by Sarudzai Zindoga and Diana Mavunduse
There is urgent need for Zimbabwe’s government to put its struggling health delivery system at the top of its priority list if the sector is to survive in the year 2000 and beyond.
The Ministry of Health and Child Welfare, which runs the country’s health system, including all public services is basically broke. Because of under funding for several years, the infrastructure is crumbling, even the most basic drugs and material resources are in desperately short supply and doctors, nurses and the health workers are demoralised and leaving the country.
Zimbabwe, like many African countries, continues to place its spending priorities on defence. The 2000 budget announced recently, gave the defence forces the second highest allocation, Z$9 billion (US$237 million). Education was highest to Health, which received Z$6 billion (US$I58 million), an increase ofZ$3.8 billion from 1999 but inadequate to meet health employee’s salaries.
Commenting on the budget, Zimbabwe’s deputy minister of Health and Child Welfare, David Parirenyatwa said, “Our allocation is completely inadequate, it is far below the $10billion (US$263 million) we had requested to rehabilitate and improve the health delivery system.”
The Z$6 billion allocation comes at a time when Zimbabwe’s major government referral hospitals cannot cope with the needs of the people at any level.
According to Lincoln Shenje, the secretary-general of the Hospital Doctors’ Association of Zimbabwe, commenting on the two week continuing junior doctor’s strike, said:
“We have been negotiating for eight months for a total revamping of the health system, because in the central hospitals, medical equipment needs to be refurbished and patients are dying because they cannot afford medication.”
Justifying the budget allocation Zimbabwe’s, Finance Minister, Herbert Murerwa said, “The situation has been worsened by the escalating cost of drugs in the face of a depreciated currency and strong inflationary pressures, also the unprecedented rates of population growth, and the immense cost that the AIDS epidemic is beginning to impose on public health budgets.”
Zimbabwe is not the only country in the region that has been criticised for failure to prioritise public expenditure on health. Lesotho, Malawi, Mozambique, Tanzania and Zambia have on the advice of the World Bank and the International Monetary Fund, seen declining public expenditure on social services including health during periods of Structural adjustment programmes.
According to the SADC-Human Development Report 1998, it revealed that, “The combination of declining health services and the AIDS pandemic are a deadly concoction for southern Africa.
On the average, the mv-infection rate among adults in SADC is rising rapidly. Zimbabwe and Botswana are the two hardest hit countries in the world.”
As a result of the AIDS pandemic, combined with inadequate and shrinking public expenditure on health services, life expectancy has already started to drop. The l l-year increase in life expectancy achieved by the region since 1960 is now being eroded.
The Malawi government introduced a five-year plan recently to curb the growing AIDS pandemic in the country. The plan seeks to discourage traditional values and other trends in the society that tend to promote the spread of the disease.
A Malawi senior official in the health ministry said, “Government conducted a study in 60 communities and discovered that poverty, drug and alcohol abuse rank high among reasons why AIDS is on the rise in Malawi.”
The Finance Ministry in Zimbabwe has introduced a three percent AIDS levy as of January 2000, which is expected to raise an estimated $1 billion (US$26,4 million).
Murerwa said that the health sector will benefit from the levy and will have the effect of leveraging additional donor resources towards it.
However, there have been negative reactions by the public towards the AIDS levy. Many taxpayers feel that the minister of finance should have introduced a separate budget for AIDS rather than to over burden the taxpayers with another levy.
“If AIDS is a disease that can be rooted out in one way or another, why then run to tax people who are already loaded with a lot of problems, without looking for the best way out,” wrote a concerned tax payer Beki Khumalo in a local daily.
Dr. Theresa Moyo, a lecturer and chairperson at the University of Zimbabwe said, “The problem is on more pressing issues.”
“Defence expenditure remains highest yet we are not at war,” lamented Nyasha Masuku, Chairman of the Hospital Doctors Association of Zimbabwe. He added that, “investment in health is a key ingredient in the formation of human capital and sustainability of socio-economic development, yet expenditures on health in Zimbabwe are not made a priority.”
The SADe report also revealed that Angola and Mozambique are the highest military spenders with the former spending over 200 percent of the combined education and health expenditure on Defence, Zimbabwe is ranked as the fifth highest in military expenditure.
Dr. Theresa Moyo, a lecturer and chairperson at the University of Zimbabwe said, “The problem is with our priorities. We could surely afford to do without the expenditure on the DRC war and focus on more pressing issue (SARDC)
