Zimbabwe’s health system is beginning to function againBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4211 (Published 04 August 2010) Cite this as: BMJ 2010;341:c4211
All rapid responses
Healthcare systems are generally defined by the socio-political and
economic contexts of the society they serve (Carr, 1997 & 1998).
According to the World Health Organization (WHO), health is a fundamental
right and is not the mere absence of disease or infirmity, but is a state
of physical, mental, social and spiritual wellbeing. To function well
healthcare systems must include those services that can be provided to all
persons within a given population at the most peripheral community and
practical level and should include those at the entry point of the health
care delivery system. It should integrate at the community level to
combine health promotion, specific prevention, early detection, curative
services and secondary health care to assist in the reduction of
disabilities. However, functional healthcare systems should combine
rehabilitative and community development activities to improve the health
of individuals, families and communities. In a well regulated system of
healthcare delivery, the primary level increases the accessibility to the
other levels of care to those who need it, especially through its
screening functions and as a result the primary levels of healthcare
practice are built on primary care. For functional healthcare systems to
be maintained it should encompass the total picture of man and his
Additionally and most importantly in maintaining functional
healthcare systems, much political will, equity at all levels,
intersectoral collaboration, health promotion, and community participation
must be integrated and sustained. The political will to influence
healthcare systems is paramount especially if social programs for
sustaining individuals, families and communities are to have any success.
In order to achieve physical and mental well-being it is essential that
all individuals in the population healthcare must not only be accessible,
affordable, and available but must be adaptable and appropriate.
Healthcare systems can be functional but much effort is required by all
and as such, the political and economic will, must be present to promote
and provide these health services. Community participation in planning,
implementing and controlling development programs and deciding on health
policies are now widely accepted. If socio- political circumstances are
positive, this will contribute to the development of a vibrant progression
of change and organization, and the health sector can attain a wider socio
Since the World Health Organization (WHO) strongly defines and
emphasizes the central role that is to be played by politics and economics
in health in order to achieve physical and mental well-being, it is
essential that individuals have healthcare accessible, affordable, and
available and that adaptable and appropriate health care are attainable.
As such, the political and economic will, must be present to promote and
provide these health services. Healthcare systems should always remain a
high responsibility of the wider government even though social systems are
responsive to the public administrative strategies employed by governments
(Carr, 1997 & 1998).
1.Carr P. Issues in health Sector Reform in the English Speaking
Caribbean: Trinidad and Tobago and Jamaica Unpublished 1997
2. Carr P. Health Services Reform in the English -Speaking Caribbean
- The Jamaican Experience: Issues and Challenges. Unpublished.1998.
3. Moody C. The rationalization of Primary health Care in Jamaica:
For Nineties and into the 21st. Century. Unpublished,1996.
4. The Ottawa Charter for Health Promotion Document (1986) produced
by the World Health Organization.
5. WHO | Health Promotion-The 7th Global Conference on Health
26-30 October 2009. Retrieved June 2010 from
Competing interests: No competing interests
I was very pleased to read Kate Adams article about the health
services in Zimbabwe. I wanted to take the opportunity to salute the
heroes of the Zimbabwean health service who have kept it going through
thick and thin. I would particularly want to mention Dr Monica Glenshaw
and Sister Barbara Wilson who work in Buhera, one of the poorest districts
in Zimbabwe, and have kept their hospital going despite poverty, violence,
cholera and the HIV-TB epidemic. Among many others, Dr Margaret Borok and
Dr "Rati" Ndlovu deserve a mention. They work in the Department of
Medicine in the medical school in Harare which continues to produce 170
medical graduates every year.
The role of the British government should also be acknowledged as,
despite extreme provocation from some elements in the Zimbabwean
government, we have continued to contribute strongly to the health economy
in Zimbabwe. At one time nearly all the drugs in Zimbabwe were being
contributed by the British through the Department for International
Development (http://www.dfid.gov.uk.). DFID agents also helped broker the
deal that put the doctors and nurses back to work and re-opened the
central hospitals in 2009. These entirely humanitarian efforts will have
saved many lives. They need to be sustained and enhanced.
Dr Adams mentioned the TB programme in Buhera which is based in
Murambinda Hospital. It is strongly supported by a group of British
doctors through the Charity “Friends of Murambinda”
(http://www.fmh.org.uk/). The charity supports salaries and
administration resulting in a very well functioning hospital. It is also
true that that the TB-HIV programme in Buhera is performing strongly when
compared with the surrounding districts. Many factors have contributed to
this but they include strong leadership, a clear vision and the engagement
of several NGOs who are building towards a common goal. The largest of
these is MSF Belgium but the British charity, TB alert
(http://www.tbalert.org/) has made a significant contribution through
financial and intellectual support. The programme is now described by the
provincial Medical Director as a "model programme" and later this year a
collaborative project between the Manicaland Provincial Health Department
and consultants from the south London Academic Health Science centre,
Kings Health Partners, will seek to evaluate whether the successes in
Buhera can be extended to other parts of the province.
I have had at least one flight to Zimbabwe paid by TB alert.
Competing interests: No competing interests