Economic adjustment and current trends in child survival: the case of Zimbabwe

Abstract

The relationship between health and welfare policies and economic performance and the efficacy of economic adjustment measures in Zimbabwe since independence are examined along with the accompanying changes in infant and young child health. As a result of the successful struggle for independence certain economic measures and social reforms have been instituted and these have had a positive influence on health. The most important include the setting of minimum wages for all categories of labor food subsidies the land resettlement program expanded education water development and drought relief programs. The management and delivery of health care; in line with the new primary health care (PHC) approach has been transformed slowly. The curative and preventive services have been integrated in provincial and district health team structures accountable both to higher levels of the health structure and to the local government structures at the level of service. Active steps have been taken to reform medical education to make the training of physicians more relevant to the needs of Zimbabwe. Some of the changes introduced since independence include: free health care; hospital and rural health center building program; the Zimbabwe expanded program on immunization (ZEPI); diarrheal disease control program (DDCP); a national nutrition program; a program of child spacing; and a national village health worker program. All these and other programs call for expansion of government expenditures. A table shows how the vote allocations and the actual expenditure of the Ministry of Health changed over the period. Due to the scarcity of data it is difficult to be anything but speculative regarding the impact of the health sector interventions on infant and child mortality and morbidity. Yet it is likely that certain programs -- particularly ZEPI and DDCP - have had and continue to have a rapid positive impact on child survival. Any significant impact on deaths resulting from respiratory infections low birth weight and other neonatal causes as well as deaths resulting either directly or indirectly from malnutrition would require improvements in nutritional status of both children and mothers as well as reductions in levels of crowding and further improvement in access to health care. The primary effect on the health sector of the recession period has been to restrict the Ministry of Healths ability to finance services.