(2010; 32 pages)
The recent Multiple Indicator Monitoring Survey (MIMS) and the Maternal and Peri-natal Mortality study as well as administrative data sources indicate a consistent pattern. The Zimbabwean health system has been in decline for more than a decade and the result is a systematic decrease in coverage of most basic services and a rising maternal and child mortality rate. This decline is most noticeable in key areas of maternal and child health, such as the Expanded Programme on Immunization and obstetric care for pregnant women, once high-performing core elements of Zimbabwe's Primary Health Care System. In addition, even in sub-sectors such as access to anti-retroviral treatment for HIV, where overall progress has been solid, coverage for critical groups such as pregnant women or children is either unknown or very low. Finally, the disparities between urban and rural access continue to grow. Support to the health sector is one of the top priorities of the Inclusive Government of Zimbabwe. Support to the sector has been emphasized in the Short Term Emergency Plan (STERP) and the soon to be released, Mid-Term Plan, 2010-2015. The Inclusive Government has indicated its commitment to reaching the Abuja target of 15% of total government expenditures going towards the health sector. In addition, an ambitious National Health Strategy is now in place that covers the period 2009-2013. Building upon these documents, the Health Sector Investment Case, 2010-2012, outlines the key package of health services, the key health system bottlenecks to be overcome, the desired coverage targets, the incremental costs and the expected achievements in relation to the health MDGs. The investment case validates the historical focus of the Ministry of Health and Child Welfare on Primary Health Care, with a strong focus on community-based approaches, complemented by robust referral systems and facilities. Under the most ambitious scenario in the investment case, an additional investment of 700 million USD over 3 years or around 19 USD per capita is required to achieve a reduction in under 5 and maternal mortality of 38% and 17% respectively. The Ministry is currently undertaking a mapping exercise to determine the current resources available, mostly through the support of bilateral and multilateral partners, in order to determine the precise financing gap. Concerted efforts will then need to be made in order to expand the fiscal space available for the health sector through internal and external sources.
Further efforts will now be made to ensure that both government resources and external aid are focused on the national health packages and priorities outlined in the investment case. While it is clear that more aid is required, it is also clear that there are risks of fragmentation of the assistance for the health sector, unless the health system is supported more broadly to deliver on the health MDGs in Zimbabwe.