The great hope and promise of post-independence efforts to promote equitable health care in Zimbabwe started with three years of dramatic improvement. Commitment to correcting inequities which were as discriminatory as any country in the world produced rapid extension of health centre infrastructure and the improvement of district hospitals. The major constraint was the entrenched pattern of sophisticated, high-technology health care left by colonial administrators which continued to monopolize resources. In spite of the excellent beginning, development of services for the poor was thwarted by recession, prolonged drought and external military destabilization. The cutbacks in funding for health care have been particularly severe as a result of economic adjustment policies imposed by IMF. Political pressure moved the health system toward private entrepreneurship returning to earlier patterns of discrimination in favour of whites and urban residents. Efforts to promote high-risk monitoring have had little impact among the poor and those living in remote areas. Equity has become symbolic rather than real. The government of Zimbabwe maintains a continuing commitment to the original goals of equity through primary health care. International agencies also would like to find a way to help reallocate services. There seems to be recognition that little will be accomplished in improving health conditions unless services are provided to those in greatest need. Disparities in maternal care are especially severe and can be improved only by building infrastructure to provide antenatal and perinatal services. The timing seems right to try surveillance for equity as a means of using limited resources to reach the most needy mothers with targeted services. A system is proposed involving periodic surveys to identify groups among whom maternal care problems are concentrated and to tailor actions to the major causes of maternal mortality and morbidity. It would also establish a process of finding locally appropriate adaptations of cost-effective and sustainable solutions. The highest-priority interventions would be defined and implemented locally by strengthening the primary health care infrastructure and community participation. Health systems research in demonstration areas could lead to national extension.
|Original language||English (US)|
|Number of pages||6|
|Journal||World Health Statistics Quarterly|
|State||Published - Dec 1 1993|
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health