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Elliot Ziwira Senior Writer
The attainment of Independence in 1980 brought more than majority rule to Zimbabweans, as it also saw citizens’ access to healthcare facilities and ancillary services improved on through Government’s commitment to the provision of social security to the previously marginalised black people.

Rhodesia’s system was skewed in favour of whites which created income inequalities and disparities in the provision of healthcare facilities. Colonial injustices led to the establishment of two economies in one country; the white people’s economy and the black people’s one. Rather, there existed two nations; the European nation and the African nation.

The European nation determined by whiteness, was urbanised, and had many facilities matched by high concentration of health personnel, especially professionals. The African nation on the other hand, was ruralised, and was marked by inadequacy in terms of arable land, rains, schools, health facilities, roads and sustainable livelihoods.

Independence, therefore, ushered in a new era in economic and social reforms for the betterment of citizens’ livelihoods. A new healthcare approach was adopted to address a plethora of discrepancies that Rhodesia’s system fed on.

To achieve its target, the Government, through the Ministry of Health (now the Ministry of Health and Child Care) partnered private stakeholders after Independence to bring together resources to create a vibrant economic base ideal for the provision of healthcare services for all citizens.

At the helm of the ministry is Dr Obadiah Moyo who is deputised by Dr John Chamunorwa Mangwiro. Dr Agnes Mahomva is the Permanent Secretary.

Mandate

The mandate of the Ministry of Health and Child Care (MoHCC) is to promote the health and quality of life of the people of Zimbabwe.

Functions

The ministry’s purposes are to: achieve equity in health by targeting resources and programmes towards the most vulnerable and needy in Zimbabwe; facilitate primary healthcare provision for health development; identify priority health problems and allocate resources to alleviate them.

The ministry endeavours to provide appropriate and accessible high quality care and facilitate health promotion programmes aimed at disease prevention. It aims to; keep as many citizens as possible in good health; provide appropriate quality services; provide high quality hospital services at the appropriate level for all citizens; and mobilise resources for the provision of healthcare services, distribute the same equitably and ensure proper financial management and control of funds.

The journey and milestones

Since Independence in 1980, the Government’s immediate task was to enact legislation that would put in place policy frameworks to correct colonial injustices in healthcare provision, among a litany of other inequalities.

In colonial Rhodesia, Andrew Fleming Hospital, now Parirenyatwa Group of Hospitals, was the largest health institution. Named after the first medical director appointed to the Rhodesian Health Service, the hospital served the white community.

Blacks had Harare (Gomo) Central Hospital (now Sally Mugabe Central Hospital), which relied on equipment and drugs deemed as excess baggage at Andrew Fleming Hospital, built for them.

Following Independence in 1980, the hospital was renamed in honour of Tichafa Samuel Parirenyatwa, who was the first black Zimbabwean to qualify as a medical doctor.

The institution encompasses Mbuya Nehanda Maternity Hospital; Sekuru Kaguvi, which specialises in eye treatment, an annex for psychiatric patients and several specialist paediatric wards. It also houses the University of Zimbabwe College of Health Sciences.

Notwithstanding economic challenges, the group of hospitals has continued to provide quality and cost-effective specialist healthcare services to citizens of Zimbabwe. It has also remained consistent in the provision of modern training and research facilities for health personnel.

In the early 1980s, Zimbabwe’s health delivery system was enhanced through Government and private sector partnerships which gave citizens access to affordable healthcare due to increased numbers of clinics and hospitals constructed countrywide. In the mid-1980s the Ministry of Health partnered the World Bank to establish a family health project to expand and upgrade selected district hospitals across the country.

As a member of the United Nations (UN), Zimbabwe also partnered with other stakeholders that include World Health Organisation (WHO), United Nations Population Fund (UNFPA), World Food Programme (WFP) and United Nations Children’s Fund (UNICEF) to achieve its objectives.

In its endeavour to provide healthcare facilities for all citizens, the Government was supported by the Church through construction of mission hospitals. The Zimbabwe Association of Church-related Hospitals (ZACH) partnered the Government in running national programmes aimed at expanding facilities on both preventive and curative health issues.

More than 65 provincial and district hospitals, among them, Chinhoyi, Chitungwiza, Guruve, Shamva, Mahusekwa, Murehwa and Hwedza, opened their doors after 1980.

The bias towards construction of more hospitals and clinics continued through the 1990s to the early 2000s and beyond. As a way of mitigating challenges associated with access to healthcare, in September 2020, President Mnangagwa said the Government had earmarked funds for the construction of 6 600 clinics to ensure that no one travels more than 10km to reach a healthcare facility.

In its quest to give all Zimbabweans access to healthcare, from 1980 the Government provided free services to those earning less than $150 per month.  Special programmes were also initiated in the early 1980s to close the yawning chasm colonialism opened between urban and rural areas regarding healthcare provision. For instance, before 1980 immunisation programmes were confined in urban areas.

To address colonial disparities, in 1982 the Government initiated an all-encompassing immunisation programme against infectious diseases among children, and tetanus among pregnant women. The programme, whose objective was to make immunisation available and accessible to every child by 1990, considerably benefited children in rural communities.

Almost 80 percent of children below the age of 12 months were successfully vaccinated by the end of 1990. According to the World Health Organisation’s estimates, the Expanded Immunisation Programme prevented more than 80 000 deaths of children under the age of five every year.

Prioritisation of diarrhoeal diseases control in 1982 paid dividends as by 1988 over 90 percent of mothers were conscious of oral rehydration therapy. Also, rural-urban discrepancy in antenatal care was significantly reduced.

Zimbabwe plans to maintain the elimination status for maternal and neonatal, tetanus and polio-free certification status until they have been eradicated.

By the early 1990s the country had attained the highest rate of contraceptive use in sub-Saharan Africa.

A nutritional programme was started to help feed over 250 000 children to mitigate the impact of drought at the peak of the 1980s and early 1990s. To date, in collaboration with donors and the private sector, the Government of Zimbabwe runs nutritional programmes aimed at feeding children and other vulnerable groups in rural and urban communities.

Moreover, Zimbabwe achieved elimination status for maternal deaths in 2000, and is in the pre-elimination phase for measles, and achieved polio-free certification status.

In March 2020, the Zimbabwe National Statistics Agency (ZIMSTAT) circulated wide-ranging findings from the Multiple Indicator Cluster Survey (MICS 2019) indicating a decline in maternal deaths. This shows that the country is in the right direction towards eradication of the scourge. In the latest MICS report, Zimbabwe recorded a decline in maternal mortality from 614 to 462 maternal deaths per 100 000 live births since 2014, and a surge in full immunisation coverage to 85 percent.

The country has remained committed to its pledges at the 2019 International Conference on Population and Development (ICPD25) in Nairobi, Kenya. Halving maternal deaths from 614 to 325 per 100 000 live births by 2030 topped the list of Zimbabwe’s pledges at the summit.

As Sachiti (2020) notes, the reduction in maternal deaths has also been necessitated by Government’s policies on healthcare provision. These are, among others, construction of mothers’ waiting homes, scrapping of maternity fees in public hospitals and issuing of free blood coupons. The donor community’s efforts, in collaboration with the Government’s, have also contributed to the decrease in maternal deaths.

Waiting shelters have come in handy to rural women who, in some cases, had to endure long distances to access healthcare facilities. Shelters or maternity waiting homes help in the reduction of maternal and perinatal mortality by facilitating access to skilled birth attendance and emergency specialised care for women, especially those in rural communities. They also arrest the three delays; delay in decision to seek care; delay in reaching care and delay in receiving sufficient healthcare.

Development partners like the United Nations Children’s Fund under programmes such as the H4+ and Health Transition Fund (HTF), and the United Nations Population Fund (UNFPA), provide funding for mothers’ waiting shelters through technical and financial support to the Ministry of Health and Child Care (Sachiti, 2020).

Direct and quantifiable causes of deaths in pregnancy and childbirth, in Zimbabwe are largely severe bleeding (after childbirth), infections, and high blood pressure during pregnancy (pre-eclampsia and eclampsia).

The Government has partnered stakeholders to curb these causes.

For instance, United Bulawayo Hospitals which records about 4 756 deliveries yearly with a 40 percent C-Section rate has benefited from a partnership between the Ministry of Health and UNFPA.

The Government of Zimbabwe, however, has taken over the funding of blood coupons.

Before Independence, training in Medicine, and other health sciences was a preserve for whites who enjoyed free and easy access to university education with blacks having to pass through a bottlenecked system that squeezed them out.

Thousands of doctors and nurses have been trained since 1980, to close the rural-urban healthcare provision gap. Between 1980 and 1989, the number of doctors graduating from the University of Zimbabwe increased by about 40 percent (Sanders, 1992).

However, the distribution of health personnel was still a challenge, especially so as the numbers fell short of requirements. Another challenge in the early 1980s and 1990s was that health personnel, especially doctors, shunned rural mission and district hospitals.

According to Sanders (1992), in 1983, 67 percent of doctors were at central level, with 1 596 at provincial level, and a further 15 percent at district mission hospitals. The proportion of doctors at central level had increased to 72 percent, 12 percent of whom were in the provinces and 16 percent in district and mission hospitals, by 1988.

To address the issue Government recruited expatriate doctors to man provincial and district hospitals while putting in place mechanisms to attract and retain personnel.

Another milestone achieved in taking primary healthcare to Zimbabweans’ doorsteps was the Village Health Worker Programme which began in 1982. The programme focuses on disease prevention and provision of community care at primary level in rural and peri-urban areas, thus, serving as a key link from the community to the formal health system.

By 1987, the Ministry of Health (now Ministry of Health and Child Care) had trained about 7 000 community-based village health workers to enhance promotive and preventive care in rural areas.

Where economic stratification exists, as is usually the case in rural areas, villagers are divided among themselves to ascertain that the neediest are the first to be served.

The 1990s and early 2000s saw demand for healthcare services surging due to HIV/AIDS prevalence, thus encumbering authorities in their efforts to contain the condition, leading to loss of many lives. However, through Government’s partnerships with donors and other stakeholders, inroads have since been made in the provision of antiretroviral therapy, containment of prevalence rate and curbing of stigmatisation.

Zimbabwe is making progress towards the UNAIDS 90-90-90 goals. The UNAIDS targets that in 2020, 90 percent of people living with HIV will know their status, 90 percent of people who know their HIV-positive status will be on treatment, and 90 percent of people on treatment will have a suppressed viral load.

According to the Zimbabwe Population-based HIV Impact Assessment (Zimphia) 2020 study, more than 95 percent of targeted people were tested for HIV in the first phase launched in 2019.

The Zimphia 2020 study is a population household survey led by the Ministry of Health and Child Care working in collaboration with the Zimbabwe National Statistics Agency (Zimstat), National Aids Council (NAC) and ICAP at Columbia University.

The study which is supported by the United States President’s Emergency Plan for Aids Relief (Pepfar) through the Centre for Disease Control and Prevention, is aimed at determining Zimbabwe’s progress towards UNAIDS’ 90-90-90 goals, as well as guiding policy and funding priorities.

Milestones were also attained in surgery.

Zimbabwe has held her forte in medical annals by successfully performing a major operation on Siamese twins born on April 22, 2014 to a Murehwa couple. A team of 50 Zimbabwean medical personnel, led by academics from the University of Zimbabwe’s College of Health Sciences, worked on the eight-hour delicate procedure at the Harare Children’s Hospital in July 2014.

The twin boys; Kupakwashe and Tapuwanashe Chitiyo, were joined from the lower chest to the upper abdomen and shared a liver.

In September 2019, Zimbabwean surgeons broke yet another world record by successfully conducting an operation to remove a 12,3kg 11-year-old kidney cyst from a patient at Parirenyatwa Group of Hospitals.

The cyst became the largest to be removed in the world, with the previous record set in Japan where a similar one weighing 11,5kg was removed. Dr Shingirai Meki, a consultant urologist and lecturer at the University of Zimbabwe’s College of Health Sciences, led the team of Zimbabwean doctors that conducted the complicated surgical procedure.

Like any other sector in Zimbabwe, the health sector has not been spared by economic challenges which are hindering the Government’s efforts to fund public health delivery, hence, restricting citizens’ access to healthcare.

In the past two decades or so, the Government’s capacity to provide adequate, efficient and reliable healthcare services and facilities has mainly been hamstrung by the illegal sanctions imposed on Zimbabwe by Western countries in response to the country’s post-2000 Fast Track Land Reform Programme aimed at correcting imbalances in land ownership.

Due to financial constraints, infrastructural development projects have been hindered. The health sector has also been burdened by brain drain, industrial actions, and inadequate equipment and drugs, which impede ordinary citizens’ access to quality healthcare.

The novel coronavirus (Covid-19) pandemic which has plunged the world into a health crisis, and described by the United Nations Development Programme (UNDP) as “the greatest challenge we have faced since World War Two”, has brought along trials of its own.

Nevertheless, the light beckons at the end of the tunnel as the Independence Flame kindled on April 18, 1980, flickers on.