Zimbabwe’s current health financing model remains highly unsustainable as it relies heavily on external financing and out-of-pocket financing, says Dr Prosper Chitambara, senior research economist and policy advisor and currently a member of the Labour and Economic Development Research Institute of Zimbabwe (LEDRIZ.)
The intersection of public underinvestment – in history and in the here-and-now – is, in the researcher’s view, at the centre of the myriad of challenges confronting the country’s health sector.
“The poor continue to bear the brunt the highest burden of disease and experience high levels of financially crippling healthcare costs,” he told a Community Working Group on Health (CWGH) meeting in the capital Harare yesterday that included Members of Parliament and civil society organisations.
The CWGH) is a network of 40 national membership-based civil society organisations focusing on advocacy,, action and networking around health issues in the country. Formed in early 1998 it has been in the forefront of taking up health issues and putting these on the public agenda.
The country’s health sector continues to face myriad challenges that include inadequate and depleted healthcare workforce, high disease burden, poor maintenance of healthcare infrastructure, ill-equipped hospitals and prohibitive cost of emergency services as well as well as demotivated staff in an environment of gross public healthcare underinvestment.
According to the World Health Organisation (WHO), in terms of Universal Health Coverage (UHC) Service Coverage Index, the country has an index of 55.04 as at 2021.
A regional scan across neighbouring Zambia and South Africa shows indices of 55.84 and 70.95 respectively. The index is measured on a scale from 0 to 100 based on the average coverage of essential services including reproductive, maternal, newborn and childbirth, infectious diseases, non-communicable diseases and service capacity and access.
According to the WHO, the country is among 55 countries with sub-par numbers of healthcare workers.
“This outmigration has been driven by heavy workloads, inadequate compensation exacerbated by high inflation,” Dr Chitambara adds.
And the adverse impact of the Covid-19 only made the bad situation worse due to increased demand of healthcare workers in developed economies.
“This has compromised health outcomes,” he emphasised.
District level health facilities have been worst affected by this outmigration and particularly in specialized areas.
Anna Takaendesa, a village health worker from Chikwaka in Goromonzi District, says the government has “forgotten” they exist although they are at the frontline of the war against any disease outbreak.
“We are trained to give the initial alert as we did during the Covid-19 pandemic,” she told the participants. “Some of our colleagues died due to infections after contracting Covid-19 in the line of duty.
“And we also end up taking care of most youths in drug and substance abuse cases and refer them for rehabilitation,” she explained, adding “it is a 24/7 calling”.
Dr Agnes Mahomva, public health advisor in the Office of the President and Cabinet, says the government “recognizes health as a critical issue” and is supporting all pillars of health from village health workers to technical professionals.
“Indeed, primary healthcare is the frontline of the country’s health and we recognize the work all those in the system are doing,” she said, acknowledging the critical role of primary healthcare work.
CWGH is building and strengthening partnerships – and are plumbing the depths of health advocacy to improve coordination to ensure success.
Itai Rusike, executive director at CWGH, says they are working on shining a light on the problems bedeviling the country’s health sector to arrest the deterioration and potential reversal of some of the gains realized so far.
Daniel Molokele, Member of Parliament and Chair of the Parliamentary Portfolio Committee on health says, despite the paucity of effective remedies and action, they are engaging and lobbying the minister of finance to ensure much more is done in terms of domestic resource mobilization for health.
“As a new Parliamentary committee we have recognized your problem and we are in your corner,” Molokele, who is also chairperson at the African Parliamentary Task Force on Domestic Resource Mobilisation, told the village health workers.
Despite the apparently insurmountable challenges, there has been some progress. Dr Chitambara reports that the country has made notable gains in, for instance, the significant decline in the HIV prevalence, child mortality, maternal mortality, scaling up of vaccinations of children and an increase in life expectancy.
