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Zimbabwe Health System Assessment 2010 ZIMBABWE HEALTH SYSTEM ASSESSMENT 2010 January 2011 This publication was produced for review by the United States Agency for International Development. It was prepared by John Osika, Danielle Altman, Leah Ekbladh, Itamar Katz, Ha Nguyen, Josh Rosenfeld (Abt Associates Inc.), Taylor Williamson (RTI International), and Sam Tapera (Best Practices, Ltd.) for Health Systems 20/20 Project. Mission The Health Systems 20/20 cooperative agreement, funded by the U.S. Agency for International Development (USAID) for the period 2006-2011, helps USAID-supported countries address health system barriers to the use of life-saving priority health services. Health Systems 20/20 works to strengthen health systems through integrated approaches to improving financing, governance, and operations, and building sustainable capacity of local institutions. January 2011 For additional copies of this report, please email [email protected] or visit our website at www.healthsystems2020.org Cooperative Agreement No.: GHS-A-00-06-00010-00 Submitted to: Robert Emrey, CTO Health Systems Division Office of Health, Infectious Disease and Nutrition Bureau for Global Health United States Agency for International Development Recommended Citation: John Osika, Danielle Altman, Leah Ekbladh, Itamar Katz, Ha Nguyen, Josh Rosenfeld Taylor Williamson, and Sam Tapera. November 2010. Zimbabwe Health System Assessment 2010. Bethesda, MD: Health Systems 20/20 Project, Abt Associates Inc. Abt Associates Inc. I 4550 Montgomery Avenue I Suite 800 North I Bethesda, Maryland 20814 I P: 301.347.5000 I F: 301.913.9061 I www.healthsystems2020.org I www.abtassociates.com In collaboration with: I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University School of Public Health and Tropical Medicine II ZIMBABWE HEALTH SYSTEM ASSESSMENT 2010 DISCLAIMER The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development (USAID) or the United States Government CONTENTS Acronyms .............................................................................................xi Acknowledgments.............................................................................xiii Executive Summary...........................................................................xv 1. Background.......................................................................................1 2. Summary of Key Recommendations .............................................3 3. Core Module .....................................................................................7 3.1 Country Overview........................................................................................7 3.2 Recent Economic Crisis in Zimbabwe.....................................................8 3.3 Establishment of the Government of National Unity, 2009–Present .................................................................................................9 3.4 Cross-Cutting Issues Regarding Current Health System Performance in Zimbabwe..........................................................................9 3.4.1 Outmigration................................................................................. 10 3.4.2 Hyperinflation and Dollarization .............................................. 10 3.4.3 Balance between preventive and Curative Services............ 10 3.4.4 Community ParticIpation to Improve Health Services....... 11 3.4.5 Coordination and Harmonization throughout the Health Care System .................................................................................. 11 3.5 Description of Zimbabwe’s Health System ......................................... 11 3.5.1 Overview........................................................................................ 11 3.5.2 Health System interaction with factors and organizations outside the public health sector............................................... 12 3.5.3 Description of Health Facilities and Health Services in Zimbabwe ...................................................................................... 14 3.5.4 Decentralization of the Health Care System ........................ 16 4. Methodology ...................................................................................21 4.1 Framework for the Health Systems Assessment Approach............ 21 4.2 Description of Assessment Tools and Activities................................ 21 4.2.1 Overview of the Health System Assessment Model........... 21 4.2.2 Assessment Tools ........................................................................ 22 4.2.3 Use of HSA Questionnaire........................................................ 22 4.2.4 Consensus Meeting and Stakeholder Feedback for HSA Questionnaire ............................................................................... 23 4.2.5 Sample of Provincial Medical Directorates, District Health Offices, and Health Facilities Used in the HSA ....... 24 4.2.6 Data Assessment Tools Used ................................................... 25 4.2.7 Validation and Prioritization Process ...................................... 25 5. Health Governance........................................................................27 5.1 Definition of Health Governance........................................................... 27 5.2 Policy and Legislation ................................................................................ 27 5.2.1 National Health Strategy............................................................ 27 5.3 Health Legislation....................................................................................... 28 5.4 Regulation of the Private Health Sector............................................... 29 V 5.4.1 Patients’ Charter .......................................................................... 29 5.5 Input into Health Planning........................................................................ 30 5.6 Voice and Methods of Providing Input to the Health System......... 31 5.6.1 Health Committees ..................................................................... 31 5.6.2 Public Advisory Board and Parliamentary Portfolio Committee on Health................................................................. 32 5.6.3 Direct Input from Communities to the Health System...... 32 5.6.4 Zimbabwe Association of Church-Related Hospitals ......... 33 5.7 User Fees ..................................................................................................... 33 5.8 Resource Transparency............................................................................ 34 5.9 Health Information Systems .................................................................... 35 5.10 SWOT Analysis for Governance .......................................................... 35 5.11 Recommendations.................................................................................... 35 6. Health Financing ............................................................................39 6.1 Overview...................................................................................................... 39 6.2 Selected Health Finance Trends............................................................. 39 6.2.1 Total Health Expenditure........................................................... 40 6.2.2 Health Expenditure per Capita via Public Health Funds..... 40 6.2.3 Human Resources Expenditure for Health............................ 41 6.2.4 Percentage of Public Health Budget Expended..................... 42 6.3 Allocation of Government Resources for Health.............................. 43 6.3.1 Budget Formulation ..................................................................... 43 5.3.2. Budget Allocation......................................................................... 44 6.4 Trends in Overall Health Spending........................................................ 47 6.4.1 Completion of New National Health Accounts (NHA)..... 47 6.5 Collection of User Fees in Government Facilities............................. 48 6.6 Government Health Spending................................................................. 50 6.7 Donor Health Spending............................................................................ 52 6.8 Pooling of Resources: Health Insurance............................................... 52 6.9 Effects of Dollarization on Health Financing ....................................... 54 6.10 Difficulty in Obtaining Health Finance Data....................................... 54 6.11 SWOT Analysis for Health Financing .................................................. 55 6.12 Recommendations.................................................................................... 56 7. Health Service Delivery.................................................................59 7.1 Overview...................................................................................................... 59 7.2 Hospital Beds by Type of Facility ........................................................... 59 7.3 Average Distances within Facility Catchment Areas......................... 60 7.4 Key Health Services Provided................................................................. 61 7.4.1 HIV/AIDS Services ....................................................................... 63 7.4.2 Malaria Services ...........................................................................
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