A strategic action plan to enhance the accessibility of healthcare in rural areas of Zimbabwe

Figures & data

Figure 1. Systems Model : as applied in the development of a validated strategic action plan to enhance accessibility to healthcare in rural areas.

Figure 2. Illustrative diagram of the process of developing the strategic action plan using the Systems Model.

Table 1. Frequency distribution: Demographic characteristics of the study respondents.

Demographic characteristics		Professional nurse respondents N = 90		Healthcare user respondents N = 445
		Frequency	Percent	Frequency	Percent
Gender
	Male	21	23.33	147	33.03
	Female	69	76.66	298	66.96
Age
	18–25	3	3.33	73	16.40
	26–35	41	45.55	102	22.92
	36–50	39	43.33	121	27.19
	51+	7	7.77	149	33.48
Education level
	Primary School			72	16.17
	Secondary School			333	74.83
	College Certificate	60	66.66	12	2.69
	College Diploma	30	33.33	15	3.37
	Degree	0	0	13	2.92

Table 2. Systems Model illustration for each resource (Inputs) strategy development.

Inputs	Goals and Strategies (developed in phase 2)	Processes to address the strategy		Outcome of the strategy
		Action	Method
Physical Resources	1. Develop health Infrastructure in the rural areas.	1.1 Building the health facilities closer to where people are, within 5 km of each village manned by professional nurses	1.1.1 Prioritising construction of health facilities in areas with poor distribution like resettlement areas.	Improved health facility coverage in rural areas of Zimbabwe where health care users walk less than 5 km.
Material Resources	2. Provision of appropriate medical drugs at the rural health facilities.	2.1 Supply medical drugs (type and quantity) as ordered by professional nurses at rural health facilities.	2.1.1 Prioritising formation of partnerships with national and international drug producers and non-government organisations to enhance medical drug supply in the rural health facilities. 2.1.2 Efficient payment systems for medical drugs to companies supplying Ministry of Health Child Care and delivered to the rural health facilities.	To ensure availability and accessibility to essential medical drugs at the health facilities for the HCUs and health workers in the rural areas.
Human Resources	4. Review the workload of the health workers at the health facilities	4.1 Conduct workload indicator staff need assessment in Zimbabwe for the purposes of reviewing health worker gaps	4.1.1 Systematic review or health worker count based on the workload at each rural health facility.	The shortage of health workers is addressed in rural areas
Material Resources	5. Provision of adequate and minimum required equipment in the health facilities.	5.1 Acquiring of basic equipment for the rural health facilities	5.1.1 Budgeting processes for basic equipment, financial resource mobilisation from other stakeholders like donors, private companies.	Improved diagnosis and health care service delivery by health workers at the first point of access for health care users.
Financial Resources	6. Free health care services for all	6.1 Remove health care user fees at the rural health facilities.	6.1.1 Exemption policy framework for the people in rural areas.	Improvements in the affordability and utilisation of health care services in the rural areas

Table 3. Strategies voted according to priorities.

Strategy number	Strategies voted as the most priority (Themes)	Total Score
1	Develop health infrastructure in the rural areas.	15
2	Provision of medical drugs at the rural health facilities.	12
3	Development and retention of human resources (health workers) in the rural health facilities.	11
4	Reviewing the establishment of health workers at the health facilities guided by workload.	8
4	Provision of adequate material resources at the rural health facilities.	8
5	Free health services for all.	5
5	Improve the capacity of the health care delivery and management systems	5

Table 4. Validated, approved and agreed Strategic Action Plan (actions are included in the text).

Systems Model Inputs	Goal	Strategy	Outcome
Physical Resources: Health facility buildings (consultation rooms, maternity wards, inpatient wards), laboratories, electricity, water, roads, communication and social amenities like mother’s shelters and pharmacies.	1. Develop health infrastructure in the rural areas	To improve the distribution and the conditions of the health facilities in rural areas of Zimbabwe. Increased physical accessibility to health facilities in rural areas. Budgeting adequate financial resources for improving health infrastructure. Enforcement of infrastructure development policy priorities to address health infrastructure backlogs and upgrading existing health facilities.	Improved health facility coverage in rural areas of Zimbabwe where healthcare users walk less than 5 km to the health facility.
		To improve the necessary infrastructure like water, electricity and communication at the existing health facilities’ infrastructure Improve road access to health facilities	Improved areas attendance by health care users at the rural health facilities and motivation of health workers to work at the rural health facilities.
Material resources: These are medical drugs, refrigerated trucks for delivering drugs, refrigerators, and computers (supply chain for medical drugs).	2. Provision of adequate medical drugs (type and quantity) at the rural health facilities	To ensure availability and accessibility to essential medical drugs at the health facilities for the healthcare users and health workers in the rural areas. Forming partnerships with national and international drug producers and non-government organisations to enhance medical drug supply in the rural health facilities A computerised (ICT) health information system with a strong medical drug management component to build the evidence base for planning for the availability of required medical drugs of desired quantity and generic in the right place. Adequate resourcing and funding for the procurement of medical drugs.	Readily available essential medical drugs at the health facilities for the healthcare users and health workers in the rural areas.
		Good management of medical drugs at the health facility level through timely ordering of the right quantities and type of medical drugs consumed at the rural health facilities. Establish a well-functioning country-wide medical drug supply system should be in place where at each level there is accountability.
Human resources: These are health workers working at rural health facilities.	3. Develop and retain human resources in the rural health facilities	To attract and retain health workers at the rural health facilities through promotion and payment of incentives. Improve Job satisfaction by health workers at the rural health facilities through improvement of working conditions. Review the workload of the health workers at the health facilities and address shortages Improved recruitment, training and staffing levels at the rural health facilities. Reinforce and scale-up in-service training of the health workers in rural areas to improve knowledge and health services delivered to HCUs particularly by professional nurses. Promoting career growth of health workers at the rural health facilities Create better employment prospect, good income, more motivating environment and good living conditions in rural areas.	Retention of competent and skilled health workers at the rural health facilities. The shortage of health workers is addressed in rural areas.
Material resources: Involve Equipment and supplies (bandages, sutures, needles, microscopes and its consumables etc)	4. To ensure adequate material and minimum required medical equipment in the health facilities is provided	Consistently maintaining the availability medical equipment and accessories in accordance with standards at the rural health facilities. Properly equipping rural health facilities and introducing point of care and testing for HIV, TB and Malaria, for example. Resources mobilisation through identifying companies that can supply health equipment and provide training on maintenance to the health workers.	Improved diagnosis and healthcare service delivery by health workers at the first point of access for healthcare users.
Financial Resources Healthcare funding Healthcare user fees Medical insurance	5. Free health care services for all	Remove health care user fees at the rural health facilities. Putting in place a clear exemption policy framework for the people in rural areas. Putting in place sound and sustainable fiscal resource mechanisms to allow health care accessibility to the vulnerable population	Improved affordability and utilisation of health care services in the rural areas
Managerial resources Supervision and management support; Strategies; Policies.	6. To ensure improved capacity of the healthcare delivery, policies, and management systems	To put in place policies, human resources, financial resources that strengthen the healthcare delivery and management systems in Zimbabwe. Favourable policies that enhance accessibility to healthcare in rural areas. Provide enough financial resources for providing sufficient health care.	Resources are used effectively in the provision of healthcare services.
			Reduction of disease burden in Zimbabwe.