Moving forward in Zimbabwe - Brooks World Poverty Institute - The ...

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Moving forward in Zimbabwe Reducing poverty and promoting growth 86
Moving forward in Zimbabwe Reducing poverty and promoting growth Moving forward in Zimbabwe Reducing poverty and promoting growth CHAPTER 7: Health 7.1 Rebuilding health services and infrastructure after the crisis When you go to the clinic, you are told there are no drugs, so they refer you to the hospital. At the hospital they will tell you there are no drugs there and the X–Ray machine is not working, so they will refer you to Murewa hospital. When you get there, if you are lucky you will get X-rayed, but the chances are that they will have to refer you to either Chitungwiza or Parirenyatwa hospital. All these journeys need money and you are not even guaranteed that you will get what you are looking for. So the referral system is getting longer and more expensive and still, I won’t see a doctor and I will not get the drugs (Makuto and James, 2007). After Independence, Zimbabwe inherited a public health service system that was geared to provide mostly for a few. Rural areas were severely underserved and what health provisioning existed was done by churches and Christian missionary groups (Agere, 1986). The state embarked on an ambitious programme to provide health for all. Using the slogan ‘Health for All by the Year 2000’, the strategy revolved around both preventive and curative health care provisioning. It also set into motion an infrastructural development programme linked to these strategies. This massive health infrastructure programme was linked to service delivery targets of a health facility within walking distance (eight kilometres) for every person, including rural areas. By the late 1990s up to 85 per cent of Zimbabweans lived within 10 kilometres of a health facility. Table 7.1 shows the infrastructure situation as of 2006. The state also embarked on an impressive health professional training programme and until the 1990s committed as much as seven per cent of GDP to support the strategy before ESAPinduced cuts in public expenditure began to affect investment in health. Since the crisis began there has been a rapid deterioration in health provisioning that culminated in one of the worst public health disasters the country has known. By May 2009 an outbreak of cholera had infected 98,424 people and claimed the lives of 4,276 of these. 1 This outbreak became a global cliché of the effect of the protracted crisis on the health system. In the next section we look at the effects of the crisis on the country’s health delivery system. Table 7.1: Public health facilities I as of 30 April 2006. Provinces Primary level 1 st Referral level 2 nd Referral level 3 rd Referral level Total Harare 45 0 0 7 52 Manicaland 253 36 1 0 290 Mashonaland Central 130 13 1 0 144 Mashonaland East 168 22 1 0 191 Mashonaland West 128 22 1 0 151 Matebeleland North 92 17 0 0 109 Matebeleland South 105 18 1 0 124 Midlands 106 28 1 0 235 Masvingo 170 23 1 0 194 Bulawayo 34 0 0 7 41 Total 1,231 179 7 14 1,431 Source: GoZ, 2008. Key Primary level = Clinics and rural health centres; 1 st Referral level = District, mission and rural hospital; 2 nd Referral level = Provincial hospital; 3 rd Referral level = Central hospital and infectious diseases hospital. 87
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