From Ready to Govern to Preparing to Govern

The Movement for Democratic Change is and remains a people’s project, with the strategic objective of completing the business of the struggle for national liberation. Over the next few days, we will provide the various policy position of the party, indicative of our readiness and preparedness to govern in accordance with the best interests of the majority of our people. The wishes of our people are supreme and can not be negotiated. Our struggle is not merely a struggle against, but it is most importantly a
struggle for an ideal.

This this alert, we provide a summary of our policy position on Health and HIV/AIDS and how we will attend to the issue of Health in general.

MDC HEALTH POLICY

*A healthy nation lives longer, we want life!*

* *

*Vision *

The provision of affordable, quality and accessible health care to every
individual in Zimbabwe

*The MDC Health Policy is based on the following core principles:*

1. *The Centrality of the Health Sector***

The MDC believes, and takes serious cognisance of the importance of health, and its centrality to national development, noting that no prospects for development will be realized if the population suffers from ill health, and if visitors and investors alike are not assured of access to quality health
care.

1. *Right to Health***

The MDC will ensure the realization of the people’s Right to Health, as enshrined in the Zimbabwe Constitution, by fulfilling the State’s obligation to ensure accessible, affordable, acceptable, quality health services, equitably distributed, and directed towards priority problems.

1. *Intersectoral Approach***

The MDC will facilitate greater participation by all relevant stakeholders and will provide for smooth coordination of the three pillars of health care provision: Public, Private and the Traditional Health Services. The MDC will at all times facilitate public involvement in the planning,implementation and management of the Health Care sector.

1. *Public Health***

The promotion of public health through education and prevention of disease is central to our health care philosophy, with community participation in the planning, provision, control, and monitoring of the service, including provision of safe drinking water, sanitation, housing, waste disposal and
food hygiene across the urban, rural, farming and resettlement communities.

1. *Approach to Primary Health Care***

The MDC is committed to a community based and managed system of primary health care clinics that will form the base of a health care system incorporating all hospitals and specialist health care services. These clinics will be so distributed as to make them conveniently available and within walking distance for all urban and rural communities. It is estimated that this will require the development of at least 2 000 primary health care centres – each centre serving the needs of approximately 1000 families.

1. *An Efficient Referral System***

The MDC believes in an efficient and well-funded referral system that complements our public and primary health care approach. To that end, new life will be infused into our moribund secondary, tertiary and quaternary referral centres with a comprehensive programme of renovation and repair
followed by the upgrading of facilities and services to an appropriate standard.

1. *HIV/A**IDS*

The MDC recognizes the HIV/AIDS pandemic as a health crisis with social, developmental and economic foundations. It also accepts that it is spreading with ferocious speed and has an unprecedented impact on the national development through the decimation of those of the economically
active age group. The pandemic is leaving a trail of fractured and impoverished families, hundreds of thousands of orphans, and destruction of entire communities. The MDC further realizes that the onus is on the leadership to face the hard realities and challenges of dealing with the HIV/AIDS pandemic head-on.

The MDC state will equip the Public & Private health sector, and Community Leadership with the tools to change the environments that produce risk, and to satisfactorily treat and care for the people infected and affected by HIV/AIDS. In particular, the MDC will tackle the related issues of poverty,
malnutrition, gender exploitation and inequality, overcrowding, insecurity, illiteracy, and adverse cultural and traditional norms that foster the growth of the pandemic in Zimbabwe today.

The policies of the MDC towards a holistic approach to the HIV/AIDS pandemic follow this general Heath Policy statement.

*Health Goals and Programmes***

A healthy society cannot be achieved through medical sector intervention alone. The most important health strategy is health promotion and the prevention of diseases. The appalling health situation demands that disease prevention is taken up across all sectors through a major public health campaign. The MDC’s goals will be incorporated into a number of key areas of economic and social policy.

*Health and the Constitution*

A minimum platform of health rights will be incorporated into the National Constitution, with requirements for the State to take reasonable legal and other measures to realize such things, including: -

N The right to a clean environment that is not harmful to health;

N The right of access to adequate food and safe water;

N The right to make informed choices on reproductive health;

N The right to emergency medical treatment irrespective of ability to
pay;

N The right to equity in access to health care services;

N Children’s right to adequate nutrition, safe environments and health
services;

N Working peoples rights to a work environment that is not harmful to
health;

N Patient rights to mental/physical integrity, to information and
consent,

N Patients right to privacy, to humane care, to participate in
treatment, and to redress when aggrieved; and

N Rights of people with disabilities to respect and human dignity.

The current legal framework for public health and health care will be reviewed, given its fragmented nature (with 17 different laws) and outdated nature (the Public Health Act having been passed over 50 years ago). A national comprehensive Public Health Act will be put into place to ensure the achievement of core public health standards across households, workplaces, local authority and sector level, with mechanisms for their implementation and enforcement.

This Act will repeal current outdated laws. Local government, economic, labour market and other instruments will be required to comply with this law, while Local Government by-laws requiring all households to have safe water and sanitation and will be extended to rural areas. Specific measures
will be put in place to facilitate the implementation in poor communities.

* *

*Proposed National Health Board***

A National Health Board integrating key economic and social sectors and stakeholders will be set up to integrate public health standards into various areas of economic and social activity. This Board will monitor, oversee and report publicly on the implementation of health impact assessments in key development areas; will ensure that high health costs are prevented or internalised within major development programmes, will stimulate and support local authorities in order to implement their
obligations to ensure good public health and to promote community action on public health.

The National Health Board will motivate and sponsor research on public health as a central element of development strategy and will promote public health training cross a number of professional disciplines. The Board, its inspection and executive arm and research will be funded through a core budget grant.

Public reporting to parliament and in the budget process will include information on progress towards meeting constitutional and statutory obligations on public health across key social groups and on the measures being put in place to reduce shortfalls in such standards. Given the significant potential for the economy, in the process of development and globalisation, to generate inequality within the population, attention will be paid to ensuring and reviewing the trends in health and health care
equity, to identify where gaps between population groups are growing unacceptably wide, and to discuss the specific measures to be taken to ensure a basic platform of health rights for all population groups.

*THE NATIONAL HEALTH DELIVERY SERVICE SYSTEM** *

* *

*Institutional Arrangements and Programmes for the Health Sector***

The past decade has witnessed shrinking investments in the public health system. The upper and middle classes have moved into private care, and the poor into self-help and other forms of coping. The traditional health sector has taken on a greater burden of caring for the ill, but the interaction between western and traditional providers is still weak. There is an urgent and critical need to restore confidence in, and use of, the public health system by the majority of people through sustained and
consistent improvements in quality, reliability and accessibility of public health services. Meaningful partnerships with non-profit, private, traditional and other providers cannot be built on a crumbling public health system.

The recognition of the right to health will be rendered operational through a core of universal public health services, organised by the state according to a publicly defined and reasonable standard of health care, provided through a network of health services. These will be equitably distributed,
directed towards priority problems and be adequately staffed. Drugs and other supplies shall be brought into free supply on a demand led basis.

To achieve this, it is important to build on positive health system legacies, and to address the weaknesses that now exist. The MDC Government will:

1. Increase investment in a public health infrastructure that will the population being within one hour travel time of the nearest health facility, expansion of district and provincial level hospitals, and investment in central hospitals and significant local authority investment in preventative and clinic/family care services.

2. Investment in high quality training and competent Zimbabwean health professionals within public and private health services (across the region) and development of new health service staff capable of meeting national health care needs.

3. Develop protocols for the prevention and management of common diseases that combine international experience with locally appropriate methods and with proven experience of positive impact when adequately resourced.

4. Establish/use of an essential drug list for generic prescriptions and its uptake across public and private sectors.

5. Increase public literacy and basic education and reasonably strong social networks to enable community health actions and informed use of health services.

The MDC recognises that this mix of past investment, existing capacity and the current decline and poor status of the entire health delivery infrastructure signals a need to direct future investment towards: -

N Maximising the gains from past investments;

N Tapping more effectively capacities and removing barriers to their
use;

N Directing reconstruction and recovery resources towards halting and reversing the decline now evident in all spheres of State health care activity and providing for an acceptable platform of health services.

The MDC programmes that give effect to this will: -

Improve working conditions for all health service personnel within a soundly based and administered system of human resource management associated with the establishment of National Employment Council for the health sector.

Direct resources towards consistent and reliable support for the preventive, primary care and district level services used by the majority of the population

Improve the functioning of the referral system by making improvements in the quality of lower level services in urban and rural areas. At the same time District and Provincial hospitals and the major national hospitals will be restored to their previous standards and adequately funded so as to be able
to support an acceptable standard of health care delivery at all levels.

*Primary Health Care*

Primary Health Care will be the main vehicle for improving health care,
covering: -

N Provide *FREE* treatment for and elimination of the five child killer
diseases

N Health education in communities and schools.

N Nutrition education and food production.

N An expanded programme of immunisation.

N Control of communicable diseases like diarrhoea, malaria and TB.

N Building safe and accessible water supplies and sanitation.

N Ensuring appropriate treatment of common diseases.

N Ensuring adequate generic drug supplies.

N Providing basic and essential preventive and curative care.

N Maternal and child health care, including family planning and
nutrition.

N Ensuring participation of communities in their health care.

N Orientation of health workers to a more client focused approach.

N Horizontal integration of health programmes.

N Training and deployment of community health workers.

N Training and deployment of primary care cadres.

*Accountability and Participation in the Health Services***

Community groups and ministry officials in both rural and urban areas have
noted that while communities have played a role in implementing health
activities, they have not participated in health planning, nor have they
been adequately updated and informed on new public health strategies. People
do not know what is taking place in relation to health budgets, in the
priorities set for Health Services, and in improving the quality of care.

The MDC will ensure an informed and proactive public, interacting with a
fully accountable health system. This means that people will: -

N Take responsibility for their health and implement health
interventions.

N Identify their health problems and needs and obtain relevant health
information.

N Know and contribute to health policies, local health standards and
goals.

N Mobilising health resources, and be involved in decisions in the
allocation thereof.

N Monitor and evaluate health activities.

The MDC recognises that for this to be achieved it requires: -

N A deeper level of devolution of authority and resources to local
government, than has been the case in the decentralisation programme to
date.

N Establishment of district health boards, hospital boards and health
centre committees that are democratically elected and appointed and
accountable to the public and to Parliament.

N Intensified public/civic health education.

N Earmarked funds for community health activities, including for
community health workers, chosen by, and reporting to, communities.

N Public input and feedback on local government budgets in pre-and post
budget meetings.

N Wide public dissemination of information on funding sources and the
employment of such funds.

*The Private Health Sector***

The MDC recognises the growth and expansion of private medicine in Zimbabwe, and notes that while costs are rising, subscriptions to Medical Aid Societies are relatively low by world standards and Medical facilities available are generally above the standard found in most other African countries.

However, the MDC recognises a missing link in the co-ordination of the private and public health sector in the planning regulation and delivery of health services in the country. To this end, the MDC will ensure that the Medical Services Board will be to co-ordinate and make recommendations to
the Ministry of Health on all factors relevant for improvement.

The private health sector shall form part of the National Health arrangements at all levels including on ensuring quality standards and ensuring that the private sector delivers on important national health
goals.

*The Traditional Health Sector***

The MDC Government will recognise the value of traditional medicine in our society. Such traditions will be recognised and supported through the Ministry of Health. Research work into the traditional remedies will be encouraged and supported, and where proved, production and use of such
remedies would be encouraged. Traditional medicine is an important part of our culture, and it has stood the test of time in the face of culture change and technological advances. We therefore need as a matter of policy, to offer legal protection of traditional medicines through patents, and to
ensure that this sector is safe and properly regulated.

The MDC will put in place measures to finance the priority health programmes
under the following principles: -

N The government will allocate a minimum per capita budget to preventive health, and within this to achieve publicly defined monitored goals.

N The current level of funding of the health sector will be improved through the development of a resource mobilisation plan, based at its core on a per capita allocation to finance a minimum core of public health services, equitably distributed between different communities according to a resource allocation formula that incorporates population density, the actual population served and poverty levels.

N Public funds for health will be mobilised in the short term from funds secured from a set proportion of national tax revenues and from special funding secured from the international community for the rehabilitation of health care services.

N Increased finances and health care resources (including drugs and staff) will be directed to the primary care clinics and district hospitals, earmarked within district budgets and reported to and monitored by the participatory mechanisms (health boards) discussed earlier.

Communities will mobilise resources for health complementary to public sector inputs and used to support health interventions that are decided on by stakeholders. Locally collected funds will be administered and retained at local levels to complement and not replace core government budget
allocations.

N Essential drug costs will be controlled through bulk purchase and distribution through a parastatal; through cross subsidy from other drugs used where generic drugs are available; through relieve from import duties and in the long term through planned localisation of production in the SADC region.’

N HIV/AIDS will be declared a Developmental crisis.

N Overall, as a short term measure, the MDC Government would increase the current central government contribution to health sector to at least the level of per capita US$23 recommended by the World Health Organisation, while in the long term further increases will be made gradually.

The MDC will ensure that all stakeholders (inclusive of civil society) within the health sector are involved at all levels in the budget process from an earlier stage. This will enhance equity, countability and good management of resources.

MDC will, in consultation with stakeholders, establish social health insurance for formal and informal sector households.

*MDC HIV/AIDS POLICY*

* *

*Summary of the **HIV/AIDS Pandemic in Zimbabwe*

The first case of AIDS in Zimbabwe was identified in 1988. Today, Zimbabwe has approximately two million HIV positive people. One in every five of the age group, 15 to 49 years, is estimated to be HIV positive. This puts Zimbabwe as one of the countries with highest HIV prevalence in the World.

About 3 000 more people are estimated to be infected every week, whilst around 3500 HIV/AIDS related deaths occur weekly (Min of Health). The already grave situation is further exacerbated by the current harsh economic climate, high unemployment (85%), malnutrition and a collapsed health
delivery system, to name but a few. The psychological impact, combined with the physical illness and difficulties, will see infected people progressing much more rapidly into full-blown AIDS.

MDC pledges to put a human face to these statistics. Zimbabwe is losing its productive and economic sector to this epidemic. Our fathers, mothers, sisters, brothers, Doctors, Nurses, Teachers, Engineers, Administrators, Economists, Lawyers, Entrepreneurs, Students, Religious leaders, Political leaders.

The epidemic’s most disturbing long-term feature is its impact on life expectancy, now 34 years of age in women and 37 years in men. This is presenting a serious threat to the country’s social and economic development. There is still no cure or vaccine. The only options are to prevent the further spread of HIV/AIDS, to minimise its impact, to mitigate and provide a caring and compassionate environment for those infected and affected. This calls for an expanded and intensified response to mobilise all players to take action aimed at slowing the spread of the epidemic, and
managing its impact.

The MDC Agenda for HIV/AIDS prevention will therefore look at the socio-economic issues, which exacerbate the spread of HIV/AIDS, including: -
N Harsh economic environment (hyper inflation and rising daily).

N High unemployment (85%) and extreme poverty.

N Lack of empowerment of, and poor economic opportunities for women.

N Stigma and discrimination of those infected and affected.

N Housing security and overcrowding.

N Poor water and sanitation delivery and access.

N A collapsed health delivery system.

N Availability of, and access to, essential drugs and the cost involved.

N Poor and often non-existent health delivery in rural and resettlement
areas.

N Break down in the rule of law resulting in condoned political crimes
such as rape, torture, and physical and mental abuse.

The above elements are inextricably linked, hence the responses required to
militate against the impact of the epidemic need to be multi-sectoral.

The MDC’s position on the challenges for tackling the HIV/AIDS problem is
one of recognising the importance of leadership to tap organisational
capacities, in order to implement the options.

MDC will take immediate measures to recognize the epidemic (in policy and
law) as a national emergency, in view of its devastating impact on both
social and economic development.

The MDC proposes the core elements of a response that begins to match the
scale and seriousness of the epidemic are: -

N Visible and committed leadership from the top levels of government,
public and private sectors, in preventing the spread of HIV, with clear
assigned responsibilities for dealing with the epidemic.

N Co-ordination of a national response that involves and mobilises ALL
social and economic institutions.

N Identifying priority areas for action for prevention and care based on
best practises.

N Mobilizing resources and identifying priorities, ensuring that these
reach the target groups with meaningful and effective support services.

N Providing public information to support changes in KAPB (Knowledge,
Attitude, Prevention and Behaviour) practices around HIV/AIDS.

N The wider social and economic determinants of HIV/AIDS will be managed
through specific programmes for improving access to education (especially
for the most vulnerable) housing and health care, outlined in other
policies.

N Attainment of best practice in HIV Medicine as far as possible in
terms of: -

· Correct use of ARV’s based on current knowledge and best practice.

· Assessment of ARV resistance in the population, taking appropriate
measures in light of available data.

· Establishment and sustainable support of backup laboratory
services for the proper case management of HIV/Aids.

· Universal access to care and treatment.

*Outstanding policy issues***

Some policy areas have not been fully resolved, and the MDC will continue to
ensure informed public debate and dialogue on issues such as partner
notification, shared confidentiality, reproductive health education for
adolescents, commercial sex workers and prisoners, and the promotion of
gender equality in a manner that respects social norms, but that also
confronts those that are leading to the spread of the disease impeding its
management.

Many policy areas that have been resolved are not being implemented, due to
pitfalls in the legal or institutional framework, the lack of political
leadership, or the absence of a clear strategy for resource allocation to
implement programmes. The MDC will ensure that its highest political
offices are used to move policies into practice and to organise the
necessary institutional and other resources to achieve this.

Hence for example the MDC will ensure that;

N Labour market institutions actively enforce non-discrimination in the
workplace.

N Public health institutions are properly equipped to manage the
epidemic.

N National campaigns are carried out to reduce the incidence of STI’s
and TB.

N Increase condom distribution.

N Hospital and palliative care for people with HIV/AIDS is improved with
a minimum platform of resources and professional supervision observed.

N VCT (Voluntary Testing and Counselling) facilities are increased and
accessible to all population groups.

N Minimum safety standards are legislated and implemented in all
settings where health care providers are in contact with body fluids, and
that post exposure prophylaxis is available for all occupational exposures.

N Increased resource allocation to youth programmes to ensure that in
and out of school youth have access to appropriate information on life
skills, reproductive health services, counselling, VCT etc.

N Information, education, counselling, male and female condoms, and STI
care services are made available to commercial sex workers.

N Appropriate strong measures are taken to prevent and penalise gender
violence and sexual abuse in all forms, especially in children.

N Far greater attention is given to the risk environments that increase
the spread of HIV, and in particular support more rapid and intensive
housing programmes for low-income groups and sustained access to formal
education for youth, particularly female adolescents.

N Public and private sector employees are not separated from their
families in their employment (e.g. Teachers), that they are adequately
housed and that specific measures are put in place to reduce the time of
family separation, where possible.

N Ensure health service and information access for mobile workers
particularly truck drivers.

*Future National Response***

MDC will ensure that government leads the national response by integrating
HIV/AIDS measures as an employer, as a provider of essential services, and
as a facilitator of social security. MDC will put in place measures to
implement responses to HIV/AIDS by government in all these spheres.

N MDC will take more immediate measures to recognise the HIV/AIDS
epidemic as a national emergency, and to set up and support a national HIV
prevention network co-ordinating and ratcheting up existing prevention work,
procure low cost treatments for HIV related opportunistic infections, for
prevention of MTCT, and post exposure prophylaxis for health workers and
victims of sexual abuse and establish the clinical facilities, drug
procurement channels and financing mechanisms for treatment of AIDS. The
MDC will ensure that public spending on treatments for HIV / AIDS or related
infections do not only, or preferentially, reach groups that currently have
better access to health services, by improving the health service
infrastructure.

N The MDC will immediately put in place legal reforms to allow for
compulsory licensing for public health emergencies, declare HIV /AIDS such
as an emergency and procure drugs at lowest cost for treatment of AIDS and
HIV related opportunistic infections

N The MDC Government will review both the National Aids Council and the
National Aids Trust Fund, which will be run by a Board of Trustees appointed
by Parliament. The Trust will report annually to Parliament and will be
required to obtain approval for its annual budget at the same time. The
Trust will assist in financing the network of prevention programmes, the
additional resources needed in the health sector to guarantee the prevention
and treatment of STIs, TB and HIV related infection and the prevention of
maternal to child transmission, the support of any community based caring
and the support of orphan care, education and health needs. The trust funds
will be disbursed through community orphan support and fostering schemes,
community prevention networks, linked to multi stakeholder district AIDS
Committees and to the local authority. A proportion of the funds will be
applied to building or reinforcing these community-based mechanisms in all
parts of the country.

* *

In all the programmes and processes, the MDC government will open up to
wider stakeholder and civil society participation. This will allow for
incorporation of, and response to, community views, to tap and support
community institutions, and improve reporting, monitoring and accountability
to/from communities on the responses.

At the same time the MDC will participate actively in regional platforms
that seek to build a move equitable and sustainable global response to the
epidemic, through improved channelling of global resources to community and
public infrastructures, reduced trade, cost and tariff barriers to drugs and
other inputs for AIDS management and through providing recognition of the
links between AIDS and poverty.

* *

*AREAS OF PRIORITY FOR IMPLEMENTATION IN THE FIRST 180 DAYS IN OFFICE***

*HIV/AIDS Programme***

Whilst the existing efforts in addressing Zimbabwe HIV/AIDS are appreciated,
they will be reviewed regularly in order to improve effectiveness.

*PRIORITIES: -***

*Declaration of HIV/AIDS as a National Emergency/Disaster***

N The MDC plan is one that will distinguish the HIV / AIDS emergency
from the ones catered for by the Civil Protection Act chapter 10.06. The
HIV/AIDS emergency will be backed by (a different) legislation so that:

· Generic drugs can easily be imported as per the WTO position,
that, countries can only import generic drugs if it/they declare, through
parliament, that it is facing National Disaster. “Generic drugs cost ¼ of
the trade-marked equivalent”

· Legislated declaration of emergency (complimented by the National
Policy, giving guiding principles) will mobilise both financial and human
resources, and leadership, as well as mainstreaming responses in all spheres
of social, economic and political activities.

· The National HIV/AIDS Policy of 1999 will be reviewed through a
consultative / all-inclusive approach to bring it up-to-date and provide for
implementation. (Currently, the policy has seriously lacked advocacy)

· In addition to the above, an urgent all Stakeholders National
Conference will be organised to streamline the co-ordination of the national
implementation programme on HIV/AIDS. The programme will define roles of
stakeholders and provide for stocktaking.

*Treatment***

N A policy on drug acquisition; pricing; distribution and general
management will be worked out on a long-term basis.

N In the first days of administration, an expeditious move will be
undertaken to ensure that, appropriate anti-retroviral’s are made available
at minimum rates for those living with the virus.

N The major pharmaceutical companies will be approached to overcome the
International Patent laws so that cheaper drugs are made available through
local manufacturing of the generic forms of the proved effective ARVs.
(International
companies have indicated their ‘will’ to lower prices only when working in
partnership with governments. However, it has not been obvious that the
current Administration is playing a meaningful and consistent partnership
role).

N The Treatment programme will expand the MTCT (Mother to Child
Transmission) and general ARV’s programme to cover all the clinics and
hospitals. MDC will assist in providing adequate infrastructure for optimum
medical management of HIV including laboratory and radiological facilities
for diagnosis and treatment of opportunistic infections and drug toxicities.

N Training in all aspects of HIV medical care will be strongly
encouraged for all members of the health care profession i.e. Doctors,
Nurses, Pharmacists etc. MDC will work in partnership with private sector
programs already in place i.e. ZIMA (the Zimbabwe Medical Association),
Government training programs and HIV Clinicians.

N In addition to the all stakeholder national programme planning and
implementation, the existing VCT programme will be increased to cover the
whole country, using drug and NATF resources as incentive.

N A National standard on counselling, and registration, will be
established to ensure quality counselling and training.

N Noting that sentinel testing is vital for government’s National
planning purposes, to facilitate and plan appropriate and timeous
prevention; treatment and drug acquisition.

* *

* *

*Funding***

N Both short term and long term programmes will be funded through the
National *fiscas* (budget), Solidarity and Global inflows, through the
National AIDS Trust Funds (NATF).

N A study will be commissioned on the NATF disbursement structures, as a
matter of urgency:

· To do away with ‘Politicisation’ of funds and eradicate power
dynamics

· To eradicate mismanagement and abuses of funds

· To ensure transparent and accountable disbursement processes

In the medium term, the NAC Act will be reviewed to provide for improved responsibility and accountability.