Zimbabwe

Things looked encouraging after the nation’s independence in 1980, when access to health care widened. But soon, global lenders’ austerity measures, the HIV/AIDS crisis and a mass exodus of health professionals led to a breakdown in medical services.

HARARE, ZIMBABWE — When Kudzai Nyere gave birth to her son in 2014, the experience was more dramatic than she had expected, because no one was with her in her public hospital room when she pushed the boy out. The nurses neglected her, she says.

“I was left alone, and the baby came out while I was on my own,” she says.

From then on, Nyere vowed, she would seek health care at private hospitals.

“Private doctors give you all the attention you require,” she says.

In the 38 turbulent years since their nation gained its independence, Zimbabweans careened from being joyously optimistic when the doors of the best health care facilities opened to them, to being stunned and bitter once they had few options for help with even basic medical needs. Now, with a new era on the horizon as they prepare to elect a president on July 30, Zimbabweans hope a fresh face will lead to better health care services.

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Zimbabwe’s Minister of Health and Child Care David Parirenyatwa, far left, tours Parkview Hospital in Harare, Zimbabwe’s capital. Zimbabwe’s health care system struggles to keep qualified doctors and nurses.

Gamuchirai Masiyiwa, GPJ Zimbabwe

That’s a hope they’ve seen realized before. When the country was known as Rhodesia, there were about 280 doctors serving 232,000 white residents, while the nation’s black majority of some 7 million made do with just 850 doctors, according to Zimbabwean government data. The facilities and doctors who served the white population garnered the lion’s share of the national health care budget.

When former President Robert Mugabe took power in 1980, his new government made a point of eliminating inequalities in education, job options and land ownership – not to mention basic medical care.

“Those early years after independence, we invested our own money in terms of domestic health financing,” says Itai Rusike, executive director of the Community Working Group on Health, referring to money from the national treasury, not international aid or investment.

Access to health care increased dramatically after the independence hero Mugabe took office, and the results were impressive. Infant mortality rates were nearly halved from 1980 to 1988. UNICEF notes that Zimbabwe’s health care system was “arguably one of the best in sub-Saharan Africa” during the 1980s and 1990s.

Those gains were short-lived, Rusike says.

One big reason for the reversal, he says, was the Economic Structural Adjustment Programme, a set of austerity measures introduced in the early 1990s by the World Bank and the International Monetary Fund that were intended to stabilize Zimbabwe’s economy. Even now, the program receives mixed reviews, and most agree that the results were not good. Some analysts argue that this and programs like it are exploitative – thinly veiled reminders of Europe’s colonial abuses in Africa. Zimbabwe’s faltering economy fell into a full-blown recession after the program took effect.

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Zimbabwe’s Minister of Health and Child Care David Parirenyatwa speaks with a patient at Parkview Hospital in Harare, Zimbabwe. Parirenyatwa says he is looking for ways to improve the nation’s health care system.

Gamuchirai Masiyiwa, GPJ Zimbabwe

The HIV/AIDS crisis, too, taxed the system, Rusike says.

By 2003, one-quarter of all Zimbabwean adults were infected with the virus, according to UNAIDS, the United Nations program established to battle the disease. UNAIDS also notes that this was among the largest nationwide epidemics of the virus in the world.

The health care system nearly collapsed entirely in 2008, when the economy tanked and the government engaged in far-reaching human rights abuses in an effort to quell support for opposition political candidates. Some improvements were made in the health sector between 2009 and 2012, before another downturn in 2013. The National Health Strategy for 2016-2020 notes that the health sector lacks resources and requires innovative, sustainable funding.

One key consequence of the lack of funding is a severe disincentive for health care workers to stay in Zimbabwe.

In 2008, 61 percent of the country’s posts for doctors remained vacant, according to research by the International Organization for Migration, a U.N. agency that conducts research on migration, among other activities. Huge numbers of health care workers had left Zimbabwe to find work elsewhere.

Among the 23 presidential candidates, only a handful have made a point of addressing the nation’s health care woes, with some even promising free health care for vulnerable people.

But Rusike, the community working group director, says those promises are unrealistic. There are already fee exemptions for some vulnerable groups, and there’s not enough money to cover even those promised benefits.

“The government has to come up with innovative health financing strategies to cover these gaps,” he says.

For ordinary Zimbabweans, the ongoing health care crisis means constant risks for people who need medical care.

Kudakwashe Chimumvuri says his brother died in 2017 after he was diagnosed with tuberculosis, because the family didn’t have the money to pay for the blood transfusions or medicine that he needed.

“What we have seen in the last years is that health is one sector that, as a country, we have not done enough to make sure that our health institutions have adequate health workers,” Chimumvuri says.