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Trends in public opinion on health care in Zimbabwe: 1999-2010
Afrobarometer
February 2011

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Introduction

Zimbabwe has experienced many economic and political problems in recent years. The unemployment rate is estimated to be close to 90% and the country officially abandoned its currency in 2009. Under such conditions all services including health care have deteriorated. Average life expectancy dropped from 65 in 1990 to 43 in 2005 while under five mortality has increased from 76 per 1000 in 1990 to 82 per 1000 in 2005.1 Immunisation, antenatal care and chronic disease treatment declined while HIV/AIDS and cholera plague the country. Post election violence in 2008 and restrictions on humanitarian aid compounded the health problems in the country.

The forced evictions under Operation Murambatsvina in 2005 contributed to the decline in the living standards and health of the population. It was estimated that 700 0002 people lost their homes. Some returned to rural areas while others moved to low income settlements in the cities. Inadequate attempts were made to re-house those who were displaced and who now reside in informal settlements under unsanitary conditions with poor access to basic services such as clean water and sanitation. Pregnant women and new born babies are especially vulnerable to illness and death under these conditions. Poverty constrains most women from utilising clinics as they do not have money for transport to clinics or to pay for services. The 2005-6 Zimbabwe Health and Demographic Survey estimated that 58%3 of women do not have access to medical treatment because they are unable to afford it. In addition dwellers from informal settlements sometimes face discrimination4 when trying to access public clinics and they may be turned away.

Using data from Afrobarometer this paper will examine public opinion trends pertaining to health care in Zimbabwe from 1999 to 2010. The data permit assessments of access to health care, problems experienced at health care facilities, satisfaction with public health care services as well as indicators of the perceived prevalence of HIV/AIDS and cholera.

The Afrobarometer is a comparative series of public attitude surveys on democracy, governance, markets and living conditions. The surveys are based on a randomly selected national probability sample of 1200 respondents representing a cross-section of adult Zimbabweans aged 18 years or older. A sample of this size yields a margin of error of ±3.0 at a 95 percent confidence level. All interviews are conducted face-to-face by trained fieldworkers in the language of the respondent's choice. Previous Afrobarometer surveys were conducted in 1999, 2004, 2005, and 2009, selected results of which are presented here for purposes of comparison. The most recent survey was conducted in October 2010.

The key findings of the paper include the following:

• Access to modern medical care and medicine improved in 2009 and 2010, although one in three (39%) went without modern medical care and medicine always or many times in 2010.
• One in five had access to traditional medicines.
• More than half (55%) experienced difficulty when seeking treatment at a clinic.
• One in three and one in four respectively went without food and water always or many times in 2010. Thus potential for malnutrition and cholera prevail.
• Seven out of ten (71%) regularly had no cash curtailing their ability to pay for treatment or even transport to a health facility.
• One in five Zimbabweans (20%) made illegal payments to public health facilities.
• High cost of medical care is the most important health problem in the country.
• Other critical problems are shortages of supplies, poor infrastructure and insufficient staff.
• The majority of Zimbabweans (59%) prefer quality health care even if they have to pay for it
• In 2009 there was optimism that government had improved health and other basic services but by end of 2010 people were disillusioned and government performance ratings fell.
• One in three was not satisfied with maternal and child health care services.
• One in three was not satisfied with nurses and midwives while one in four was dissatisfied with the village health workers network.
• One in four waited for long times for service and reports of dirty facilities and illegal payments increased since 2005.
• There was some improvement with the availability of medical supplies and doctors in public clinics since 2005.
• HIV/AIDS is believed to be the primary killer of women and children.
• There was widespread satisfaction with government performance on HIV/AIDS.
• The majority (58%) did not want government to prioritise HIV/AIDS above other problems.
• Over 80% were content with the information provided on HIV/AIDS prevention and treatment as well as their own ability to apply it.

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