In Zimbabwe, the Community Working Group on Health (CWGH) builds local level participation in the health sector in co-operation with the Ministry of Health, local government and other providers. It carries out training, campaigns and community activities on HIV and AIDS prevention, as well as on reproductive health – with a particular focus on women, young people, orphans and other vulnerable children – and liaises with officials. Bottom-up approaches that begin with ownership at the local level and filter up to the top are promoted. Communities have begun to take greater responsibility for their health by identifying and prioritising local health concerns and actions, and monitoring their implementation.
Photo: Rural Chikwaka, Goromonzi (Itai Rusike CWGH)
During the past decade, Zimbabwe has been experiencing economic difficulties which have escalated in the last years. The economic decline has resulted in a sharp decrease in funding for social services, in real terms. This has directly contributed towards an unprecedented deterioration of health infrastructure, loss of experienced health professionals, drug shortages and a drastic decline in the quality of public health services. The cholera epidemic, exacerbated by a country-wide breakdown of sewerage and water supply and treatment systems, has claimed thousands of lives. Yet, the health system remains seriously underfunded. The current revised budgetary allocation is approximately USD 7 per head and year. The WHO recommendation is for at least USD 34. The gap between rich and poor continues to widen and hits women and children. Whilst women are the ones who look after the ill – often through provision of home based care – they have been little more than passive observers of changes to the health system itself.
The CWGH structure in 25 districts promotes local health actions and puts into place mechanisms that facilitate community participation in these districts. Active participants across the 25 districts encourage active involvement and participation of women through health education campaigns, participatory processes and advocacy work at both the local and national levels. The CWGH has since 1998 held the government accountable and ensures an effective lobby for social issues in national policy making and budget processes. More recently communities are demanding the inclusion of the right to health in the Zimbabwe Constitution, making the case that health is not a privilege but a right.
The formation of an inclusive government in September 2008 raised the hopes and interest of a number of donors who set up a Donor Trust Fund that is being coordinated by the Ministry of Finance. The major objective for 2009 was to revitalize both the primary health care facilities and its referral hospitals so that basic minimum services can be provided at each level of care.
Democratic ownership is strengthened by financing and building the capacity of civil society organisations to support human rights, gender equality, environmental sustainability, social inclusion, improved health and poverty reduction.
Civil society can be instrumental in “capturing voices” and facilitating dialogue between citizens and the state.
Accountability is an essential companion to ownership.
Budget literacy and transparency are prerequisites for national accountability.
Successful development programmes cannot be run independently of the relevant ministries and structures.
“People are poorly informed about health service issues. But they will not hesitate to source materials if the end result does not alienate them”
- Judith Machingauta, CWGH Chairperson, Chinhoyi
This case study was prepared by the DAC GOVNET’s task team on human rights. The original version of this case study was included in the report “Key messages and case studies for the Third High Level Forum”, from the workshop on “Strengthening the development results and impacts of the Paris Declaration on aid effectiveness through work on gender equality, social exclusion and human rights”, London, 12-13 March 2008.
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