The great hope and promise of post-independence efforts to promote equitable health care in Zimbabwe started with three years of dramatic improvement. Commitment to correcting inequities which were as discriminatory as any country in the world produced rapid extension of health centre infrastructure and the improvement of district hospitals. The major constraint was the entrenched pattern of sophisticated, high-technology health care left by colonial administrators which continued to monopolize resources. In spite of the excellent beginning, development of services for the poor was thwarted by recession, prolonged drought and external military destabilization. The cutbacks in funding for health care have been particularly severe as a result of economic adjustment policies imposed by IMF. Political pressure moved the health system toward private entrepreneurship returning to earlier patterns of discrimination in favour of whites and urban residents. Efforts to promote high-risk monitoring have had little impact among the poor and those living in remote areas. Equity has become symbolic rather than real. The government of Zimbabwe maintains a continuing commitment to the original goals of equity through primary health care. International agencies also would like to find a way to help reallocate services. There seems to be recognition that little will be accomplished in improving health conditions unless services are provided to those in greatest need. Disparities in maternal care are especially severe and can be improved only by building infrastructure to provide antenatal and perinatal services.(ABSTRACT TRUNCATED AT 250 WORDS)
PIP: Zimbabwe adopted the goal of equity in health care. A range of options for monitoring progress toward equity is available. Surveillance systems for monitoring equity characteristically are population-based. Population-based information can be used to identify priority subgroups, corrective action, and appropriate research questions. Equality of access and other social and health factors can be used to measure equity. Surveillance should stimulate community action. Self-financing health systems are appropriate only for those who can afford it. Public acceptance of equity requires social changes in attitudes. Cooperative relations between health services and local academic centers can contribute to local problem solving. Implementing a surveillance system for equity involves first conducting a Situation Analysis and setting priorities. Priority should be on carefully selected indicators. A list of biomedical, socioeconomic, and service indicators was provided. After independence in Zimbabwe some improvement was made in maternal mortality, infant mortality, and malnutrition. After independence, primary health care was promoted, but severe economic problems and the structural adjustment policies resulted in severe cuts to the social services. By 1987 there were 274 rural health centers, but funding was still lopsided in favor of curative care. Health center deliveries increased, but after a fee increase in 1988, there were declines. There was a shift to private medical care in urban areas. Inequities in health manpower were corrected by training health workers and reorienting the emphasis to prevention and health promotion. The number of deliveries with trained medical personnel and deliveries in health facilities increased by 1988. Immunization increased, albeit unevenly in poorer areas. Services for the poor were thwarted by recession, prolonged drought, and external military destabilization. Equity is only a symbol, unless a surveillance system can be established as a means of using limited resources to reach the most in need with targeted services.