A World Bank country study : Zimbabwe Financing Health Services

ABSTRACT

The main objectives of the report are to identify options for improving efficiency in the provision of health services in Zimbabwe; and to find more effective ways to mobilize additional resources for the country's rapidly evolving health system. Through the use of national; provincial-district; and health facility-specific data (much of which were collected and analysed for the first time for use in the present report); the authors are able to examine a series of key issues related to (a) allocative and technical efficiency in the health sector; (b) the equitable distribution of financial resources and health services; and (c) the immediate and long-run availability of funding to meet Zimbabwe's changing health needs. The context for the report is one of rising personal incomes (and demand for health care); increasingly severe budgetary constraints; and an epidemiological pattern that includes both traditional childhood and communicable diseases and new challenges in the form of adult chronic disease and AIDS. The authors conclude that; while Zimbabwe has made enormous strides during its first decade of independence (1980-89) in expanding health services; especially to neglected rural areas; much remains to be done in the 1990s to make services accessible to all segments of the preventive health care such as child immunizations; safe motherhood activities; family planning; and rural water and sanitation; and increase technical efficiency (especially in hospitals) by controlling length of patient stay; staff deployment; drug consumption; and vehicle usage. Continuing to improve access and enhance efficiency are especially important for Zimbabwe at this critical juncture; with the country about to embark on an economic adjustment program that will entail fiscal austerity and could have adverse effects on the poor; if countervailing measures are not adopted. The report also concludes that; with the cash-strapped public sector now providing more than half the health services and health financing in Zimbabwe; non-governmental actors will need to play an increasingly important role in the future. This means that the Government will have to find ways to permit and encourage non-governmental institutions (including church missions; private doctors; and nurses; commercial enterprises; and traditional practitioners) to extend service coverage. Moreover; a wide range of existing but under-exploited sources of heatlh financing in Zimbabwe -- including user fees; private insurance; and municipal and local government revenues -- need to be tapped more fully; in order to stretch scarce central government funding further and ensure that all Zimbabweans will eventually have access to good quality health care services