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The loan of US$193,3 million by two South African banks and the local subsidiary of one for the Government to accelerate its programme to provide mid-level hospital care to Zimbabweans, all backed by the appropriate authorities in South Africa, has a number of implications.

The health implications are fairly obvious: five more 80-bed district hospitals in districts where these are missing, plus another 22 of the new 20-bed health centres to complement the four already built and four now being built. 

All that provides a lot of the needed major tier of health care between the small clinics and the provincial and referral hospitals, the tier that copes with most of the routine hospital care.

This is the vital pair of levels between the clinics, which are supposed to be within a few kilometres of even the most isolated households, and the big provincial and referral hospitals, with their specialist medical professionals.

The clinic network, which was not that bad, but still had too many households more than the ideal of being within 8km of everyone, is being expanded at an ever faster rate, as rural district councils and the communities they serve rope in devolution funds and every other dollar they see floating around to filling in the gaps, so that hardly a week now passes without a new clinic being commissioned.

There was a small network of district hospitals inherited from the colonial days, largely built along the line of rail in the small towns serving the white farmer population, and perhaps more importantly the mission hospitals, built by committed churches and which provided life-saving services to the overwhelming majority.

Many of these have had to be expanded, or are being expanded, and obviously they are now seeing their buildings and equipment being upgraded in the present stress on the general upgrade of the public health system, that had been allowed in the previous dispensation to run down. All this is in the now routine upgrade of our health system.

The new district hospitals will obviously be sited where the gaps are the worse, so that no one is more than a modest ambulance ride away, and the whole system of clinics, which handle the bulk of outpatients and many of the routine maternity cases, and the district hospitals needs an efficient ambulance service. 

That the Government is also handling and progress is strong in the initial phase of providing 200 new ambulances.

The new 20-bed health centres have been introduced to provide a much-needed extra tier between the clinics and the district hospitals. Besides handling a good share of the outpatients and the more complex maternity cases, they also provide the beds for a wide swathe of patients who need decent nursing care and even some emergency stabilisation before being loaded into the ambulance, but otherwise do not need the full services of a hospital. 

The private sector in the middle and upper income suburbs in most cities has already put in similar establishments for those who do not need to use the public health system, and this extra tier now brings that incredibly useful service within reach of the vast majority who do. 

The network means that as it is developed, there will be in-bed health care within close proximity to most households.

The second implication of the loan is that it is a private sector loan. This displays the dramatic progress made by the Second Republic over the last almost five years. 

Zimbabwe was almost a basket case in many respects, and the number of people lining up to lend the Government money was basically zero. 

The consistent and successful fiscal and monetary reforms of the Second Republic, along with the discipline required and the detailed budgeting that is now implemented, rather than being seen as a possible wish list, is now having its effect.

Not everyone outside the country is on board, but this latest loan shows that those who know what is going on are not worried about the risks of lending. 

Of the three banks, one is the Zimbabwean subsidiary of one of the two South African banks. The three banks have the advantage of fairly detailed knowledge, both from the Zimbabwean member of the trio and what the South African principals can see from next door.

Besides all the official, and checked, progress, they also presumably have been picking up information from their own customers, basically to the effect that people in Zimbabwe fulfil commitments and pay their bills. This is important.

While most banks in the modern world like to display their adherence to having a noticeable chunk of their loan book dedicated to what is termed in the bankers’ jargon as environment, social and governance, and lending to expand a public health network definitely counts, they are not as banks in the business of handing out free cash.

They can sympathise with their ESG goals, but still want to make money themselves, that is being sure that the borrower will pay back the money, on time and with the set interest, with negligible risk of any other outcome. 

The three obviously feel that this stage has now been reached with Zimbabwean sovereign loans, and that would have been difficult for them to accept five years ago.

The main point is that Zimbabwean debt has now moved out of the junk category into something that is acceptable in normal private-sector banking. 

The support of the Export Credit Insurance Corporation of South Africa adds another positive heavy weight to this attitude. They would not be insuring some high risk policy by a bank.

Word of this sort of routine banking business gets around, and that helps Zimbabwe and Zimbabwean companies as well, as banks see that despite the sanctions and other hits against the country, we are actually a functioning nation and can be treated as such. 

Hopefully that attitude will penetrate the political leadership in the countries that imposed sanctions.

Meanwhile, we get the double benefit, first a rapid acceleration of a health expansion programme that is already showing results, and secondly a growing name for being a respectable, diligent and functioning country that can stand with other such states as a normal business partner.