DELINEATINGACCESS TO SPECIALTY HEALTHCARE IN ZIMBABWE A CROSS-SECTIONAL STUDY TO INFORMEVIDENCE-BASED PUBLIC HEALTH POLICY AND PRACTICE
Authors:   Health Economist and Researcher on public health,affiliated to ISSCAD,National School Development, Peking University China. Director Performance Improvement and Development, Zimbabwe Health Service Board., Nkala Bernard , Liu Gordon ,   Professor of Economics at the National School of Development at Peking University (PKU), and Director of PKU China Center for Health Economic Research.
Published: March 2021

The study investigated the determinants of access and utilization of specialty healthcare services in the case of public referral hospitals in Zimbabwe using the period post-independence in 1980s to 2018. This becomes an exciting period for the study as it presents the rise and fall of ZimbabweÃ¢Â€Â™s healthcare system. Although there are many specialists offering specialty healthcare, the study limited its focus on specialty care physicians operating at public health facilities. The study objectives were to identify the socio-economic and health behavioural determinants that could influence access to and utilization of specialty healthcare amongst different groupings in Zimbabwe. The study specifically examined the influence of household income, insurance, health information/ education, distance to the nearest health centre, waiting time and dual practice as a variable of interest on access to specialty care. The study utilized cross-sectional household data collected through a survey from April to October 2019. Out of the 40 selected districts from a cluster of 63 existing administrative health districts, 1000 households were randomly selected using one stage cluster sampling (probability sampling design). The study used the Logistic regression model to identify the determinants of access to and utilisation of specialty healthcare based on 653 households that had reported sickness of a member within the last twelve months before the survey. The study tested the hypotheses that dual practice does not affect the supply capacity at public hospitals hence does not reduce access and utilisation of specialty healthcare household income does not increase the demand for specialized healthcare services and that the distance to the nearest health facility does not reduce the probability of seeking of specialty healthcare services. The Logistic regression results revealed that distance to the nearest health care facility, household income, health insurance coverage, presence of dual practice and waiting time all had a significant statistical relationship with access and utilization (demand) for specialty healthcare at public health institutions. However, the study found out that health information had negative effect though an insignificant variable. Distance to the nearest health facility and waiting time was found to negatively affect access (demand) to specialty healthcare whereas household income, dual practice and insurance coverage were found to positively influence access and utilization of specialty healthcare at public health institutions. The study established that, as there is an increase in income and insurance coverage, access and utilization of specialty care also increased. More households in Zimbabwe (71%) are not medically insured. The study found that the provision of specialty healthcare services is too centralized thereby patients are compelled to travel long distancesto metropolitan facilities where specialty health services are more concentrated. The study further established that dual practice affects the supply capacity in public hospitals. The constraining arrangement of management and teaching services at main teaching hospitals affects the supply of specialty services. Households tend to wait longer to consult specialists at public hospitals due to poorly regulated dual practice that induces long waiting times. Given the study findings, the study recommends health policy planners to adopt a balanced centralized and decentralized modelon access to specialty care, differentiating higher and lower tier specialty care facilities to address the geographic accessibility and availability dimensions and revisiting management of training and structuring of specialty teaching services. Other major recommendations of the study include the review of supply-side policies used to enhance access to specialty healthcare services. The policies may target at implementing a public sector Ã¢Â€Â˜National Health Insurance FundÃ¢Â€Â™, driven by the government of Zimbabwe offering realistic, acceptable and affordable premiums for vulnerable groups and expanding the scope of participation in developing the policy regulating dual practice. The study also recommends the creation of Special Economic Zones (SEZ) for Specialty health riding on the existing Government framework on SEZs. The adoption of Strategic Specialty care Partnerships (SSCPs) can enhance access and institutional capacities in dealing with the expensive response to Non Communicable Diseases, which are the main drivers for households to seek specialty care. Zimbabwe through its national health authority needs to Ã¢Â€Â˜Reframe the Health AgendaÃ¢Â€Â™ on specialty care thus initiate a national health action plan that will continue to drive to evidence-based health policy and practice.