Post-independence saw a rapid increase in education and health facilities in rural areas but developments were threatened by increasing demands on the health sector and dwindling government health expenditure. Nevertheless, it is estimated that 85% of the population live within 8 kilometres of a health facility.¹⁹

The WHO reports:

‘Zimbabwe has a long tradition in palliative care provided by the hospice movement; however this is still not widely integrated into the health system. There is no exclusive national policy concerning palliative care although palliative care policies are included in the following documents: the Home Based Care Policy, the Discharge Policy and the Ten Year Plan produced by the Committee for Prevention and Control of Cancer in Zimbabwe (PCCZ). Like Hospice Uganda, Island Hospice in Zimbabwe provides training at various levels in palliative care within the community, within the country and to neighbouring countries.’²¹

Among the strengths and opportunities in Zimbabwe, WHO recognises the following:

• training of hospice workers and community volunteers
• integration of palliative care into the mainstream health care system
• oncology and HIV/AIDS policies (developed as early as 1992)
• publication of guidelines, training manuals and booklets on the care of the terminally ill
• the community home based care policy launched in 2001

Concerns, however, centre on the following:

• lack of support for home based care patients
• lack of access to national AIDS levy for AIDS patients
• procurement and distribution of drugs
• implementation of an effective policy on morphine
• lack of resources and inadequate equipment
• staff recruitment, motivation and retention

In 2001, the total per capita expenditure on health care was Intl $142 (6.2% of GDP).⁴⁴ Among the countries of Africa, this figure falls within a spending range of Intl $652 in South Africa (8.6% of GDP) and Intl $12 in the Democratic Republic of Congo (3.5% of GDP). At 2.0% the smallest spending as a percentage of GDP is in Equatorial Guinea (Tables 9 and 10).

An AIDS levy of 3% was added to income tax in January 2000 to help those affected by AIDS and support around 1 million AIDS orphans currently living in Zimbabwe.⁴⁵ The levy initially raised around $20 million per year.

The WHO overall health system performance score places Zimbabwe 155/191 countries. This composite measure of overall health system attainment⁴⁶ is based on a country’s goals relating to health, responsiveness, and fairness in financing. The measure varies widely across countries and is highly correlated with general levels of human development as captured in the human development index.

Tables 9 and 10 Total health expenditure (Intl $) per capita and as a percentage of GDP: countries of Africa, 2001

Table 9 Health expenditure (Intl $) per capita: Africa

Table10 Health expenditure (Intl $) as a percentage of GDP: Africa

Country   Per capita   South Africa 652 Tunisia 463 Botswana 381 Namibia 342 Libya 239 Morocco 199 Gabon 197 Algeria 169 Swaziland 167 Egypt 153 Zimbabwe 142 Côte d'Ivoire 127 Liberia 127 Kenya 114 Equatorial Guinea 106 Lesotho 101 Djibouti 90 Gambia 78 Angola 70 Senegal 63 Guinea 61 Ghana 60 Central African Republic 58 Uganda 57 Zambia 52 Mozambique 47 Mauritania 45 Togo 45 Rwanda 44 Cameroon 42 Sudan 39 Malawi 39 Benin 39 Guinea-Bissau 37 Eritrea 36 Nigeria 31 Mali 30 Burkina Faso 27 Sierra Leone 26 Utd Rep of Tanzania 26 Congo 22 Niger 22 Burundi 19 Chad 17 Ethiopia 14 Dem Rep of the Congo 12 Somalia   Source WHO

Country   %GPD   South Africa 8.6 Kenya 7.8 Malawi 7.8 Namibia 7.0 Djibouti 7.0 Botswana 6.6 Tunisia 6.4 Gambia 6.4 Zimbabwe 6.2 Côte d'Ivoire 6.2 Mozambique 5.9 Uganda 5.9 Guinea-Bissau 5.9 Zambia 5.7 Eritrea 5.7 Lesotho 5.5 Rwanda 5.5 Morocco 5.1 Senegal 4.8 Ghana 4.7 Sudan 4.5 Central African Republic 4.5 Utd Rep of Tanzania 4.4 Angola 4.4 Benin 4.4 Mali 4.3 Sierra Leone 4.3 Liberia 4.3 Algeria 4.1 Egypt 3.9 Niger 3.7 Ethiopia 3.6 Mauritania 3.6 Burundi 3.6 Gabon 3.6 Guinea 3.5 Dem Rep of the Congo 3.5 Nigeria 3.4 Cameroon 3.3 Swaziland 3.3 Burkina Faso 3.0 Libya 2.9 Togo 2.8 Chad 2.6 Somalia 2.6 Congo 2.1 Equatorial Guinea 2.0