ZADHR News
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Human rights education in medical education (Continued from page 1)
disparities in poverty, illiteracy, unemployment and
other social determinants of health also received little
attention. The TRC believed this could have been different had the health practitioners had some training
on human rights.
victim after a violation. Whether they are a patient suffering from cholera as a result of a lack of access to adequate sanitation and safe water, or a patient who has sustained a fracture as a result of torture, the health professional is often a first point of contact.
In its report of 1998, the TRC recommended that
‘training in human rights be a fundamental and integral aspect of all curricula for health professionals.
Knowledge of and competence and proficiency...should be a requirement for qualification
and registration.”
The health professional therefore has an attendant responsibility of calling attention to human rights violations when they occur and working to put and end to
them. Health professionals cannot be expected to do this
if they have not been equipped with the necessary
knowledge. Health professionals must be educated on
human rights, how to play a role in promoting and protecting them and how to recognise and respond to violations of human rights when they occur.
Ultimately health professionals are frontline witness
of respect for or violation of human rights. They are
likely to be one of the first people to encounter the
What is the way forward for health in Zimbabwe?
Charles Todd, Sunanda Ray, Farai Madzimbamuto, David Sanders
(This article was first published online in The Lancet
www.thelancet.com on 13 October 2009 DOI:10.1016/S0140-6736
(09)61498-7)
Zimbabwe’s Government of National Unity (GNU), established on Feb 13, 2009, faced immense challenges: a collapsed economy with 94% of the population without a job1
and almost 50% needing food aid;2 a severe cholera epidemic;3 HIV/AIDS prevalence of more than 15% in adults
aged 15–49 years;4 and a collapsed health system.5 The
GNU responded to the issues of the health sector by holding
an inclusive summit and adopting an ambitious 100-day
recovery plan for the health sector.6,7 Here, we describe the
recent health crisis and its causes, and make proposals for
an effective and sustainable health system.
Zimbabwe was once a beacon of hope in Africa, improving
health tremendously after independence in 1980. A declining national income, a huge national debt, economic structural adjustment, recurrent droughts, widespread HIV/
AIDS, and a weakening health system all contributed to the
deterioration of Zimbabweans’ health since 1990. Between
2000 and 2005, the gross national income (GNI) per head
declined by 54%.8 The latest estimate of US$340 places
Zimbabwe among the world’s poorest countries:9 all the
income gains of the past 56 years have been wiped out.10
Economic decline has driven the exodus of Zimbabweans,
with over 3 million of the total population of 13·5 million
estimated to be living outside the country;11 the funds remitted by them are the main source of income for many families. For those having no access to external funds the situation is dire.
Between 1990 and 2006, life expectancy at birth plummeted
from 62 to 43 years, mostly from increased young adult
mortality from HIV-related conditions.12 Mortality rates of
children younger than 5 years and infants rose from 77 and
53 per 1000 livebirths in 1992 to 82 and 60 in 2003, respectively.13 Maternal mortality rose from 168 per 100 000
births in 199014 to 725 per 100 000 in 2007.15 Tuberculosis
incidence increased from 136 per 100 000 in 1990 to 557
per 100 000 in 2006.16 These indicators are related to the high
prevalence of HIV/AIDS, which was estimated at 26% in
2000 in adults aged 15–45 years but declined to 15.3% by
2007.4 In 1994, 80.1% of children aged 12–23 months had
received all basic vaccines compared with 74.8% in 1999 and
only 52.6% in 2006–07.13 By early 2009, hospitals in the
country were hardly operating, with massive shortages of essential medicines and supplies.5 Although most hospitals are
now functioning again, shortages are still commonplace and
patients usually need to buy medicines, intravenous fluids, and
sutures. Women delivering in rural clinics must bring candles,
cotton wool, methylated spirit, gloves, and even fresh water.
The physical infrastructure of most government health facilities is decrepit, and ambulances sparse.
The recent cholera outbreak further exposed Zimbabwe’s collapsed infrastructure and its health system. Between August,
2008, and July, 2009, 98 591 suspected cholera cases were
reported, including 4288 deaths.17 The epidemic resulted from
the breakdown of urban water and sanitation systems, leading
to contamination of piped water and shallow wells.5 The casefatality rate peaked at almost 6%,3 greatly exceeding the 1%
WHO norm, indicating the weakened health system and poor
access in rural areas.5
Total health expenditure per head fell by 56% between 2000
and 2005 to $21, of which $9 was government expenditure.12
External funding contributed 21% of total health spending, a
low proportion compared with that in most African countries.
Under the previous government, which was led by Zimbabwe
African National Union-Patriotic Front (ZANU-PF) party,
bilateral donors channelled funds to specific activities such as
HIV programmes and family planning. Therefore, 58% of
currently married women use modern contraceptive methods,13 and about 100 000 people were receiving antiretroviral
treatment by the end of 2007.4 However, antiretroviral treatment coverage at 17% is the lowest of any country in southern
Africa, with an estimated 570 000 people needing treatment.4
Furthermore, HIV-positive patients displaced by political violence and those affected by stock-outs of common AIDS