Zimbabwe's reversal of fortune

Abstract

With the media dominated by the Pope's death and a royal wedding, coverage of results of the parliamentary election in Zimbabwe on March 31 got rather lost in the news cycle. Amid allegations of a gerrymandered electoral process, President Robert Mugabe's ZANU PF party was returned to power with a two-thirds majority that will allow it to change the country's constitution if it so wishes. Whatever the rights and wrongs of the charges of a fraudulent vote, one thing is certain: ZANU PF was not re-elected because of its record of good government. Since Mugabe first came to power in 1980, his government has presided over a boom and bust in the fortunes of the people of Zimbabwe, as exemplified by the control of infectious diseases. From the era of white minority rule, Mugabe inherited a country rich in natural resources and agricultural production, with a well-developed infrastructure by the standards of sub-Saharan Africa and highly educated segments of the population. In its early years the Mugabe government invested heavily in health care and education, so that by 1987 state spending on health was 2·3% of gross domestic product (GDP)—three times the regional average—and Zimbabwe has the highest literacy rate in Africa at 90%. As a result of this investment, between 1980 and 1988 life expectancy at birth rose from 54·9 years to 63 years. The percentage of children fully immunised reached around 80% by the mid 1990s (compared with an average of about 50% for sub-Saharan Africa), and under-5 mortality fell to 73/1000 in 1996 from 125/1000 in 1980. However, in the past decade, these health gains have largely been undone. Government health expenditure was still 2·8% of GDP in 2001, but in an economy that in 2003 was shrinking by at least 13% per annum, with inflation approaching 400%, this equates to a severe decline in real health expenditure. In 2002, coverage for diphtheria, tetanus, and pertussis and measles vaccines fell to 58%. Although these rates recovered to 80% in 2003, under-5 mortality rocketed to 126/1000 in that year. Perhaps the most staggering statistic is the fall in life expectancy in 2003 to 33 years. The fall in life expectancy can substantially be attributed to the rise of HIV/AIDS in Zimbabwe, where adult prevalence has reached 25%, the fourth highest rate in the world. Although Mugabe's government can hardly be blamed for spreading HIV, its mishandling of the country's economy, use of food supplies as a weapon of political control, and record of human rights violations have crippled efforts to control the epidemic. GDP per caput was US$622 in 1985, but government interference, cronyism, and corruption put Zimbabwe's economy into decline by the 1990s. Although severe drought in the early 1990s did nothing to help, the rot really set in with Mugabe's so-called “land reform” programme in 2000. This measure saw commercial farmers forcibly removed from their land, and, as a result, the destruction of the productive agricultural industry. By October 2004, maize production was only 16% of government forecasts, and, in a country that was once an exporter of maize, 5·8 million of Zimbabwe's 12·5 million population were in need of food aid. With unemployment running at 80%, GDP per caput has fallen to US$521. Poverty and malnutrition are hardly a recipe for staving off the spread of HIV, and neither do government disease-control policies help. Although 3% was added to income tax in 2000 to buy antiretrovirals and care for the sick, no drugs were bought until 2003—perhaps because no income equals no income tax. To compound the ineptitude, the state charges duty on antiretrovirals imported by non-governmental organisations. Malaria control has also suffered because of the economic meltdown, with only 3·4% of planned indoor residual spraying actually being carried out, and some observers reporting 2 million cases per year, up from 400 000 in 1992. What can be done to turn round the fortunes of Zimbabwe's people? Neighbouring countries have been reluctant to put pressure on Mugabe to reform, but unless they are prepared to do so they risk the disease, hunger, and violence of Zimbabwe destabilising southern Africa. Perhaps Mugabe will feel secure enough in his legacy to step aside soon, but we fear that many more Zimbabweans will dies unneccessarily before this happens.