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  • Title: Two models for change in the health services in Zimbabwe.
    Author: Bloom G.
    Journal: Int J Health Serv; 1985; 15(3):451-68. PubMed ID: 4055184.
    Abstract:
    The health situation in pre-Independence Zimbabwe was much as elsewhere in the Third World. While the majority suffered excess mortality and morbidity, the affluent enjoyed a health status similar to that of the populations of developed countries. The health services also showed the familiar pattern, with expenditure concentrated on sophisticated facilities in the towns, leaving the rural majority with practically no services at all. With the coming of Majority Rule, the previous pattern of controlling access to facilities on the basis of race could not continue. Two broad routes forward were defined. On the one hand, the private doctors, the private insurance companies, and the settler state proposed a model based on improving urban facilities, depending on a trickle-down to eventually answer the needs of the rural people. On the other hand, the post-Independence Ministry of Health advocated a policy of concentrating on developing services in the rural areas. The pattern of the future health service will depend on the capacity of the senior health planners and on the enthusiasm of front-line health workers but, of overriding importance will be the political commitment to answer the needs of the majority and the outcome of the inevitable struggle for access to scarce health sector resources. Health in pre-Independence Zimbabwe was much as elswhere in the Third World. While the majority suffered excess mortality and morbidity, the affulent enjoyed a health status on a developed country level. For example, among urban whites, infant mortality was 14/1000, urban blacks, 30 to 50/1000, and rural blacks, 140 to 200/1000. Health service expenditures were concentrated on sophisticated government facilities in the cities, to which fee for service private physicians had access. Established with the principal intent of epidemic prevention, rural medical facilities were a mix of mission clinics, 74 government district and rural hospitals with a total of 16 physicians, underequipped African council clinics, and limited occupational health facilities. Services for urban blacks were only slightly superior. With the coming of Majority Rule, 2 broad reforms were defined. On the one hand the private doctors, the private insurance companies, and the settler state proposed a model based on improving urban facilities, depending on tricle down to eventually answer the needs of the rural people. However, the post Independence Ministry of Health advocated developing services in the rural areas. Considerable use would be made of community health workers, chosen by the community and trained for 6 weeks by the government. Communities would be encouraged to help build their health facilities. Further efforts included removal of fees for the poorer 90% of the population, publication of a planning document, creation of integrated administration, capital development (which is slightly behind schedule) control of private hospital construction, and reorientation of health workers towards the new goals beginning during their training. The pattern of the future health service will depend on the capacity of the senior health planners and on the enthusiasm of front-line health workers, but of overriding importance will be the political commitment to answer the needs of the majority and the outcome of the inevitable struggle for access to scarce health sector resources.
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