Introduction
The past trends, system of governance as well as values held towards delivering health distinguishes health pillars for different countries at a broader perspective. Nevertheless, global institutions like WHO provide associated themes along which to establish and evaluate health such as workforce capacity, budgetary allocation, government policies, infrastructural baselines and the social environments. On these bases, the immediate state of health may be a consequence of the strength of achievements made across the thematic lines or a cross cutting issue compounded by the challenges facing a nation. Ultimately, the assessment of the state of health has bases on equity, efficacy, patient satisfaction, service timeframes, and safety (Skolnik, 2012). As a humanitarian factor, the focus on health issues in Zimbabwe has been in the forefront since the turn of the millennia.
Location/Geography
Zimbabwe lies within the Southern African countries block. The administrative units in Zimbabwe divide at broader scales into 10 provinces, out of which two have city status (World Health Organization, 2012). These Provinces subdivide into 62 districts. The districts subdivide into wards. Harare is the capital city of Zimbabwe.
Population
According to Osika et al. (2011), Zimbabwe is home to an estimated 12.4 million and has a yearly population growth rate of 0.11 percent. Nevertheless, in the recent HIV/AIDS pandemic (particularly among the adult citizens) appears to be decelerating the population growth rate (Kraemer & Mosler, 2010). Close to 66 percent of the populace are in the rural areas, but the number of urban dwellers is set to rise. Moreover, 66 percent of the populace lives below the poverty line. Close to a quarter (24.1 percent) of the country’s population, stay in foreign countries. Just over two-fifths of the country’s populace is 15 years-and-below and the overall median age is 18.8 years (Osika et al., 2011).
Limited varieties in the education and employment sectors are discouraging the younger population within the secondary schooling age (Osika et al., 2011). Children in the secondary school going age within the lowest quintile are thrice than those at the top quintile within the wealth spectrum. This is an indication of widening education inequality. Gender imbalances (in favor of the male) are evident at primary level (UNICEF, 2011).
Government
In a bid to bring political stability, Zimbabwe established a Government of National Unity at the onset of 2009 (Osika et al., 2011). Immediately, two programs were set out to check the country’s social and well-being and stabilize the economy; that is a Short-Term Emergency Recovery Program implemented in 2009 and a Medium-Term-Plan lasting between 2010 and 2015. Moreover, at the beginning of 2009, through a dollarization scheme by the Zimbabwean Government, the South African Rand and the US$ were officially allowed to circulate (Osika et al., 2011). In mid-2009, the government implemented a hundred days action-plan for health care.
Economy
Early in the 1990s decade, Zimbabwe began an Economic Structural Adjustment Program; however, failed to timely cut-down the public sector and revise key fiscal policies (Osika et al., 2011). A three-year drought that ended in 1995 further exacerbated the subsequent economic difficulties. The adoption of the Zimbabwe Program for Economic and Social Transformation that lasted until 2000 was an effort to reverse the resulting problem. In 1997, the country’s stock market collapsed; real wages plummeted and consumer prices skyrocketed (Osika et al., 2011). The damage extended into the manufacturing sector. With dismal state support, hospitals and other public health facilities closed or cut-down services. Majority of skilled employees across sectors sought employment opportunities in foreign destinations. The adoption of dollarization intended to check hyperinflation levels. Recent inflation statistics show improved stability ranging at 1.4-4.2 percent (Osika et al., 2011).
State of Health
The major health threats result from communicable diseases and more complex by sporadic infections of typhoid and cross-border transmission of wild poliovirus (World Health Organization, 2012). Diarrhea leading to dehydration, fever, and acute respiratory infection has exacerbated child mortality (Cumberland, 2009). Use of mosquito nets (at 41.1 percent) is an important indicator of malaria concern. HIV/AIDS awareness campaigns have directly reached-out to about 98 percent of adults.
Key Determinants of Health
Governance & Leadership
Health care is under the Ministry of Health and Child welfare that is vested with the authority to make decisions, administer and guide on policy affairs, approve and manage funding allocations, principal player in health care response and handle recruitment matters at provincial and district health care amenity centers. The National Health Strategy (2009-2013) intends to strengthen the participation in decision making and health policy improvement (Osika et al., 2011). Delivery of health care services involves public amenities, faith-based interests, for-profit and non-profit clinics, and company-operated clinics. Rural and urban polyclinics are the most numerous health facilities. Four levels of care that define the health service categories are primary, secondary, tertiary, and Quaternary/central (Osika et al., 2011).
According to World Health Organization (2012), the state of public health is still critical due to financial limitations and the absence of coordinated engagement to handle current social determinants of health. Moreover, other challenges facing health include few staff; problems facing the six pillars of health, political confrontation at national level, interference in activities and donor apathy particularly under the CAP 2012 Appeal.
Health Workforce
There are workforce deficits and are mainly caused by outmigration, poor remuneration and unappreciated working conditions, HIV/AIDS pandemic and limited high cadre health administration staff (Osika et al., 2011).
Pharmaceutical Management
There are two channels that allow public sector participation in medical product handling: The National Pharmaceutical Company of Zimbabwe and The Medicines Control Authority of Zimbabwe (Osika et al., 2011). The Medicine Control Authority of Zimbabwe is a regulatory body; while, the National Pharmaceutical Company of Zimbabwe is a clearing-house for pharmaceutical products (Osika et al., 2011).
Information
The National Health Information and Surveillance system of Zimbabwe became fully fledged in 1988. A medium term strategy 2009-2014 has majorly reviewed and evaluated the National Health Information and Surveillance operations (Osika et al., 2011). To achieve efficacy, the National Health Information and Surveillance focuses on four components: resources, policies, data gathering and synthesis and mainstreaming information analysis outcomes into policies, management, accountability and governance (Osika et al., 2011).
Key Health Status Indicators
In Zimbabwe, the population that accesses water supply as well as enhanced sanitation are 79% and 36%, respectively. Life expectancy at birth is 49 years; while the infant mortality rate (per-1,000-live-births) is at 61.5 (Lopman et al., 2006). HIV/Aids prevalence in the age bracket 15-49 years stands as at 20%. The country’s annual TB incidence per-100,000 was 714. The crude birth and death rates in Zimbabwe are at 30 and 16, respectively. Under-five mortality rate per-1,000-live-births are 95.6 (Osika et al., 2011). In 2011, the neonatal mortality in the country is at 25 per 1000 live births (Zimbabwe National Statistics Agency, 2011).
Total spending on health as a percentage of the country’s GDP was 2 percent in 2010. In the same year, the fiscal amount spent on health US$42.5 million; while per-capita spending was US$5.77 (Osika et al., 2011).
Burden of Disease
In Zimbabwe, burdens of disease comprise of communicable and non-communicable. A ten-year cyclic re-emergence of cholera has reduced to an annual occurrence since 1998. Half of the populace resides in malaria prone areas. In more than 15 of the highly burdened districts, infants and pregnant women are the most vulnerable groups to risks of malaria. TB cases are leading cause of morbidity and mortality in the country. Nearly 80 percent of TB cases co-infect with HIV/AIDS (WHO Regional Office for Africa, 2009). In Zimbabwe, non-communicable burdens fall under ailments and mental problems, neurological and psychosocial disorders. Prevalent cases fall under oral health problems, heart diseases, cancer, diabetes, violence, injuries, and drug abuse. In 2005, diabetes and hypertension prevalence were 10% and 26.7%, respectively. Adults AIDS prevalence in 2007 was at 15.6 percent. More than 10,000 children are under ART (WHO Regional Office for Africa, 2009).
Culture/Traditional Medicine
Traditional medicine in Zimbabwe is widespread and abstract in structure and framework, though key institutional players of government are aware of its presence. Nevertheless, there is believe that traditional medicine has attended to a range of ailments. Its abstract nature makes it difficult to track and quantify patient data and efficacy (Osika et al., 2011). Osika et al. (2011) notes that the Ministry of Health and Child Welfare (MOHCW) has made efforts to integrate traditional medicine into the wider health care delivery system; however, the absence of data makes it difficult to demonstrate their strategic value-added as players within the health care system roll out because of their private practice nature. Within the National Health strategy, there is a Traditional medicine policy. Much of the private practice of traditional medicine occurs in non-formal settings; hence, the exact number of patients attended remains relatively unknown. Simmons (2009) explains that traditional healers play an important role in educating the community on HIV/AIDS.
Healthcare System and Delivery
The historical track of structures and institutions delivering health services in Zimbabwe date back to pre-independence. However, over the time the state macroeconomic environment has shaped the performance framework of the system adversely affecting the statistics of professionals. Thus, the state of the health care system in Zimbabwe is a reflection of the ability of the public sector’s health care priorities and resources allocated, thereof. Private practitioners in health care in Zimbabwe focus their services in the urban settings compared to other areas. In the assessment of key health care issues (primarily on reproductive health, malaria, TB and HIV/AIDS); there are major developmental differences in achievements across provinces such that some facilities are well capacitated compared to others (Osaka et al., 2011). Osika et al. (2011) consider the existence of gaps in health care service delivery between provinces as requiring immediate attention considering the existence of well tailored treatment guidelines at the disposal of national, provincial and district hospitals. Cases of ill-equipped medical labs and workforce limitations pose grave challenges to health care systems leading to the variations on a regional bases. On average the furthest distance a district hospital is from the community is about 120 km; while mission hospitals as well as rural health facilities have their distances at 38 and 25km, respectively (Osika et al., 2011).
The MOHCW is the health affiliate ministry and the provincial medical directorate provides regional governance. Pharmaceutical management is undertaken by National Pharmaceutical Company of Zimbabwe while, pharmaceutical regulation is done by the Medicine Control Authority of Zimbabwe. Consumer Council of Zimbabwe and Community Working Group on Health perform patient advocacy at the grassroots. Professional and organization associations include Medical and Dental Practitioners Council of Zimbabwe, Zimbabwe Association of Church Related Hospital and Zimbabwe Association of Doctors for Human Rights (Osika et al., 2011).
Health Priorities
Osika et al. (2011) explains the priority areas of health in Zimbabwe are the cross cutting issues that include immigration, hyperinflation, grassroots participation in health delivery, the equilibrium between preventive and curative services and synergizing and standardizing health care systems. The absence of informative data for factual deliberation, there is a negative perception about the imbalance between curative and preventive services by ministry officials and donors. Community is providing crucial support to rural and district hospitals; however, there is a huge gap of their participation at tertiary and central levels. This urgently needs redress as indicated in the National Health Strategy. There are systemic and coordination challenges that are facing the referral processes for patients (Osika et al., 2011)
Nursing Implications
Across the personnel involved in health care in Zimbabwe, nurses and midwifery form the largest bulk of staff at the facility level (Osika et al., 2011). In rural areas, nurses are the operators and promoters of primary care by village health centers, community-based and small clinics. Their services are basic and in overwhelming cases, nurses refer patients to district hospitals. Associations such as the Nursing Council of Zimbabwe have to raise awareness to encourage more enrollments of trainees into the medical school since less-than 25% of nurses have graduate training (Osika et al., 2011). NCZ ensures that nursing practitioners meet professional standards. Moreover, regional assessment across Southern Africa in 2004 indicates that Zimbabwe had among the youngest (aged under-30years) health care practitioners. The wage gaps that lead to outmigration has compounded workforce issues. Nurses can gain additional basic skills to supplement the need for accounting staff to handle user fees payment records for patients, particularly in the rural settings. The Zimbabwean government is pushing medical schools to double their intake for trainees in nursing and medical doctors; however, financial challenges constrain efforts.
Conclusion
There is a need to emphasize on preventive over curative approaches to health in order to cut down on budget allocation and out of pocket spending. There is a need to peg spending on health with the population growth rate and leverage it with the GDP performance over-the-time. Innovatively, the government ought to introduce or revamp the health insurance fund as a way of funding (per-capita) healthcare services. This has received limited attention. Using Herzberg’s-Two-Factor Theory staff can be motivated and job satisfaction improved in order to cut-down on outmigration. The chain supply among statutory bodies should improve through synchronization and communication to ensure efficient pharmaceutical commodity flow.
References
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