Staff writer
Zimbabwe’s public health sector is grappling with a severe human resources crisis, which has been ongoing for several years. This crisis has significantly impacted the country’s ability to provide adequate healthcare services to its population.In early 2020, just before the COVID-19 pandemic hit the country, Zimbabwe was already experiencing a critical shortage of medical personnel. The vacancy rate for doctors stood at 34%, while for medical laboratory scientists, it was an astounding 64% . These high vacancy rates have put immense pressure on the remaining healthcare workers, compromising the quality of care provided to patients. The exodus of healthcare professionals from Zimbabwe has been a persistent issue, contributing to the ongoing crisis. This “medical brain drain” has been a subject of intense debate and concern
By 2000, 51% of Zimbabwe’s doctors and 25% of its nurses were already practicing abroad.
In 2019, the UK’s National Health Service employed 4,049 Zimbabwean healthcare professionals, including doctors, nurses, and clinical support staff.
More than 4,000 health workers, including over 2,600 nurses, left Zimbabwe in 2021 and 2022 alone.
This continuous loss of experienced healthcare professionals has had a crippling effect on Zimbabwe’s public health system. It has resulted in a decline in health outcomes, with life expectancy dropping from 60.7 years in 2019 to 58.5 years in 2021, lower than the African average of 63.6 years.
On the other hand, the Zimbabwean government faces significant challenges in recruiting and retaining healthcare professionals. These include economic factors, working conditions, workload, legal constraints and government restrictions.
These , coupled with the ongoing exodus of healthcare professionals, have created a vicious cycle that continues to weaken Zimbabwe’s public health sector.
Addressing these issues will require comprehensive strategies that focus on improving working conditions, offering competitive salaries, and creating a supportive environment for healthcare workers.
Impact on Medical Education and Training Medical Schools Capacity
Zimbabwe’s medical education system has shown remarkable resilience and growth despite the challenges faced by the country’s healthcare sector. Between 2010 and 2015, the University of Zimbabwe College of Health Sciences (UZCHS) experienced significant expansion. Full-time academic staff numbers increased by 36%, growing from 122 to 166 posts 8. This growth in faculty was accompanied by a substantial rise in student enrollment. Annual postgraduate enrollments surged by 61%, from 75 to 121 students, while annual medical student intakes increased by an impressive 71%, from 123 to 210 students 8.
The capacity of medical schools to train healthcare professionals has continued to improve even after the conclusion of the Medical Education Partnership Initiative (MEPI) in 2015. From 2015 to 2017, the annual enrollment of Master of Medicine (MMed) residents increased by 12.5%, rising from 48 to 54, while medical student enrollment grew by 10.5%, from 210 to 232 8.
Quality of Education
The quality of medical education in Zimbabwe has been a focus of improvement efforts. The UZCHS implemented several initiatives to enhance the quality of education provided to students:
Faculty Development: Fifteen core faculty development workshops were conducted over five years, with 69% of faculty members attending one or more workshops .
Curriculum Review: By 2015, 79% of faculty respondents reported initiating the process of curriculum review. By 2017, 50% of departments had completed the review and were implementing new working drafts.
However efforts have been made to support the ongoing development of healthcare professionals in Zimbabwe:
HEALZ Program which by 2017,had seen five cohorts totaling 65 scholars had completing the programme while after the MEPI grant period, the Department of Health Professions Education continued to organize two faculty development workshops per year with funding from the University of Zimbabwe.
These efforts in medical education and training have had a positive impact on the healthcare workforce in Zimbabwe. The number of medical practitioners registered to practice in the country increased by 32.6% between 2011 and 2014, rising from 2,003 to 2,656.
The staff shortage has also impacted HIV/AIDS programs. For instance, Médecins Sans Frontières (MSF) supported the ART program with incentives, which inadvertently led to the underperformance of other health programs like the Expanded Program on Immunization (EPI).The COVID-19 pandemic has significantly impacted tuberculosis (TB) control efforts in Zimbabwe. In 2020, there was a 25% decline in TB case notifications and a 30% decline in drug-resistant TB (DR-TB) case notifications compared to 2019 .
The restrictions implemented by the government during 2020 limited clients’ access to diagnosis, treatment, and care in most areas. To address these challenges, the National TB Program (NTP) is implementing several strategies for example, strengthening community systems for systematic TB screening, training community healthcare workers (CHWs) on signs and symptoms of presumptive TB and COVID-19 ,engaging TB survivors and school health coordinators for psychosocial support and involving traditional and faith healers in referrals and treatment support.
The management of non-communicable diseases (NCDs) in Zimbabwe has also faced significant challenges due to staff shortages and resource constraints. NCDs are projected to overtake communicable, maternal, neonatal, and nutritional diseases combined as the leading cause of mortality in sub-Saharan Africa by 2030.
To address the growing burden of NCDs, Zimbabwe has implemented innovative approaches:
- Task-shifting: The Friendship Bench program has successfully engaged community health workers (CHWs) in managing common mental disorders such as depression and anxiety at the primary healthcare level .
- Integration of services: There are efforts to integrate NCD services within existing HIV and mental health programs as a cost-effective way to increase availability, especially at the primary care level .
However, challenges remain in the management of NCDs for example limited resources, shortage of healthcare workers and lack of protective equipment with shortages of latex gloves and other sterilized equipment putting healthcare professionals at risk of contracting infections.
To improve NCD care, stakeholders suggest leveraging existing programs like the Friendship Bench to provide an integrated NCD care package for diabetes, hypertension, and depression. This approach could help address the limited resources and staff shortages while improving access to care for patients with multiple chronic conditions.
The mental health and well-being of healthcare workers in Zimbabwe have been significantly impacted by various challenges, including the COVID-19 pandemic, staff shortages, and economic crises. These factors have led to increased stress, anxiety, and other mental health issues among healthcare professionals.
At a time, healthcare workers in Zimbabwe face a high prevalence of mental health issues, a study conducted in neighboring Malawi, which shares similar healthcare challenges, found a concerning prevalence of COVID-19-related depression (31%), anxiety (30%), and post-traumatic stress disorder (PTSD) (25%) among healthcare workers. These findings likely reflect the situation in Zimbabwe as well.
Economic Implications of Staff Shortages
The staff shortages in Zimbabwe’s healthcare sector have far-reaching economic implications, affecting healthcare costs, productivity, and national development.The shortage of healthcare workers in Zimbabwe has led to increased healthcare costs for both the government and individuals. With limited access to public healthcare services, many Zimbabweans are forced to seek medical treatment abroad or in private facilities, resulting in significant financial burdens.
An estimated 20,000 Zimbabwean citizens have spent $4 billion on medical tourism over the past decade, primarily in India. This translates to approximately $400 million each year, or $20,000 per person.
Private Healthcare Expenses: While private hospitals continue to operate cancer services, the costs are prohibitively high for most Zimbabweans. A course of chemotherapy can cost between $1,000 and $2,000, with additional expenses such as $650 for hospital admission and $500 for specialist tests.
Zimbabwe’s healthcare spending has historically been poor compared to other countries in the region. The World Health Organization (WHO) recommends a spending level of $86 per person, which is more than four times what Zimbabwe currently allocates.
By 2000, 51% of Zimbabwe’s doctors and 25% of its nurses were already practicing abroad. This trend has continued, with more than 4,000 health workers, including over 2,600 nurses, leaving Zimbabwe in 2021 and 2022 alone.
Zimbabwe faces a serious problem of unemployment and underemployment, especially among youth. In 2017, unemployment rates reached 11.2% for the working-age population and 17.6% for young people aged 15-24.
A recent skills audit revealed that Zimbabwe faces a serious deficit of skilled professionals, particularly in the engineering, science, technology, health, and agricultural sectors. A survey of 580 formal and informal firms found that 20.6% of respondents consider workers to have significant skills deficits, while an additional 22.2% consider them to have minor skills deficits.
Inflationary pressures remain high, with annual inflation increasing from 26.5% in December 2023 to 47.6% in February 2024. This is largely due to local currency depreciation and exchange rate distortions.
The government faces increased fiscal pressures due to higher civil servants’ salaries, debt servicing, and drought mitigation-related spending. The fiscal deficit is projected to reach 2.5% of GDP in 2024.
The brain drain of health professionals has had a crippling effect on the country’s public health system and health outcomes. Life expectancy dropped from 60.7 years in 2019 to 58.5 years in 2021, lower than the African average of 63.6 years.
Lack of employment opportunities is also the main cause of emigration, especially for skilled workers. The United Nations estimates that there were 571,970 Zimbabweans living in the top 5 countries of destination in 2013, with the total number of Zimbabweans living abroad estimated at around 3 million.
The economic implications of staff shortages in Zimbabwe’s healthcare sector are profound and multifaceted. Addressing these challenges will require comprehensive strategies that focus on retaining skilled professionals, improving working conditions, and investing in the country’s healthcare infrastructure.
To address the critical staff shortages in Zimbabwe’s healthcare sector, policymakers should consider implementing a comprehensive set of strategies. These recommendations focus on workforce planning, incentive schemes, and public-private partnerships to strengthen the healthcare system and improve service delivery.
Effective workforce planning is crucial to ensure an adequate supply of healthcare professionals. The Zimbabwe National Health Strategy 2021-2025 aims to improve the health and well-being of the population and achieve universal health coverage .
To retain skilled healthcare workers and attract new talent, Zimbabwe should implement robust incentive schemes. The following recommendations can help improve the effectiveness of these programs:
Review and update the retention package offered by the Zimbabwe Health Services Board (ZHSB) to ensure it remains attractive and competitive.At the same time focus on non-financial incentives that are not directly eroded by inflation, such as professional development opportunities and improved working conditions can also be useful.
Public-Private Partnerships
Leveraging public-private partnerships can help address infrastructure challenges and improve healthcare service delivery. The following recommendations can guide the implementation of effective PPPs for example finalizing and adopting the PPP policy development, including the Public-Private Partnership Policy 2010 and related guidelines,simplify rules, regulations, and procedures to remove bottlenecks and enhance the smooth functionality of PPP arrangements and developing innovative procurement strategies to support local pharmaceutical production, such as assuring markets for products.
To ensure the success of these policy recommendations, it is crucial to have continuous appraisal and documentation of the roles and contributions of different actors in PPPs. Additionally, policymakers should invest in capabilities and resources for coordination to realize the broad range of benefits from partnerships.
By implementing these strategies, Zimbabwe can work towards addressing its healthcare workforce challenges and improving the overall quality of its healthcare system.
In conclusion staff shortages in Zimbabwe’s public health sector have a profound impact on the country’s healthcare system and overall development. This crisis has led to increased healthcare costs, productivity losses, and a decline in health outcomes.
To tackle these challenges, it’s crucial to implement comprehensive strategies that focus on workforce planning, incentive schemes, and public-private partnerships.
Moving forward, it’s essential for policymakers to prioritize the healthcare sector and invest in long-term solutions.