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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. 88
Moving forward in Zimbabwe Reducing poverty and promoting growth Figure 7.1: Crude death rate trends, 1980-2007. Source: GoZ, 2008. Figure 7.1 shows the deterioration in Zimbabwe’s health status. After initial improvements during the 1980’s, from the early 1990s crude death rates rose as the impact of HIV/AIDS mortality and cuts in public health expenditure began to affect health delivery. The crude death rate dropped from 10.8 in 1982 to 6.1 in 1987, then rose to 9.49 in 1992 before nearly doubling to 17.2/1,000 population in 2007. Similarly infant mortality that had declined to 53 per 1,000 live birth had risen to 68 per 1,000 by 2008. Although this is nowhere near the rates reached by other countries emerging from conflict (for example, Sierra Leone had rates of 170 per 1,000 at the end of the war in 1999 while rates in Mozambique had reached 269 per 1,000 by the time the civil war ended in 1991 3 ) it is the reversal of gains that is worrying here. A look at life expectancy at birth reflected in Table 7.4 also shows a dramatic decline from 62 in 1990 to the current 43 years. Most of this decline has been attributed to the HIV/AIDS epidemic and deterioration in health services programming and delivery. Zimbabwe is one of the countries hardest hit by the HIV/ AIDS epidemic. Programming in this area continued mainly due to dedicated funding from a government levy and also donor support. Figure 7.2 shows trends in the adult prevalence and incidence of HIV/AIDS between 1980 and 2007. Table 7.4: Life expectancy at birth, 1984-2006. 1984 1986 1988 1990 1995 2000 2002 2006 Male 60 61 61 58 52.6 44 43 44 Female 61 61 63 65 57.2 46 46 43 Total 60 61 62 62 55 45 45 43 Source: Zimbabwe Inter-Censal Demographic Survey (ZICDS), CSO World Health statistics. Figure 7.2 shows an impressive decline in prevalence rates from 24.5 per cent in 2004 to 15.6 per cent by 2007. The incidence rate is also down to two per cent from a peak well above four per cent in the mid 1990s. Success in tackling HIV/AIDS has been due to a combination of behaviour change, migration and the economic situation. Most significant, however, is the fact that this is one of the few areas where continued long-term programming has been maintained through dedicated funding from the state and considerable donor support. It is partly this sustained and coordinated effort that has delivered the decline. Figure 7.2: Trends in HIV and AIDS prevalence and incidence, 1980-2007. Source: GoZ, 2008. 89
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