Trading the spanner for Universal Health Coverage…The meteoric rise of Itai Rusike into public health stardom

To many, he is just an ordinary human being and a health activist with a zeal for health issues. Some call him Wadyegora, a name synonymous with his Moyo or heart totem. Born during the liberation struggle in a place of rich mixed soils in Saruwe or Selous, Itai Josh Rusike’s or Mukoma Josh’s as he is known by many, knew at a tender age that he was destined for greatness on this earth.

Over the years, Itai has grown into becoming one of the leading Public Health Voices in the country owing to numerous interventions he has undertaken as an individual and through an organisation he leads, the Community Working Group on Health (CWGH).

Did you know that before Itai emabrked on his public health Journey he was once a motor mechanic and an artisan engineer? To get an insight into the life and history of Itai outside his daily public health work, our Editor, Michael Gwarisa (M.G) caught up with the man himself, Itai Rusike (I.R) who opened up about his background, love life as well as how he ended becoming a Public Health advocate championing Universal Health Coverage (UHC) in Zimbabwe.

M.G: Who is Mr Rusike?

I.R: Itai Rusike is a public health activist with over 20 years’ experience organizing involvement of communities in health actions in Zimbabwe. I am the current Executive Director for the Community Working Group on Health (CWGH) having joined the organisation at its inception in early 1998 and risen through the ranks from a Field Officer, Health Education Officer and Programme Manager. I was born in Selous (Ku Saruwe) near Chegutu during the liberation struggle uko kwataidya matohwe, maroro, matamba ne tsambatsi. My kids call me Old Man so that should give you an idea of my age. I have always been an advocate for health rights, health equity, active and informed community participation in health, primary health care and universal health coverage. I spent the early years of my life with my maternal grandmother in a big family with a very loving, supportive and exceptionally intelligent grandmother. We used to have lots of fun and adventure as young boys without any worries of where our next meal would come from, it was indeed a big tent with plenty of cousin brothers and sisters all under the care of our late, hardworking and no- nonsense grandmother who taught us a lot about family love, togetherness, hard work and the importance of education. Our grandmother VaMajeke was a Master Farmer, full of wisdom and she used to spoil us with all kinds of traditional foods such as Nhopi, Rupiza, Mapudzi, Manhanga, Mabumbe, Hohwa, Sadza re Zviyo and Mupunga we brown from her own fields just to name a few hence my love for the organic traditional foods up to now. She was indeed a true legend and will always remain my true hero and idol!

M.G: Which schools to did you attend from primary up to tertiary level and what program did you do in University of College?

I.R: I went to Msengezi Primary School and we used to walk about 20kms to school and 20kms back mostly barefooted but the good thing is that we were always comforted by the fact that me and my two cousin brothers were always top in our class as we were highly competitive amongst ourselves and my 2 cousin brothers are all doing well in their own chosen careers. I recently met my Grade 1 teacher Mr Reuben Mtatabikwa who is now 94 years old and is still riding a bicycle for over 20kms at that ripe old age. My Grade 7 was a bit of a nightmare as I was taught by my Sekuru Hanzvadzi ya Amai and the guy used to beat us (me and my 2 cousins) like hell as he always wanted us to be his top students in class and also wanted to use us as an example to the other kids when it comes to discipline but he will then be so nice to us after school as our Sekuru.. I then went to Msengezi High School, which later on became famous for recording music but that was after we had left the school in 1988 because during our time it was all about the pass rate and good grades especially when we were competing with schools such as Moleli High School and Kutama Mission. So after high school I trained as a Fitter and Turner (Artisan in Mechanical Engineering) and worked in the private sector. I then met Dr Rene Loewenson in 1996, an accomplished Public Health/ Epidemiologist and the Director for Training and Research Support Centre (TARSC). She is the one who convinced me to make the greatest transformation of my professional life from working in industrial workshops with machinery and equipment to Community Engagement, Advocacy and Policy work. So from 1996 Dr Rene Loewenson became my Mentor and Manager. She mentored me (ndakabikwa) on the operations of civil society organizations, Community Based Research, People-Centered Health Systems, Health Governance, Health Literacy, Universal Health Coverage and the Right to Health. I then later on enrolled at different institutions of higher learning further education but after going through the practical education and learning mill of a real work experience and environment. But like they always say “the rest is history” I have been in the public health trenches for almost 3 decades now and i have no regrets at all.

M.G: How many are/were you in your family?

I.R: You know my Father was a businessman from the old school so naturally we are a very big family. Sadly I have lost some of my siblings but I always take pride in my two elder brothers who left Makumbe High School in Buhera in the late 1970s to join the liberation struggle by paying the ultimate price of sacrificing their own education and careers in order to liberate the country, i will forever honour their courage, commitment and sacrifice and through their actions I am inspired. I was also greatly inspired by my late brother Lah Rusike who was a Chartered Accountant and an exceptionally intelligent and smart guy, unfortunately he died very young without achieving his full potential. We used to go to soccer matches and do everything together and at one time I had to stop going to soccer matches after his death as people used to ask me where is your friend not knowing that he was my brother.

M.G: Tell us a bit about your family (Wife/kids)?

I.R: I am married to Mavis Garamukanwa and I have 4 beautiful kids (2 boys and 2 girls) My eldest daughter completed her Masters degree in International Relations and Diplomacy some two years ago and she has been a good example to her younger siblings. My Second born named after me is now doing his second year at varsity and studying Social Work and my twins the famous Rusike Twins the last born are doing Grade 7. I also named my last daughter one of the Rusike Twins (Rene) after my Mentor Dr Rene Loewenson with the other twin named after my late father Giles.

M.G: Maybe could you juts share a bit about your love story? How did you meet Mrs Rusike and your story blossomed from girlfriend and boyfriend to husband and wife?

I.R: My wife was a friend to my Niece and they were going to the same College here in Harare. I used to stay in a flat in the Avenues during that time but I was hardly home because of my CWGH Field Work as I was still a Field Officer during that time and i would spend a lot of time traveling all over the country setting up the CWGH District Structures. So I would occasionally ask my Niece to come and clean-up the flat in my absence and she would always bring her friend with her until she later on introduced me to her friend who is now my wife, so one thing led to the other and we got married in 2000 (traditionally paying Lobola and Kutinha Mombe dze Danga and I personally drove the Cattle kwa Rusape and paid my Lobola in full and I don’t owe my late Tezvara kana sokisi zvaro hence I had an excellent relationship with my Tezvara because he really felt respected kwete vakuwasha vemazuva ano vasingadi kubvisa pfuma until tragedy strikes). We then had our white wedding on 31 August 2001. So we have been married for a good 21 years now and still counting.

M.G: How do you juggle between work and family?

I.R: I am kind of lucky to have a very supportive and understanding family as i travel a lot all over the world because of the Global Health Advocacy and Policy work that I now do and also even here locally carrying out monitoring and support visits to our district chapters hence I spend most of my time away from home and family. Sadly, even when I am around I also usually work in the office until very late BUT my family comes first where it matters most as I always do my best to give them quality time whenever I am free. Even my little twins appreciates that I will be on national duty whenever I leave the house for work. Unfortunately, I do not have much of a social life as i have been a workaholic ever since I started development work even though I am now scaling down as we have built a lot of capacity in our Program Officers and the Young Public Health Activists who are highly capable to take the organisation forward and also bring new and fresh ideas as i am now focusing on Global Health Advocacy and Policy work and very soon I will be handing over the relay baton to the younger generation so that I can focus on High Level Engagements.

M.G: What do you enjoy doing outside work during your spare time?

I.R: I love gardening and farming as I believe in food self- sufficient. I personally did the landscaping in our garden at our house and planted all the fruit trees. I love soccer and support Dynamos, I am also a fan of Arsenal. I enjoy driving especially to visit family and friends as I sometimes miss some important family gatherings and functions due to work travels. I have a lot of nephews that I go with ku Gotchie – Gotchie whenever I a free.

M.G: Have you received any awards or accolades to your name (list them)?

I.R: I appreciate that my work and efforts have been recognized both national and globally. And just to name a few recognition and awards;

a. Deputy Chairperson – Public Health Advisory Board (PHAB) Zimbabwe – 2009 – 2014
b. Member of the Advisory Group for the UHC2030 Civil Society Engagement Mechanism (CSEM) 2015 – 2020
c. Board Member for the World AIDS Campaign (WACI Health) 2015 to current
d. Steering Committee Member of the Regional Network for Equity in Health in east and southern Africa (EQUINET), co-ordinating the Social Empowerment Cluster for Primary Health Care oriented health systems 2002 – current
e. Chairperson of the Zimbabwe Global Financing Facility (GFF CSO Platform) 2020 to current
f. Africa NGO Leadership Award – Mauritius, 2016
g. Outstanding Organisation in Community Health Care, Zimbabwe – 2021
h. Member of the Global Fund Advocates Network (GFAN) Africa
i. National Steering Committee Member to several statutory bodies including Board Member to several local, regional and international NGOs

M.G: Now turning to your work, over the years you have been involved in Community Health Work under the CWGH. Could you give us a background about your community health work and how and why the CWGH came into being?

I.R: HEALTH has long been one of the most important social concerns of Zimbabwean people. Major gains were achieved in the 1980s through joint and complimentary action between the health sector and communities. However, the combined impact of AIDS, structural adjustment, and real reductions in the health budget and in household incomes, has reversed many of these gains. The quality of health care has declined, and health workers and their clients have become demoralized. Communities have had to take on more and more responsibility for looking after the ill, by providing home-based care, paying for their health care and dealing with their health problems. But despite this critical involvement, they have been little more than passive observers of changes to the health system itself.

By the late 1990s a wave of strikes amongst health workers signaled that health workers were also not happy with the situation. While a lot of attention was given to the strikes by doctors and nurses, those working at clinic level and in communities also lost wellbeing and morale. As 2000 approached, “health for all” seemed like an empty promise. As a result of this situation several national civic organizations, came together in 1997 to review the current state of affairs in the health sector and look at ways in which communities could achieve greater control of their own health. The first step was to carry out research on communities’ and civic organizations’ perceptions of health and health services in Zimbabwe. This was done in 1997. The survey brought up concerns about the inadequacy of public funds for health, the declining quality of public health services, the negative attitudes of providers and the weaknesses of current mechanisms for expressing community participation in health. After the finalization of the Survey Report in January 1998, a meeting of constituent organizations was held to review the outcomes; examine the health, and health care, priorities they implied; and suggest strategies for implementing these priorities. The participating civic groups decided to form a network of organizations called the Community Working Group on Health (CWGH), with a responsibility to add weight to their input in health policy negotiations and maximize the effect of their joint actions in the health sector. In March 1998 they came together and discussed the feedback they had received. The CWGH members invited the associations of health professionals and representatives of government, churches, the private sector, NGOs and traditional health providers in order to identify conflict or consensus over community views and strategies. The result was a final report and Community Views on Strategies for health in Zimbabwe, which summarized the perspectives and experiences of CWGH and communities organizing for health in Zimbabwe.

M.G: What are some of the works CWGH are in involved in besides advocating for access to healthcare?

I.R: After the establishment of the CWGH, it started working on a number of programs including establishing local CWGH fora at district level. These fora comprise representatives of all civic groups in the local authority area and in the immediate surrounding peri-urban, rural and urban areas. They have an elected committee comprising a chair, vice chair, secretary and three committee members from among the local civil society groups. These local CWGH fora co-ordinate local activities including education and health action, and link civil society groups with all health providers (public, private, traditional, NGO) and local authorities on health issues. They inform their members of national and local CWGH activities, policies and issues; promote health actions within their organizations and area; and take up health issues raised by communities with health providers. The CWGH also advocates for the establishment of health centre committees and district health boards that involve local councillors, civic groups and health providers to enable participation and effective links between members of the public and health providers. It advocates for hospital advisory boards to include civil society organizations, particularly those that represent hospital users. This enables civil society participation in the planning and implementation of health activities in a more substantive manner, including in respect of CWGH activities.

M.G: How has been community work over the years and what would you say have some of the major highlights of your work?

I.R: The network of civic groups in CWGH has grown more purposive and informed in their heath actions, more deeply rooted in the community and is now an important national voice on health. It is a vocal advocate on health. It is a vocal advocate for equity, primary health care and public participation in health. These are national policy goals, but have become sidelined by the market driven economic reforms. The CWGH has consistently taken up health strategy goals it drew from its grassroots consultation in the late 1990s – improved public financing of public health systems, stronger resource allocation for primary health care, preventive health and district health systems, and a greater status and role for community and public inputs to decision making on health. The CWGH inputs to the parliamentary committee on health, the Public Health Advisory Board, the National AIDS Council and other such forums offer formal channels for influence of public policy. The CWGH is a pressure point for public policy to reflect the health rights and social values that are widely held by Zimbabweans. The challenge for the CWGH will be to ensure that the health sector is rebuilt from the bottom up, not the top down, and that the lowest income communities are the first to see improvements and not the last.

M.G: What inspires you to do what you do and what would you say have been some of the major driving forces behind you venturing into public health and community health work?

I.R: My motivation is one of increasing and widening confidence within the civil society of the right to act, of the ability to act and the issues to act on. This has begun to generate some tangible health gains for communities in a situation of general decline. The CWGH builds on the lessons learned from the exceptional health gains based on primary health and community mobilisation in Zimbabwe in the 1980s. Given the withdrawal of those gains in the late 1990s, it adds the new understanding that these gains are not a privilege but a right, one that demand active community organizing, advocacy and control within health systems. The challenge for the CWGH is thus to ensure that real improvements in public health are irreversibly sustained by an informed public that protects its rights to health

M.G: You have been at forefront of advocating for Primary Healthcare Support, how has been the response to this over years?

I.R: The principle that health is a basic and a fundamental human right can never be overemphasized. For any country to be successful, it must guarantee that every individual has access to health, which is affordable, acceptable and available. It is heartening to note that the country, in its wisdom, has enshrined the individual right to health in the new constitution, (Constitution, 2013), unlike the previous constitution which just guaranteed life but was silent on health. This is also in tandem with the early adoption of the primary health care concept and philosophy, (Alma Ata Declaration, 1978) soon after the country attained independence in 1980. This saw the adoption of policies that were in favor of ensuring health access for the majority of the population such as The White Paper on Health, and the mantra “Health for All by 2000”). The deliberate implementation of these policies under the auspices of PHC addressed some of the colonial imbalances in health, with decentralization of the health budget and services. The country saw significant improvements in population health as exemplified by favorable child and maternal health indicators, (Demographic and Health Surveys, of 1990, 95, 2000, 2005; Multiple Indicator Cluster Surveys, Maternal and Child Health Survey) due to deliberate implementation of a well-defined and comprehensive PHC package of interventions for prevention, care, rehabilitation and sanitation, with support for Blair toilets and protected wells. However, a number of challenges including the HIV and AIDS pandemic, the structural adjustment programs of the mid-80’s, vertical programming and the increasing burden of emerging and re-emerging communicable and neglected tropical diseases and the unattended burden of non-communicable diseases among others have caused a reversal of some of these gains. The focus seems to have shifted away from PHC and yet given the above and the disruption and devastation caused by the Covid-19 pandemic on the population, health and other systems, primary health care may hasten restoration and enable the country and health system’s movement to achieve set targets in health and the broader social context.

M.G: How would you rate our health systems as a national and what would you say needs improvement?

I.R: It is undeniable that the deplorable state of the country’s health system requires urgent attention, especially giving priority focus to revitalizing the PHC system and addressing the social determinants of health to achieve UHC, thus enabling every Zimbabwean equitable access to essential quality health services without facing financial hardships. Zimbabwe need sustained investments in primary health care to revitalise the health system to close gaps in access to services and to address the causes of ill health. Presenetly, infrastructure in hospitals is dilapidated, some is obsolete; medicines and supplies are in short supply; doctors, laboratorians, pharmacists, paramedics and nurses are inadequate and poorly motivated. And this against a background of sustained paltry funding to the sector from national fiscus is of major concern. The problems in the health sector are compounded by the very high prevalence of largely preventable diseases as well as behaviour, lifestyles, environmental and basic water and sanitation issues. The quadruple burden of disease, (communicable, non-communicable, injuries, HIV, maternal, peri-natal, neglected tropical diseases, cancers) is unmatched by the institutional and health staff skills to adequatey manage and these have individually or in combination translated into premature and excess mortalities across the ages. Therefore, the health system must be strengthened in accordance with the World Health Organization’s six building blocks and the over ambitious SDG targets, to respond to this huge burden of disease, and enable the country to reach its full developmental trajectory.

M.G: What are some of the challenges you have encountered in health advocacy work?

I.R: People generally use public sector clinics as the primary source of health care, making it important for public and social accountability in the health delivery system. Since 1998 the CWGH working with the Parliamentary Portfolio Committee on Health compiles a position a paper on the health budget with input from its district structure and presents this paper to the Ministry of Finance and Ministry of Health as a way of community participation in the budget process. The government has, however, kept its health budget low, opting instead to increase health fees and tighten the conditions of treatment for patients in its health centers, for example patients continue to be referred to pharmacies to buy medication were it is expensive. Operating space for civil society actors has been shrinking over the years mainly due to – State Interference, Legislative Restrictions and Economic Factors. Sadly, some of the government officials are not used to public criticism and hence their non-engagement with CSO.

M.G: Any word of advice, encouragement to anyone who might want to venture into the Health Civil Society and health advocacy work and what to look forward to in terms of challenges and rewards?

I.R: Zimbabwe needs a renewed commitment to health and well-being for all based on UHC and should locate PHC as a necessary foundation to achieve UHC. Our focus is thus on UHC as the end and PHC as the means. We call for an economic order that would serve the attainment of health and reduce inequalities in health nationally, while also recognizing that the promotion and protection of people’s health in both public and private sectors is essential for socio-economic development. It is risky and unsustainable for a country to depend substantially on external partners as donors can withdraw financial support anytime should their interests shift for some reasons.

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