The transformation of Zimbabwe's health care system: A review of the white paper on health

The political economy of health financing reforms in Zimbabwe: a scoping review

“…The first decade post-independence (1980-1990) was driven by the idea of nation-building, equality, and solidarity as a post-colonial strategy [ 22 – 24 ]. Central to this thrust was the idea of disrupting the pervasive social injustice that prevailed during the colonial period where a racially divided health care system accorded the minority White population sophisticated health care amenities whilst the majority Black population remained marginalized and plagued with diseases of poverty [ 25 , 26 ]. Whilst the colonial government had never published health indicators by race, the newly independent government released statistics that showed that the expenditure per capita was 36 times higher amongst White population compared to the rural Black population [ 27 ].…”

“…In response, the government implemented policies aimed at tackling racial inequalities inherited from the colonial period within the Primary Health Care (PHC) concept [ 28 , 29 ]. In a White Paper entitled Planning for Equity in Health, A Sectoral Review and Policy Statement the government of Zimbabwe detailed how it intended to transform the existing health care system into one consonant with the government’s commitment to socialist development [ 25 ].…”

“…During the colonial period, institutions were designed to entrench racial inequalities between Whites and Blacks. The Medical Services Act of 1979 allowed certain beds in the best government hospitals to be ‘open’ to designated medical practitioners to admit their private patients, while the African wards were ‘closed’ to private doctors [ 25 ]. Additionally, the levying of user charges discriminated the population according to ability to pay which further entrenched the segregation.…”

“…In a 1984 White paper entitled ‘Equity in health planning’ , the government pronounced the intention to create the National Health Service that would be financed out of central government revenue. It also proposed funds to be raised through a scheme involving compulsory national health insurance as part of the National Social Security System that was due for adoption [ 25 ]. In 1992, the World Bank underscored the creation of the National Health service and went further to propose the establishment of a National Health Development Fund (NHDF) incremental to the MOH budget [ 37 ].…”

“…At independence, Zimbabwe inherited a sophisticated private sector that was developed to serve the affluent minority White population comprising a medical sector and health insurance (referred to as medical aid societies). In practice, the medical sector basically comprised of physicians practicing privately and receiving fee for- service from medical aid societies or directly from patients [ 25 ]. In light of the contradictions between the reality of private sector dominance and its vested interests viz-viz the government’s vision of a socialist health care system, it was often suggested that the litmus test for the government's commitment towards a socialist health model was its attitude and policies towards the private medical sector.…”

The political economy of health financing reforms in Zimbabwe: a scoping review

“…The first decade post-independence (1980-1990) was driven by the idea of nation-building, equality, and solidarity as a post-colonial strategy [ 22 – 24 ]. Central to this thrust was the idea of disrupting the pervasive social injustice that prevailed during the colonial period where a racially divided health care system accorded the minority White population sophisticated health care amenities whilst the majority Black population remained marginalized and plagued with diseases of poverty [ 25 , 26 ]. Whilst the colonial government had never published health indicators by race, the newly independent government released statistics that showed that the expenditure per capita was 36 times higher amongst White population compared to the rural Black population [ 27 ].…”

“…In response, the government implemented policies aimed at tackling racial inequalities inherited from the colonial period within the Primary Health Care (PHC) concept [ 28 , 29 ]. In a White Paper entitled Planning for Equity in Health, A Sectoral Review and Policy Statement the government of Zimbabwe detailed how it intended to transform the existing health care system into one consonant with the government’s commitment to socialist development [ 25 ].…”

“…During the colonial period, institutions were designed to entrench racial inequalities between Whites and Blacks. The Medical Services Act of 1979 allowed certain beds in the best government hospitals to be ‘open’ to designated medical practitioners to admit their private patients, while the African wards were ‘closed’ to private doctors [ 25 ]. Additionally, the levying of user charges discriminated the population according to ability to pay which further entrenched the segregation.…”

“…In a 1984 White paper entitled ‘Equity in health planning’ , the government pronounced the intention to create the National Health Service that would be financed out of central government revenue. It also proposed funds to be raised through a scheme involving compulsory national health insurance as part of the National Social Security System that was due for adoption [ 25 ]. In 1992, the World Bank underscored the creation of the National Health service and went further to propose the establishment of a National Health Development Fund (NHDF) incremental to the MOH budget [ 37 ].…”

“…At independence, Zimbabwe inherited a sophisticated private sector that was developed to serve the affluent minority White population comprising a medical sector and health insurance (referred to as medical aid societies). In practice, the medical sector basically comprised of physicians practicing privately and receiving fee for- service from medical aid societies or directly from patients [ 25 ]. In light of the contradictions between the reality of private sector dominance and its vested interests viz-viz the government’s vision of a socialist health care system, it was often suggested that the litmus test for the government's commitment towards a socialist health model was its attitude and policies towards the private medical sector.…”

The political economy of health financing reforms in Zimbabwe: a scoping review

“…The first decade post-independence (1980-1990) was driven by the idea of nation-building, equality, and solidarity as a post-colonial strategy [ 22 – 24 ]. Central to this thrust was the idea of disrupting the pervasive social injustice that prevailed during the colonial period where a racially divided health care system accorded the minority White population sophisticated health care amenities whilst the majority Black population remained marginalized and plagued with diseases of poverty [ 25 , 26 ]. Whilst the colonial government had never published health indicators by race, the newly independent government released statistics that showed that the expenditure per capita was 36 times higher amongst White population compared to the rural Black population [ 27 ].…”

“…In response, the government implemented policies aimed at tackling racial inequalities inherited from the colonial period within the Primary Health Care (PHC) concept [ 28 , 29 ]. In a White Paper entitled Planning for Equity in Health, A Sectoral Review and Policy Statement the government of Zimbabwe detailed how it intended to transform the existing health care system into one consonant with the government’s commitment to socialist development [ 25 ].…”

“…During the colonial period, institutions were designed to entrench racial inequalities between Whites and Blacks. The Medical Services Act of 1979 allowed certain beds in the best government hospitals to be ‘open’ to designated medical practitioners to admit their private patients, while the African wards were ‘closed’ to private doctors [ 25 ]. Additionally, the levying of user charges discriminated the population according to ability to pay which further entrenched the segregation.…”

“…In a 1984 White paper entitled ‘Equity in health planning’ , the government pronounced the intention to create the National Health Service that would be financed out of central government revenue. It also proposed funds to be raised through a scheme involving compulsory national health insurance as part of the National Social Security System that was due for adoption [ 25 ]. In 1992, the World Bank underscored the creation of the National Health service and went further to propose the establishment of a National Health Development Fund (NHDF) incremental to the MOH budget [ 37 ].…”

“…At independence, Zimbabwe inherited a sophisticated private sector that was developed to serve the affluent minority White population comprising a medical sector and health insurance (referred to as medical aid societies). In practice, the medical sector basically comprised of physicians practicing privately and receiving fee for- service from medical aid societies or directly from patients [ 25 ]. In light of the contradictions between the reality of private sector dominance and its vested interests viz-viz the government’s vision of a socialist health care system, it was often suggested that the litmus test for the government's commitment towards a socialist health model was its attitude and policies towards the private medical sector.…”

The political economy of health financing reforms in Zimbabwe: a scoping review

“…The first decade post-independence (1980-1990) was driven by the idea of nation-building, equality, and solidarity as a post-colonial strategy [ 22 – 24 ]. Central to this thrust was the idea of disrupting the pervasive social injustice that prevailed during the colonial period where a racially divided health care system accorded the minority White population sophisticated health care amenities whilst the majority Black population remained marginalized and plagued with diseases of poverty [ 25 , 26 ]. Whilst the colonial government had never published health indicators by race, the newly independent government released statistics that showed that the expenditure per capita was 36 times higher amongst White population compared to the rural Black population [ 27 ].…”

“…In response, the government implemented policies aimed at tackling racial inequalities inherited from the colonial period within the Primary Health Care (PHC) concept [ 28 , 29 ]. In a White Paper entitled Planning for Equity in Health, A Sectoral Review and Policy Statement the government of Zimbabwe detailed how it intended to transform the existing health care system into one consonant with the government’s commitment to socialist development [ 25 ].…”

“…During the colonial period, institutions were designed to entrench racial inequalities between Whites and Blacks. The Medical Services Act of 1979 allowed certain beds in the best government hospitals to be ‘open’ to designated medical practitioners to admit their private patients, while the African wards were ‘closed’ to private doctors [ 25 ]. Additionally, the levying of user charges discriminated the population according to ability to pay which further entrenched the segregation.…”

“…In a 1984 White paper entitled ‘Equity in health planning’ , the government pronounced the intention to create the National Health Service that would be financed out of central government revenue. It also proposed funds to be raised through a scheme involving compulsory national health insurance as part of the National Social Security System that was due for adoption [ 25 ]. In 1992, the World Bank underscored the creation of the National Health service and went further to propose the establishment of a National Health Development Fund (NHDF) incremental to the MOH budget [ 37 ].…”

“…At independence, Zimbabwe inherited a sophisticated private sector that was developed to serve the affluent minority White population comprising a medical sector and health insurance (referred to as medical aid societies). In practice, the medical sector basically comprised of physicians practicing privately and receiving fee for- service from medical aid societies or directly from patients [ 25 ]. In light of the contradictions between the reality of private sector dominance and its vested interests viz-viz the government’s vision of a socialist health care system, it was often suggested that the litmus test for the government's commitment towards a socialist health model was its attitude and policies towards the private medical sector.…”