Online Reporter
Rumbidzayi Zinyuke
Senior Health Reporter
As Zimbabwe celebrates 45 years of Independence under the theme “Zim@45: Devolve and Develop Together Towards Vision 2030,” the health sector stands as an example of what devolution can achieve when policy meets purpose.
“Leaving no place and no one behind” is more than a policy statement.
It is a vision rooted in history.
From the foundations laid in 1980, when the country attained independence to today’s health system, the Government, through the Ministry of Health and Child Care, has been steadily reshaping healthcare delivery, taking services closer to the people and leaving no district behind.
The journey towards these milestones began in 1980, in the aftermath of the liberation war, when the health landscape was marked by gross inequalities between urban and rural populations.
Today, with the shift towards devolution, communities that were once far from quality healthcare are now being drawn into the national vision for a healthier, more equitable future.
Devolution is enshrined in the 2013 Constitution, but its implementation began in earnest with the coming in of the Second Republic under President Mnangagwa as part of efforts to enhance infrastructure development in line with Vision 2030, which seeks to create an upper-middle-income economy.
According to Health and Child Care Secretary Dr Aspect Maunganidze, this year’s Independence theme isn’t just timely, it is symbolic of the Ministry’s core agenda.
“Zim@45: Devolve and Develop Together Towards Vision 2030” is a good theme that we need to carry forward as the Ministry of Health and Child Care on the foundations that have been laid over the last 45 years since independence.
“Our health system has developed in leaps and bounds. We have been devolving and developing with all our structures in the country, leaving no place behind,” he said.
What began in the early 80s as a mission to expand primary healthcare to underserved rural areas has now morphed into a full-scale devolution programme, with governance, training, infrastructure, medicine supply, and even emergency care now decentralised to meet local needs more effectively.
Dr Maunganidze said devolution, in its purest sense, starts with strengthened health systems across the board.
Over the years, he said, the ministry had entrenched governance structures across the country’s 10 provinces and their districts.
“We have got our provinces, which have a provincial health executive headed by provincial medical directors who run with devolved health service delivery strategies,” he said.
“This continues down to district health executives, who are empowered in procurement, infrastructure, and human resource management which has been done to make sure that it all speaks to the needs of each district, each province.”
Human resource development: Training for communities, by communities
This empowerment has been matched with training and mentorship programmes, done in collaboration with the Health Services Commission, to ensure that both provincial and district leaders are equipped not only administratively, but also strategically.
Human capital remains the heartbeat of any health system. Recognising this, the Ministry has localised the recruitment and training of nurses, giving priority to district and provincial candidates.
Recognising this, Dr Maunganidze said, each school of nursing is now recruiting with a special focus on the district and province it is in.
This has ensured that health workers are trained close to home, and when they graduate, they can also serve those same communities.
The revival of the Primary Care Nurse training programme also underscores this focus on local communities as it mandates deployment to underserved areas, bridging the urban-rural gap in professional coverage.
Specialist services, which were once the preserve of urban hospitals, have also been decentralised. From Gweru to Mutare, specialist doctors in surgery, medicine, and paediatrics are increasingly being deployed at provincial level.
“We want to continue devolving to the districts, so that all the major specialist areas are available on the ground,” said Dr Maunganidze.
Infrastructure that reflects need, not geography
Infrastructure investment has been one of the most visible markers of devolution. The ministry has made it a point to prioritise areas with the greatest need, often in remote rural districts.
Under the NMS programme, new hospitals and clinics are being constructed in the grassroots and being equipped.
While Stoneridge and Cowdray Park hospitals have already been commissioned, the Government is set to commission Mataga Hospital in Mberengwa and ground has already been broken in Manhize (Chivhu) for another hospital.
The same is set to happen in Paradza, Rudhanda in Zaka as well as in Bulilima districts. To ensure all health facilities are not affected by power shortages are able to continue providing services, over 1 000 clinics have been solarised and the Ministry is now upgrading from gel to lithium batteries for even greater sustainability.
The “Last Mile”: Medicines, technology and accountability
One of the less visible, but critical successes of devolution is in the medical supply chain.
The Ministry of Health has adopted the “last mile delivery” model for medicines and commodities, ensuring that even the most remote clinics are stocked with essential drugs.
To cut down on drug shortages, wastage and pilferage, Dr Maunganidze said the Ministry was rolling out an electronic logistics management information system (eLMIS), replacing a paper-based system riddled with inefficiencies.
“We had nightmares with physical requisitions with increased losses. The new system will ensure accountability of every drug in the pipeline,” he added.
Radiotherapy services are being expanded too, with new machines being procured for Parirenyatwa and Mpilo Hospitals.
Functional older equipment as well as new machines expected to be purchased soon will be redistributed to other provinces like Gweru and Mutare, ensuring more equitable access to cancer treatment.
Emergency response: Taking action where it happens
Emergency and disaster response is no longer coordinated solely from Harare. Through devolution, the Ministry of Health has set up provincial Public Health Emergency Operating Centres (PHEOCs) in Midlands, Mashonaland Central, and Manicaland – ensuring real-time response to outbreaks like cholera, typhoid or mpox and other emerging diseases.
“We are expanding on emergency response and we have devolved this aspect. Initially we had a national public health emergency operating centre, but we have gone on to decentralise and commission these in Midlands, Masvingo and Manicaland,” he said.
“We want all the provinces to have these PHEOCs which will then coordinate the response. You must realise that our systems have remained robust in the public health area. Our surveillance system and ability to detect diseases and prevent them from coming into the country has enabled us to make Zimbabwe safe when we report diseases that affect our region.
“In particular, Mpox, Marburg and even Ebola have not affected our countries because of the robust surveillance system which we have devolved to all the port health centres.”
Also being decentralised is trauma and emergency care, as the Ministry is now building trauma centres along highways such as Harare-Masvingo and Harare-Chirundu roads where the highest number of road accidents are reported. Air ambulance services are also being expanded to cover more areas.
Toward 2030: Cementing the legacy
With less than five years to go before the country’s Vision 2030 deadline, the Ministry of Health is focused on consolidating gains and completing the devolution journey.
“All the progress we’ve made since 1980, we now want to solidify and cement it as we go towards 2030. We believe that the Ministry of Health is on the right trajectory to achieve this,” he said.
The spirit of “devolving and developing together” goes beyond being just a theme, it serves as a guiding roadmap, particularly in the health sector, where it has actively transformed lives and shaped a more inclusive, responsive system of care.
