Abstract
Zimbabweans continue to experience challenges in combating communicable diseases such as tuberculosis, diarrheal diseases, and HIV/AIDS. The country’s health sector decentralisation implementation is moving at a snail’s speed, triggering complaints of unsatisfactory service delivery at rural health centres. The study examined the impact of political reforms in improving quality health services in Shamva District. The identified political reforms were decentralisation and the second republic that emerged in November 2018 that embraced the 100-day plans approach, civil service reform agenda, development of transitional stabilisation plan and vision 2030 agenda. The study was guided by interpretive and critical post-modernist paradigms. Qualitative methodology was utilised; key informant interviews, focus group discussion and desk reviews were data generation tools that were utilised. The data generated were analysed using grounded theory. The key findings are that decentralisation enabled district health officials to interact with communities through social accountability strategies such as community scorecard, results-based financing and village health worker model that is implemented in Shamva District by Civil Society Organisations. The second republic political reforms enforced the user fee policy in the health sector and focused on improving primary health care. The political reforms led to improved health rights knowledge of communities and quality health services in Shamva District. The study concluded that lack of continuous funding and sustainable plans led to the reversal of positive results that were brought in by the political reforms. The major recommendation is that government should understand that service delivery is not poor by accident; rather it is a symptom of the underlying institutional environment and political economy analysis should be done to address the real blockages in health sector.
Highlights
The study was conducted in Shamva District in a bid to understand whether political reforms are improving quality health services
The key findings are that decentralisation enabled district health officials to interact with communities through social accountability strategies such as community scorecard, results-based financing and village health worker model that is implemented in Shamva District by Civil Society Organisations
The major recommendation is that government should understand that service delivery is not poor by accident; rather it is a symptom of the underlying institutional environment and political economy analysis should be done to address the real blockages in health sector
Summary
The study was conducted in Shamva District in a bid to understand whether political reforms are improving quality health services. The background to the problem is given below. Zimbabwe held her harmonised elections on the 31st of July 2018. The elections were of the President, 201 constituency seats in the National Assembly, and seats in the urban and rural local authorities. These were the country’s first elections without the participation of Robert Mugabe, who ruled Zimbabwe for 37 years. The nature of decentralisation in Zimbabwe kept on changing from administrative to elected local authorities and there have been policy gaps between rhetoric and reality (Wekwete, 1990; Makumbe, 1998; Chakaipa, 2001). Post-independence the government of Zimbabwe adopted systems and structures that entrenched exclusion of citizens in policy formulation and development (Kaseke, 1998)
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