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

Moving forward in Zimbabwe
Reducing poverty and promoting growth
Demographic and socio-economic developments
The country’s population grew from 7.6 million in 1982 to 10.4
million in 1992 and 11.3 million in 2002. It is currently estimated to be
around 13.4 million. Although the population grew rapidly between
1982 and 1992, the rate of growth slowed down considerably in
the 1990s and into the new millennium. The slowdown has been
attributed to a combination of factors. High mortality rates from
an AIDS epidemic (adult infection rates were 33 per cent in 2000
but fell to about 11 per cent by 2008 2 ) decimated the population,
while declining fertility rates as a result of a successful reproductive
health campaign helped slow down growth. This was coupled with
unprecedented levels of migration, especially since 2000. Table 7.2
shows the key trends in vital social statistics.
We can also see from Table 7.2 that some of the initial gains
made during the first decade have begun to unravel in the second
decade, especially with regards to life expectancy, which declined
from a high of 61 years in the early 1990s to about 43 years by
2006. This decline has also been reflected in other areas of socioeconomic
development since the late 1990s. From this brief
introduction to Zimbabwe’s health situation, we can say that after
initial progress in socio-economic development during the first
decade of independence, the country has been in decline since
the late 1990s. Repeated droughts, an AIDS epidemic, an unstable
economic policy environment, and a crisis in political governance
continue to influence the setting in which the people make a
living.
Health funding and the crisis
One of the first areas to be hit by the crisis was funding for
public health care provisioning. As the budget deficit grew in the
early 1990s the health budget in real terms also began to shrink.
What information is available suggests that by 2007 the per capita
allocation of health in the budget had declined to less than US$0.19
per year. Table 7.3 indicates the trends in the health budget since
1999.
It is clear that by the year 2007, before the crisis peaked, the
allocation was virtually worthless and people had been left to their
own devices to provide for their health care. With declining budgets,
one of the main casualties became long-term programming,
which was an absolute necessity at the time when the country
was confronting an HIV/AIDS pandemic that had infection rates
running at almost 25 per cent at its peak in the early 2000s. Donor
support ensured that long-term programming continued in the area
of HIV/AIDS, although for the most part national programming
declined in most of the other preventive health care areas. A further
consequence of cuts in budgets was that health infrastructure,
equipment and supplies that had been set up over nearly two
decades began to decline. Similarly, the staffing situation began to
deteriorate as health professionals left for greener pastures in the
region and abroad. Health training that had also reached impressive
levels declined markedly and by November 2008 the main College
of Health Sciences had all but ceased operations. A detailed look
at the effects of this on selected health indicators will clarify the
nature and form of the necessary post-crisis work.
Table 7.2: Main demographic features of Zimbabwe, 1982-2008.
Aspect 1982 1992 2002 2008
Total population 7.6 million 10.4 million 11.6 million 13.4 million
Population growth rate 3.0% 3.1% 1.15% 0.8%
Life expectancy (years)
Male: 56.2
Female: 57.1
Male: 58
Female: 62
Male: 43
Female: 46
Literacy rate 48% 80.38% 88.7%
Crude birth rate 39.5/1000 34.5/1000 33/1000 31.6/1000
Crude death rate 10.8/1000 9.5/1000 18/1000 17.3/1000
Total fertility rate 6.20 5.91 4.1 3.8
Infant mortality 86/1000 66/1000 65/1000 68/1000
AIDS infection rates in adults (15-49yrs) – – 24.6% 15.6%
Source: GoZ, 2000; 2001; UNAIDS, 2008.
Year Health budget, Z$
Table 7.3: Trends in health budget, 1999-2007.
% of total
budget
Budget per
capita, Z$
Reserve Bank
exchange rate
Budget per
capita, US$
1999 3,667,544,000 9 325 38 8.55
2000 6,189,168,000 10.5 543 55 9.87
2001 14,026,298,000 11.5 1,218 55 22.15
2002 22,459,863,000 9.5 1,931 55 35.11
2003 73,427,927,000 12.7 6,250 824 7.59
2004 701,209,680,000 14 59,097 824 71.72
2005 3,006,296,970,000 16.95 250,857 26,000 9.65
2006 8,110,431,506,000 9.33 670,065 100,000 6.70
2007 590,082,761,000 13.48 48,269 250,000 0.19
Source: GoZ, 2008.
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