Itai Rusike works for the Community Working Group on Health (CWGH) which is a civil society network advocating for a functioning and just health system in Zimbabwe. The director of the medico international project partner visited Germany in autumn 2010 and reported about the situation in Zimbabwe, as well as, the work of the CWGH on the Right to Health.
medico: Can you give us a brief update about the general situation in Harare?
Itai: When I left last week not much has changed regarding the mood of the general public. People are still in a state of confusion concerning where the country is going. I am talking mainly in terms of some of the commitments that were made when the Government of National Unity (GNU) was signed between the three major political parties in 2008. The MDC-T led by Morgan Tsvangirai, the MDC-M, led by Arthur Mutambara and the Zanu PF of Robert Mugabe.
Generally you found people who invested their hope in the new GNU in terms of that their needs will be addressed, meaning for them to meet daily needs such as health, education, food and also employment. So generally it is the situation of losing that hope.
medico: Do you see any positive things as well? With, for instance, regards to the food situation?
Itai: We observed very positive changes in the sense that food is now readily available even in the streets. But the challenge is the costs of purchasing that food because people have vey little disposable income. But there are a lot of positive things in terms of service delivery. For the first time we have seen some garbage trucks moving around in the townships collecting waste. We have also seen an improvement in terms of potable water. Moreover, in some areas the streetlights have been restored. Concerning power there are still some electric cuts.
medico: What about the health situation? Do you see relevant changes after the coalition of Zanu PF and MDC started their work in 2009?
Itai: It was very sad to see the old health system collapsing, which existed in the 1980s. When the new GNU from 2008 was formed, health was one of their key priorities. And in fact we have seen some improvements, especially in terms of access to drugs. We have seen that the old health workers who had left the country [due to the bad political and economical situation most of the professionals gave up their jobs or left the country; editor’s note] are coming back. Moreover, the equipment in some of the central hospitals is being partially refurbished and hospitals that were closed are now reopening. So generally there has been an improvement to some extend, but not to the level that we definitely would have wanted, but at least there is an element of a working health system at the moment.
medico: The government pays very low allowances instead of wages for the employees in the public sector. Doctors get 200 USD/month, after the Zimbabwe-Dollar was abolished due to the hyperinflation. What are the consequences for the patients?
Itai: The people, working in the health area are frustrated due to the low payments. This situation will ultimately affect the patients because the moral among health workers is at its lowest point and sometimes the employees have to seek part time jobs so they can raise other revenues. Majority of the people do not have private medical cover. Consequently, they rely on the public health system. However, this public health system is not functioning fully due to the reasons described above. If the patients seek health services elsewhere, than in public medical facilities, they end up paying more due to different reasons. For instance, they have to travel further to mission hospitals where the services are better. Or they need to sell everything they have so they can afford services in a private hospital.
Generally the issue of allowances has to be urgently addressed because it has affected the quality of service that is now being offered.
medico: Health is a political issue in Zimbabwe. How would you describe your difficult working conditions between cooperating with the state, institutions and structures? And how would you criticise the state and the shortcomings that you see in their duties?
Itai: For us as the civil society it has been very difficult to openly criticise the system, given the fact that the government is not used to that kind of interaction with civil society. But to a certain extend we have seen space opening up now with the new minister of health, who is from the MDC. He has really identified civil society and NGOs as partners. We recognised that the prime minster changed the state structures in the health sector, which exist at different levels, to ensure participation of the civil societies and NGOs. And we feel that this is the right direction the minister is taking in terms of creating space for dialog and for democratic participation of the different stakeholders.
medico: Do you see a risk to lose your independence if you cooperate too close with the government?
Itai: To work with the government does not automatically mean that you lose your identity, does not necessarily mean that you lose your principles or that you lose your values. Yes, we cooperate with the government but we have not been absorbed by the government. We remain very independent. We are a very critical organisation that raises political issues. But it does not necessarily stop us from engaging in dialoguing with the government and some of the issues can be resolved through dialogue. But in terms of our focus, we remain focused on our agenda, so that we do not end up becoming servants for the government.
medico: The Community Working Group on Health works with Communities in rural areas. Can you inform us about the concrete activities?
Itai: In the communities we have the governance in health program which is a program funded by medico and which aims at strengthening the local participation. In “health centre committees”, which are built up through this program, health workers are working together with local authorities and representatives of the communities to decide independently about their priorities and activities. In this way communities are taking responsibility of their health and are also taking ownership of the health resources available in their locality.
Moreover, we built up water and sanitation programmes to make sure that at least in every household there is a toilet. This is a way to avoid infectious diseases, such as Cholera, at community level. Through our structures, close to the communities, we developed a health literacy program where communities are educated to know their rights, claiming their rights and also coming up with community actions to address health problems within their areas so that they do not just wait for outsiders to come in and give them some assistance.
Furthermore, we achieved that national budget processes became more transparent and participatory. The planning and usage of the public health budget is monitored and accompanied from the municipal up to the national level, by the citizens, to ensure the appropriate use of the resources and to control the actions politicians are taking.
medico: The CWGH started a campaign to include the Right to Health in the new constitution. Could you explain a little bit more about that?
Itai: In fact we started the Right to Health campaign as part of the People’s Health Movement (PHM) after the 2nd People’s Health assembly, which was held in Ecuador in 2005. A concrete idea for a campaign was developed when the GNU was built and decided to come up with a new constitution. We asked for input from the community to influence the making of the constitution, to ensure the inclusion of the Right to Health.
So based on that input from the stakeholders, we came up with a position paper. As an organisation our focus in on the Right to Health and we want to see universal coverage and access to treatment in Zimbabwe. So we are hoping after “the parliamentary outreach teams” have completed collecting all the information that a draft constitution is formulated, which will have the Right to Health as one of the key fundamental rights in it. Than it will be taken for referendum and if people vote for the new constitution we will have the next election in 2011. It is important to have the Right to Health in a constitution but at the bottom line is the implementation – without it the written law itself will not have any value, which can be seen from the example of South Africa.
medico: You already mentioned that the CWGH is part of regional and international networks, which demand the universal access to health, such as the People’s Health Movement which is active in many countries and Equinet, the African Health network. Do these networks strengthen your work?
Itai: I can safely say we have benefited a lot engaging with these regional and global movements. Within Equinet CWGH coordinates the “social empowerment cluster” that brings together all the different civil society organisations that are doing work on health literacy. There is always solidarity within the region, for instance on the issue of the Right to Health. And we feel it is important that decisions which are made on global level should be informed from what happens at community level.
medico: How do you see the prospects for the future development of Zimbabwe? What are the most important steps to achieve change?
Itai: I think the most urgent issue besides health includes employment. We have an economy where 80% of the people are unemployed. And the 20% which are employed are mainly under-employed, meaning that they are underpaid. We also have the situation of the uncertainty in the political environment, where anything can happen. We also see a situation of people losing the hope they invested in the new government of national unity. But we still believe that there is potential for Zimbabwe to recover and if the politicians are sincere in whatever agreements that they enter in to, Zimbabwe can still recover.
Interview 23.09.2010, conducted by Anne Jung and Anna Schumacher
Translation and editing: Juliane Gross und Anna Schumacher