Zimpapers Logo

Lovemore Chikova Development Matrix
The up-scaling of health facilities access in rural areas should be an integral part of the development matrix, as Government envisages a quick turnaround of the economy.

A healthy rural population will always be at the centre of developmental aspirations for countries like Zimbabwe.

The main reason being that the majority of people in developing countries, including Zimbabwe, live in the rural areas.

This makes the development of rural areas in general critical, as it entails not leaving out the majority of the population.

It is a fact that health access in rural areas has been lagging behind compared to urban areas where access is guaranteed, even for the low-income earners.

Although the Government embarked on a programme aimed at promoting equitable access to health services by focusing on improving the situation in rural areas, there is still an existing gap.

This bids on authorities to start thinking hard on how access to health in rural areas can be up-scaled so that the majority is not left behind as the economy improves.

Diseases and other troubles associated with lack of access to health services are always prevalent in rural areas compared to urban areas.

It is acknowledged that Government did a lot to improve access to health after Independence in 1980 by building new hospitals and clinics and equipping them, but much more still needs to be done.

Some of the rural areas remain sidelined in terms of easy access to health services, despite the country having embraced the concept of universal access to health.

Problems to do with lack of access to health services in rural areas mainly revolve around geographical accessibility, financial accessibility and acceptability.

Geographical accessibility is in relation to the scarcity of health institutions and health services, and the long distances that people have to sometimes walk to reach the nearest health services centre.

Financial accessibility simply means that because of the poor status of many rural folks, most of them cannot afford health services.

Acceptability relates to the fact that some health centres in rural areas do not match the needs of the locals, hence they are shunned since they are viewed as offering poor services.

Given this background, the way forward is to identify the key approaches that inform access to health in rural areas, and then implement strategies that help improve the situation.

There is need to change the traditional model of concentrating on urban health services in the hope that a strong urban health services system will have its effects trickle down to rural areas.

This model has only succeeded in creating a huge chasm between health access in urban areas and health access in rural areas.

But there are various strategies and policies that can be considered to upscale access to health in rural communities in developing countries like Zimbabwe.

Part of the solutions to the lack of access to health in rural areas emanates from the authorities’ over concentration in up-scaling access in urban areas.

More resources are usually directed to the urban areas despite that the majority of the people live in rural areas, further marginalising the rural communities.

Other developing countries like China, Cuba and Thailand have come up with policies around provision of transportation, energy, clean potable water, telecommunications and fuels to rural areas to ensure that qualified health workers are attracted to such areas.

In rural areas, health service centres are far away from those they are supposed to serve, leading people to travel long distances to access rural health service centres.

In this respect, it is important to shorten this distance by at least building more health institutions and providing mobile clinics that can be used to visit certain areas on particular days.

Mobile clinics can help scale up access to primary healthcare quickly and effectively because they are cheaper to operate and come with less costs to rural communities.

First Lady Auxilla Mnangagwa has been effectively using a bus as a mobile clinic for cervical cancer screening in rural areas.

In the last half of 2018 alone, more than 100 000 women had benefited from cancer screening using machines on the mobile clinic, which are accessed for free.

The other problem facing rural health centres is that qualified health workers shun them because of their poor conditions of living, as they lack essential provisions like electricity.

Although community health workers cannot entirely substitute qualified personnel, they can undergo basic training to offer services like administering medicines, first aid, home nursing and even deliver babies.

They can help by teaching individuals and families on how to prevent illnesses and referring the sick for expert treatment.

Community health workers can help people identify what is causing health problems and what resources they have to solve the health problems.

In some cases, the community health workers organise people around special projects to deal with diseases like tuberculosis and HIV and AIDS, while also visiting homes and workplaces to support the sick, disabled, elderly, children and the mentally ill.

Zimbabwe used to have a successful village health worker programme in the 1980s, whose focus was on disease prevention and providing community care at primary level in rural communities and peri-urban wards where they served as a key link from the community to the formal health system.

A revival of this noble programme can help increase access to health in rural areas.

Another strategy that can help increase access to health services in rural areas is the use of communication technologies like mobile phones.

Mobile phones can be used to disseminate information about health services from call centres in urban areas, where experts can talk to centrally-located people about health problems and how they can be addressed with local remedies.

Through such mobile phones, rural people can get information on how to stay healthy, how to prevent occurrences of diseases and how to deal with outbreaks of diseases. It is important that programmes targeted at bringing health insurance to rural areas are instituted, as a means of ensuring access to health by people who live in such communities.

This calls for policies that determine the premiums so that the health insurance is affordable to the rural poor.

Government should come up with deliberate policies that offer free health insurance for those who live in rural areas to enhance its goals of achieving universal health coverage.

It is important that in the 2020 National Budget, Finance and Economic Development Minister Professor Mthuli Ncube allocated the second biggest chunk to health at $6,5 billion.

The highest amount, $8,5 billion, was allocated to the Ministry of Primary and Secondary Education.

Despite the numerous problems facing the health sector at the moment, it is important that measures are taken to improve efficiency of public health spending, and ensuring that more financial resources out of the $6,5 billion are allocated to marginalised areas.

It is always important that in planning for the health delivery system, programmes and policies are designed in such a way that they target the vulnerable populations.

Deliberate efforts should be made to come up with policies that encourage health literacy among rural people to enhance their preparedness on health matters.

There was disgruntlement recently in the Matabeleland region when it was discovered that most of the trainee nurses recruited through a Government electronic system did not come from the area.

This raised an important point since these people were rest assured that the trainees would not like to work in the region once they qualified, as they were likely to relocate to their home areas.

This can be a lesson for the authorities in terms of scaling up health access to rural areas — that recruiting trainees locally means that they are likely to return and work in the same communities after qualifying.

An urbanite nurse, for example, will find it unfathomable to seek placement in rural areas after training, as this means living far away from their relatives and friends, under some difficult conditions.

Feedback: [email protected]