By Dr Nyasha Manyeruke
The Zimbabwean healthcare system is currently battling a strategic funding gap towards the rising prevalence of non-communicable diseases such as diabetes (World Health Organisation, 2020). Any increase in national budgetary allocation towards addressing this growing public health threat, must take into consideration the existent intersectional endemicity of communicable diseases, El-nino drought, current economic contraction and historic marginalisation of women (UN Women, 2022). In this article, I discuss the evidence supporting the call to increase investment towards a diabetes primary health intervention focused on reproductive age women living in rural Zimbabwe.
Approximately two thirds of Zimbabwe’s population live in the rural areas according to a World Bank Open Data report (2023). Additional statistics from a 2024 Multidimensional Poverty Index (MPI) report on Zimbabwe indicate that a quarter of the citizenry live in a multi-faceted state of poverty, while an additional 26.3% are considered vulnerable (UNDP, 2024). The broader discussion on the social determinants of health in Zimbabwe are highlighted by UNDP (2024), as they explore the interlinked deficiencies in housing, sanitation, access to electricity, cooking fuel, school attendance and nutrition. The disproportionate effect that multilayered poverty has on women is made explicit in the MPI document, however it does not further explore this additional layering through factors such as, menstrual, maternal and reproductive health deprivations. A key mechanism for these disparities is the social position and marginalisation of Zimbabwean rural communities, rooted in systemic injustices and colonial structures (Zinyama, 2020).
Data on the risk factors for premature death attributable to NCDs is presented in the Global Burden of Disease (GBD) 2019 report, detailing the micro visuals of age, sex, water-scarcity and dietary differences that better describe the growing incidence of NCDs in Zimbabwe (Murray et al., 2020). Disparities in access to key dietary elements, such as fruits and vegetables, are outlined to bring a more contextual appreciation of the evolving nature of the healthcare risk landscape from a predominance of communicable diseases to NCDs. The GBD 2019 report highlights that for both genders- child and maternal malnutrition is a top risk factor for mortality and morbidity associated with NCDs. Consequently, the ‘window of opportunity’ for diabetic and NCD intervention is during adolescence- through optimizing nutrition status. This early approach to diabetes intervention, has cumulative health benefits for rural communities enabling upward social mobility and future intergenerational positive effects (World Health Organisation, 2020).
Implementing policies that optimise the preconceptual care for reproductive age women has been endorsed by the World Health Organisation (WHO); as a strategy towards reducing the risk of untimely death attributed to NCDs, and this has been outlined in the WHO Package of Essential Noncommunicable (PEN) Disease Interventions for Primary Health Care (2020). Inter-ministerial cooperation towards tackling diabetes through additional agricultural policies that increase food availability, and incentivising horticultural crop production using climate adaptive techniques, while addressing gender based violence is proving to be an effective ‘multiplier’ strategy (UN Women, 2022). This multisectoral approach can serve to reduce the drivers of daily stress, which has been linked to poor diabetic outcomes.
It is the imperative mandate of the government to implement public health interventions that promote justice and equity, by increasing investment in the well-being of rural women to ensure maximisation of health benefits for the historically disenfranchised (UN Women, 2022). The geographical, social exclusionary and economic obstacles inhibiting marginalised communities from being reached by public health policy interventions have been well documented historically in Zimbabwe.
Zimbabwe remains committed to addressing historical discriminations against women through uptake of various legal and policy frameworks such as, the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and inclusion of strong gender equality policies in the 2013 Constitution (UN Women, 2022). Linking investment in rural reproductive and maternal services to the current programming for communicable diseases; has the potential to substantially reduce premature death and disability attributable to Diabetes (World Health Organisation, 2020). For the Zimbabwean context, implementation strategies staged in rural villages, accompanied by concurrently run program evaluation studies to access the long-term impact of these interventions- can maximise return on investment, while improving accountability (Zinyama, 2020).
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