COURSE: HSWS 311, COMMUNITY HEALTH FOR SOCIAL

WORKERS

PROGRAMME: SOCIAL WORK (HSWS)

FACULTY: SOCIAL AND BEHAVIORAL SCIENCES

LECTURER: DR B.K CHIKWAIWA

QUESTION: TRACE THE HISTORICAL DEVELOPMENT OF COMMUNITY AND PUBLIC HEALTH IN

ZIMBABWE

1.Tatenda Migeri R224938W 9.Chido Kawonza R215157C

2.Jamila Reza R226512F 10.Elsie R. Chirenje R226510T

3.Faith P. Kakweza R224296U 11.Lloyd Dube R224948K

4.Gugulethu Masuku R224959Y 12.Ronwin R.L R226515F

Zimowa

5.Claudia Nyahuye R224916V 13.Blessing Jekiseni R224949E

A.

6.Aleah Y. R224943W 14.Isheanesu R224939N

Mukundwa Simango

7.Rutendo P. R224927X 15.Ruva R227874L

Zangaroti Maguranyanga

8.Nigel Jowa R226501D 16.Monica Gana R226542X

The historical development of community and public health in Zimbabwe is a complex narrative
that reflects the interplay of traditional practices, colonial impact, nationalist movements, and
socio-political changes. The historical development of community and public health in
Zimbabwe dates back beginning from the precolonial era before 1890, colonial era from1890 to
1980, early nationalist movements from the 1950s to the1960s, independence and primary health
care from 1980 to 1990, economic structural adjustment from 1990 to 2000, HIV/AIDS
epidemic from the 1980s to the 2000s, political crisis and health system collapse from 2000 to
2008, health sector reform from 2000 to 2010, inclusive government and health recovery from
2009 to 2013, current challenges and opportunities from 2013 to present and lastly, future
directions and recommendations. This essay explores the evolution of health care in Zimbabwe,
tracing its journey from pre-colonial times to the present inclusive of all the points above.

To commence, public and community health in Zimbabwe historically development starting from the
precolonial era from all the years before 1890. Before the advent of colonial rule, Zimbabwean
communities relied heavily on traditional healing practices and community-based health care systems.
Traditional healers, often regarded as custodians of indigenous knowledge, played a critical role in
maintaining the health of their communities. They utilized herbal medicine, spiritual healing, and rituals
to treat various ailments, emphasizing a holistic approach to health that integrated physical, emotional,
and spiritual well-being (Chavunduka, 1994). Traditional leaders were instrumental in health care
delivery, organizing community resources and ensuring access to traditional healers. This community-
centric model of health care fostered social cohesion and resilience, as health was viewed as a
communal responsibility rather than an individual concern (Mavundla et al., 2005).

The colonial era marked a significant disruption to traditional health practices and community structures
in Zimbabwe. The introduction of Western medicine and missionary hospitals led to the marginalization
of traditional healers and the suppression of indigenous knowledge. Colonial authorities and
missionaries viewed traditional practices as "primitive" and "superstitious," leading to a decline in their
use and a loss of cultural heritage (Moyo, 2000). Furthermore, colonial policies exacerbated health
inequalities, as access to Western medical services was often limited to white settlers and a select few
African elites, leaving rural and marginalized communities to rely on traditional healers as their primary
health care providers (Mlambo, 2008). This led to a brain drain, as traditional healers were discouraged
from practicing, and their knowledge and expertise were not passed on to future generations.
Traditional medicine in Zimbabwe was a holistic approach that integrated physical, emotional, and
spiritual well-being (Chavunduka, 1994). The impact of colonialism on community structures was equally
profound. Traditional leaders, who played a critical role in health care delivery, saw their authority
eroded as colonial authorities assumed control over health care decision-making. Community resources
were redirected towards supporting Western medical facilities, leading to a decline in community-based
health care systems. This disruption to traditional health practices and community structures had long-
lasting effects, including a loss of cultural identity, social cohesion, and resilience (Mavundla et al.,
2005). The imposition of Western medicine also led to a decline in the use of traditional remedies and
spiritual healing practices, which were integral to the holistic approach of traditional health care.

The 1950s and 1960s saw the emergence of African nationalist movements, which began to advocate for
health care as a fundamental human right. Leaders recognized that access to quality health care was
essential for social justice and liberation. Health campaigns became integral to the liberation struggle,
with nationalist leaders using health care as a tool to mobilize communities against colonial oppression
(Chikanda, 2006). The nationalist movements also sought to integrate traditional healing practices with
Western medicine, creating a more inclusive health care framework that respected cultural identities
while addressing modern health challenges (Mavundla et al., 2005).On the same note, the nationalist
movement in Zimbabwe played a pivital role in shaping community and public health development,
particularly during the struggle for independence in 1950s and the 1960s .This movement did not only
sought political freedom but also aimed to address the systemic health disparities that had been
entrenched under colonial rule. This was through advocacy for health as a human right .Nationalist
leaders recognized that health care was a fundamental huma right that needed to be prioritized in the
fight against colonial oppression . They articulated a vision for a post - colonial Zimbabwe where
healthservices would be accessible to all cities , particularly the black majority .This advocacy was
crucialin mobilizing supportand fostering a sense of national identity among the people .Adding on, the
nationalist movement also emphasized the importance of community engagement in health
initiatives .Leaders encouraged grassroots , recognising that local communities were best positioned to
identity their health needs and challenges .This approach laid the group work for the established of
community health worker programs , which have been vital in extending health sevices to underserved
areas.The programs did not only improved access to care but also empowered communities to take
charge of their health outcomes . Despite the successes in health care development, the emergy of
nationalist movements in Zimbabwe , economic and political instability followed in the following
decades , hence hindering the sustainability of health programs and access to services .However, the
legacy of the nationalist movement continued to inspire ongoing advocacy for health rights. Civil society
organization and health advocates draw on the historical context of the nationalist struggle to push for
reform that address current health disparities and ensure that health care remain a priority for the
nation.Therefore, the nationalist movement in Zimbabwe was instrumental in addressing community
and public health development by advocating for health as a human right, promoting community
engagement and influencing post- independence health policies.

Moving on, the public and community health in Zimbabwe continued to develop after Independence.
Following Zimbabwe's independence in 1980, the newly established government adopted a Primary
Health Care (PHC) approach, emphasizing preventive care and community involvement. The Ministry of
Health was established to oversee health service delivery, and significant investments were made in
expanding health services to rural areas (Ndlovu, 2010). The PHC model aimed to provide accessible and
affordable health care, recognizing the importance of community participation in health programs. This
approach also emphasized the integration of traditional healing practices, acknowledging their relevance
in the Zimbabwean context (Chikanda, 2006).Post-colonial Zimbabwe had a health care system that had
a focus on providing essential healthcare services to the population. The country was going through
extreme income inequality that had stemmed from the colonial era and thus the current government
made efforts to alleviate these problems. Independence from colonial rule saw the introduction of a
primary health care approach in line with the social and economic reforms taking place. This involved
reforms to health facilities in rural areas. The government in agreement with the World Bank established
a family health project that expanded and upgraded health care facilities in the rural areas. There was
also free healthcare to those who had an average income of below $150, which at the time covered a
majority of the population. In 1981, special programs such as immunization programs and diarrhoeal
disease protection which was introduced in 1982 and a nutritional program which helped to feed up to
250 000 children at the peak of the 1980’s drought (David Sanders 1992). This period also saw an
increase in healthcare personnel as new training programs were introduced which saw up to 7 000
community based health workers posted in various rural areas in the country. According to David
Sanders (1992) a central feature of Primary Health Care was the community participation aspect. This
meant that there was a flourishing relationship between the state and its people. The Primary Health
Care approach also saw the introduction of Village Health Workers (VHW), whose function was to
extend health care programs to poor and isolate areas, but also mobilising people to transform their
conditions, which was an effective way to make sure no citizens were left out of the program.

The 1990s was characterized by a series of economic reforms aimed at stabilizing the economy,
promoting growth, and addressing the challenges posed by hyperinflation and rising unemployment
which led to the implementation of the Economic Structural Adjustment Programs (SAPs), prescribed by
international financial institutions to include the International Monetary Fund (IMF) and the World
Bank.The implementation of structural adjustment policies had a profound impact on health care
funding and services in Zimbabwe. As the government sought to reduce public spending, health budgets
were significantly slashed. According to Mlambo (2003), health expenditure as a percentage of GDP
decreased, leading to resource constraints that severely affected the availability and quality of services.
The prioritization of macroeconomic stability over social spending meant that health services, which
were once well-funded, faced severe budget cuts which resulted in shortages of essential medicines
resulting in declining health outcomes. For instance, the maternal mortality rate surged during this
period, as access to antenatal and emergency obstetric care became limited (Gonzalez et al., 2006).
Additionally, the public health infrastructure that had been built in the post-independence era began to
deteriorate, with many clinics and hospitals lacking basic supplies and maintenance Mlambo (2008)

Inorder to generate revenue for the underfunded health, user fees were introduced.However,
Mavhunga (2002) noted that user fees disproportionately affected the most vulnerable populations,
particularly those in rural and low-income urban areas.This was further supported by Mlambo (2008)
who stated that the introduction of user fees in public health facilities created barriers to access for
many vulnerable populations. During that period, a significant drop in health care utilization was
observed, particularly for preventive services such as immunizations and maternal health care. For
example, a study by Moyo (2004) indicated that the introduction of user fees led to a thirty percent
decline in clinic attendance in rural areas, which directly impacted public health outcomes. Many
families were forced to prioritize immediate economic needs over health care, leading to delayed
treatment and informalization of health care, with many patients resorting to traditional healers or
unregulated private practitioners, further complicating the public health landscape (Chirenda, 2005).
This shift led to a fragmented health care system.Thus, Zimbabwe's economic structural adjustment era,
which lasted from 1990 to 2000, represented a dramatic shift in the country's public health
environment. Although the goal of these economic reforms was to stabilize the economy, they had a
very negative impact on the availability and financing of health care.
The emergence of the HIV/AIDS epidemic in the 1980s had a profound impact on Zimbabwe's health
landscape. The epidemic not only strained the health system but also exacerbated existing social and
economic inequalities (Chikanda, 2006). National responses included awareness campaigns, the
establishment of treatment programs, and community-based initiatives to address the crisis. However,
stigma and discrimination against those affected by HIV/AIDS hindered effective responses. Community
involvement and the integration of traditional healers into HIV/AIDS programs emerged as vital
components of the national strategy (Mavundla et al., 2005). It is critical to note that the emergency of
HIV and I played a vital role on the development of community and public health in Zimbabwe in late
1980s to 1990 where the rates of infection was very high. . The mid-1990s, HIV/AIDS had become a full-
blown epidemic, with far-reaching consequences for Zimbabwe's health, social, and economic fabric.
The pandemic destroyed communities, decimating entire families, and leaving millions of orphans and
vulnerable children. In response, the government launched the National AIDS Coordination Programme
(NACP) in 1999, which coordinated efforts to curb the epidemic. The country embarked on different
initiatives such HIV testing , counseling sessions and antiretroviral treatment to reduce the transmission
of pandemic from mother to child. Non-governmental organizations (NGOs) and international partners
also played a crucial role in supporting the national response (Nhampossa,2013). Despite these efforts,
challenges persisted, including stigma, limited access to treatment, and funding constraints. However,
by the mid-2000s, there was a reduction on the number of infections. attributed to adherence, and
increased awareness. The national response continued to evolve, with a greater emphasis on
community-led initiatives, HIV prevention, and addressing the social determinants of health. Thus the
emergency of HIV and AIDS played a central role on the development of community and public health in
Zimbabwe.

Between 2000 and 2010, Zimbabwe's health sector reform efforts, primarily through decentralization
and privatization, aimed to enhance healthcare delivery amidst severe economic decline and public
health crises. Decentralization sought to empower local authorities to manage health resources more
effectively, fostering community participation and improving accountability (Madhavan, 2008).
However, the economic turmoil, characterized by hyperinflation and resource shortages, severely
undermined these efforts, leading to increased out-of-pocket expenses and limited access to care,
particularly for low-income populations (Chikanda, 2012). Privatization introduced a dual healthcare
system that benefited those who could afford it while leaving public facilities in decline, exacerbating
health inequalities (Mlambo, 2013). Ultimately, these reforms resulted in mixed outcomes, with
deteriorating public health metrics, increased morbidity, and mortality from preventable diseases
reflecting the broader systemic challenges (Dixon et al., 2010). Thus, while the reforms aimed to
improve efficiency and accessibility, the reality revealed significant disparities and ongoing public health
challenges in Zimbabwe.

The political crisis in Zimbabwe from 2000 to 2008 had devastating consequences for the health system.
Economic instability, hyperinflation, and political violence led to the collapse of health services, with
many health care workers emigrating in search of better opportunities (Mlambo, 2008). This brain drain
severely affected the capacity of the health system to respond to the needs of the population.
International organizations played a crucial role in providing support during this period, delivering
emergency health services and humanitarian assistance to vulnerable communities (Ndlovu, 2010).

The establishment of the inclusive government in 2009 marked a turning point for Zimbabwe’s health
system. Efforts to recover included the development of a National Health Strategy that aimed to
revitalize primary health care and improve service delivery (Mavundla et al., 2005). Community health
programs were reinvigorated, focusing on partnerships between government, non-governmental
organizations, and communities.

The inclusion of traditional healers in health initiatives was recognized as a vital approach to addressing
health challenges, particularly in rural areas (Chikanda, 2006).

Since 2013, the community and public health sector in Zimbabwe has encountered a multitude of
challenges that impede the nation's advancement toward the provision of quality healthcare for all
citizens. Despite ongoing initiatives aimed at enhancing the healthcare system, persistent issues such as
limited resources, a deficit of healthcare professionals, and economic volatility continue to pose
significant barriers to effective healthcare delivery. A critical issue plaguing Zimbabwe's healthcare
system is the emigration of skilled health professionals (Ndlovu, 2010). The country has witnessed a
considerable outflow of medical personnel, including doctors and nurses, who seek better opportunities
abroad. This migration has led to a pronounced shortage of qualified healthcare workers, resulting in
many communities being inadequately served. The deficiency of trained healthcare professionals has
adversely affected the quality of healthcare services, culminating in poor health outcomes, especially in
rural regions. Furthermore, the scarcity of healthcare workers has exerted pressure on the remaining
workforce, contributing to burnout and diminished morale.
It is essential to recognize that there exist avenues for innovation and enhancement within community
health. One promising avenue is the incorporation of technology into healthcare delivery. The adoption
of technological solutions, such as mobile health applications and telemedicine, has the potential to
improve access to healthcare services, particularly in rural areas where healthcare facilities are limited
(Mlambo, 2008). Additionally, technology can streamline healthcare delivery processes, thereby
reducing waiting times and enhancing patient outcomes. Another viable opportunity lies in the
implementation of community health worker programs, which can effectively address gaps in healthcare
delivery, particularly in rural settings. Community health workers are capable of providing fundamental
healthcare services, including health education, disease prevention, and basic curative care, thus
fostering improved health outcomes in underserved populations.Furthermore, the integration of
traditional healing practices into modern healthcare delivery offers another avenue for improving access
to healthcare services. Traditional healing practices are an integral part of Zimbabwe’s cultural heritage,
and many people in rural areas rely on traditional healers for their healthcare needs. By integrating
traditional healing practices into modern healthcare delivery, healthcare providers can tap into the
existing knowledge and skills of traditional healers, improving health outcomes and increasing access to
healthcare services.

Looking ahead, Zimbabwe’s community and public health can benefit from a holistic approach that
integrates traditional and modern health practices. Recommendations for policy, practice, and research
include strengthening community engagement by involving communities in health program planning
and implementation to ensure that services are culturally relevant and accessible. There is also a need
for enhancing health workforce capacity by invest in training and retaining health professionals,
addressing the brain drain through incentives and support. Integrating traditional healers is also crucial
through formalizing the role of traditional healers in health care delivery, recognizing their contribution
to community health. Promoting health equity is also significant through developing policies that
prioritize vulnerable populations, ensuring equitable access to health services. Lastly, utilizing
technology is of great importance through leveraging technology to improve health service delivery,
enhance communication, and increase access to information.

The historical development of community and public health in Zimbabwe reflects a dynamic interplay of
traditional practices, colonial influences, and socio-political changes. While significant challenges persist,
there are opportunities for innovation and improvement. By embracing a holistic approach and
recognizing the value of both traditional and modern health practices, Zimbabwe can work towards
achieving a healthier future for all its citizens.

References

1. Chavunduka, G. (1994). Traditional Medicine in Zimbabwe: The Ethnobotanical Perspective.

Zimbabwe Journal of Health Sciences.

2. Chikanda, A. (2006). The Politics of Health: A Case Study of Zimbabwe. Journal of African Studies

3. Mavundla, T. R., et al. (2005). The Role of Traditional Healers in Primary Health Care in South Africa.
Health Policy and Planning

4. Mlambo, A. S. (2008). The Impact of Economic Reforms on Health Care in Zimbabwe. Journal of
Contemporary African Studies

5. Moyo, S. (2000). Colonialism and Health in Zimbabwe: The Historical Context. African Journal of
History and Culture

6. Ndlovu, T. (2010). Health Care Delivery in Zimbabwe: Challenges and Opportunities. Zimbabwe
Medical Journal

7. Mlambo, C. (2013). Privatization and Health Inequities in Zimbabwe. Social Science & Medicine, 82,
78-86.

8. Chikanda, A. (2012). Health Sector Reforms in Zimbabwe: Constraints and Opportunities. Journal of
Health Policy, 21(3), 45-61
9. Dixon, J., et al. (2010). The Health of Zimbabwe: Trends and Implications*. Health Systems Review,
34(2), 122-135.

10. Madhavan, S. (2008). *Decentralization and Health Care in Zimbabwe: The Promise and the Pitfalls*.
African Journal of Health Economics, 5(1), 15-29.

11. Nhampossa, J. (2013). Community groups as ‘critical enablers’ of the HIV response in Zimbabwe.
BMC Health Services Research, 13(1), 195.

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