The Health System in Crisis
Zimbabwe’s health system is facing a severe crisis that has persisted for years, marked by consistent reports of a deteriorating public health infrastructure. This crisis disproportionately affects marginalized and vulnerable populations, including women and children in rural areas, who are often the most impacted by disasters and pandemics such as HIV, tuberculosis (TB), COVID-19, cholera, droughts, and climate-related crises.
The consequences of this crisis have led to significant health inequalities, with only those who can afford it accessing quality healthcare through the private sector. Public healthcare, on the other hand, is underfunded, resulting in outdated infrastructure, shortages of essential drugs and equipment, poor or non-existent emergency services, and a dwindling workforce due to low pay and poor working conditions.
High Maternal Mortality and Disease Burden
Several indicators highlight the adverse effects of this crisis. For instance, Zimbabwe’s maternal mortality rate stands at 362 per 100,000 live births, reflecting the severity of the situation. Additionally, the country continues to face a heavy burden of diseases, further straining an already overburdened system.
Impact of US Funding Cuts
Recent budget cuts by the United States government to foreign health aid funding have exacerbated an already dire situation. Zimbabwe has historically relied heavily on foreign aid for its health budget, receiving support through mechanisms like the Health Transition Fund (HTF) and the Health Development Fund (HDF). According to a 2023 World Bank report, Zimbabwe received approximately $2 billion from external funders between 2015 and 2020.
In 2023 alone, the US provided around $170 million in health funding, including support for HIV, general healthcare, and reproductive healthcare. The US President’s Emergency Plan for AIDS Relief (Pepfar) has traditionally been a major source of global HIV funding, allocating about $6 billion annually, which accounts for roughly 17% of Zimbabwe’s HIV funding.
Global Fund and Other Donors
Zimbabwe also receives a significant portion of its HIV management funds from the Global Fund, along with support from the World Health Organization (WHO) and other multilateral institutions. However, the Global Fund has recently announced cuts and re-prioritization of funds due to reduced US contributions, directly affecting Zimbabwe.
This heavy reliance on foreign aid means that funding cuts from the US and other bilateral donors are likely to have a substantial impact on healthcare availability in Zimbabwe. While some relief has been provided for Pepfar funding, the uncertainty surrounding future allocations remains a concern.
Domestic Resource Financing
Plugging this gap requires a stronger focus on domestic resource financing. The government of Zimbabwe has made efforts to raise and ringfence funds for healthcare domestically, aiming to reduce dependence on unpredictable foreign funding. Taxation is the primary source of domestic public health financing, with several taxes officially earmarked for health, including:
- A 3% AIDS levy as part of income tax
- A 5% tax on mobile airtime and data
- A 2% tax on electronic financial transactions
- A “sugar tax” on cordials and juices
Despite these mechanisms, the national budget continues to rely heavily on foreign funding, with health allocations remaining below 15%, falling short of the Abuja Declaration’s target of at least 15% of the budget for health.
Transparency and Accountability
Transparency in the use of public funds is crucial for accountability. However, there is a lack of publicly available information regarding the allocation and use of these taxes. Only the National Aids Council, responsible for managing the AIDS levy, provides detailed reports on its use.
The government recently announced plans to refurbish major public hospitals, starting with Parirenyatwa Hospital. Yet, concerns persist about transparency in funding models, allocation processes, and procurement practices.
The Way Forward
To maintain progress in healthcare, especially in the context of reduced foreign funding, domestic financing must become a priority. The government should enhance existing accountability mechanisms, improve coordination, and increase transparency in budget planning, procurement, and spending.
Regular public updates and information-sharing will help build public confidence, combat misinformation, and encourage informed health-seeking behavior. Ultimately, transparency and accountability are essential for ensuring the prudent management of public funds and unlocking further domestic financing, including from the private sector.