Zimbabwe, 12 July 2013: Transition fund breathes new life into Zimbabwe's health system
A multi-donor fund helps revitalize Zimbabwe’s health system after years of shortages and neglect brought on by economic crisis.
CHIVI, Zimbabwe, 12 July 2013 – With the first pangs of labour pain, Mercy Muchero started out on the long walk from her village in southeast Zimbabwe’s Chivi district to the nearest hospital. But she miscalculated how long it would take to get there. “Suddenly, I felt my water break. The child was on its way,” the 26-year-old recalls.
Halfway to the hospital, she gave birth on the side of the road. Barely able to walk, with the newborn in her arms, she slowly continued, unaware that her uterus had prolapsed during delivery.
When she reached Chivi District Hospital, a doctor instantly took her to surgery. “Her infection risk was extremely high,” the hospital’s district medical officer, Dr. Emmanuel Chagondah, explains. “She could have died if a physician had not been available.”
Ms. Muchero would not have been so lucky just a year ago. Back then, the district hospital did not have a single doctor on staff, and many nursing positions were vacant. Such conditions were no exception in Zimbabwe – many health facilities in the southern African nation faced similar personnel shortages. According to the Ministry of Health and Child Welfare, 69 per cent of doctor positions and 80 per cent of midwife posts were vacant in 2011.
Zimbabwe’s health sector was one of the best in sub-Saharan Africa in the 1980s, but it nearly collapsed when an economic crisis caused hyperinflation of more than 230 million per cent in 2008. Over the next years, chronic underinvestment made a bad situation worse.
Dr. Henry Madzorera, Minister of Health and Child Welfare, remembers the worst of it. “There was lack of equipment. Drug supply had dried up. Public hospitals had to close. Most health workers left the country for better opportunities in other countries,” he says.
Mothers and babies suffered most under the crumbling health system. Maternal and child mortality rates shot up. Around eight women died every day of pregnancy-related complications, according to the 2010–2011 Demographic Health Survey. In addition, an estimated 80 children under age 5 died each day, mainly from preventable causes – common newborn disorders, pediatric HIV, diarrhoea, pneumonia and malnutrition.
Eventually, the international donor community stepped in. Through a fund led by the health ministry and managed by UNICEF, a group of donors pledged $435 million for Zimbabwe’s health system between 2011 and 2015. The money goes towards maternal and child health and nutrition, essential medicines, vaccines and basic equipment, and human resources, as well as health policy and financial planning.
One of the most urgent measures of the Health Transition Fund (HTF) was to retain the few skilled health workers left in the country by raising low wages, in collaboration with the Global Fund to Fight AIDS, Tuberculosis and Malaria. Progress has been steady but hampered by administrative hurdles, and many posts remain vacant, especially in rural areas.
Aboubacar Kampo, UNICEF Zimbabwe’s Chief of Young Child Survival and Development, says that because the HTF is a transitional mechanism, it is critical that the Government work closely with UNICEF and other development partners to improve the health system and assure long-term sustainability. Most importantly, it needs to increase the national health budget – currently $380 million, less than half the need – to take over the expenses currently carried by donors.
The shortfalls become obvious as soon as one leaves Zimbabwe’s urban centres. At Chivi District Hospital in Masvingo province, Dr. Chagondah walks through echoing corridors, pointing out the conditions under which he has to run a facility that serves 174,000 people.
Most days, there is no running water, and power outages are frequent, he says. Resuscitation machines and other life-saving equipment are broken.
Signs of improvement
Despite these struggles, Dr. Chagondah notes some positive developments. Because the Government has started to remove user fees for pregnant and lactating mothers and children under 5, barriers to access have been considerably lowered, he says. With the help of the supplemental payments, additional staff have been hired.
The 29-year-old doctor is himself an example of some of the early successes of the HTF scheme, which boosted his salary to allow him to accept a position in rural Chivi. “I knew there hadn’t been a doctor in Chivi for more than four years,” he says. “I wanted to help.”
Meanwhile, Ms. Muchero is recovering in the maternity ward.
“The nurses treated me very well, with a lot of passion,” she says with a shy smile. Since she gave birth to her second-born child almost three years ago at the same hospital, she can see a marked difference in service provision: “The last time I was here, there was no doctor. [This time] I felt very safe. I definitely want to deliver here again.”
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