A Chikanda

Africa Health Workforce Observatory

Barbara McPake

C Chasokela

D Auret

D Makuto

D Sanders

EQUINET

Global Observatory

Government of Zimbabwe

Health Service Board

J Campbell

J Herbst

J Osika

L Bijlmakers

M Clemens

Malvern Munjoma

Ministry of Health

MJ Chimbari

N Gupta

O Mudyarabikwa

P Manga

R Hecht

R Yates

S Witter

Shungu Munyati

Sophie Witter

ST Agere

Tim Ensor

UNFPA MoHCW

UNICEF

Wilson Mashange

World Bank

World Health Organisation

Yotamu Chirwa

Zimbabwe National Statistics Agency (ZIMSTAT) and ICF International

Zimbabwe Workforce Observatory

ZIMSTAT

BMC Health Services Research

English

PubMed

Chirwa, Yotamu

Witter, Sophie

Munjoma, Malvern

Mashange, Wilson

Ensor, Tim

McPake, Barbara

Munyati, Shungu

Aberdeen University Research

A decade of development Zimbabwe 1980–1990.

and child health: the social protection dividend - west and central Africa. Regional thematic report 4. Dakar: UNICEF Regional Office for West and Central Africa;

and women in Zimbabwe – a situation analysis update,

and women in Zimbabwe – a situation analysis. Harare: United Nations Children’s Fund;

Board: HSB annual report.

Board: HSB strategic plan (2011–2014). Harare: Health Service Board;

Costs and causes of Zimbabwe’s crisis. Washington DC: Center for Global Development;

Dal Poz M: Assessment of human resources for health using cross-national comparison of facility surveys in Six countries. Hum Resour Heal

EQUINET: Assessing progress towards equity in health Zimbabwe. Zimbabwe: Equity Watch, Training and Research Support Centre (TARSC);

Global Observatory: World Health Organisation

Health service Act chapter 15:16. Zimbabwe, Harare: Law Development Commission;

Improving the implementation of cost recovery for health: lessons from Zimbabwe. Health Policy

Increasing access to ‘free’ health services: are health workers not a missing link? Int J Clin Pract

Mapping user fees for health care in high-mortality countries: evidence from a recent survey. London: HLSP Institute;

Mbengwa A: Distribution of public sector health workers in Zimbabwe: a challenge for equity in health,

Medical leave: the exodus of health professionals from Zimbabwe,

Observatory: Human resources for health country profile.

Policy challenges for the nursing profession. Africa Policy Dev Rev

Poverty Analysis

Progress and problems in the health care delivery system. In Zimbabwe: The political economy of transition 1980–1986. Edited by Mandaza I.

Retention incentives for health workers in Zimbabwe,

Skilled health professionals’ migration and its impact on health delivery in Zimbabwe. University of Oxford: Centre on Migration, Policy and Society Working Paper

State politics in Zimbabwe. Harare:

Structural adjustment: source of structural adversity socio-economic stress, health and child nutritional status in Zimbabwe. The Netherlands: Amsterdam Research Institute for Global Issues and Development Studies (AGIDS);

Study on access to health care services in Zimbabwe. ECORYS Nederland BV: European Union;

Tapera S: Zimbabwe health system assessment

The Herald: Zimbabwe: PM Launches Health Transition Fund.

The potential and limits of health sector reforms in Zimbabwe. In Reaching health for all. Edited by

The transformation of Zimbabwe’s health care system: a review of the white paper on health. Soc Sci Med

UNICEF &WHO: Assessment of maternal and neonatal health services in Zimbabwe. Zimbabwe: Final Working Draft;

UNICEF: A review of social dimensions of adjustment in Zimbabwe 1990–94. Harare: United Nations Children’s Fund, revised edition

Universal health care and the removal of user fees. Lancet

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World Health Organisation: WHO global health expenditure atlas.

Zimbabwe demographic and health survey 2010–11, preliminary report. Calverton, Maryland: ZIMSTAT and ICF International Inc;

Zimbabwe: Growth with equity: an economic policy statement. Harare: Government of Zimbabwe;

The human resource implications of improving financial risk protection for mothers and newborns in Zimbabwe

Springer - Publisher Connector

Abstract (provisional)\ud
Background\ud
A paradigm shift in global health policy on user fees has been evident in the last decade with a growing consensus that user fees undermine equitable access to essential health care in many low and middle income countries. Changes to fees have major implications for human resources for health (HRH), though the linkages are rarely explicitly examined. This study aimed to examine the inter-linkages in Zimbabwe in order to generate lessons for HRH and fee policies, with particular respect to reproductive, maternal and newborn health (RMNH). \ud
Methods\ud
The study used secondary data and small-scale qualitative fieldwork (key informant interview and focus group discussions) at national level and in one district in 2011. \ud
Results\ud
The past decades have seen a shift in the burden of payments onto households. Implementation of the complex rules on exemptions is patchy and confused. RMNH services are seen as hard for families to afford, even in the absence of complications. Human resources are constrained in managing current demand and any growth in demand by high external and internal migration, and low remuneration, amongst other factors. We find that nurses and midwives are evenly distributed across the country (at least in the public sector), though doctors are not. This means that for four provinces, there are not enough doctors to provide more complex care, and only three provinces could provide cover in the event of all deliveries taking place in facilities. \ud
Conclusions\ud
This analysis suggests that there is a strong case for reducing the financial burden on clients of RMNH services and also a pressing need to improve the terms and conditions of key health staff. Numbers need to grow, and distribution is also a challenge, suggesting the need for differentiated policies in relation to rural areas, especially for doctors and specialists. The management of user fees should also be reviewed, particularly for non-Ministry facilities, which do not retain their revenues, and receive limited investment in return from the municipalities and district councils. Overall public investment in health needs to grow

Chirwa, Y

Munjoma, M

Mashange, W

Munyati, S

Name not available

Abstract (provisional)
Background
A paradigm shift in global health policy on user fees has been evident in the last decade with a growing consensus that user fees undermine equitable access to essential health care in many low and middle income countries. Changes to fees have major implications for human resources for health (HRH), though the linkages are rarely explicitly examined. This study aimed to examine the inter-linkages in Zimbabwe in order to generate lessons for HRH and fee policies, with particular respect to reproductive, maternal and newborn health (RMNH). 
Methods
The study used secondary data and small-scale qualitative fieldwork (key informant interview and focus group discussions) at national level and in one district in 2011. 
Results
The past decades have seen a shift in the burden of payments onto households. Implementation of the complex rules on exemptions is patchy and confused. RMNH services are seen as hard for families to afford, even in the absence of complications. Human resources are constrained in managing current demand and any growth in demand by high external and internal migration, and low remuneration, amongst other factors. We find that nurses and midwives are evenly distributed across the country (at least in the public sector), though doctors are not. This means that for four provinces, there are not enough doctors to provide more complex care, and only three provinces could provide cover in the event of all deliveries taking place in facilities. 
Conclusions
This analysis suggests that there is a strong case for reducing the financial burden on clients of RMNH services and also a pressing need to improve the terms and conditions of key health staff. Numbers need to grow, and distribution is also a challenge, suggesting the need for differentiated policies in relation to rural areas, especially for doctors and specialists. The management of user fees should also be reviewed, particularly for non-Ministry facilities, which do not retain their revenues, and receive limited investment in return from the municipalities and district councils. Overall public investment in health needs to grow.sch_iih1. Yates R: Universal health care and the removal of user fees. Lancet 2009,
373(9680):2078-2081.
2. Campbell J, Oulton JA, McPake B, Buchan J: Increasing access to 'free' health services:
are health workers not a missing link? Int J Clin Pract 2011, 65(1):12-15.
3. Witter S: Mapping user fees for health care in high-mortality countries: evidence from a
recent survey. London: HLSP Institute; 2010. http://www.hlsp.org/Home/Resources/
Mappinguserfeesforhealthcare.aspx.
4. UNICEF: Maternal and child health: the social protection dividend - west and central
Africa. Regional thematic report 4. Dakar: UNICEF Regional Office for West and Central
Africa; 2009.
5. UNICEF: Children and women in Zimbabwe - a situation analysis. Harare: United Nations
Children's Fund; 1985.
6. Agere ST: Progress and problems in the health care delivery system. In Zimbabwe: The
political economy of transition 1980-1986. Edited by Mandaza I. Dakar: CODESRIA; 1986
7. Manga P: The transformation of Zimbabwe's health care system: a review of the
white paper on health. Soc Sci Med 1988, 27(11):1131-1138.
8. Herbst J: State politics in Zimbabwe. Harare: University of Zimbabwe Publications; 1990.
9. Auret D: A decade of development Zimbabwe 1980-1990. Gweru: Mambo Press; 1990.
10. Sanders D: The potential and limits of health sector reforms in Zimbabwe. In
Reaching health for all. Edited by Rohde J, Chatterjee M, Morley D. Oxford: Oxford
University Press; 1993.
11. Government of Zimbabwe: Growth with equity: an economic policy statement. Harare:
Government of Zimbabwe; 1981.
12. Bijlmakers L: Structural adjustment: source of structural adversity socio-economic
stress, health and child nutritional status in Zimbabwe. The Netherlands: Amsterdam
Research Institute for Global Issues and Development Studies (AGIDS); 2003.
13. Chikanda A: Skilled health professionals' migration and its impact on health delivery in
Zimbabwe. University of Oxford: Centre on Migration, Policy and Society Working Paper
No. 4; 2004.
14. Ministry of Health: Zimbabwe health for all action plan 1991-95. Harare: MoH; 1991.
15. World Bank: World development indicators database. Washington DC: World Bank;
2008. http://ddp-ext.worldbank.org/ext/ddpreports.
16. UNICEF: Children and women in Zimbabwe - a situation analysis update, July 1985-
July 1990. Harare: United Nations Children's Fund; 1990.
17. UNICEF: A review of social dimensions of adjustment in Zimbabwe 1990-94. Harare:
United Nations Children's Fund, revised edition (September); 1994.
18. World Bank: World development indicators. Washington DC: World Bank; 2010.
http://data.worldbank.org/data-catalog/world-development-indicators.
19. Global Observatory: World Health Organisation. 2011. http://www.who.int/gho/countries
/zwe/en.
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Zimbabwe; 2009. http://www.hrh-observatory.afro.who.int/images/Document_Centre/
zimbabwe_hrh_country_profile.pdf.
21. Makuto D, James V: Study on access to health care services in Zimbabwe. ECORYS
Nederland BV: European Union; 2007.
22. Osika J, Altman D, Ekbladh L, Katz I, Nguyen H, Rosenfeld J, Williamson T, Tapera S:
Zimbabwe health system assessment 2010. Bethesda, MD: Health Systems 20/20 Project, Abt
Associates Inc; 2010.
23. World Health Organisation: WHO global health expenditure atlas. Geneva: WHO; 2012.
24. Hecht R, Catherine O, Hopkins H: Improving the implementation of cost recovery for
health: lessons from Zimbabwe. Health Policy 1993, 25:213-242.
25. Government of Zimbabwe: National Health Accounts 2001. Harare: GoZ; 2001.
26. EQUINET: Assessing progress towards equity in health Zimbabwe. Zimbabwe: Equity
Watch, Training and Research Support Centre (TARSC); 2008:1-47.
27. Zimbabwe: PM Launches Health Transition Fund. http://allafrica.com/stories/
201111010110.html.
28. Moss T, Clemens M: Cost and causes of Zimbabwe's crisis. Washington DC: Center for
Global Development; 2005. http://www.cgdev.org/content/publications/detail/2918.
29. Chikanda A: Medical leave: the exodus of health professionals from Zimbabwe,
Migration Policy Series, No. 34. Cape Town: Southern African Migration Project, Idasa;
2005.
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1(1):1-6.
31. Chimbari MJ, Madhina D, Nyamangara F, Mtandwa H, Damba V: Retention incentives
for health workers in Zimbabwe, EQUINET Discussion Paper 65. Harare: EQUINET; 2008.
www.equinetafrica.com.
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services in Zimbabwe. Zimbabwe: Final Working Draft; 2005.
33. Africa Health Workforce Observatory: Human resources for health country profile
Zimbabwe. Zimbabwe: Health Workforce Observatory; 2009.
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comparison of facility surveys in Six countries. Hum Resour Heal 2009, 7(22):1-9.
35. Health Service Board: HSB annual report. Harare: HSB; 2010.
36. GoZ: Health service Act chapter 15:16. Zimbabwe, Harare: Law Development
Commission; 2004.
37. Health Service Board: HSB strategic plan (2011-2014). Harare: Health Service Board;
2011.
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for equity in health, EQUINET Discussion paper 4. Harare: EQUINET; 2006.
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ZIMSTAT and ICF International Inc; 2012.13pub3193pu

Munjoma, M.

Mashange, W.

Munyati, S.

Queen Margaret University eResearch

BACKGROUND: A paradigm shift in global health policy on user fees has been evident in the last decade with a growing consensus that user fees undermine equitable access to essential health care in many low and middle income countries. Changes to fees have major implications for human resources for health (HRH), though the linkages are rarely explicitly examined. This study aimed to examine the inter-linkages in Zimbabwe in order to generate lessons for HRH and fee policies, with particular respect to reproductive, maternal and newborn health (RMNH). METHODS: The study used secondary data and small-scale qualitative fieldwork (key informant interview and focus group discussions) at national level and in one district in 2011. RESULTS: The past decades have seen a shift in the burden of payments onto households. Implementation of the complex rules on exemptions is patchy and confused. RMNH services are seen as hard for families to afford, even in the absence of complications. Human resources are constrained in managing current demand and any growth in demand by high external and internal migration, and low remuneration, amongst other factors. We find that nurses and midwives are evenly distributed across the country (at least in the public sector), though doctors are not. This means that for four provinces, there are not enough doctors to provide more complex care, and only three provinces could provide cover in the event of all deliveries taking place in facilities. CONCLUSIONS: This analysis suggests that there is a strong case for reducing the financial burden on clients of RMNH services and also a pressing need to improve the terms and conditions of key health staff. Numbers need to grow, and distribution is also a challenge, suggesting the need for differentiated policies in relation to rural areas, especially for doctors and specialists. The management of user fees should also be reviewed, particularly for non-Ministry facilities, which do not retain their revenues, and receive limited investment in return from the municipalities and district councils. Overall public investment in health needs to grow

Witter, S

Ensor, T

McPake, B

University of Melbourne Institutional Repository

Queen Margaret University eTheses

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The human resource implications of improving financial risk protection for mothers and newborns in Zimbabwe

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