Deterioration of public health in Zimbabwe

by Cesar Chelala

NEW YORK — Zimbabwe is a problematic state. Once the breadbasket of Africa, the country’s population is now suffering the consequences of government policies that have seriously harmed their health and quality of life.

With inflation rates at an unprecedented 231 million percent and rising, the country is trapped in a political impasse that hinders humanitarian relief. Urgent measures are needed to avoid catastrophe.

Hopes for a political settlement following the power-sharing agreement between President Robert Mugabe and opposition leader Morgan Tsvangirai are on the verge of collapse because of the inability of these adversaries to agree on which one should control the most important ministries.

President Mugabe’s recent swearing-in of two vice presidents runs the risk of forcing Tsvangirai to abandon the power-sharing agreement and sending the country into deeper chaos.

In the meantime, public health in the country’s larger cities continues to deteriorate, affecting children especially. The United Nations estimates that more than 5 million people — almost half of the country’s population — is in need of food aid.

Eighty-three percent of Zimbabweans live on less than $2 a day and 45 percent are malnourished, according to the U.N. World Food Program.

Rachel Pounds, the Zimbabwe country director for Save the Children, has called attention to the rising malnutrition level among children and the need for increased food aid. According to the agency, many children are eating rats or inedible roots such as makuri — which is riddled with toxic parasites — to control their hunger. The root has no nutritional value and provokes terrible stomach pains.

Lack of proper nutrition seriously affects people’s immune systems, leaving them more vulnerable to illnesses. This is particularly true for those with HIV/AIDS, which affects one in five adults in Zimbabwe. Zimbabwe has the fourth-largest HIV infection rate in the world and only one-third of the 300,000 Zimbabweans who need antiretroviral drugs are getting them. Lack of adequate statistics also makes it difficult to follow the course of the epidemic.

The situation is even more dire in rural areas, where there is a critical lack of basic materials, refrigerators, medicines and medical personnel. Ambulances are grounded for lack of fuel and spare parts and many rural clinics have been left under the supervision of nursing aides who are without the knowledge and the means to treat most patients.

Significant gains that were made in child health during the 1980s are being eroded, according to the World Health Organization. The mortality rate of children under the age of 5 rose from 80 per 1,000 live births in 1990 to 123 per 1,000 in 2005. Immunization programs now cover less than 70 percent of children for major childhood diseases such as polio, diphtheria and measles. Approximately 115,000 children under 14 are infected with HIV, according to UNICEF.

Physicians have been leaving the country in droves because of low salaries and bad working conditions. The Zimbabwe Association of Doctors for Human Rights declared in June 2007: “It can no longer be said the health service is near collapse. The emptying of central and other hospitals of staff, and therefore patients, means the health service has collapsed.”

The food crisis also has had a significant impact on children’s education. Many children drop out of school because they cannot afford to go — they must work for food. In some cases the teachers cannot afford the journey to schools. Not only this, but many teachers have become HIV-infected.

This is a sad state of affairs for a country whose public health system was, together with South Africa’s, among the most developed among some 40 other nations of sub-Saharan Africa, as I can attest from a visit to the country in the mid-1980s.

While people’s rights in the widest sense have been systematically abused, President Mugabe has strongly objected to criticisms of his policies. He has repeatedly declared: “Let me say once again that the West should spare us their lessons on human rights. They don’t have the moral authority to parade themselves as torchbearers of human rights.”

Zimbabwe needs massive foreign assistance to overcome this crisis. But the government has placed serious restrictions on work by aid agencies. Although foreign aid is crucial, it is up to Zimbabwe’s new unity government to lead the country out of these dire straits and restore what was once a model public health system.

Cesar Chelala, M.D., is an international public health consultant and a cowinner of an Overseas Press Club of America award for an article on human rights.