US embassy cable - 03HARARE2449

UNCLAS SECTION 01 OF 03 HARARE 002449 
 
SIPDIS 
 
AID FOR DCHA/FFP LANDIS, CRUMBLY, MUTAMBA, PETERSEN 
DCHA/OFDA FOR PRATT, BARTON, KHANDAGLE, MENGHETTI, 
BORNS, MARX, HALMRAST-SANCHEZ, MCCONNELL 
AFR/SA FOR FLEURET, COPSON, FORT, BAKER, MACNAIRN 
STATE/AF FOR RAYNOR, DELISI 
PRETORIA FOR DIJKERMAN, HELM, DISKIN, HALE 
NAIROBI FOR SMITH, RILEY 
LILONGWE FOR RUBEY, SINK 
LUSAKA FOR GUNTHER, NIELSON 
MAPUTO FOR POLAND, BLISS 
MASERU FOR AMB LOFTIS 
MBABANE FOR KENNA 
GABORONE FOR THOMAS, MULLINS AND DORMAN 
ROME FOR FODAG FOR LAVELLE, DAVIS 
 
E.O. 12958: N/A 
TAGS: EAID, PREL, US, ZI 
SUBJECT: RAPID DETERIORATION OF SOCIAL SERVICES IN ZIMBABWE 
 
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SUMMARY 
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1. As detailed in a recent UN briefing to donors on trends 
in Zimbabwe's social sectors, the continuing complex 
emergency in Zimbabwe is taking a heavy toll on its 
citizens. This cable summarizes UN figures presented at 
recent special donor meeting. Crumbling social services are 
failing to meet basic demands for health care, education, 
water and sanitation. The country is moving rapidly towards 
a situation of chronic and widespread poverty. Severe 
economic decline, a crippled agricultural sector and 
HIV/AIDS exacerbate the problems.  US and other donor 
contributions help mitigate the symptoms of the crisis and 
lay a tentative groundwork for recovery, but the downward 
spiral continues. 
 
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DETERIORATING CONDITIONS 
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2. The United Nations Humanitarian Coordinator recently 
briefed international donors on the rapid deterioration of 
Zimbabwe's social sectors and its consequences for health, 
education, child protection, water and sanitation. The UN 
team presented some alarming statistics, summarized below. 
 
3. Zimbabwe is facing macroeconomic instability, reflected 
by an "official" inflation rate of over 600%, a decrease in 
manufacturing by almost 20%, and rising unemployment in the 
formal economy (now over 80%). For most Zimbabweans, these 
macroeconomic indicators mean income insecurity and eroded 
purchasing power. 
 
4. Overall poverty is increasing. In 2002 (the last year for 
which data are available), 80% of the population lived below 
the poverty datum line and 69% lived below the food poverty 
line. About 36% of the population lived on less than US 
$1/day. 
 
5. Life Expectancy is declining rapidly, decreasing from 
approximately 60 yrs in 1997 to 35 yrs in 2001. 
 
6. Not only are conditions deteriorating, but information 
systems are breaking down as well.  Only limited 
surveillance data has been available since 2000. 
 
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HEALTH AND NUTRITION 
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7. Access to health care services in the country has 
declined rapidly since the beginning of the GOZ's fast- 
track land reform program. Many health care professionals 
have joined the continuing widespread "brain drain" and left 
the country. According to the United Nations, only 687 
medical doctors are still working in Zimbabwe -- a vacancy 
rate of 55 percent. Vacancy rates for other key health 
professionals are alarming -- 73 percent for dentists, 90 
percent for pharmacists, 40 percent for nurses, and 53 
percent for environmental health officers. On-going strikes 
by health care professionals have further limited their 
availability. Several medical doctors have been arrested. 
 
8.  The AIDS pandemic continues in Zimbabwe with an HIV/AIDS 
infection rate estimated at 24.6% of the sexually active (15- 
49) population (CDC/UNAIDS/MOH - 2003). An estimated 
1,820,000 Zimbabweans were living with HIV/AIDS in 2003. The 
UN reported that an estimated 135,000 adults died from AIDS 
during 2003. (According to our figures, an additional 36,000 
children died from AIDS this year.) There are an estimated 
761,000 AIDS orphans in Zimbabwe (aged 0-14). 
 
9. Acute malnutrition has increased from 1.2% (ZDHS 1988) to 
5.0% in 2003, while chronic malnutrition, as measured by 
stunting, has increased from 23.3% to 26.5% (projections 
based on MOHCW/UNICEF 2003). Approximately 26,000 children 
(6-59 months) were severely malnourished at the time of the 
survey (MOH/UNICEF - 2003) and the number continues to 
increase. 
 
10. In 2002, more than 25 percent of mothers delivered their 
babies at home, often without the assistance of a skilled 
attendant, due to the high costs of transport and health 
care.  Maternal mortality has doubled from 300 per 100,000 
in 2000 to over 600 per 100,000 in 2003. Mortality of 
children under five years old increased from 70/1000 to 
150/1000 during the same time period. 
 
11.  A current outbreak of cholera within Zimbabwe has 
already claimed 17 lives between mid-October and mid- 
November, out of 76 cases reported. Other diseases are 
increasing. The incidence of tuberculosis rose from just 
under 100/100,000 in 1990, to 550/100,000 in 2002.  Deaths 
due to measles were reported for the first time in five 
years.  Malaria contributes to about 12 percent of total 
outpatient attendees and 15 percent of all admissions, with 
over 3,000 deaths in 2001. 
 
12. Essential drugs are becoming scarce. The percentage of 
rural health care centers with no remaining stock of 
critical drugs is distressing: 69% lacked Erythromycin, 80% 
Norflaxine, 29% Penicillin, 28% Ergometrin and 63% Oxytocin. 
 
13. On the bright side, immunization programs are still on- 
going and the Ministry of Health and Child Welfare and 
partners still maintain high coverage of selected antigens 
during National Immunization Days. 
 
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ACCESS TO WATER 
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14. One of the most basic of human needs -- clean water -- 
is getting harder to come by in Zimbabwe.  The UN estimates 
that between 45-50% of all boreholes in rural Zimbabwe are 
non-functional.  Others are functioning at vastly reduced 
output.  The acute shortage of water supply and sanitation 
affects 864,000 women and 648,000 children under five years 
of age in rural areas, including resettlement areas 
(UNICEF/MOH 2002). Rural residents are forced to travel 
increasing distances to obtain potable water. 
 
15. USAID and OFDA staff examined several boreholes during a 
visit to Zvimba District last week and a visit to Bubi 
District the previous week.  These visits confirmed the 
disrepair of a significant percentage of boreholes. Twisted 
barbwire substituted for missing bolts, and wooden sticks 
replaced missing metal lynchpins on the "bushpumps". In 
several cases, villagers were required to use handpumps for 
an hour or more before water would begin to trickle out. 
 
16. In urban areas, chemicals used to purify the water are 
in distressingly short supply due to lack of foreign 
exchange. This potentially threatens the health of up to 4.6 
million urban people. 
 
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EDUCATION 
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17. Education in Zimbabwe is plagued by a lack of basic 
infrastructure, lack of teaching and learning materials and 
poor sanitation facilities. The number of qualified teachers 
is decreasing due to HIV/AIDS, uncompetitive salaries and 
working conditions, and emigration of teachers. The number 
of school drop-outs is rising. 
 
 
 
 
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CONCLUSION 
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18. UN figures confirm that Zimbabwe is caught in a downward 
spiral of increasing poverty. The corrosion of the social 
service sector is widespread and the food security crisis is 
worsening.  Zimbabweans are becoming increasingly dependent 
on humanitarian assistance. US and other donor activities 
help mitigate the symptoms of the crisis, including 
USAID/OFDA's program to rehabilitate boreholes in several 
districts, and lay a tentative groundwork for recovery in 
some areas.  The donors will continue to monitor these 
trends and to identify opportunities for additional 
mitigation efforts but, without the necessary policy changes 
by the GOZ the deterioration will continue.  Sullivan