Health for All: Zim, where are we?

In 1977, the World Health Assembly (a decision-making body of WHO) decided that the major social goal of all its member governments and WHO should be that by 2020 there should be an attainment by all people of the world, a level of health that would permit them to lead a socially and economically productive life. In 1981, the assembly unanimously adopted a Global Strategy for Health for All by the Year 2000 and this birthed the beginning of the “Health for All” movement.

The tenets of  “Health for All” does not mean or state an end to disease and disability, or that doctors and nurses will care for everyone. The movement advocates for an even distribution of health resources and the accessibility of health care to everyone. It mainly focuses on the provision and accessibility of primary health care for and to all.

The movement therefore advocates for a world where health awareness begins at home, in schools, and at the workplace, and also the better use of approaches for preventing illness and alleviation of avoidable disease and disability. This means that people recognize that ill-health is not inevitable and that they can shape their own lives and the lives of their families, free from the avoidable burden of disease.

In most member countries of the WHO, some noticeable progress towards these goals has been made, but the goals have clearly not yet been met on a global level and Zimbabwe is nowhere near the attainment of these goals.

The adoption of  “Health for All” by the WHO member governments meant that they were taking up a commitment to promote the advancement of all their citizens to achieve a higher quality of life. Everybody needs and is entitled to the highest possible standard of health. This right to health has been interpreted broadly by the United Nations Committee on Economic, Social and Cultural Rights (2000) as:

“An inclusive right extending not only to timely and appropriate health care; but also to the underlying determinants of health, such as access to safe and potable water and adequate sanitation, an adequate supply of safe food, nutrition and housing, healthy occupational and environmental conditions; and access to health related education and information, including on sexual and reproductive health. A further important aspect is the participation of the population in all health related decision making at the community, national and international levels. (p. 11)”

It is important to note that the rate of the progress in attaining  Health for All in Zimbabwe was or is mainly dependent on the country’s political will, just like in all the other countries. Though there has been more progressive movements in the health sector, there is still a lot that needs to be done as the progress from the government side still leaves a lot to be desired. However, the private sector and the donor community are making noticeable efforts to make the country at least stride towards the “Health for All” concept in the country.

In Zimbabwe, there are still certain ills that have been consuming the health sector for decades now and not much has been done to try to at least put a stop to all these ills. Since the late 90’s into the beginning of the early 2000’s there has been a constant failure to contain and manage the loss of health sector personnel due to unattractive retention incentives and poor working conditions.

There has been a massive exodus of health care workers to overseas in order to seek better remuneration and better working conditions. There are however no reliable figures to confirm this,  but all around us, in the medical and business world, people talk about emigrating. The high workload during the pandemic times and poor working conditions have also driven health sector workers to strike in recent times.

There is still some noticeable unequal distribution of health workers as well as health funds within the sector. There is a need to boost government spending on rural health centers to avoid dependence on donor financing and be able to better cater for over 70 percent of Zimbabwe’s population that lives in the rural areas.

The ruling party’s 2018 election campaign manifesto pledged to “ensure that the treasury allocates at least 15% of the national budget to the healthcare sector”. There was also a proposal to review medical professionals’ remuneration, and to rehabilitate and invest in new healthcare facilities. Up to today, most of these promises have not yet been met.

In the 2021 national budget statement , it was noted that the Government committed $683 million towards the health sector. This is 12,9% of the country’s overall budget, 2,1% short of the promised 15% allocation.

In order for our country to achieve the health-for-all concept as advocated for by the WHO, our country needs to regard health as an ultimate goal of economic development and not merely as one of the means of attaining it. The moment the health sector is fully equipped and citizens have access to affordable and good quality health services, then economic development will begin to take shape.

There is also a need to have an understanding of what health means for every individual. This will enable the proper structures of the different health systems to be put in place. Encompassing the different health needs for all citizens can assist the authorities to put in place a holistic approach of attaining a proper health-for-all system. Just as Loewenson (1988) stated, “Participation and accountability for strengthening Zimbabwe’s health sector will mean involving interest groups to recommend changes for enhancing public accountability in health at district levels, referral hospitals and national level facilities.”

Health for all depends on the continued progress in medical care and public health. After understanding what health means to its population, health services must then be made accessible through the provision of primary health care .

Medical help is to be made available to everyone and in all communities and this should be backed by the referral services to more specialised care.

The attainment of all such progress therefore depends on a holistic approach which calls for efforts such as those in agriculture, industry, education, housing and communications just as much as in medicine and public health.

The removal of obstacles as in other economic sectors should also be the center of attention in the health sector just as the provision of health services and infrastructure. “Health For All” implies the removal of the obstacles to health, that is to say, the elimination of malnutrition, ignorance, contaminated drinking water and unhygienic housing, quite as much as it does the solution of purely medical problems such as a lack of doctors, hospital beds, drugs and vaccines.

This therefore means that for Zimbabwe to achieve the goals of the “Health for All” movement, there should be an alignment of sectoral goals and aims among the health sector and other economic sectors such as the agriculture sector, housing and communication sector, public works sector etc.

In considering the attainment of the “Health for All” goals in Zimbabwe, it is then imperative to recognize the areas of uncertainty and also those that need improvements. The “Health for All” vision is not beyond our grasp, it can be achieved. Clearly focused and committed action is only needed to transform the vision of “Health for All” into a practical and sustainable reality.

However, like previously mentioned, this depends on the political will of those in charge of our country.

A specific and clear vision and action plan on how the country can attain the “Health for All” goals should be put in place. The Government should also ensure equity in the health sector through solidarity in action. The prevention and controlling of diseases should also be on the forefront of the country’s health policies as well as the promotion of an outcome oriented health sector.

Chivige is an economist. These weekly New Horizon articles are coordinated by Lovemore Kadenge, an independent consultant, past president of the Zimbabwe Economics Society  and past president of the Institute of Chartered Secretaries and Administrators in Zimbabwe. Email: kadenge.zes@gmail.com/ cell: +263 772 382 852