An Opportunity to Improve Health in Post-Mugabe Zimbabwe

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Ewodaghe Harrell is a Franklin Williams intern for global health, economics, and development at the Council on Foreign Relations. She received her master’s in public health from Brown University in 2017.

In November 2017, President Robert Mugabe of Zimbabwe resigned after thirty-seven years in power. He leaves behind a legacy of disastrous government campaigns and policies which rolled back social, economic, and cultural progress for Zimbabweans. Emmerson Mnangagwa, Mugabe’s successor and former vice president, has indicated that genuine change is coming, pledging to rebuild the country and “protect and promote the rights and people of Zimbabwe.”

However, based on his recent cabinet appointments, some skeptics worry that Mnangagwa’s government will be a continuation of Mugabe’s. Further, Mnangagwa is associated with many of the harmful reforms committed under Mugabe’s rule that led to the collapse of the healthcare system. To make good on his lofty, post-Mugabe promises, Mnangagwa must promote economic reform in order to to have a shot at transforming the healthcare system.

Mnangagwa must address the key challenges in public health. Currently the majority of Zimbabwe’s health sector is understaffed and overburdened. Since 2000, an estimated three million people, including many health workers, have left the country in search of economic opportunity and better working conditions abroad. According to the WHO, there is an overall density of only 1.23 health workers per 1,000 people, which is half of the estimated minimum density of health workers needed across sub-Saharan Africa. In 2008, for instance, the health workforce was so small that a fast-spreading cholera outbreak contributed to over four thousand deaths and an estimated ninety thousand infections within months.

Zimbabweans continue to experience challenges in combating communicable diseases such as tuberculosis, diarrheal diseases, and HIV/AIDS. The HIV/AIDS epidemic continues to be a significant public health problem in Zimbabwe, placing a tremendous strain on the health sector. In 2016, approximately 14 percent of the adults in Zimbabwe were living with HIV/AIDS, the sixth highest HIV/AIDS prevalence in sub-Saharan Africa.

Zimbabwe’s Ministry of Health and Child Care estimates that 45 percent of women who died of pregnancy-related complications were HIV positive. Although maternal mortality has declined from 960 deaths per 100,000 live births to 614 deaths per 100,000 live births in recent years, the ratio is still unacceptably high.

The high disease burden from preventable diseases is characteristic of most low- and middle-income countries, and is particularly a result of inadequate health financing. With billions of dollars of domestic debt and millions more in stolen public funds, Zimbabwe has in recent years relied on funding agencies to support public services. In fact, USAID has invested nearly $100 million annually in Zimbabwe to support health programs that provide treatment for and prevention of diseases and help make health care services more accessible to families.

To address these challenges, the government will need to first establish economic stability. Second, Mnangagwa must ensure the government prioritizes financing the public healthcare system and developing a comprehensive health strategy that targets the greatest health problems. Such investment in improving health services will require international support. Zimbabwe is facing considerable challenges, but if Mnangagwa takes reengagement seriously and if global partners continue to work with the health sector, the country will have the tools to make remarkable progress. – Council on Foreign Relations