THE ROLE OF NON-STATE ACTORS IN STRENGTHENING HEALTH SYSTEMS Changing the narrative: the case of Zimbabwe AUTHORS Godknows Muperekedzwa Kudzai Vere Deloune Matongo Chitando Mutsawashe
PEER REVIEWER: Anusckha Coovadia
EXECUTIVE SUMMARY Two years after the Alma Ata Declaration (1978), the government of Zimbabwe adopted the primary healthcare (PHC) approach, directing resources equitably and stimulating community participation in transforming health. Zimbabwe's health sector has been facing unprecedented challenges in its endeavour to achieve equitable access to health services for all. The current economic collapse and a growing population, corruption, political instability, health financing and health systems structure have compromised government’s efforts to meet the demands for health service provision. Recurring disease outbreaks have not done the ailing health system any good, either. Additionally, non-communicable diseases are on the rise, further exacerbating the burden on the health system. The finance ministry has failed to adhere to the Abuja Declaration, leaving substantial funding gaps for health. This non-adherence and funding deficits have led to an influx of ‘non-state actors’, but lack of coordination and profiteering interests have impeded their actions. They include non-governmental organisations, health insurance providers, corporates and individuals. The health ministry is highly dependent on non-state actor funding for its key programmes. Failure of health insurance markets due to limited government fiscal space and high premiums, which are out of reach to many of the informally employed, has resulted in high numbers of uninsured and under-insured individuals. Increased healthcare costs, increased out-of-pocket payments and collapsing PHC have severely affected the delivery of services. Given the deficiencies in government-supported facilities, private institutions have become the beacon of light for the Zimbabwean health system. They have evolved from just offering complementary services to becoming the health system’s backbone. There are still concerns about the modus operandi of these private players. However, the future of the health system in Zimbabwe cannot be guaranteed without their being included as key stakeholders. Based on the evidence above, the government may consider regulatory instruments to control the environment and safeguard PHC. This will also create a conducive environment that promotes private-public partnerships.
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