Remembering the Zim health care system’s heyday

WARDS bustling with highly motivated healthcare workers, readily available medication, decent salaries, a thriving teaching hospital network — defined Zimbabwe’s health care system in the 1980s. Back then, it was considered a model of efficiency and effectiveness in Africa.

Today, however, the system is broken. Shortages of medical supplies, a crumbled infrastructure and a mass exodus of healthcare workers have left the country unable to meet the needs of its people.

Among those left questioning the decline is Stella, who worked as a nurse in Zimbabwe in the 1980s and witnessed the system’s heyday. She, like many others, wonders: What went wrong?

Stella, who chose to be identified only by her first name for fear of stigma, was 19 when she packed her bags to join St. David’s Bonda Hospital, a nurse training institute in Nyanga, east of Harare near the border with Mozambique. This was in 1959, about two decades before the country gained independence from British colonial rule and four years after her mother died. In fact, it had been her mother’s idea that she joins nursing school.

“[She] told me that I would be able to take care of myself if I became a nurse,” she said.

A model of efficiency

Soon after graduating, Stella moved to Zambia (then Northern Rhodesia) where she worked for two decades as a nurse at a copper mine hospital. Once Zimbabwe gained independence in 1980, she returned home and secured a job as a nurse in the capital.

Working in Zimbabwe immediately after independence was a stark difference for Stella compared to what she witnesses today. Healthcare workers had the resources to treat patients. “Ambulances were readily available,” said Stella, who also worked as a midwife at a local clinic.

Felix Manyimbiri, a retired teacher, also remembers the good days. For him, it was the 1960s.

“I had pneumonia when I was around 10 years and at that time there were no clinics in our rural home. I was ferried in a scotch cart to Ndanga District Hospital and got admitted for four days. I received good medical care; the doctor was on call 24/7,” the 70-year-old said.

His wife, Moudy Manyimbiri (62) remembers giving birth to their first child in 1980 at what was then Gweru General Hospital, a public hospital. “The nurses were there and provided a service I loved and admired, all the necessities like cotton wool [and] Betadine [topical antiseptic], among others, were provided for,” she said, with a smile plastered on her face. The rewards for health care workers must have been good too, she said. “Nurses could afford to buy cars.”

Zimbabwe’s health care system even gained a reputation as a medical tourism destination within the region, said David Parirenyatwa, who served in the Health and Child Care ministry as a deputy minister (1998-2002) and minister (2002-2009 and 2013-2018).

In fact, members of the Central African Federation, an economic and political alliance among Southern Rhodesia, Northern Rhodesia and Nyasaland (now Zimbabwe, Zambia and Malawi, respectively) considered Zimbabwe their health hub, Parirenyatwa said.

“The capital of the federation was Salisbury, now Harare, so things were happening here. The University of Rhodesia was the [training] university for the whole federation,” he said, adding that citizens from the federation countries sought treatment at Andrew Fleming Hospital (now Parirenyatwa Group of Hospitals) and Harare Central Hospital (now Sally Mugabe Central Hospital).

“It was more like the medical tourism centre,”he said.

Mugabe’s vision

This was a significant revival from the country’s colonial past.

During Ian Smith’s rule, who served as prime minister of what was then called Southern Rhodesia, from 1964 to 1979, health care favoured the white minority population. For example, government funding to private services, which catered to whites, was five times more than public medical services in cities — and 36 times more than public funding in rural areas.

Urban areas were staffed by 389 doctors, compared to just 11 doctors in the rural areas where 80% of the population lived, according to figures from Zimbabwean researcher Neddy Matshalaga.

But Robert Mugabe — who became Zimbabwe’s first post-independence prime minister — would soon overhaul the system.

In 1975, Mugabe led a civil war against the white minority regime and in 1980, the country gained independence. Mugabe soon invested in health care, especially in rural areas, to address disparities. He allocated more resources to health care, built more facilities and increased immunisation programmes, to mention a few efforts.

In 1978, 134 World Health Organisation member States — including Zimbabwe — had made a commitment at the Alma-Ata conference in Kazakhstan to protect and promote health for all people around the world.

Parirenyatwa said that in the early and late 1980s, several countries provided Zimbabwe with aid. “There was a lot of goodwill, health grew and Zimbabwe was a centre for all,” he said. “We became top-notch.”

What happened?

This did not last long. Zimbabwe’s health care system began to crumble.

The terms of the Lancaster House Agreement, signed in 1979 to abolish the white-dominated regime and pave the way for an independent Zimbabwe, were expiring. The most significant of the terms was white farmers’ right to retain the land they occupied for 10 years and in return the British would fund half the cost of a resettlement scheme for black farmers.

“Talk of taking the land back started, things started to go on a downward trajectory,” Parirenyatwa said.

Sanctions followed. Funding to health care was reduced. Parirenyatwa’s voice drops to a murmur as he recalls that time. “In 2000s, people [black majority] started taking their land back. In 2002, sanctions were put in place. Things started going haywire.”

Aid organisations stopped funding the health care system. For example, in 2002, the European Union withdrew its funding. Some groups packed up and left incomplete projects, Parirenyatwa said. The consequences of Zimbabwe’s dependency on donors became evident.

In the 2000s, the economy also deteriorated, causing both a surge in skilled health worker emigration and a reduction in public spending, particularly in the social sector, including healthcare, according to recent research on Zimbabwe’s health financing policy. As a result of reduced health spending, government implemented both formal and informal user fees, decreasing the population’s access to health care.

In 2006, as Zimbabwe’s economic crisis intensified — marked by inflation surpassing 1 000% — Stella said she began to notice changes. Salaries were low. Staff morale plummeted. Medical staff no longer upheld ethics. “I felt hurt and sad knowing that people were being made to buy [supplies] that they should get for free,” she said, frowning in disgust at the memories.

Things got even worse. Damaged beds remained unrepaired. A ward that previously accommodated 10 beds could only accommodate six, leading to premature discharge of new mothers to accommodate incoming patients.

“It was a disaster,” she said as she folds her hands across her chest.

Some of her colleagues migrated to the United Kingdom and Ireland. However, some returned after an inclusive government between Zimbabwe’s ruling Zanu PF party and the opposition in 2009 adopted a multi-currency system as a measure to restore economic stability and curb hyperinflation. A period of social, economic and political stability followed.

The idea of migrating again was no longer an option for Stella because of her age. “If it was not for age, I would have left again,” said Stella, who officially retired from nursing in 2012 due to age and ill health.

Health worker migration

Parirenyatwa said signs of the migration of healthcare workers began around 2002, as the country was going into a crisis due to the land reform exercise. “Zimbabwean borders became literally porous for our health staff. South Africa and Botswana were the easiest destinations at

APART from politics, religion and, in these parts of the world, football, not many other subjects tend to elicit more emotive debates than the subject of taxes. Taxes are money that must be paid to the State. They are mandatory payments.

Once it has been decreed that certain activities, transactions, earnings or assets should attract a tax then that will be pretty much it, really.

No discussions thereon will be entertained! Taxes are among those actions by a government that leave no room for argument against their imposition. The best that the public can do to minimise the tax burden is to engage tax accountants or tax lawyers or economists who are able to analyse a taxpayer’s standing to see if there could be instances where the referred to tax payer could avoid, please note not evade, paying a tax.

To a linguist those two terms appear to have the same meaning but to tax specialists the two demarcate the boundary between a legal action and an outright illegality. Avoidance of tax calls for lawful means that a taxpayer could avail themselves of and not pay a particular tax without violating the law. Tax evasion, on the other hand, is illegal.

Governments, the world over, levy taxes on citizens.

Some countries levy low taxes and others levy extremely high taxes. The history of taxes is a very noble one. When communities morphed from nomadic hunter gathering communities, whose inhabitants wandered about the then largely open space in search of food and water, into settled closely-knit agrarian-centred communities, a paramount need for the regulation of community members’ activities was born. Community dwellers with sticky fingers had to be excluded from mainstream society and confined somewhere where they would not be able to continue practising their disgraceful art of illegally dispossessing individuals of their assets.

Institutions referred to as correctional