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Quarterly Community Assessment of the Socio-economic Situation in Zimbabwe:
Health and Education - March 2004 - Summary
Civic Monitoring Programme integrating the FOSENET Food Security Monitoring
May 26, 2004

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This first round of NGO and community based monitoring on health and education conditions was carried out in March 2004 from 80 monitoring reports from 53 districts from all provinces of Zimbabwe, with an average of 1.5 reports per district.

Health
In terms of the priority areas of health rights articulated by communities and civil society, the monitoring round provides reports from community level that:

• Rights to the highest standard of health reasonably possible are affected by where people live, by their incomes and by differences in the quality of health care provided. Nearly a half of areas reported dissatisfaction with the current quality of health services.
• A basic level of health services, ie a clinic, is accessible within the policy standard of 5km for about half the population.
• The right to health care is limited by the availability and costs of care, particularly due to shortages of medicines and of adequate qualified staffing at primary care levels of the health services.
• The biggest cost barrier to curative services is that of drugs. When these are not available in clinics or public hospitals poor households find it difficult to afford these from commercial facilities. Medical aid or insurance cover is limited.
• For the large group of low income people ill with AIDS and other common diseases the shortfalls in the public sector at local level mean that they have to seek care elsewhere at costs that they may not be able to afford. People with influence and money are reported to be able to overcome these barriers.
• Generally people are happy with the treatment they get from health workers (with a few exceptions) noting that the constraints causing dissatisfaction with services are to do with resources.
• Primary health care programmes are taking place, although not uniformly across all communities.
• Mechanisms for community participation and representation in decision making such as health centre committees are underdeveloped or poorly functioning and thus need to be strengthened.

Education
In terms of rights to education,

• Education services are reported to be provided without discrimination on the basis of sex, religion, race, tribe, creed or ability. The sites were from areas where incomes are relatively similar, so the income disparities in access to or supply of education would not show in this monitoring.
• Children generally have access to these services without discrimination. The exceptions to this reported in about a quarter of sites are those who face barriers due to inability to pay fees or who don't have birth certificates and orphans.
• There are constraints reported to public assistance programmes dealing with these vulnerable groups both due to inadequate funds and due to the lack of public information on the funds and thus public knowledge on how to access funds. A more effective public assistance programme would appear to be needed to overcome barriers to access.
• The constraint in education is less one of access than one of quality of education, particularly in terms of qualified staff and learning resources.
• School Development Associations are generally (but not always) found and functional. There is a mechanism for participation in addressing these issues but their effectiveness, composition or role in community outreach was not explored.

AIDS treatment and care
In the case of ARV treatment there is knowledge about ARVs, but lack of adequate literacy on exactly what treatment is and few resources for treatment at local level.

In the case of the AIDS Levy Fund, while resources are flowing to community level, there is inadequate public information on where they are going. Communities report that deserving beneficiaries are still not accessing.

In both cases the results suggest an important role for information and literacy on the systems supporting the community response to AIDS.

Other social conditions
The monitoring round reported that:

• Access to basic citizenship documents (birth certificates and IDs) is not universal. In about a tenth of sites there were reported problems of access for many in the site. The monitoring reported findings that suggest that older people have better access than younger to these documents. If this indicates falling access in young people the reasons would need to be identified and addressed.
• Most sites report that people sometimes feel free to speak their mind. The provinces with highest perceived freedom to speak also had a higher reported presence of mechanisms for participation in health services, of functioning school development associations, more people reported to have heard of ARVs and lower reporting of problems with accessing public assistance funds.
• Communities perceive that life has improved for those with secure formal employment and incomes, for those engaged in trading, for businessmen and those with political influence. They are perceived to be able to secure their family needs.
• Those whose lives are perceived to have got worse are unemployed people, former farmworkers, elderly people, orphans, and those who are ill. They are perceived to have suffered from insecure incomes, especially with food shortages, inflation and AIDS.
  

CMP welcomes feedback on these reports. Follow up queries and feedback to fsmt2@mweb.co.zw

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