ZADHR NEWSLETTER: Volume 7, Issue 3 - August 2009
Article Index
ZADHR NEWSLETTER: Volume 7, Issue 3 - August 2009
The Right to Health and a New Zimbabwean Constitution
Monitoring the Right Health Programme
Report on Bulawayo National Conference, 26 June 2009
All Pages

ZADHR NEWSLETTER: Volume 7, Issue 3 - August 2009


* Zimbabwe: Health Rights in Practice
* The Right to Health in a New Zimbabwean Constitution
* South Africa’s Constitution: A Constitutional Model for the Right to Health
* Monitoring the Right to Health: Prison Health Protection Programme
* A Human Rights Approach to Mental Health: Report on Bulawayo Workshop



Zimbabwe: Health Rights in Practice

Health is a fundamental human right, indispensable for the exercise of other human rights. Health in Zimbabwe is, however,  largely a remote privilege, out of the reach of most. Zimbabweans entered 2009 with health care and the determinants of health being unavailable, unacceptable, inaccessible and of poor quality. Large scale efforts to address this situation are continuing, including work by the Human Resources for Health Taskforce, a 100 day plan by the Ministry of Health and Child Welfare, re-engagement with the Global Fund to Fight AIDS, TB and Malaria and other detailed plans and programmes by the Ministry of Health and other partners to improve health in Zimbabwe.

The main challenge remains that of resources, with little money available to address a great many problems. It is in this context of limited resources, that the government must carry out its obligation to fulfil the right to health to the maximum of the available resources; allocating the few resources available to those that need them the most and ensuring that there is transparency and only today buy cialis online cialis accountability in the use of funds to minimise resources lost to corruption and inefficient use.

It is evident that the Zimbabwean government cannot rebuild the health system without significant bilateral donor support. With Zimbabwe currently generating little of its own revenue, it will require the long term commitment of humanitarian and donor agencies working in the country with large scale, multi-faceted assistance to address the situation.


Health care

The right to health requires that appropriate health care be provided in a timely manner. This includes operational health facilities that are equipped to provide health care with the necessary equipment, drugs, sundries and human resources. In hospitals and clinics that were manned by skeleton staff or had no health workers at all, availability of vital drugs on the essential drugs list, which should always be at 100 percent, ranged between 29 and 58 percent in 2008. People are hesitant to go to health centres which they know will not be able to assist them. In addition, with transport now charged in foreign currency many rural and urban dwellers cannot afford to travel to health centres.

These people stay at home and get sicker or die at home with no help. This lack of access to health care was evidenced by the unacceptably high number of community deaths during the cholera outbreak, when 60 percent of fatalities occurred in the community. According to the World Health Organisation the target for cholera deaths occurring outside of cholera treatment centres is zero percent.

There must be a balance in efforts to restore affordable and cialis buying accessible health care in primary and secondary care services (clinics and district hospitals) without placing excessive emphasis on tertiary and quaternary facilities (provincial and central hospitals).

Maternal and child health

A major indicator of fulfilling health rights is the lowering of maternal and infant mortality rates and overnight cialis assistance improving the quality of maternal and child health. With access to health care impaired, maternal health has deteriorated. Women who develop complications during child birth lack access to lifesaving surgical and other forms of emergency obstetric care when they deliver at home or at health facilities without the necessary staffing, drugs and equipment to deal with those complications. Maternal mortality levels are currently estimated at 725 deaths per 100 000 up from 168 per 100 000 in 1990. Immediate steps need to be taken to ensure that all women are able to access ante and post-natal care and that they are not impeded by user fees in doing so.


Maternal and Child Health are inextricably linked. Efforts to improve maternal health will also improve child health. The Children’s Rehabilitation Unit at Harare Central Hospital has witnessed a 3 fold increase in infants presenting with severe brain damage from birth complications since 2004. This increased morbidity is a reflection of a general decline in obstetric care which mirrored the economic decline.

The November 2008 Zimbabwe Combined Micronutrient and Nutrition Survey Report, indicated that 27.5 percent of children under-5 have stunted growth due to under-nutrition. Addressing children’s health rights will include addressing the high levels of malnutrition currently prevailing in children, especially those under-5 and improving full immunization coverage which according to the Zimbabwe Demographic and Health Survey of 2005/6 stood at 53 percent. This will be assisted by programmes such as the National Measles, Polio Immunization and Vitamin A Supplementation Programme that was undertaken in June 2009.

A malnaurished child

Water and best viagra uk chemist non prescription Sanitation

The cholera outbreak in Zimbabwe was the result of an inadequate supply of safe drinking water and broken down sanitation systems that have often left residents without safe water and surrounded by flowing raw sewage. It is the Government of Zimbabwe’s obligation to ensure that all Zimbabweans have access to safe water and adequate sewage disposal systems. General Comment Number 14 by the UN Committee on Economic Social and Cultural Rights cites an adequate supply of safe and potable water and sanitation as minimum essentials for fulfilment of the right to health. The government continues to be in violation of these rights by failing to ensure that these minimum obligations to Zimbabwe’s population have been met. Without ensuring adequate supply of safe water and sanitation, Zimbabwe risks another significant cholera outbreak in late 2009.

Human Resources for Health

In December 2008 vacancy levels in the public health system stood at 69 percent for doctors, 61 percent for environmental health technicians, 80 percent for nursing midwives and 63 percent for medical school lecturers.

Health professionals who have continued to deliver health services and remain committed to the recovery and improvement of the public health system must be commended. They have done so in very difficult circumstances.
There are now various schemes being implemented in an attempt to retain human resources for health including retention allowances and the best place provision of transport. Moving forward, it is imperative that health workers are properly consulted on what would best serve them in the current environment and that they are kept abreast of discussions going on to address their concerns.

Medical Education

Teaching resumed at the University of Zimbabwe Medical School in May this year after a closure of almost 6 months. Efforts now need to be concentrated on improving the state of medical education in Zimbabwe which has been declining for many years now. Massive brain drain has resulted in reduction in teaching staff leaving a consultant: student ratio of more than 1:25; which is not only impractical for learning but often traumatic for patients who are being examined during bedside tutorials.

The majority of students are not getting surgical experience as they are not allowed into theatre because of the large numbers and the shortage of theatre clothes. There has also been no increase in training resources such as textbooks and computers in correlation with rising student intakes. Student enrolment has been increasing every year. Average intake into the medical school in the 1980s was between 70 and 90 students. Despite the dramatic reduction in teaching and learning resources over the past two decades, there was an intake of 270 students last year as the government tries to address medical brain drain by increasing the number of doctors trained.

The government must balance the need to increase the number of health professionals trained with the ability to retain trained health professionals and with the need to produce a quality cadre that is able to offer acceptable, quality health care.

Students from the University of Zimbabwe Medical School receiving a donation of textbooks from Physicians for Human Rights, USA