Health

ZIMBABWE'S HEALTH DELIVERY SYSTEM

Zimbabwe has made remarkable progress in the area of health especially for the majority blacks who were marginalized during the colonial era. Prior to Zimbabwe's independence, the white minority had access to a first world, insurance-funded health care system, while the blacks enjoyed only the basic of medical services. It is worth noting that at independence in 1980, there were only four referral hospitals in the country. Two were in Harare, while the other two were in Bulawayo. Of these, two were reserved for whites, while the other two served the entire black population. The only access to health care for blacks in rural areas was through church-run clinics or clinics provided by white farmers for their workers. As a remedy to these glaring disparities, the Zimbabwean government made health care easily accessible to all through repairing, building and upgrading health facilities throughout the country. Now every Zimbabwean is within walking distance of a health facility. Training health workers and reorienting the emphasis to prevention and health promotion corrected inequalities in health manpower. Health care was also made free for those earning below the minimum wage. Consequently, Zimbabwe recorded remarkable achievements in important social indicators such as crude death rate, infant mortality and life expectancy.

Prior to independence, Zimbabwe had a fragmented and two tier medical system that was highly skewed in favor of the urban population in general and the white minority in particular. While there were approximately 280 doctors to service the country's 232 422 whites, there were only 850 doctors for the seven million Africans in 1978. The standards of health services for whites in Rhodesia were comparable to those of the populations of the industrialized West, with crude death rates at 8.2 per 1 000{cf to 11.2 per 1 000 in England and Wales} while infant mortality rates at 1977 were 17 per 1 000{cf 16 in England and Wales}. In comparison, African infant mortality rates were 122 per 1 000 and reached as high as 300 per 1 000 in remote areas like Binga. Government run urban health institutions, those serving the white community like Andrew Fleming, [now renamed Parirenyatwa] were not only better equipped and staffed but they also received a disproportionately large share of the health budget each year.

While health institutions abounded in the urban areas, the colonial government largely neglected the masses of Zimbabwean population in the countryside. Without the sterling work of church-run hospitals, the countryside would have received little or no medical attention. Even where government clinics existed, the long distances the rural people had to walk to reach them, together with the fees charged for treatment which were beyond the reach of many, tended to discourage the rural people from availing themselves of the services provided by such institutions.

Moreover, the emphasis of colonial medicine on curative rather than preventative care meant that the health needs of African majority were not addressed, since most of the diseases that affected African rural dwellers were mainly communicable diseases, maternity related problems and disease caused by nutritional deficiencies, all of which were preventable.

As a remedy to the above shortfalls, the Zimbabwean government soon after independence rationalized the health system, made it colour blind and equally accessible to all. It repaired 161 clinics which had been damaged by the war, built 163 new health centers and upgraded another 450 primary health care facilities throughout the country in the first four years of independence. Furthermore, training facilities for nurses at both government and mission institutions were increased. Due to the accessibility and availability of trained health personnel, the 2005 to 2006 Zimbabwe Demographic and Health Survey revealed a marked increase in women visiting health institutions. It noted that 81% of mothers received at least one tetanus toxoid injection during pregnancy while 80% were assisted by a trained health professional at their last birth.

Immunization campaigns were stepped up, especially in the rural areas, oral rehydration was introduced for diarrhoea, breast-feeding was promoted alongside childhood supplementary feeding and improvements in water supply and sanitation. By 2006, the percentage of fully immunized children stood at 53%, as compared to only 25% in 1980. In addition, as a result of the child-feeding scheme introduced by the government under the Ministry of Health's Supplementary Feeding Programme, infant malnutrition declined from 29% to 16% between 1980 and 1987.

Concerned about the high birth rate in the country, the Ministry of Health set up the Zimbabwe Child Spacing and Family Planning Council in 1981 to promote the use of family planning methods and to supervise the teaching of family planning in the nation's schools. The contraceptive prevalence rate in the country has increased in the last 22 years from 38% in 1984 to 60% in 2006. So effective was this unit in disseminating family planning information and promoting child spacing methods that Zimbabwe is reputed to have the highest rate of contraceptive use in all Sub- Saharan Africa.

Zimbabwe's health reforms were not restricted to modern medicines alone. Traditional healers, who had always played an important role in the psychological and indeed, physical health of the African population but who had been persecuted, ridiculed and marginalized by colonial authorities instead of being appreciated and recognized, were made part and parcel of the Zimbabwe health revolution in 1981, with the government passing the Traditional Medical Practitioners Act establishing the Zimbabwe National Traditional Healer's Association. The Association's members were encouraged to cooperate with the more conventional modern medical practitioners.

Zimbabwe's infant mortality rate has dropped from 102 deaths for every 1 000 births in 1999 to 82 deaths for the same number of deaths in 2006 owing to measures being taken to combat HIV. Other factors like wide vaccination coverage that the country has always aimed for, also played a part in cutting down on child deaths. Anti-retroviral treatment for children is also now available in the country, a factor that has seen many HIV positive children surviving beyond the age of five unlike the situation of the past years.

The decline in infant mortality rate comes at a time when the country has reduced its HIV prevalence rate from 33% in 1999 to 18.1 in 2006. This prompted the British and Canadian Ambassadors in Harare to separately hail Zimbabwe for its defined and effective HIV/AIDS policies, educational awareness campaigns and significant strides made in the prevention of Mother to Child Transmission [PMTCT] programmes. Nearly all the districts have at least one facility for providing HIV testing and counseling.

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