77 per 1 000 live births in 1994 to 67 and 94 per 1 000 live births respectively in 2009," the parliamentary report said.

A local analyst, Alexander Rusero said despite the political bickering in the inclusive government, the health sector is improving.

"While there is too much politics in the country, the health sector is showing signs of revival as compared to the past two decades," Rusero said.

"From 2005 to 2009, taking your son or wife to a local hospital was like giving them a death sentence because you knew they might not return alive," he said.

Rusero said the only stumbling block is on the staffing side which has resulted in all state-run hospitals being seriously understaffed and under-remunerated.

Community Working Group on Health executive director Itai Rusike concurs but adds there is still a long way to go in terms of recruitments.

"The health sector is reviving from a decade of decline but we are very slow in terms of meeting the Abuja target in which African countries agreed to commit 15% of their total budget towards health," Rusike said.

"There is need to revamp the infrastructure in all major hospitals and aim to reduce maternal mortality so as to achieve our millennium development goals," he said.

Rusike also said government and all stakeholders need to focus on improving the accessibility of ARVs which are only accessible to 40% of HIV-positive patients as the rest continue to suffer without proper medication.

He also said the shortage of doctors in Zimbabwe has reached crisis levels with the country having only 21% of the required medical practitioners.

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