A System in Crisis: Ethical Concerns about Zimbabwean Healthcare in the 21st Century.

[摘要] ENGLISH SUMMARY: Health care services in post-independent Zimbabwe have undergone turbulence with periods ofseemingly significant improvements and other periods of definite decline. This thesis looks athealth-care systems in general and in particular, the way in which they are reflected through thehealth-care system of Zimbabwean. Ethical issues and challenges in health care can take manyforms ranging from debates and discussions on the fairness or the lack thereof in the health-carereform process, the ethics of inter-professional relationships, the ethical problems with doctorpatientrelationships, the state of advocacy in health matters, and patient rights, ethical perspectivesinfluencing discourses on health systems, the ethics of health-care funding, and debates on accessto health care. This thesis reflects on the complexities of the challenges, needs and reformrequirements of the Zimbabwean situation.A critical analysis of the ethical principles, their impact on the Zimbabwe health care system, usinglargely the principlist approach as enunciated by Beauchamp and Childress (2013), is conducted.Other moral theories such as the social contract theory is also discussed in some detail because ofits important application to issues related to health care. A whole chapter is dedicated to theprinciple of distributive justice and its relevance and implications for the health care systems ingeneral, but also with particular relevance to the situation in Zimbabwe. Lack of or inadequateinsurance is the biggest economic hurdle in accessing health care in many low income countries.There are two main arguments, which appear to support some sort of moral right to a health carefunded by the government – 'the collective social protection and the 'fair opportunity arguments(Beauchamp & Childress, 2013). Both of these arguments are discussed in detail. Right to healthand right health care are two concepts which confuse a lot of readers because they are close butrefer to different dimensions of the concept of health. They are discussed with a particularemphasis on the ethical issues involving allocation of health resources, rationing and setting ofpriorities. This thesis winds up by looking at the possible solutions to the health crisis inZimbabwe. The much-flaunted National Health Insurance, amongst other possible remedies, isanalyzed. A list of recommendations is outlined, in the last chapter.

[发布机构] Stellenbosch University