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In late 2004, the Zimbabwean parliament approved an NGO Act that prohibits organizations working on human rights, and gives the Government the power to interfere with how NGOs are run. Although this Act had not yet been signed or implemented by the president, some foreign NGOs pulled out of Zimbabwe, having found it too difficult to operate in the country. Relations between humanitarian agencies and ZANU-PF have been poor for several years as the Government has repeatedly accused NGOs and humanitarian organizations, of supporting the MDC and working with western donors to overthrow the Government (regime change agenda). Growing international isolation resulting from controversial Government policies has also led to greatly reduced donor funds for the country which has adversely affected most people who are living below the poverty datum line and who are in dire need of food, medical and financial aid.

On June 4 2008, the Minister of Public Service, Labour and Social Welfare wrote to all NGOs and private voluntary organizations and announced a full suspension of all their field operations. Earlier, the Minister of Local Government had accused local and international humanitarian agencies of breaching their registration terms and conditions and accused some NGOs of using food distribution programmes to support the MDC despite the fact that the Zimbabwe authorities have failed to provide any evidence to support their allegations. This raises theories that the suspension was an attempt to prevent NGOs from witnessing and reporting on the state-sponsored violence that was taking place in the rural parts of the country at the time.

The terms of a new Memorandum of Understanding that were later signed between local and international humanitarian agencies and the Government authorities state that if the agencies wish to operate in a specific area, they must first get permission and sign a written agreement with local Government structures setting the terms for the distribution. While such a request by the Government may seem reasonable, local Government and party structures in Zimbabwe have attempted to use this requirement to control and impede the efforts of humanitarian agencies to assess needs and provide much needed food and other assistance to Zimbabweans. The requirements have also left the delivery of humanitarian assistance open to manipulation by Government agents and ZANU-PF officials. The Government has also hampered the work of international humanitarian organizations by unnecessarily denying foreign staff employment permits and extensions of permits. The next chapter provides the finding on the extent to which the crisis affected the health delivery system in Harare and subsequently the HIV prevalence rates.

CHAPTER 5

HIV PREVENTION PROGRAMMES IN A COLLAPSING HEALTH DELIVERY SYSTEM

This chapter gives an account of the HIV Prevention strategies that were implemented during the crisis. The researcher will provide a narration of the conditions of the health delivery system that prevailed prior to discussing HIV prevention programmes. The starting point for discussing any health behavioural dynamics in a crisis state and the effectiveness on implementation of programmes and is a good analysis of the health situation that prevailed during the time the research was conducted. The onbe Zimbabwe was named World Health Organization (WHO)'s best health service provider in 1985 because of its efficient health delivery system. During that period it managed to eradicate polio⁸⁷. Health care was fully subsidized at that time and Mhloyi (1994) reported that 85%

of the population lived within 8km of a health care centre and the Government upgraded 550 health centres and built 321 new ones all over the country.

The findings of the research shows that, the health sector in Zimbabwe includes organized public and private health services (health promotion, disease prevention, diagnosis, treatment and care). Zimbabwe has a diverse health sector that is composed of the following health institutions;

87 Polio is a highly infectious disease caused by a virus. It invades the nervous system, and can cause total paralysis in a matter of hours

 State funded public health institutions

 Private-not-for-profit including mission health institutions run by Faith based organizations

 Private-for-profit health facilities

 Allopathic practitioners (Traditional and Alternative medicine).

Records from the Ministry of Health indicated in 2007, approximately 2 800 registered health institutions in the public sector clinics and hospitals , private general and specialist practices, industrial, mining and agricultural clinics, hospitals and pharmacies, mission clinics and hospitals, emergency rooms and trauma centres, ambulance services, x-ray service facilities and laboratories among others were registered..

However, many of these institutions in particular the district hospitals and municipal clinics were forced to shut down or operated at minimum capacity. Other aggravating factors include dilapidated infrastructure, equipment failures, and a ―brain drain⁸⁸‖ of medical professionals. This crisis turned Zimbabwe's once impressive health care gains of the early years of independence in the 1980s into a major disaster resulting in the removal of subsidies to all social sectors including health.

Health personnel within the School of Medicine at the University of Zimbabwe that 92%

of the medical students who graduated in 2006 from the University of Zimbabwe have since left the country citing poor remuneration as the factor that forced them to look for greener pastures. The health personnel in Zimbabwe were poorly remunerated and they had no incentives to keep them working in the country. Zimbabwe has more than 2,000

88Large-scale emigration of a large group of individuals with technical skills or knowledge.

registered doctors, but many are leaving after being attracted to better working conditions and remuneration in neighbouring countries, mainly Botswana, Namibia and South Africa.

As a result, patients sometimes hardly see doctors. They are now only attended to by nurses and in some worst case scenarios, by nurse aids. The researcher observed nurses no longer provided bathing and feeding services to patients and this role was taken over by relatives due to high attrition. More than 80% of the medical professional interviewed admitted of considering using hospitals facilities for their private gain by booking private appointments with desperate patients.

The consultation fees and medication were out of reach for many Harare residents. At the time this study was conducted, the admission fee for a private hospital stood at ZW$40million in November 2007 whilst the monthly average incomes where at ZW$20 million. At the time of the research, an official exchange rate was ZW$30,000 to US$1, although the black market exchange rate was estimated to be ZW$600,000 to US$1⁸⁹. Medical aid societies did very little to help their beneficiaries resulting in residents cancelling their medical aid contributions, as in most cases, patients were asked to top up the fees by as much as 90% of the bills. Shortages of medication was also visible at the hospitals resulting in patients being handed over a prescription after consultation, where they were asked to find the medicine themselves.

89Raath, Jan. Devaluation is 'too little, too late' to save Zimbabwe. Times Online. 7 September 2007.