Zimbabwe’s health system is failing to meet the needs of its population and urgently needs treatment itself. Political and economic crisis is leading to health infrastructure collapse. A devastating cholera epidemic, shortages of drugs and low (or no) pay for health workers are symptoms of this collapse in healthcare. Andy Guise

The current crisis in the Zimbabwean economy has complex causes, contemporary and historical. That change is needed in the management of Zimbabwe’s economy however seems beyond doubt. The question then becomes what this change is, how it is organised and ensuring it addresses the health needs of the Zimbabwean people.

Following the creation of the new government including former political foes and their parties there have been calls from within Zimbabwe for external aid. The IMF recently sent a delegation to Zimbabwe to explore aid and reform, marking the start of communication between the parties after a period of silence.

The role of the IMF raises two main concerns: 1 – initial reports suggest the IMF is calling for cuts in social spending as a step to get the Zimbabwean economy back on its feet. When people are dying of cholera, health workers are going unpaid and hospitals are short of supplies asking for cuts in spending is absurd. This is a perfect illustration of how economic models dictating IMF policy are far removed from the needs of people. 2 – at a time when the international community is calling for increased democracy in Zimbabwe, it seems ironic that an institution that is itself non-democratic, non-transparent and non-accountable is involved in discussions around potential reform.

Included in the agenda for the G20 London summit was discussion around the IMF, principally increasing its resources to $500 billion. Yet much more is needed if the IMF is to play any kind of role in working with Zimbabwe. Discussion also needs to focus on addressing the democratic deficit at the heart of IMF and its role in influencing national policy, including the healthcare system.

A governance structure initiated in the dying days of colonialism must be reformed. Decision making within the IMF is dictated by the interests of the most economically powerful countries. Decisions are not subject to formal voting that can be monitored, instead emerging from shadowy ‘consensus’. This lack of discussion and input from those affected by IMF policy are a key factor in creating policy that is so damaging to national healthcare systems. IMF policy conventionally limits social spending in an effort to curb inflation. These limits then prevent the hiring of health workers and purchase of much needed supplies essential to maintaining a health system. Fighting economic inflation is very literally placed above fighting ill-health.

As Zimbabwe seeks to rebuild the role of those seeking to work with the new government must also be scrutinised. Reform to how the IMF is run to ensure that policy decisions are taken democratically and transparently, and therefore in the interests of those affected, is urgent.

Andy Guise

Recent Lancet articles highlight the perilous state of the Zimbabwean health system, for example: Chambers, K. 2009 Zimbabwe’s battle against cholera, Lancet Vol 373, March 21 2009, p993-993.

For a more in-depth overview of the IMF see www.eg4health.org/get-informed/imf/