Short introduction to our work in Zimbabwe, August 2011
During ReBUILD the Zimbabwe team worked towards the priorities of the countries’ health system managers: tackling the shortage of human resources and supporting primary health care and public health. One of the main challenges facing the health system at the time was a shortage of funds including development aid. The available data showed that in the mid 1990s vacancies for doctors and nurses were 60% and 45% respectively. The number of registered doctors in the country declined from about 1600 to about 800 in the intervening period. However, with the dollarization of the economy, many health workers returned to the workplace. Task shifting towards nursing aides was ongoing and a new cadre trained, for example in microscopy, was planned for rural areas. Informal charging was not a documented problem in Zimbabwe but dual practice was an important economic strategy for public health workers during the crisis. User fees were in place in the 1990s but exemption was almost universal and they were withdrawn. However, the emergency situation resulted in the re-establishment of user fees in some hospitals with unknown implications for health service access. In Zimbabwe there was strong support for the development of evidence-based strategies in health service delivery from both the Ministry of Health & Child Welfare and from University of Zimbabwe College of Health Sciences.
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