Primary Health Care for Universal Health Coverage.
Malaria scourge: Community education vital cog to save lives
By Nhau Mangirazi, Newsday
Sadness engulfed Rosina Mujakachi after visiting her pregnant sister battling a malaria attack at Karoi District Hospital two weeks ago.
Her sister was among the over 30 people from the surrounding outlying Hurungwe villages receiving treatment for malaria at the hospital.
It is reported that at least five people died this month at the medical institution when malaria cases peaked in the rural communities, including a malaria hotspot, Kazangarare in Hurungwe North constituency.
Mujakachi said her sister, who is from the Kazangarare area, was diagnosed with malaria. Nyama resettlement is also another malaria hotspot that claimed a local headman last week, according to sources.
Mujakachi was grateful that her sister was being treated.
CWGH Executive Director Itai Rusike
“My concern is on communities which get free mosquito nets regularly but ignore proper use of the nets,” said Mujakachi, adding that most villagers appeared to be reckless about their health.
Hurungwe district medical officer, Munyaradzi Chidaushe, confirmed a malaria outbreak in the area.
“We are calling for precautionary measures from everyone. People must seek medical attention urgently so that we can curb malaria. They must use mosquito nets regularly,” Chidaushe said.
Local transmission in the community has been reduced to very low levels among most outlying rural communities within Mashonaland West province, in three districts, including Chegutu, Mhondoro Ngezi and Zvimba.
Other districts like Kariba, Sanyati, Makonde and Hurungwe are in the control phase where the malaria disease burden is significantly high.
Ironically, last week, Kariba district recorded a surge in malaria cases that reached a peak of 87 cases in one week.
Kariba district medical officer Godwin Muza told stakeholders that the cases were in both urban and rural communities.
Of these 30% are from Msampakaruma rural, with Nyamhunga in Kariba town pegged at 24%.
Kanyati and Kasvisva are at 10% apiece while Gache Gache stands at 8%.
Mahombekombe and Siakobvu have 6% of the cases each.
On April 25, Zimbabwe joined the rest of the world to celebrate World Malaria Day amid renewed calls for community education to support malaria eradication.
Women Action Group director Edna Masiiwa commended Zimbabwe for making positive strides in combating malaria through donor support.
“Fortunately, Zimbabwe has sound policies on malaria with full-fledged personnel at the ministerial level covering all communities with the support of grassroots community health workers. Some donors, including the Global Fund, are pushing the country’s agenda of malaria eradication. We hope it further helps the country to reinvest and reimagine its focus on the malaria thrust,” she said.
Masiiwa, however, noted that the health sector faces challenges of worker flight.
“Retention of some workers in health sector remains a challenge, but we hope and trust that it will be corrected sooner rather than later,” she added.
She bemoaned abuse of mosquito nets in some communities.
“As a country, we must continue with community education to help those mostly affected in remote areas understand the positive gains of using mosquito nets donated freely for their well-being. It’s a challenge that the country faces and needs a holistic health approach to overcome,” Masiiwa, a women’s rights advocate, noted.
Mrs Masiiwa
Community Working Group on Health executive director, Itai Rusike, admitted that malaria remains a national health challenge.
“The burden is particularly devastating for pregnant women and young children,” Rusike said.
He added that sustained funding was critical to keep prevention and treatment efforts on track.
“If mosquito nets and preventive medicines for pregnant women are unavailable, lives will be lost. When the supply of test kits and first-line treatments is disrupted, malaria cases and deaths spiral. Investing in the fight against malaria not only saves lives but also boosts productivity, creates economic opportunities, strengthens national health security and makes the country safer for everyone,” Rusike said.
“Now is not the time to pause the fight. It’s the time to give everything or risk a surge in malaria cases, growing resistance and the spread of the disease across districts including to non-malaria areas. If left unchecked, malaria will become much harder and more expensive to control, thereby putting millions of lives and decades of progress at risk.”
Rusike, a health advocate, said the country must act decisively to end malaria as a public health threat and build a healthier, safer, more prosperous future for all.
“Everyone must help in the eradication fight,” he said.
Mashonaland West provincial health promotion officer, George Kambondo, said World Malaria Day was a reminder for continued efforts to eliminate malaria and ensure a healthier future for all.
“Let’s work together to raise awareness, support research and advocate for better healthcare systems. Zimbabwe joins other countries in the world to commemorate Malaria Day. Let’s fight malaria. Together, we can make a difference and save lives,” he said.
Kambondo added that there was a need for combined efforts.
“Let’s remember that every life lost to malaria is one too many. By investing in prevention, diagnosis and treatment, we can save lives and build stronger, healthier communities,” he said.
According to government, Manicaland province is the most affected province, contributing 40,7% of malaria cases and 38,8% of deaths in the country, followed by Mashonaland Central, which contributed 28,2% of cases and 24% of deaths.
“Children under 5 years of age account for 14% of the cases. Nationally, there were 36 423 malaria cases with 85 deaths recorded,” the statement by the Health and Child Care ministry said.
On a positive note, Africa stands at the forefront of a revolutionary shift in global health, driven by artificial intelligence (AI) and data science, according to a report released in early April.
The landscape presents an unprecedented view into the potential to improve AI governance in Africa to reduce the risk and stop the perpetuation of inequity.
Titled Governance of Artificial Intelligence for Global Health in Africa, the report was sponsored by Science for Africa Foundation after a culmination of a year-long effort involving convenings across Africa’s five regions, policy analysis and extensive surveys to identify policy gaps and opportunities in AI and data science for global health.
This year’s theme is Malaria ends with us, reinvest, reimagine and reignite, calling for renewed investment, innovation and commitment at all levels of the malaria eradication community to accelerate progress towards ending the disease.
Globally, there were 597 000 malaria deaths in 2023, with 263 million new cases of malaria in the same year.
According to the World Health Organisation (WHO), 95% of malaria cases are in the African region.
The global community recommitted to eradicating malaria in the late 1990s and, as a result, an estimated 2,2 billion cases and 12,7 million deaths have been prevented over more than two decades.
WHO noted that after years of a steady decline, progress has stalled.
“Further progress and decades of hard-won gains are in jeopardy.
Extreme weather events, conflict, humanitarian emergencies and economic stresses are disrupting malaria control efforts in many endemic countries, leaving tens of millions of people with limited access to the services they need to prevent, detect and treat the disease,” WHO said.
It added that without prompt treatment, malaria can rapidly escalate to a severe illness and death.
“It’s time to recommit to ending malaria. We have the knowledge, life-saving tools and targeted prevention, testing and treatment methods to defeat this disease.
We must reinvest in proven interventions, reimagine our strategies to overcome current obstacles and reignite our collective efforts together with countries and communities to accelerate progress towards ending malaria,” WHO said. – Newsday
Childhood on the Brink in Zimbabwe’s Midlands
By Gamuchirai Masiyiwa,
Eneles Zhou cooks outside her home. Zhou, a mother of five, has dedicated her life to caring for her children with sickle cell disease.
ZVISHAVANE, ZIMBABWE — Morning light slants through the window as Eneles Zhou inspects two of her children. They’re wrapped in blankets. Despite March’s typically warm days, in this home in the Midlands province, Zhou’s children struggle with temperatures their bodies cannot regulate.
A mother of five, Zhou quickly coaxes flames to life and prepares porridge, timing it with the children’s medication schedule — folic acid to boost red blood cells, then hydroxyurea to prevent any complications. Over the years, this routine has become familiar.
When her firstborn was diagnosed with sickle cell anemia, a hereditary disease, at 7 years old, Zhou had never heard of it. Doctors told her that 1 in 4 children might inherit it, and with two symptom-free, she clung to hope.
But by 2021, tests had confirmed that three of her children carry a severe form of the disease. Two others have a milder version.
Zimbabwe’s widespread failure to screen newborns means many families only discover the condition after irreversible damage has begun. Without early detection, children often suffer severe complications or die, even before the age of 5, says Dr. Patience Kuona, a pediatric hematologist who’s spearheading a sickle cell research initiative.
In 2024, Zimbabwe launched its first pilot screening program, testing 550 newborns and revealing that the sickle cell trait affects between 3% and 12% of the population. The data is not yet published, says Kuona, the lead researcher.
Still, the pilot — part of ongoing research by the Sickle Hemoglobinopathy Research in Zimbabwe and Zambia — marks only the beginning of a much longer journey for those with the disease.
Specialized care, especially for families outside major cities, remains a mirage. Essential medicines — folic acid, penicillin, hydroxyurea — are often unavailable in public health facilities. Advanced treatments such as bone marrow transplants and gene therapy are not available due to resource constraints. Specialized sickle cell disease clinics exist in five central hospitals, with limited provincial access.
“Pain relief is there, but opioids are scarce in lower-level hospitals,” Kuona says.
Eneles Zhou high-fives her daughter, Partner Sibanda, at Gresham Primary School. Despite frequent absences due to her sickle cell disease, Partner excels academically.
Sickle cell disease, the world’s most common inherited blood disorder, warps healthy cells into crescents. The sickle cells break down easily, leading to anemia. They can also clog small blood vessels, causing excruciating pain and organ damage.
Globally, 7.74 million people bear this genetic burden. Over half a million children were born with the disease in 2021. While Zimbabwe’s 12% prevalence rate appears modest compared to hot spots like Nigeria, Uganda and Democratic Republic of Congo, where rates soar to between 20% and 45%, the country’s fragile health care infrastructure magnifies suffering, turning what should be a manageable condition into a daily battle for survival.
Zhou’s case is especially challenging. Her five affected children are different ages — one adolescent, two teenagers and two preschoolers — and the complications worsen as children grow, with higher risks of infections, kidney problems, blood clots and stroke.
Zhou’s eldest, Panashe Sibanda, 20, has endured the worst. Despite six daily medications, he is constantly in pain. He struggles to sustain friendships. He can’t join gatherings because pathogens infect him too easily. A simple cold triggers what he calls a “pain crisis,” which no over-the-counter painkiller can relieve.
For 1 in 3 people with sickle cell disease, pain is a near-daily companion. More than half grapple with pain most days.
“I’ve survived 61 near-death experiences since I was 13,” Sibanda says.
The disease burdens families financially through frequent hospitalizations and work loss. Zhou’s husband’s irregular carpentry work barely sustains them. Zhou doesn’t work outside her home; her children’s disease requires full-time care.
During her children’s playtime, Zhou remains alert. These aren’t carefree moments of childhood abandon; they’re carefully monitored sessions within the confines of their immaculate home. One dust mote could trigger an infection.
“I am always nervous,” she says. “Always anxious.”
Eneles Zhou walks her daughter, Partner Sibanda, to school. Zhou’s daily routines are shaped by her children’s medical needs, including monitoring school attendance.
Photos Credit: Gamu Masiyiwa
This article was first published in the Global Press Journal (GPJ)
A Worthwhile Opportunity #SRH
Afya na Haki (Ahaki) is an African research and training institute that uses africentric approaches to generate knowledge and enhance advocacy capacities in the areas of Health, Human Rights and Sexual and Reproductive Health and Rights (SRHR).
38 Measles Cases Reported in Zimbabwe
ZIMBABWE recorded at least 38 new suspected measles cases last week from all provinces except Bulawayo metropolitan.
The disease re-emerged several weeks ago and according to the Health and Child Care ministry, 15 suspected cases and zero deaths had been reported by April 3 this year.
The ministry said the cases were reported from Mashonaland East (6), Masvingo (2), Harare (2), Mashonaland Central (1), Mashonaland West (1), Matabeleland North (1), Matabeleland South (1) and one case in Manicaland.
The cumulative figures are 93 cases.
Experts who spoke to NewsDay expressed concern over the re-emergence of the medieval disease.
Johannes Marisa, a medical expert, said there was need for more awareness so that people knew how to prevent the disease.
“Measles has always been there and it can come in outbreaks which can be sporadic like what you highlighted above. What matters for now is for people to be cognisant of the fact that they have to receive a vaccination against measles, especially those that have not been vaccinated,” he said.
Marisa said children should be vaccinated at all costs to limit the risk of contracting the disease.
“Children should not escape vaccination. If one is not vaccinated, they are at a very high risk of mortality since the severity of the disease can be very high.
“I encourage everyone to take vaccination seriously so that we have a milder disease or we can stop the spread of the viral disease,” he said.
Marisa expressed concern over religious sects that do not embrace vaccination, saying this complicates healthcare delivery as it leaves people exposed to preventable diseases like measles.
Community Working Group on Health executive director Itai Rusike described the outbreak as unfortunate, adding it was sad that young Zimbabwean children, mostly those under the age of five, continued to contract measles despite the availability of a vaccine.
“The current measles outbreak in almost all the provinces may be as a result of a drop in vaccination coverage or depressed vaccination coverage post-COVID-19 and other health systems coverage.
“There is a need to accelerate immunisation activities to reduce measles cases and a deliberate effort should be made to reach out to the leadership of the various religious groups so that they can appreciate the benefits of getting their children vaccinated against measles,” he said.
Zimbabwe suffered a severe nationwide measles outbreak in April 2022 that proved to be deadly, particularly for children.
More than 750 children died from the disease within first six months of the outbreak.
Doctors fight silent war with mental health
By Nhau Mangirazi, Newsday
CWGH Executive Director Itai Rusike
DESPITE putting up a brave front while attending to patients, one of the few doctors assigned to a district hospital in rural Zimbabwe is unhappy.
Speaking in a hushed tone, he confesses that all is not well for the medical staff.
They normally face harsher realities of mental health challenges.
“The sad reality is that many doctors are undergoing mental health challenges fuelled by poor working conditions and lack of innovation and medical equipment to use,” he said, speaking on condition of anonymity.
“We are working under stressful conditions.”
Three medical doctors, instead of seven, man the hospital, making the workload unbearable for them.
According to a random survey, doctors have not been spared by mental health challenges which have become a growing concern, amid an economic crisis gripping the nation.
Key stakeholders have challenged government to invest more in the recruitment of medical personnel to ease the burden on the few who are working in the health sector, many of whom are considering migrating to stable economies.
The calls were made as the country commemorated the World Doctors Day on March 30.
Zimbabwe Association of Doctors for Human Rights executive director Calvin Fambirai confirmed that all is not well in the health sector.
“There is poor and limited recruitment, retention of skilled healthcare professionals,” he said.
“This can be achieved through improved working conditions and fair remuneration.”
Fambirai further explained that shortages of essential medicines and medical supplies have worsened the situation.
“Generally, doctors face shortages of personal protective equipment and it’s a battle for survival,” he said.
“We are committed to doing our best, but these limitations affect our operations.”
Community Working Group on Health executive director Itai Rusike acknowledged that in Zimbabwe, the standards have fallen really low, where doctors suffer burnout, low self-esteem due to the system-wide poverty, limited management support and lack of staff health support.
“While this mostly pertains to the public sector doctors, those in the private sector are also suffering from fatigue and sometimes late or non-payment of claims by medical aid companies, which take advantage of both the service providers and the patients,” Rusike said.
He, however, noted that by design, the work of a physician is mentally challenging as one is always expected to be in the know and to provide solutions, including support to junior staff.
“When no one cares for the carer, this becomes a tall order and results in mental breakdown. The family and other societal expectations also add rather than subtract from this burden,” Rusike said.
“Furthermore, doctors work as multi-professional and multi-disciplinary teams if they are to deliver comprehensive patient management.
“The current situation of a multi-systems collapse exerts undue pressure on clinical and public health physicians and their respective teams as they fail to provide optimal care and yet they too have numerous insufficiencies at personal level.”
According to Rusike, the work of a doctor comes as a package and gets severely disrupted should the tools of trade be unavailable.
“While medical doctors require a hospital environment to deliver effective services, the population health specialists require a conducive framework combining socio-economic, political and environmental provisions in order to function optimally and deliver the full basket of preventive, promotive, therapeutic and rehabilitative services.”
The World Health Organisation (WHO) said the commitment of doctors around the world was under silent crisis.
“Doctors worldwide face high levels of burnout, depression, anxiety and suicide. They dedicate their lives to healing others, yet their own mental health is often overlooked,” the global health body said in a statement on World Doctors Day.
It noted key facts affecting the doctors, including workload, low pay, unsafe environment and stigma that see many struggling in silence.
“WHO warns of a shortfall of 11 million health workers by 2030, where female doctors are 76% more likely to die by suicide than other women,” the statement said.
Globally, there are only 35% of countries that offer national work-related mental health support programmes.
“On this day, let’s raise awareness and celebrate doctors everywhere for the care and dedication they bring to their work everyday,” WHO concluded. -Newsday
‘Abuja Declaration target remains a pipe dream for Zimbabwe’
By Vanessa Gonye, Newsday
CWGH Executive Director, Itai Rusike
HARARE, Apr. 2, (NewsDayLive) – The Community Working Group on Health (CWGH) says Zimbabwe’s hope of achieving the Abuja Declaration target on healthcare funding will likely remain a pipe dream as allocations and fiscal disbursements to the health sector have remained below 15% of the national budget.
Signed on April 27, 2001 when African governments pledged to allocate at least 15% of their annual budgets to the health sector, the Abuja Declaration was meant to strengthen Africa’s health systems and ensure they are adequately capacitated to manage natural disasters.
Speaking on the country’s failure to meet the allocation as stipulated by the declaration on Tuesday, CWGH executive director Itai Rusike said despite progressive increases in budgetary allocations towards the 15% allocation for health, the fiscal disbursements have been inadequate to keep the system afloat.
“The 15% mark has never been attained, with government spending on health care as a percentage of total public expenditure increasing only from 10.6% in 2022 to 11.2% in 2023,” Rusike said.
“This poor financing for health has been another sore issue for the health workers as they interface with clients they cannot adequately serve.
“The majority of clients seen in the public sector remain without comprehensive healthcare except for a few selected diseases and conditions which receive vertical funding (HIV/Aids, TB, Malaria, maternal and child conditions).
“Despite the recent moves towards integration, community health workers get frustrated rendering inadequate service and have, therefore, been moving to more resourced jurisdictions.”
He said the situation means that universal access to health remains beyond reach, until the budgetary bottlenecks have been adequately addressed .
Rusike also noted that the past two decades have been characterised by massive outward migration of health, education, social and other professionals due to the protracted social, political and economic demise.
“This state of affairs has greatly impacted the government’s functionality with the high levels of corruption taking resources away from where they are needed most,” he said.
“The results have been telling in the multi system collapse including public health infrastructure and services.”
Health minister Douglas Mombeshora last month claimed that several key health indicators had shown notable improvements.
“We are particularly proud of the advancements in areas like maternal and child health, disease prevention, and healthcare infrastructure,” Mombeshora said.
“Looking ahead, we remain fully committed to our shared vision of increasing access to quality healthcare for all Zimbabweans.”
Revitalizing PHC4UHC by 2030 and rebuilding a fragile health system from the bottom up
… Addressing Zimbabwe’s Health System Demise and Brain Drain
By Itai Rusike
This article was first published in the Medicus Mundi Switzerland (MMS) Bulletin, #172 March 2025
The health and social services must function optimally for a country to realize social cohesion, economic growth, and be in tandem with the global health and security agenda. The current situation of investing in education and professional training and then “donating” the young and able-bodied products to already established, functional health systems located in wealthy countries is a luxury that poor economies like Zimbabwe cannot afford. The remaining few health workers remain frustrated and incapacitated to deliver effective care resulting in the subdued population health status currently obtaining in Zimbabwe.
CHWs in Zimbabwe participating at the National Health Financing Dialogue – @Itai Rusike
The development and transition of the health system in Zimbabwe over the decades
Zimbabwe has documented a number of transitions in its healthcare delivery system. In the pre-colonial era and before introduction of conventional medicine, traditional and spiritual methods of diagnosis and treatments were complemented by diets and taboos that supported the health across the life course. There were specific foods and medicinal plants for the pregnant women, newborns, young children, adolescents, young adults and the elderly. Various medicine men and women and the older uncles and aunts would oversee these, but there were no formally trained health professionals.
The colonial era came with introduction of western medicine but was limited mostly to the urban, mining and agricultural areas, and left the rural areas to continue their various traditional medical practices to address ailments. This saw the introduction of formal training of the natives in health especially nursing, environmental health to complement those introduced by the settlers. The first African Zimbabwean doctor was Samuel Parirenyatwa.
At its Independence in 1980, and just two years after the Alma Ata Declaration the government premised its health delivery system on the concept and philosophy of Primary Health Care (PHC) (WHO, UNICEF, 1978); greatly expanding the reach of conventional medicine to the rest of the country in terms of more health institutions and a defined healthcare workforce for the public health system, to be followed by a health workforce “establishment”. This was after the realization that the majority of the population resided in the rural areas and yet health care was centralized in the few urban centers. A number of policy pronouncements guided the process of ensuring the goal of “health for all by 2000”; including the white paper on health of 1981, “Planning for Equity in Health” of 1985, and the accompanying decentralization saw much improvement in the population access to affordable and quality health care.
In the 1997-2007 national health strategy, 85% of the population had access to a health facility within 10Km. The public health system catered for about 80% of the population through central government, local government, church and NGO run institutions. The life expectancy, maternal, child and general mortality in the population greatly reduced while health status and other favorable indicators improved leading to the country attaining notable health and welfare standards.
At its Independence in 1980, and just two years after the Alma Ata Declaration the government premised its health delivery system on the concept and philosophy of Primary Health Care (PHC).
Current situation
A number of challenges have almost reversed this progress and development of Zimbabwe’s health sector of which have been decades of socio-economic and political challenges that impacted negatively on health and related social services. These have been compounded by weaknesses within the system characterized by rigidity within the governance and management levels and resultant failures to adapt to the changes. The health workforce bear the brunt of these systemic weaknesses and failures and so after the demise of almost all the health system building blocks trained and experienced staff have been leaving in large numbers to join the private sector, neighboring countries and the diaspora. The major complaints have been poor remuneration, limited access to tools of the trade, as the health institutions continue to have stock outs of medicines and major supplies.
The weak governance systems also mean that there is no organized systems to adequately plan for and deploy the few trained personnel to benefit their populations, nor benefit the country when they emigrate to other countries.
The country and health system failed to adequately adopt to major transitions and have left healthcare workers with little or no support in terms of capacitation to cope, protection from infections within institutions and during public health crises, nor financial cover to make their work and contribution worthwhile. Among the transitions have been the structural adjustment programs, (ESAP) of the mid 1980’s, the HIV pandemic of the early 1990’s, and now the socioeconomic and political situation since the turn of the millennium. There have also been demographic, epidemiological and technological transitions in line with population increases, disease trends and this combination of major changes required a corresponding governance and management structure that responds with timely and effective policy and legislative responses that ensure sustainable service delivery with the health workforce at the center- being a services sector.
However the decentralization of early 1990’s was not followed by devolution and healthcare worker issues have continued to be centralized, fueling frustration and health worker exodus and thus almost emptying the institutions of their health workforce.
Despite progressive increases in budgetary allocations towards the 15% allocation for health, (Abuja, 2001), the fiscal disbursements have been inadequate to keep the system afloat. The 15% mark has never been attained, with Government spending on health care as a percentage of total public expenditure increasing only from 10.6% in 2022 to 11.2% in 2023.
This poor financing for health has been another sore issue for the health workers as they interface with clients they cannot adequately serve. The majority of clients seen in the public sector remain without comprehensive care except for a few selected diseases and conditions which receive vertical funding (HIV/Aids, TB, Malaria, maternal and child conditions). Despite the recent moves to integration Health Communitiy Workers (HCWs) get frustrated rendering inadequate service and have therefore been moving to more resourced jurisdictions.
This situation means that universal access to health remains beyond reach, until and unless the complex health situation is effectively addressed. The recent developments of wars, climate crises and the major shifts in the donor landscape well before the earlier warning of the 2030 deadline requires urgent action on the part of government and the health ministry.
The majority of clients seen in the public sector remain without comprehensive care except for a few selected diseases and conditions which receive vertical funding (HIV/Aids, TB, Malaria, maternal and child conditions).
Causes of the global health care workforce shortages
A number of factors are responsible for the current situation including the demographic and epidemic transitions. The inadequate health workforce in developed countries cannot cope with the combined complexities of chronic diseases compounded by ageing populations. Meanwhile in developing countries it’s the opposite in that the epidemiological transition has not been effectively addressed as they remain with a huge burden of infections, emerging and re-emerging diseases, unchecked chronic/noncommunicable diseases which include injuries, mental health conditions and substance abuse.
The demographics are characteristically young populations but with limited access to education and training opportunities due to weak health, education and other social systems. The weak governance systems also mean that there is no organized system to adequately plan for and deploy the few trained personnel to benefit their populations, nor benefit the country when they emigrate to other countries. The case in point being that of the expatriates deployed to Zimbabwe during the post-independence era and in recent times, the Cuban health, education etc brigades whose deployment is regulated by their state, and follows signed agreements with the receiving countries. The World Health Organization (WHO) Global code on recruitment of health care workers has not been heeded, neither is it enforceable in the member states as is the framework convention on tobacco control, (FCTC) and the international health regulations, (IHR, 2005, 20012), both of which are binding.
The current situation of investing in education and professional training and then “donating” the young and able-bodied products to already established, functional health systems located in wealthy countries is a luxury that poor economies like Zimbabwe cannot afford.
Social and economic consequences of a shortage of HCWs for countries with weaker health systems
In Zimbabwe, the past two decades have been characterized by massive outward migration of health, education, social and other professionals due to the protracted social political and economic demise. This state of affairs has greatly impacted on government’s functionality with the high levels of corruption taking resources away from where they are needed most. The results have been telling in the multi system collapse including public health infrastructure and services.
As a result, the major determinants of health have become severely neglected, causing outbreaks and adding a considerable burden of preventable diseases and conditions. For a largely unemployed population, the paradox is the huge out of pocket expenditure for preventable ailments while the collapsed system cannot serve the clients. The result has been adverse health indicators across the population with considerable premature, avoidable and excess mortality.
How do HCWs experience the effects of staff shortage?
Healthcare workers are supposed to work as teams and seldom in isolation. At central, city and provincial hospitals there used to be multidisciplinary teams of 2-4 consultants per firm, with registrars, senior and junior residents, then the nursing team, physiotherapists, nutritionist etc., but currently there may just be one doctor -and few nurses. The workload becomes unmanageable and each shift is taxing as oftentimes one cadre has to carry out the tasks of 3 or 4 others, with no one to discuss the patient condition, treatment options nor debrief.
This has resulted in burnout of the few cadres whose recognition and remuneration has not increased significantly despite the increased demand on them. The patients and their relatives often accuse them of blocking services and pilfering medicines and supplies for their benefit when in fact it’s the nationwide corruption that has stripped the system and caused the neglect. At the districts and remote clinics often one nurse has to oversee a whole unit and this compromises patient care, accurate documentation and patient follow up. There is little time for continuous professional development as most of the time the staff is overwhelmed and working solo.
The patients and their relatives often accuse them of blocking services and pilfering medicines and supplies for their benefit when in fact it’s the nationwide corruption that has stripped the system and caused the neglect.
How effective is the WHO Global Code of Practice on international recruitment of HCWs?
For countries like Zimbabwe the global and even the WHO Afro regional office pronouncements on preventing or minimizing health worker migration have been ineffective. There has to be some acknowledgment to the sending country to compensate for its investment in the professional and this to be ring-fenced to further enable training and or improving the working environment of those who remain in-country. Deliberate efforts must be made to invest in addressing the demise of the health systems that have bled too many healthcare workers by the major receiving and wealthy nations.
There has to be some acknowledgment to the sending country to compensate for its investment in the professional and this to be ring-fenced to further enable training and or improving the working environment of those who remain in-country.
What are the potential solutions to address HCWs crisis/shortage long term?
– Address the work environment by re-investing and revitalizing the health delivery system across the WHO’s six building blocks of a health delivery system, and in tandem with a revitalized primary health care for universal health access (PHC4UHC, CWGH, PHCPI, 2022).
– Implement the health financing reform in line with the dwindling donor support and the critical need for a robust local financing architecture.
– Improve the governance and management of the healthcare workforce and ensure that well trained health professionals are in charge and make decisions rather than the corruptly appointed management.
The latter have been competing with and further frustrating the healthcare workers and yet remain without a sound understanding of the system and its complexities. Given the extent of the demise and the high turnover of staff over a protracted period, there may be need to bring in some of the old guard, (retired but not tired) to hand hold and mentor the young inexperienced staff. This can help restore the dignity of the profession, improve confidence, service delivery and patient outcomes.
The government must also ensure implementation of the Constitutional provisions for health and its determinants, enforce the public health act and enforce mandates across all sectors that hold key determinants of health in order to effectively prevent disease and promote health. The result will be more manageable workloads for the reduced staff. Furthermore, there has to be strategies that address the huge and unchecked burden of non-communicable diseases, injuries and mass trauma casualties, mental health, substance abuse and climate induced health issues that have not yet received attention but are over-loading the limited health workforce.
Itai Rusike is the Executive Director, Community Working Group on Health (CWGH) – Zimbabwe. Itai is a Public Health Activist with more than 20 years’ experience organising involvement of communities in health actions in Zimbabwe. He is a member and chairperson of various health related committees, along with being the Vice-President of Medicus Mundi International Network.
For the full bulletin, follow link : https://www.medicusmundi.ch/en/advocacy/publications/mms-bulletin/health-workforce-shortage-are-there-potential/kapitel-1/addressing-zimbabwe%E2%80%99s-health-system-demise
CSOs, women call for amendment of Termination Of Pregnancy Act
CSOs, women call for amendment of Termination Of Pregnancy Act
By Virginia Njovo, TellZim News
Young women and Civic Society Organisations (CSOs) have called for the amendment of the Termination of Pregnancy Act (TOP) to allow safe abortion services to be accessed widely with studies showing that 25 percent of pregnancies end up getting aborted due to various personal and social circumstances.
Speaking to TellZim News in an interview, Community Working Group on Health (CWGH) Executive Director Itai Rusike, said there was need for the revision of the laws that abolish abortion because despite it being illegal, a large number of women were doing it unsafely.
“Many women and girls are driven into the shadows because of restrictive abortion laws and lack of clarity about their provisions.
“They continue to seek for abortion services outside health facilities, with most of these abortions being done in unhygienic conditions by people who are not trained to do the procedure, let alone address the complications which may arise leading to high morbidity and mortality,” Rusike said.
He said the topic was taboo in Zimbabwe and the African society but abortions continue to happen behind the scenes so revising the legislation would help promote safe practices.
“The topic of abortion is taboo within the African context and cultures, as it is not openly talked about although evidence shows that it happens frequently,” said Rusike.
Adolescent Girls and Women Rights Forum (AGWRF) Executive Director and Sexual Reproductive Health Rights (SRHR) advocate Priscilla Mafa told TellZim News that the restrictive laws do not stop the need but promotes unsafe abortions.
“The restrictive abortion laws in Zimbabwe do not stop the need for abortion; they only make it unsafe. People are having backdoor abortions. The fact that 25 percent of pregnancies result in abortion despite legal barriers shows a critical gap in SRHR services, access to contraception, and comprehensive sexuality education,” said Mafa.
She said the restrictions endanger women and violates their bodily autonomy against the Maputo Protocol in which Zimbabwe is a signatory to saying there was need for policies that respect women’s health choices.
“Criminalizing abortion not only endangers women’s health but also violates their right to bodily autonomy as recognized by international agreements like the Maputo Protocol and Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), to which Zimbabwe is a signatory. We need progressive, evidence-based policies that prioritize women’s health and choices, rather than punitive measures that perpetuate stigma and inequality,” she said.
The Maputo Protocol, officially the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa, is a landmark human rights instrument adopted in 2003 that guarantees comprehensive rights for women and girls in Africa, including political participation, equality, reproductive health, and freedom from violence
CEDAW was adopted in 1979 by the UN General Assembly, and is described as an international bill of rights for women, defining discrimination against women and establishing legal obligations for states to end it.
In another interview with TellZim News, My Age Zimbabwe Trust Communications and Advocacy Officer, Veeslee Mhepo, said there was need for legislative reform to expand abortion access as lives were being lost due to unsafe abortion practices.
“We are advocating for the amendment of the TOP Act so that abortion services become available in every healthcare facility. Currently, only Post-Abortion Care (PAC) services are provided, but abortion itself remains largely inaccessible.
“We are losing lives due to unsafe backyard abortions. In addition to advocating for legal changes, we are conducting outreach programs to educate young people on Sexual and Reproductive Health (SRH) to reduce unwanted pregnancies,” said Mhepo.
Several young women who spoke to TellZim News expressed their desire for legal abortion services to be accessible at public health institutions, as many young girls get pregnant before they are ready for motherhood, leading to an increase in unsafe backyard abortions, which put lives at risk.
“We engage in sex but in most cases pregnancy is not expected. It may be another burden on top of my existing struggles so I may choose to terminate it. In most cases we are forced to do unsafe abortions because of its legality. So we think it the act should be revised so that safe services are provided,” said one young woman.
Another young woman said some were getting pregnant whilst in school thereby affecting their school despite the government allowing them to remain in school. So she said there was need for the law to consider that and allow victims of such situations to have safe abortions.
“I might not have been raped, but if I fall pregnant before finishing my studies, approaching my parents would be difficult so terminating the pregnancy will be the best option. So access to safe abortion should be available for those who need it,” she said.
Another woman said if the government does not want to amend the law, at least there should be more circumstances in which termination is allowed.
“We are having girls below 14 getting pregnant and the law should allow abortion in that circumstance and any other which may be deemed appropriate,” said the young woman.
Despite growing calls for reform, Masvingo Urban MP Martin Mureri, who is also a human rights lawyer, opposed the changes to the law.
“I am against this proposal. We must consider the original intent of the legislature when this law was made. What problem was it meant to address? Has that problem been solved?
“Yes, we know that abortions are happening through the backdoor, but that does not mean they should be legalized. Culturally, this cannot be defended,” said Mureri.
The TOP Act, which was enacted in 1977, has remained unchanged despite significant social and medical advancements. When Zimbabwe’s Constitution was amended in 2013, the law was left intact, despite shifting global perspectives on reproductive rights.
According to the TOP Act, abortion is legally permitted only if the pregnancy poses a serious threat to the mother’s life or could cause permanent physical impairment to the child. Abortion is also permitted if the pregnancy resulted from rape, incest, or intercourse with a mentally disabled woman.-TellZim News
Zimbabwe’s New Mothers Face Extortion for ‘Free’ Child Health Cards
By Gamuchirai Masiyiwa, GPJ Zimbabwe
Women wait with their children at a local clinic in Harare. Many reported being unable to obtain the free Child Health Card, leaving them without official records of their infants’ medical histories.
Photo Credit: Gamuchirai Masiyiwa, GPJ Zimbabwe
HARARE, ZIMBABWE — First-time mother Connie Jowa stands with her 3-month-old baby nestled against her back, chatting with other mothers in line. Like many women at this crowded clinic in Harare’s Mabvuku suburb, Jowa is trying to get a Child Health Card, which was unavailable when she gave birth at a public hospital, and was still out of reach at her local clinic. Health cards are mysteriously out of stock.
But they can be bought under the table, if you know who to ask and are willing to pay.
Zimbabwe’s Child Health Cards, meant to be free to new mothers, are crucial documents that track babies’ growth, vaccinations and medical histories. Without them, each clinic visit becomes a reset button. Inquiry into the child’s medical history starts from scratch. Since July 2024, the cards have disappeared from health facilities across Harare’s central hospitals and 42 council clinics — even though the card’s producers say they’re making enough to meet demand. This artificial shortage has birthed a shadow market where clinic staff quietly sell this essential document to desperate mothers. This sort of nickel-and-dime bribery exposes deep cracks in a health care system that’s already failing the most vulnerable people.
What started as a clandestine operation has become an open secret.
“When cards arrive at a clinic, they’re kept by the sister in charge. But it’s usually nurse aides or junior staff who sell them, working in cahoots with other staff members,” says Simbarashe James Tafirenyika, who leads the Zimbabwe Municipality’s Nurses and Allied Workers Union.
Someone who sells 100 cards can pocket around US$500, she says, and none of that money goes to the government of the council.
The going rate for the Child Health Card is US$5, say several mothers who spoke to Global Press Journal.
Medical Histories on Scraps of Paper
When the system works as designed, every mother receives a Child Health Card when her baby is born. Now, most mothers must track their infants’ medical histories on scraps of paper.
Harare’s council clinics alone deliver more than 3,000 babies every month, with each mother left scrambling for documentation.
“I feel hurt,” Jowa says. “I want to know what vaccines my child has received and their purposes, but I just can’t get that information.”
A nurse aide assistant at one of the council clinics has witnessed this shadow market.
“If a nurse is selling, they ask the mother to be ‘skillful’ if they need the card,” says the assistant, who requested anonymity for fear of retribution. In Zimbabwe, “skillful” is a common euphemism for paying small bribes.
While the Ministry of Health and Child Care is supposed to supply the cards for free, Prosper Chonzi, the City of Harare’s director of health, admits supplies have been erratic for six months and that people have complained about being forced to purchase these cards. Clinic workers may be exploiting the known shortage and coordinating among themselves to sell the cards rather than providing them for free, he says.
“We can’t rule that out,” he says.
The card shortage coincides with the quiet return of maternity fees in public hospitals. Though not officially announced, hospitals have begun billing mothers after delivery — a policy change the government would neither confirm nor deny.
High Inflation, More Corruption
Between 2011 and 2024, more than 1 million pregnant women in the country delivered babies for free at health care clinics, under a scheme called results-based financing. Maternal mortality rates dropped during that time.
But these gains, partly achieved through better access to safe delivery services, face new hurdles as budget constraints and economic pressures reshape the health care landscape.
Even in 2021, a study from Transparency International Zimbabwe surveyed over 1,000 people in Zimbabwe and found that 74% had been asked to pay a bribe while trying to access health care services. A feeling of being underpaid amidst a deteriorating economy and high inflation was a key driver among health workers who solicitated bribes, which has been a rising trend, according to the study.
“The motivation for earning an extra income is strong especially in countries with a high rate of inflation,” the study states.
Zimbabwe’s health care system faces chronic challenges, including an exodus of health workers to other countries, inadequate funding, drug shortages, obsolete infrastructure and more. In 1991, the government introduced user fees across public institutions as part of an economic structural adjustment program. The government abolished the fees in 2011, only to partially reinstate them around 2013.
Prudence Hanyani, a community activist in Harare, says the reintroduction of user fees in public hospitals will burden women who already shoulder extra costs, like paying for midwives, so they can get better treatment when giving birth.
“Maternal health services should be free,” she says, “because giving birth is a service for the nation that contributes to the country’s population.”
Mothers Pay the Price
Valerie Shangwa, who gave birth four and a half months ago at a private maternity hospital, still has no card for her daughter.
“You know how difficult it is to keep a paper,” she says. “When nurses ask about last month’s weight, you end up guessing, and that distorts the whole record.”
Charlton Prickise, technical director at Print Flow, says his company sells Child Health Cards only to government-authorized health facilities and faces no shortages.
“The shortages mean health facilities simply aren’t coming to get them,” he says.
Though Print Flow hasn’t detected leaks, Prickise recalls finding other versions of this card on the market two years ago, possibly from a nongovernmental organization. Print Flow isn’t the sole supplier of the cards, and they haven’t received any government orders recently.
In a written response to Global Press Journal, Donald Mujiri, spokesperson for the Ministry of Health and Child Care, said the shortage of Child Health Cards is due to supply chain inefficiencies and insufficient donor funding. The cards, he says, are procured with government funding and aid from supporting partners such as the United Nations Children’s Fund. Nevertheless, Mujiri says, the ministry needs to strengthen the supply chain management system at all levels and proactively mobilize resources for procuring the cards.
Meanwhile, mothers wait — or pay the price. Faith Musinami, 26, delivered her daughter in July 2024. An orderly told her the clinic only had cards for boys, but if she wanted, they could organize one for US$5. Musinami had not budgeted for the cost. She sacrificed the last penny she had. -Global Press Journal