Macro-economic policies and the health sector: past experiences and future actions

Abstract

The paper presents an analysis of the impacts of macroeconomic policies on the public health sector in Zimbabwe from 1980 to 1998. The presentation categorizes the review period into two: (1) 1980 - 1990, a period characterised by macroeconomic policies which were supporting the health sector to expand services so that health can be accessible to all, and (2) 1991-1998, a period where economic reforms have been implemented to achieve a more market-oriented economy. A conceptual framework and empirical evidence of the impact of macroeconomic policies on the public health sector are presented. Findings indicate that tremendous gains in health were achieved in the 1980 - 1990 period with all the major health indicators indicating spectacular improvements. While on the other hand, the 1991- 1998 period was characterised by cut backs in the health budget, cost recovery measures, and declines in real incomes of the potential health users resulting in increasing poverty, which have resulted in poor performance of the health sector with some health indicators declining to below 1980 levels. However caution needs to be exercised when interpreting the poor performance of health indicators because the HIV/AIDS epidemic has placed additional stress on the health sector and one can not easily separate the macroeconomic impacts from the HIV/AIDS impacts. Drawing from the presented review on macroeconomic policies and the health sector in Zimbabwe, experiences from other countries, basic projections of the HIV/AIDS epidemic, lessons are outlined that can enable health to be more securely embedded in future macroeconomic policies.