A number of global, regional and local targets have been adopted since the landmark September 1978 Alma Ata Declaration that ushered in the Primary Health Care (PHC) approach to health service delivery. Since 1980, the concept has been the cornerstone of health service delivery in Zimbabwe.
The Health for All by 2 000, the Abuja Declaration with its target of 15 percent of national budgets to health, the 15-year Millennium Development Goals (MDGs) of 2000 and now the Sustainable Development Goals (SDGs) which expire in 2030 are other major health goals the country adopted.
Significant strides have been made in a number of areas particularly HIV/AIDS where prevalence has been reduced from 29 percent in 1997 to the current 15 percent. It also made remarkable progress in the 15 years with maternal mortality dropping from 960 per 100 000 live births to 525 while infant mortality plummeted from 65 deaths per 1,000 live births in 1999 to 26.55 deaths/1,000 live births.
Nevertheless the health system still faces excess challenges attributed to shifting disease patterns, general growth in population and limited resources.
Last year the country transitioned with the rest of the world to SDGs. Unlike the previous targets to which Zimbabwe faired averagely, the current goals are much broader and many with a total of 17 goals with at least six targets under each. Such targets have placed a much bigger responsibility on Zimbabwe which calls for accelerated effort from all stakeholders before they can become a reality.
Adopted at a time when external funding is fast becoming elusive owing to competing global issues among them immigration and incessant new outbreaks such as Zika and Ebola, local experts have been querying the country’s capacity to meet the targets.
Now there is much talk of improving domestic health financing to ensure sustainability of the various interventions aimed at fostering the general well-being of the country. Operating in a depressed economic environment, the national budget allocations remain below the Abuja Declaration stipulation of 15 percent while citizen’s incomes continue to dwindle.
Ministry of Health and Child Care permanent secretary Gerald Gwinji said the SDGs agenda builds onto the unfinished MDGs adding that, although SGD three is the major area of responsibility for the ministry, their strategy will also enhance health matters that are contained in other goals.
“Working through the cluster system that Government put in place we should therefore be able to get facilitation and enhancement from other ministries and therefore cover all pertinent matters,” said Dr Gwinji.
Goal three specifically speaks to "Ensuring Healthy lives and promotion of well-being for all at all ages. According to Dr Gwinji, to achieve the goal his ministry is working towards revitalising primary health care and bring services into the community.
“We are proposing a strategy for this and it is at an advanced stage. We now have to realistically address communicable as well as non-communicable challenge and a number of area specific strategies are already in place,” he said.
Outside the heavy burden of communicable diseases such as HIV, non-communicable diseases such as cancer, diabetes and cardio-vascular mal-functioning cases are on the increase in the country.
Dr Gwinji also said, towards achieving health-related Goal two, the ministry will contribute to nutrition sensitive policies and strategies with particular attention to pregnant women and young children. At least 2,1 percent children under-five years have severe acute malnutrition and the ministry is already working with partners to improve volatile nutrition of 4, 5 million people facing starvation as a result of the El-Nino induced drought.
The ministry will use its regulatory powers on the food industry to ensure food safety and also address micro-nutrient deficiencies by food fortification.
“Goal 17 calls for us to work in partnerships that result in development. We will be enhancing the old partnerships that have seen addressing e.g. HIV/TB/Malaria/ Maternal and Child health issues and building new ones for sustainable programming. This success is however dependent upon investment that is commensurate with expected results,” he said.
Community Working Group on Health (CWGH) executive director Itai Rusike said the principles of human rights and equality should underpin the implementation of SDGs if Zimbabwe is to make any meaningful progress.
“From our own experience here in Zimbabwe, we have seen realities time and again fall short of health promises, and are concerned that without more clearly defined national responsibilities for health and greater accountability, such a fate may also befall the health SDGs,” said Rusike.
“Major considerations and decisions must now be made before any new commitments are made on what benefits accrue to the nation's continued participation in these processes in the face of continued failures to achieve the set milestones.