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

Moving forward in Zimbabwe
Reducing poverty and promoting growth
Figure 7.3: Growth of public sector employees in health, 1980-2004.
Laboratory services were negatively affected by the
hyperinflationary economic environment prevailing in the country.
Since most laboratory logistics (such as equipment and spares/
accessories) required scarce foreign currency, most remained
unrepaired as maintenance routines were severely curtailed. This
saw a general deterioration of laboratory services, where the tiered
system failed to provide the standard package of laboratory tests
in support of the health delivery system at each level of healthcare.
The result was that patients sought services from the private sector
where costs were unaffordable and beyond the reach of most of the
patients. Tests such as CD4 (to measure the stage and prognosis for
HIV patients), liver function and some related tests for screening
patients before enrolment into the national ART programme
continue to have logistical challenges, in that the reagents required
to perform the tests are not always available. It should be noted that
where there is external support, in districts supported by the Global
Fund and the Expanded Support Programme, some new pieces of
equipment have been procured which are being used when there is
staff to man them, but they also run the risk of quick wear and tear
due to high demand.
Table 7.5: Stock status of VEN items from NatPharm.
2004 2005 2006 2007
Vital 63% 72% 82% 42%
Essential 21% 56% 62% 23%
All drugs 41% 65% 68% 31%
Availability for the first half of 2008, shows a declining trend.
The VEN stock classification system in the Essential Drug List of
Zimbabwe of medicines and surgical sundries was made on the
following criteria:
Vital items – life-saving, non-availability may result in serious
illness or death, optimum availability to be 100 per cent;
Essential items – non-availability may result in pain or discomfort
to the patient, optimum availability to be 80 per cent;
Necessary items – required but of a lower priority than V and N,
optimum availability to be 60 per cent.
One of the major challenges the health delivery system faced
was a severe shortage of medical and surgical items. Table 7.5
shows the stock status at the central pharmaceutical supplies.
Although ART commodities were provided through the
Global Fund, US government, UNDP’s Expanded Support
Programme and some NGOs, these could not meet the needs
of the over 300,000 patients who needed ART. In the end people
relied on private pharmacies if they could afford the high costs
charged. The Centers for Disease Control and Prevention and
USAID continued to support the country on HIV/AIDS issues
and provided support in training, equipment and reagents for the
laboratory services throughout the country.
Human resources
Health delivery service in Zimbabwe is generally labour intensive,
as some of the new technologies available in the more developed
parts of the world are too expensive for a developing economy.
Although the state embarked on a sustained programme of health
and auxiliary staff training, this sector and the education sector
have been those hardest hit by the brain drain. Given the staff
conditions during the crisis it was not surprising that most of
the staff, trained at very substantial costs to the state, simply left
for greener pastures. Officially the Ministry of Health and Child
Welfare declared a vacancy rate of 29 per cent, but this average
hides the fact that the situation on the ground was always much
worse. Part of the problem of establishing the vacancy rate was
that most professionals just walked out of their posts and did not
officially resign. So although on paper they still appeared on the
books, they were not physically turning up for work. This affected
health service delivery quite significantly. A look at Table 7.6
shows that most of the core functions of the services were heavily
depleted by the brain drain.
Table 7.6 suggests an average vacancy rate of 81 per cent
among the senior positions in the Ministry of Health and Child
Welfare. This means that the Ministry of Health and Child Welfare,
as at December 2007, was operating with 19 per cent of its approved
senior management positions. Loss of experienced managers and
senior health staff at all levels resulted in a leadership vacuum
and reduced management capacity. Programme management was
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