CRS-23 Poor sanitation and water shortages pose serious health risks in Zimbabwe’s urban centers. Basic hygiene items, such as soap, have become too expensive for many residents. In the country’s second largest city, Bulawayo, service delivery, including garbage collection, has declined severely because of budget shortages, and reports suggest many ambulances and fire trucks sit unused because the city council cannot afford fuel or spare parts. According to U.N. reports, the current violence has impeded the delivery of assistance by NGOs. Economic Recovery.99 In tandem with diplomatic pressure, the Bush Administration and other international actors have discussed financial incentives and assistance to facilitate Zimbabwe’s economic recovery in the event of a democratic transition. Zimbabwe’s economy has collapsed in the last decade, and every sector of the economy has been affected. Annual outputs of wheat, maize, and tobacco, once Zimbabwe’s largest foreign exchange earner, have plummeted. Manufacturing output dropped over 47 percent in the decade between 1996 and 2006. Zimbabwe’s mining sector has been similarly affected, although the platinum industry remains a major income earner for the government.100 World Bank and IMF lending has been suspended for more than six years due to nonpayment of arrears, and foreign currency for essential imports, particularly fuel, is in extremely short supply. Zimbabwe’s inflation rate, at almost 165,000 percent according to official government figures, is the highest in the world and has contributed significantly to the country’s economic collapse. Zimbabweans continue to face steep rises in the prices of food and non-food items, including rents. These factors all contribute to increasing pressure on both the people of Zimbabwe and members of Mugabe’s regime. According to the IMF, the Reserve Bank of Zimbabwe’s quasi-fiscal activities are primarily responsible for the surge in the country’s money supply in recent years. Losses from such activities were estimated to be 75 percent of GDP in 2006. These activities include monetary operations to absorb excess liquidity; subsidized credit; sustained foreign exchange losses through subsidized exchange rates for selected government purchases and multiple currency practices; and financial sector restructuring. After the government implemented its price control policy in June 2007, cutting prices of basic commodities by 50 percent in an effort to stem inflation, manufacturing output fell more than 50 percent within six months and many firms were forced to close. The price controls also resulted in a shortage of basic goods and have contributed to worsening social indicators. The government’s fast track land reform and more recent policy changes such as the Indigenization and Economic 99 Information in this section was drawn from a variety of sources, including David Coltart, “A Decade of Suffering in Zimbabwe: Economic Collapse and Political Repression under Robert Mugabe,” CATO Institute Development Policy Analysis No. 5, March 24, 2008; Sonia Munoz, “Central Bank Quasi-fiscal Losses and High Inflation in Zimbabwe: A Note,” IMF Working Paper, April 2007; and “Zimbabwe: Article IV Consultation - Staff Notes,” IMF Country Report No. 05/360, October 2005. 100 Zimbabwe has the world’s second largest reserves of platinum, behind South Africa. The largest mining operations in the country are controlled by Impala Platinum and Anglo Platinum, respectively. These South African-owned companies are the world’s largest platinum producers.