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

Yotamu Chirwa, Sophie Witter, Malvern Munjoma, Wilson Mashange, Tim Ensor, Barbara McPake, Shungu Munyati

Research output: Contribution to journalArticle

2 Citations (Scopus)
5 Downloads (Pure)

Abstract

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.
Original languageEnglish
Article number197
JournalBMC Health Services Research
Volume13
DOIs
Publication statusPublished - 28 May 2013

Fingerprint

Zimbabwe
Fees and Charges
Mothers
Newborn Infant
Reproductive Health
Maternal Health Services
Health Policy
Remuneration
Nurse Midwives
Health Services Accessibility
Health Resources
Public Sector
Health
Focus Groups
Consensus
Interviews
Growth
Infant Health

Keywords

  • human resources for health
  • Zimbabwe
  • reproductive
  • maternal and newborn health
  • financial access
  • user fees

Cite this

The human resource implications of improving financial risk protection for mothers and newborns in Zimbabwe. / Chirwa, Yotamu; Witter, Sophie; Munjoma, Malvern; Mashange, Wilson; Ensor, Tim; McPake, Barbara; Munyati, Shungu.

In: BMC Health Services Research, Vol. 13, 197, 28.05.2013.

Research output: Contribution to journalArticle

Chirwa, Yotamu ; Witter, Sophie ; Munjoma, Malvern ; Mashange, Wilson ; Ensor, Tim ; McPake, Barbara ; Munyati, Shungu. / The human resource implications of improving financial risk protection for mothers and newborns in Zimbabwe. In: BMC Health Services Research. 2013 ; Vol. 13.
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AB - BackgroundA 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).MethodsThe 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.ResultsThe 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.ConclusionsThis 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.

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