Resolving Equity Issues in Social Policy (We need a new mindset)

February 24th, 2017

Words by Tendai Murisa

13 min read


Public Policy and Social Policy

In the discussion we refer to innovations as the implementation of a new or significantly improved product (good or service), or process, a new marketing method, or a new organizational method in business practices, workplace organization or external relations, (OECD, 2005). Inclusive innovation is defined as “the development and implementation of new ideas which aspire to create opportunities that enhance social and economic wellbeing for disenfranchised members of society” (George, McGahan and Prabhu, 2012:.663). Research should drive the process of innovation. Sadly, there has not been any significant evidence that research carried out on Zimbabwe and indeed Africa has been used to inform policy.

In this short essay we attempt to highlight some case studies as well as identify some of the cross-cutting measures/models that can be adopted in order to improve prospects for enhanced equity within the social sector.

Responding to the Crisis in Education

However, there are fundamental reforms that need to take place within the education system to achieve the balance between academic and vocational skills. Zimbabwe is a signatory to the Dakar Declaration on Education which, among other things, commits African countries to the goal of achieving education for all by the year 2015. In fact, given the level of development required within the country, we take a bold step to suggest that beyond policy changes and improved budgetary allocations we need to revitalize vocational training at both secondary levels and also after high school. Every five-year development strategy should scientifically identify the top ten skills / job categories that will be required by the economy and develop national skills plans that from secondary though to technical training institutions. In order for this to work we envisage a process where employers work closely with education providers by clarifying the skills they requires and also providing internships to learners.

In that respect, from a governmental perspective, there is a need to have a bird’s eye view of educational/skills needs as opposed to a Ministry of Labour vs Ministry of Education and Higher education vs. Manpower Development view. This approach will by nature include other stakeholders such as the different chambers of commerce. Specialist education/skill development may require leadership from the relevant industry or economic sector.

On Vocational Training

The Nziramasanga Commission report of 1999 recommended the vocationalisation of the curriculum. However, vocational training has historically not been viewed as lucrative and prestigious -it was originally designed for, students who were not adequately academically equipped to handle the demands and rigors of higher education and was never really promoted as an alternative career path nor a serious profession. We need to change that and increase the number of learners keen on developing specific artisanal skills. There are a number of approaches that have been tried elsewhere and we could replicate them. Siemens, a German based multinational, in response to the challenge of ensuring the attractiveness of vocational training, invited high school students to come and tour their plant and facilities and parents who initially were not supportive of the idea of their children learning a trade promptly changed their mind – mostly due to exposure of the different career routes available after such training. South Korea, which has one of the highest university enrollments in the world developed Meister Schools (Meister is German for Craftsman). The government of South Korea has taken the lead and pays for tuition, room and board and the students are referred to as ‘young meisters’, with the overall intention of creating a sense of status and prestige and thus nullifying the stigma attached to manual and technical work. Additionally, the vocational streams have become aligned with academic streams to allow seamless transition to universities to allow for further advancement should one desire to pursue higher education and/or explore alternative career paths. It is imperative that students’ and parents’ views of vocational training change and this can be achieved by switching the subject from academic versus vocational to the opportunities of professions as a whole. Global forecasts estimate that by 2030 there will be very little demand for unskilled labour, but semi-skilled, skilled and specialised skill, largely due to technology (Mourshed, Farrel, Barton, 2012).

At this juncture, it is essential that the GoZ through the Ministry of Finance working in partnership with bilateral and multilateral partners take responsibility and be accountable for the mobilisation of finances required to adequately resource this sector. Adequate financial provision should be made to at least stabilise the sector and reduce the levels of out-migration. The main stakeholders that need to be engaged include educators, learners, parents, institutions and officials. In cases where salaries cannot be hiked for educators, perhaps a different approach such as meeting housing needs or ensuring access to housing loans for educators could somewhat supplement income.

Our education system should focus on the development of higher-order cognitive abilities, creativity and challenging and the capacity to critique received knowledge should be allowed in our classrooms and lecture theatres – particularly given the urgent need to chart Zimbabwe’s own path of inclusive of development. A survey by Chivore (1989), notes that the most popular ambition of ‘O’-level students was to pursue ‘A’-level schooling followed by professional training. Looking for a job was a third priority, while self-employment was the least-preferred option.

Job opportunities have drastically shrunk since the time of the survey, but generally the desire to continue to university has not abated. An intervention aimed at developing entrepreneurship skills of high school and tertiary college graduates is highly recommended. Furthermore an inclusive ecosystem consisting of friendly finance, mentoring partnerships (with established businesses) and a policy that insists on doing business with enterprises owned by such graduates should lead to smooth integration of vocational training graduates into the economy. Kenya and South Africa are some of the leaders in this area; they have established business incubation centres to cater for aspiring business people. In Zimbabwe the ILO-inspired Empretec should be revived and work closely with vocational colleges. A good educational base is important for attracting investment, but a solid skills base drives productivity.

Exploring Cases of Best Practice in Health Delivery and Policy Recommendations

Anna Mungara (seated, short hair), a midwife in training, who attends the midwifery school at Masvingo Provincial Hospital, treats a newborn baby in the neonatal ward. UNICEF in Zimbabwe. Development of Fundraising and Advocacy materials for the Health Transition Fund. Masvingo, Zimbabwe. 11th April 2013. Picture by Jordi Matas/UNICEF

We have already discussed how in the first ten years of independence the GoZ sought to achieve a delicate balance between a curative and preventative approach to health delivery through providing integrated health services which were development oriented. However this delicate balance fizzled out in the 1990s with the Ministry showing a preference towards the curative approach. There are many possible reasons behind such a turn of events; the dependence on Western based multilateral and bilateral donors in many of their programmes who preferred a curative approach and also the Ministry became a victim of its own success. Since independence the Ministry invested significant resources towards the training of medical doctors and could thus afford to have a system of health delivery that is centred around these professionals rather than depending on actors steeped in primary health methodologies. There was no significant change in the curriculum from the colonial times.

The GoZ needs to revisit possibilities of creating a balance between the curative and also preventative approaches. The recent outbreaks of cholera and typhoid suggest the need for increasing attention towards preventative approaches that entail robust dialogue between other service ministries such as housing and local government to ensure the provision of clean water and also improving sanitation services. The drive for rural toilets also needs to be revamped as part of the Ministry’s mandate. The community development mandate should be moved from the Ministry of Women’s Affairs into the Ministry of Health. The training of Primary healthcare givers should be prioritised and these officials should be at the frontline of communities’ based measures to mitigate against the breakout of diseases. The system of sending alerts to district and provincial centres should also be improved by taking advantage of the new innovations in communication technology. The Ministry should also focus on improved diagnosis of causes of diseases, working on broader interventions such as public education especially on communicable diseases.

Furthermore there is reason to believe that low cost technology based innovations of diagnosis and treatment implemented elsewhere can also be adapted for the Zimbabwean environment. For instance patients should not travel long distance for a diagnostic check especially if it’s not an emergency and also to decongest the district and provincial hospitals. There are a number of successful diagnosis innovations; in Mexico and Mali, Pesinet uses cell phone technology, such as the SMS platform to carry out diagnosis of various diseases. The most common cellphone based diagnoses are used in investigating cases of malnutrition. Information on a patient’s age, weight and height is sent by SMS to a central server and then a reply is sent back with information determining whether the patient is at risk or not. This innovation has helped reduce childhood mortality and also costs much less than a physician’s consultation fee (Ehrbeck et al.,  2010.). A number of other diagnoses could be provided using this innovation. Furthermore sample-taking centres should be decentralised further into community clinics and then sent to a more centralised place for analysis.

Some tasks in this process can shift from doctors to nurses, and in some cases, to lay workers or volunteers, for instance, in the less accessible places; careers can be empowered for activities such as screening. Currently, our policies are rigid in their prescriptive nature of the duties of the nurse in relation to the doctor. Relaxing of these conditions can mitigate against the high out-migration rates of medical doctors. The following initiatives may potentially contribute towards improved inclusive health service delivery:

  • Establish a campaign for the return of health professionals with incentives
  • Lobby nations that employ Zimbabwean health professionals to set aside resources for the training of health professionals in Zimbabwe through a regional Manpower Development Fund
  • Lobby the GoZ’s Ministry of Health for flexi-contracts that allow specialized skills to work temporarily in Zimbabwe.
  • Request that all practitioners and specialists to work a certain minimum number of hours in the public sector, whether they are Zimbabwean trained or not, but as long as they have practices in Zimbabwe.
  • Mobilise private sector to partner with Ministry of Health in paying for medical professionals willing to work in Zimbabwe

The Ministry of Health should also consider working with the private sector or social entrepreneurs, not only for catering for the higher end of the market but also within the low-income markets. HealthStore and Vision-Springs are excellent cases of best practice. HealthStore operates in Southern African and has taught community based health care workers to diagnose the top 5 diseases within the region. Through the program ‘Child and Family welfare’, HealthStore Foundation has a network of micro-pharmacies using a franchising model for reach. Through this network, outlets are established and located at market centres in marginalised communities such as agricultural areas with approximately 5000 people. Access to essential medicines is thus made available together with health education and prevention services. Currently the organisation is focusing on training community health providers diagnose cases of malaria, dysentery, and respiratory infections and accurately prescribe correct medicines. Zimbabwean rural communities could be well served by such an innovation and it can also relieve pressure on the district hospitals. In Rwanda, this model also acts as an entry point for those that may want to pursue further studies or careers in the health professions and thus act as ‘filters’ for higher posts in the public health system as well.

Life Springs in India has increased the scope of the midwife role to oversee all aspects of child delivery and provide the maternity care where a doctor may not be available. The company charges $40 for a normal delivery, and this releases medical doctors to see more patients and making maternity care more affordable. In Zimbabwe, considering the doctor: patient ratio, this would be well worth considering though it would necessitate a review of the current doctor-centred approach currently dominant within our policies. The up-skilling element cannot be ignored and may have the benefit of boosting morale also serve as an incentive for the nursing and midwife staff to serve in our public institutions where the load is shared.  In developed countries such as Australia and the USA nurses play a much more significant role in screening patients that have to see a doctor and those that they can treat on their own. Nurses should thus be exposed to current trends of diagnosis and treatment. The UZ-based Bachelor of Nursing should be expanded and where possible offered at other Nursing training centres.

In Ghana, the community-based health and planning service (CHPS) was introduced to bring access to the more than 45% of a population of 22 million that survive on less than $1 dollar a day – most of these being in subsistence farming areas and engaged in other informal economic activities (Russell, 2008). CHPS brings trained health care workers directly into the communities and rallies community support behind them to ensure the system’s acceptability and sustainability. One major characteristic is the basis of its adoption – it was built on the back of solid research and testing, Nyonator et al. (2005). It was essentially a strategy to decentralize Ghana’s national health system (Russell, 2008).

By 1996, the findings suggested that “relocating a nurse to communities could outperform an entire sub-district health centre, increasing the volume of health service encounters in pilot communities eight-fold and simultaneously improving immunization coverage”, Nyonator et al. (2005).The objectives of the programme were ultimately achieved through incremental innovation, adoption through a phased approach grounded in organisational science and social learning and by 2005 the CHPS had reached 104 of the 110 districts. In addition, it had created jobs, ‘community health officers’, in these areas as opposed to volunteer staff, thus also making an economic impact.

Reviving Low Cost Housing: Some Suggestions

Despite an increasingly biased focus on urban housing and development, low-income households still continue to face challenges. The GNU did not develop a coherent strategy for delivery of low cost houses for the more than 1 million households on councils’ waiting list. The GoZ in 2009 approved a housing project promoted by a consortium of Russian businessmen but the scheme will most likely benefit the middle-income groups. Recently the GoZ released approximately 1,000 low-cost stands in the Ruwa area specifically earmarked for civil servants. These developments are not likely to have a huge impact on the housing situation prevailing in the country.

The housing challenge is not necessarily due to the fact that low income earners cannot pay but rather policy and urban planning practitioners have broadly failed to come up with models of delivery that are affordable and provide sufficient terms for purchase over a long term period. Rather the low-income groups have been unjustifiably neglected in terms of targeting and even consultations on their demand capacities for housing. The current bottlenecks to low cost housing supply derive partly from the GoZ’s and local councils’ rigid positions that they are the only ones capable of delivering low cost housing.

Experiences elsewhere, discussed below, have shown that a regulated private sector (mostly in partnership with the local councils) can deliver low cost housing at a faster and more efficient pace than governments. Currently housing investments are focused on servicing the upper middle class and the elites given the cash based transactions prevailing in Zimbabwe.

The RBZ-led Home-Link was potentially one of the credible solutions to the housing problems in Zimbabwe but it did not receive adequate support for a variety of reasons. There is need to establish a similar mechanism/fund for low-cost housing. However this will need to be led by an entity that is widely credible and trusted by the potential investors such as a new Building Society that will then mobilise diaspora investment through the disposal of shares.

There is also a need to identify ways to tap into the organic non-state based forms of organisation around housing supply. A study by Mubvumbi and Kamete (1999), found that there were a total of 154 housing cooperatives in the 10 major urban centres in Zimbabwe. Of these 123 were in Harare, 4 in Bulawayo, and Mutare and 3 in Gweru. By 1999 housing cooperatives had constructed 1.6% of the total housing supply in the major urban centres of Zimbabwe. There is potential for the resuscitation of these cooperatives to work in partnership with international NGOs such as Habitat International in the supply of low cost housing. Even globally, informal systems such as housing cooperatives are still the dominant suppliers of low cost housing stock. Approximately 60% to 70% of Mexico’s and Brazil’s current housing stock was built informally. We also suggest learning from these countries but ensure that effective regulations are in place to maintain minimum standards.

In Mexico, CEMEX, one of the three largest cement providers in the world, developed their PH program aimed at the low end of the market, which generally tends to take a long time to build a house depending on availability of money or need, e.g. a new child is born. PH covers financing, construction materials at discounted prices, technical assistance free of charge amongst other things. Community savings and micro-lending are leveraged over a 70-week period and members contribute $17 a week and credit takes the form of materials.

A market response such as the PH Program by CEMEX in Mexico would be adequate as a complementary measure and can be deployed to service civil servants’ housing needs where average salaries are approximately $300 per month. Such incentives if adequately supported can provide a modicum of dignity to those in the teaching, health, nursing and other professions.

Still, in Mexico, public-private-sector partnerships (PPPs) and attractive incentives have been developed. The federal housing commission initiated the National Housing Program which is legally recognised and providing sufficient protection to investors. The program involves ensuring access to finance, provision of subsidies (worth 20-25% of acquisition costs), options for low-income residents and availability of green housing. To help fast-track such initiatives, the government granted contracts, credits and favourable financing terms to private developers constructing green or low-income homes. To reach the lowest-income populations, organizations such as FONHAPO (the National Peoples Housing Trust) and SEDESOL (the Secretariat for Social Development) provide mortgages to those without credit histories, to seasonal or temporary workers and to those participating in Mexico’s large informal economy. However the greatest threat to the sustainable housing program is the instability of Mexico’s political system (Schmidt and Budinich, 2008).

Huangshi, a city of 2.6 million in central China recently experienced an influx of rural migrants and 80% low-income households and rising employment, this led to the emergence of approximately 164 slum settlements. In response, the deputy mayor initiated an innovative process to bring thousands of housing units to market. A state owned company (called Zhongbang) was established in order to provide a financing and management platform and $21.4 million was provided by the city government, as well as land. Tax and fee exemptions were offered and then using these funds and assets, the company was able to borrow from the China Development Bank at below market rates ultimately increasing the asset base to $103 million. With this package of funding sources, the public-housing program was successfully launched using Zhongbang’s platform (McKinsey & Company, 2012).

In order to make the program financially sustainable, a package was created and tenants were allowed to buy housing property oninstallment based on their income with selling price at 50% of market price. Zhongbang was allowed to manage the commercial-development projects, mainly retail businesses, in the public-housing zones in order to generate extra revenue thus having a self-sustainable system, (McKinsey & Company, 2012).

To ensure fair distribution of units among the population and the supervision of the program individual financial data was collected from banks and tax offices and interaction with community groups and the internet was used as supervisory tools to ensure that the system is not abused by those with capacity to build independently. Tenants are qualified every two years. Another innovation is that tenants actually pay market rates which are subsidized. When a tenant no longer receives subsidies, they are then expected to pay market rates.[1]

Closer to home the Kavango Block Brick System in South Africa, (patented by the proprietor Heinrich Schroeder) is an innovation focused on providing affordable housing to low income groups. The Kavango Block Brick uses conventional raw materials but the techniques for construction, or rather assembly is different from the usual approach to building a house. Each block is fitted with a tongue and lip, enabling the blocks to efficiently interlock. The blocks are then stacked to form isometric wall systems. Two apertures are provided to allow for plumbing and electrical fittings, which means that no chasing need take place in the structure – maintaining the integrity of the building. Only the most basic tools — such as hammers and trowels — are required for assembly. Low skilled workers can use it, thus driving labour costs down and the technology allows for quick assembly thus significantly reducing turn-around time, approximated to about 60%.

Coetzer (2010) identified Moladi as an innovative South African company operating in Latin America and West Africa which seeks to provide solutions to some of the challenges of affordable housing for the poor by addressing a lack of resources, lack of skilled labour, time constraints, work flow control and waste management. The company ‘casts’ bricks in plastic moulds, reusable up to 50 times, using aerated mortar and with a simplified assembly method which reduces costs, complexity, and reducing use of traditional materials such as steel and timber. Though the company has not made much inroads in the local market, it is thriving in Sierra Leone, Mexico, Panama, Ghana, and India. The building process offered by Moladi’s can be summarised in four steps consisting of erecting the formwork (the basic casting), reinforcing, pouring the mortar mix into the casting and removing the formwork panels.

At policy levels, there are several other schemes which are working with varying degrees of success, some aimed at promoting private participation. In India the government has introduced fiscal concessions coupled with legislative measures to encourage increased private investment in housing. In Singapore, the core policy is aimed at providing homes at rental rates that people can afford. They also have a Homeownership Scheme where 99-year leases are availed and first time homebuyers are provided with grants of $30,000.

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