The cost of health in Zimbabwe
Zimbabwe has recently announced that it intends to abolish fees for women using its maternal health clinics. This is a welcome step, and comes amidst growing pressure on developing countries to abandon the practice of charging patients so-called ‘user fees’ for primary health care, especially for maternal health and young children, which had been encouraged as part of Structural Adjustment Programmes driven by the IMF and World Bank in the 1980s and 1990s.
User fees
As a result of user fees many people in the world’s poorest countries simply do not seek treatment when they are ill, or delay getting help. This can be fatal for conditions that require urgent attention, such as malaria in children or complications during labour. Research has suggested that abolishing user fees could prevent over 230,000 child deaths each year, across 20 African countries. Fees disproportionately damage the health of marginalised people, pushing families into debt and poverty. They can especially penalise women who have fewer resources to draw upon.
Zimbabwe’s Health Minister Henry Madzorera has said that the idea of eliminating maternal care fees was reinforced at July’s African Union summit in Uganda. It also comes in the wake of Sierra Leone’s abolition of fees for pregnant women, new mothers and children under five, which it has been rolling out since 27 April 2010.
However, to introduce free maternal health care in Zimbabwe will require funding. After years of hyper inflation, economic mismanagement, and the collapse of social services, finding the money to pay for this initiative will be challenging. Zimbabwe has only recently begun to re-engage with international donors after years of ‘pariah status’ on the international stage, and will be looking to these donors for help to fund free maternal healthcare.
Ballooning debts
In the meantime, Zimbabwe continues to owe billions in unpayable, and unjust, debts to other countries and multilateral bodies like the World Bank. If Zimbabwe has to repay these debts, long-term funding which could go to healthcare and other essential services will be spent instead on debt service. Zimbabwe’s vast debt burden therefore threatens any sustainable future for its people and its economy. On the other hand, if Zimbabwe’s debts were cancelled, it would free up billions of dollars, on an ongoing basis, which could provide long-term finance for health.
Zimbabwe owes over $5.7 billion to external creditors which represented over 192% of its Gross Domestic Product in 2009. $3.8 billion of this amount is currently arrears. This debt could soar to over $13.4 billion by 2013. Arrears would account for $10.4 billion of this.
To put this in context, African Union leaders have just made an appeal to donors who will gather in October at the annual meeting of the Global Fund to fight AIDS, TB and Malaria, calling on them to extend the Fund’s support for child and maternal health. This is crucial as without funding, efforts to improve health across the continent will not succeed, but the numbers compared to Zimbabwe’s debt make for stark reading.
Since 2003, the Global Fund has dispersed $173 million to Zimbabwe to help fight the three killer diseases. This has resulted in an additional 77,000 HIV positive people receiving ARV therapy, 34,000 cases of tuberculosis diagnosed and treated, and almost 500,000 mosquito nets distributed. But compare $173 million to the $3.8 billion arrears currently owed by Zimbabwe, and to the health and wider needs of this country, such as 1 million AIDS orphans, over 100,000 cases of TB, and 1.5 million reported cases of malaria. Debt cancellation in this context is a matter of life and death for Zimbabweans.
Debt relief?
Some donor countries are keen for Zimbabwe to be classified as a Heavily Indebted Poor Country (HIPC) so it can be granted some debt relief through the HIPC scheme, created in the late 1990s. However HIPC is notoriously slow and is tied to a whole range of controversial conditions, often including deregulation, privatisation and cuts in social spending.
Some analysts argue that it might be better for Zimbabwe to use its significant natural resources to attract emerging lenders such as China, who do not expect harsh policy reforms in exchange for their money. This option is also highly controversial, as these lenders have been widely criticised for their lack of transparency and accountability and their impact on environmental, social and human rights grounds.
Debt justice
The debt campaign in Zimbabwe, ZIMCODD, advocates instead for a full public audit of the country’s debt burden to assess whether and how much of the debt could be classed as illegitimate. This would mean that where funds have been misused or corruption has taken place, the resulting debts would be cancelled and those responsible would be held to account. Both the leaders of Zimbabwe, and those international lenders who turned a blind eye and carried on lending, who profited from corruption, or who simply made bad lending decisions, must share responsibility for the country’s debt.
The context of the current power-sharing deal admittedly makes progress on the debt issue complex. At a minimum the build up of arrears should be frozen, and an audit carried out. Ultimately, it is the people of Zimbabwe who are suffering, and a just debt cancellation settlement would free up billions of dollars to help rebuild health services and provide free care to those in need.
NB: all dollar amounts are US. Debt figures from Jubilee Debt Campaign.
Last modified: 16/12/2010
