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Comprehensive Analytical Profile: Zimbabwe

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This analytical profile provides a health situation analysis of the Zimbabwe and, coupled with the Factsheet, it is the most significant output of the African Health Observatory. The profile is structured in such a way to be as comprehensive as possible. It is systematically arranged under eight major headings:
1. Introduction to country context
2. Health status and trends
3. Progress on the Health-Related MDGs
4. The Health System
5. Specific Programmes and Services
6. Key Determinants
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Statistical profile
Introduction to Country Context

The Republic of Zimbabwe is a landlocked country in the Southern African Development Community (SADC) region and shares borders with Botswana, Zambia, South Africa and Mozambique. She gained her independence from the British rule in1980 and developed one of the strongest economies and health systems in Southern Africa until the late 1990s when there was a rapid decline (Zimbabwe Health Assessment 2010)[1].

The country lies just north of the Tropic of Capricorn between the Limpopo and Zambezi rivers. The total surface area of 390,757 square kilometres is made up of 386,847 sq km of land and 3,910 sq km of water. Only 8.24% of the land area is arable. The major tribes are Shona and Ndebele with minor sub dialects.

Health Status and Trends

Major diseases affecting the Zimbabwean population remain Malaria, Tuberculosis, HIV and AIDS, Diarrhoea, Acute Respiratory Infections, Malnutrition, Injuries, Hypertension, Pregnancy Related and Perinatal complications, mental health disorders and non-communicable diseases. Most of these diseases are preventable.

The observed high disease burden from preventable diseases is characteristic of most low to middle income countries but specifically for Zimbabwe, this is due to inadequate health financing over the last decade. Other causes are emerging infectious diseases, like drug resistant tuberculosis and malaria, and change in population life styles (The National Health Strategy for Zimbabwe, 2009-2013).

Progress
Progress on SDGs
The Health System
Health system outcomes

In 1980, the Government of Zimbabwe adopted the Primary Health Care Approach as a strategy to deliver health services.

The primary health care aimed at ensuring the provision of quality and safe health services through a network of health facilities organized to function on the basis of increasing levels of sophistication[2] .

The Primary Health Care assessment of 2009 revealed that less than 50% of the sampled households were satisfied with the performance of the health system.

Leadership and governance

The deteriorating economic conditions of the last decade resulted in the most senior health care workers emigrating to neighbouring countries and abroad. The combination of reduced financial and experienced human resources for health made the management of health services a challenge.

A deliberate need to build leadership and governance capacity became critical. Building leadership and governance capacity at all levels is one of the objectives under the health system strengthening of the 2009 – 2013 National Health Strategy for Zimbabwe.

Community ownership and participation
Partnerships for health development
Health information, research, evidence and knowledge

To support the implementation of the new health policy based on the primary health care (PHC) approach, the Ministry of Health and Child Welfare (MOHCW) designed and piloted a National Health Information and Surveillance (NHIS) system in 1985.

Since the nationwide rollout of the system in 1988, its further strengthening continued as envisaged in “Zimbabwe Health for All Action Plan”. In 1999, the MOHCW and the World Health Organisation (WHO) carried out a joint evaluation of the system, which identified several issues and recommended necessary remedial measures[3].

Health financing system

The Government of Zimbabwe has always prioritized the social services sector. The Ministry of Health and Child Welfare has remained in the top five ministries in allocation by Government. The Public sector introduced the Public Finance Management system (PFMS) which was introduced in the MoH & CW in 2004.

In 2005, the Results Based Management system was introduced to link finances to service delivery[4]. After the announcement of the budget estimate by the Ministry of Finance, funds are leased quarterly to sector Ministries as funds accumulate.

Service delivery

The government of Zimbabwe adopted the primary health care approach in 1983. Each level of care has a well defined package of health services provided by appropriately trained health care workers.

Health workforce

Most of Zimbabwe’s health institutions are understaffed and burdened with heavy workloads. This shortage is most critical in rural areas. The vacancy rate for doctors as of 2011 was 69%, nurses 62%, midwives 80%, environmental health technicians 61% and medical school lecturers 63%[5].

The overall density of health workers per 1,000 population is 1.23[6].

Medical products, vaccines, infrastructures and equipment

Zimbabwe’s National Health Strategy, 2009-2013, aims to ensure that all health institutions have adequate and constant supply of safe and efficacious medicines, surgical sundries and other supplies at all times[7].

General country health policies
Universal coverage

Zimbabwe has a wealth of resources with a potential for health financing, a highly literate population and rich natural, mineral and agricultural resources. However, the country has faced economic and social challenges in the past decade that threaten provision of health.

The level of debt makes debt relief important to ensure that debt servicing does not withdraw resources from investing in this social recovery[8].

Specific Programmes and Services
HIV/AIDS

Zimbabwe is one of the countries in Sub-Saharan Africa that have been worst affected by the HIV and AIDS epidemic with a projected population of 12 million people.

The HIV and AIDS epidemic has remained a significant public health problem in Zimbabwe, threatening the socio-economic fibre of the country and placing a tremendous strain on the capacity of the health sector to respond to the health needs of the population[9].

Tuberculosis

The National TB Programme was established in the sixties and in 1983; the government integrated all TB activities in the general health services[10].

Malaria

Zimbabwe has a large seasonal and geographic variation in malaria transmission with the main malaria transmission season occurring during the rainy season, from November to April [11].

Immunization and vaccines development

Besides the economic hardships, immunizations were given a priority by the MOHCW over the last difficult decade[12].

Full immunization growth monitoring and promotion are available at primary health care level, the first point of care, in Zimbabwe[13].

Child and adolescent health

Child mortality rate is believed to be a sensitive indicator of the level of socio-economic development of a country.

Maternal and newborn health

Children under 15 years and female population constitute 70% of the total population in Zimbabwe and this sub-population is vulnerable to malnutrition, infectious diseases and reproductive health challenges[14].

Gender and women's health

Zimbabwe launched the Adolescent Sexual and Reproductive Strategic plan in 2010[15].

A Ministry of Gender was introduced in 2000.

Epidemic and pandemic-prone diseases

Epidemic prone diseases of priority to Zimbabwe include Malaria, Tuberculosis, diarrhoeal diseases and zoonotic diseases[16].

Neglected tropical diseases

Not provided yet!!!!

Non-communicable diseases and conditions

Zimbabwe is faced by the triple burden of communicable, re-emerging and non-communicable diseases, like other developing countries. Zimbabwe implemented the STEPwise survey in 2005.

Key Determinants
Risk factors for health

The risk factors summarised below are based on the WHOSTEPS NCDS Risk Factor Surveillance of 2005.

The physical environment

The WHO and UNEP have adopted some global efforts on Health and Environmental linkages Initiatives (HELI) to support developing country policymakers on environmental threats to health. In the Sub Sahara Africa environmental hazards contribute nearly 35% of disease burden.

HELI encourages countries to address health and environment linkages through valuation of ecosystem 'services' to human health and well-being.

Food safety and nutrition

In Zimbabwe, food output per capita remains a challenge. The traditional African diet is shifting towards more fats and processed foods.

There has been an increase in non-communicable diseases and obesity. Whilst agriculture plays a central role in the Zimbabwean economy, the food safety/control systems are under the Ministry of Health and Child Welfare.

Social determinants

Good health and quality of life do not derive only from the health sector, but are influenced by a myriad of other factors that are outside its direct influence.

All sectors of the economy, to varying extents, play a significant role that has an impact on the health and quality of life of the citizens through their direct influence on the social determinants of health[17].



References
  1. Ministry of Health and Child Welfare. Zimbabwe Health System Assessment 2010
  2. The National Health Strategy for Zimbabwe, 2009-2013
  3. NHIS: An Assessment & Recommendations report, 2005
  4. National Health Strategy for Zimbabwe, 2009-2013; page 112
  5. Government of Zimbabwe. Health Transition Fund: A multi donor pooled Fund for Health in Zimbabwe; 2011 page 18
  6. Ministry of Health and Child Welfare. National Health Strategy for Zimbabwe, 2009-2015; page 96
  7. MoHCW. National Health Strategy 2009-2013
  8. MoHCW, TARSC EQUINET (2012) Stakeholders meeting on the Zimbabwe Equity Watch Harare, Zimbabwe February 23 2012, EQUINET, Harare
  9. MoHCW. National Health Strategy for Zimbabwe, 2009-2013; page 54
  10. MoHCW. National Health Strategy for Zimbabwe 2009-2013; page 57
  11. PRESIDENT’S MALARIA INITIATIVE; Malaria Operational Plan – FY2012; ZIMBABWE
  12. MoHCW. National Health Strategy for Zimbabwe, 2009-2013; page 47
  13. MoHCW, UNICEF and WHO. National Child Survival Strategy for Zimbabwe; 2010-2015
  14. MoHCW. National Health Strategy for Zimbabwe; 2009-2013; page 42
  15. MoHCW. National Adolescent Sexual and Reproductive Health Strategy; 2010-2015
  16. MoHCW. The National Health Strategy for Zimbabwe; 2009-2013
  17. NHS, 2009-14