Health citizens transforming health systems in the developing world: the case of Rugare Medical Centre’s health for all initiative

Author: Dr Charles Mpofu, Auckland University of Technology, New Zealand

Just like medical education for social accountability, health citizenship can be embedded in the curriculum to conscientise health professionals in the Global North about health inequalities and lack of access to care in the Global South.

Health citizenship is an emerging concept that has been adopted by health professionals and some medical education schools to prepare health professionals to engage communities in underserved and marginalised populations in promoting health equity and social justice.

A health citizenship example of a UK-based psychiatric nurse, Quinn Sowa, who in 2020 visited her family with her son in Zimbabwe and found herself struggling to fund the care of her son who became very sick on arrival. This was further compounded by endemic health system issues of resource constraints, infrastructure deficiencies and health workforce shortages, especially access to specialist services as is the case in many other developing countries in the global south.

The case study challenge and solution

Psychiatric nurse Quinn Sowa modelled how health citizens can transform a personal experience of denial of access to care and work towards realising a dream of local and global health equity focusing on mobilising the existing professional networks and family resources. After paying $5000 USD for her son to access care, Miss Sowa felt compelled to take action to address health care access and health equity issues in two strands- within the country and by leveraging on her skills, family resources and professional networks in both Zimbabwe and the UK to build and equip Rugare Medical Centre.

In addition, the Rugare Medical Centre has now acquired kidney dialysis machines and a Mercedes Benz ambulance from the UK. A further layer of promoting health equity and access to care was by complementing the medical centre with an accessible insurance scheme. Encouraging families to invest in a good life is an upstream health promotion strategy that is further facilitated by an accessible health insurance of approximately $US40 per month for both general practitioner and specialist care. The insurance scheme was to be modelled on an inclusive approach accommodating children, over 65s, unemployed, low income, large families, high income earners and those outside the country. The affordability was further facilitated by allowing families in the diasporan global North to pay for their relatives in Zimbabwe.

The above approaches are local context relevant because Zimbabwe is a country with a high unemployment rate of nearly 90% but with a large diaspora population of nearly 2 million people. Furthermore, the new medical Center exists in the context of the previous 3 decades of high death rates caused by HIV/AIDs and other poverty related diseases. Such a high death rate resulted in:

• Families investing in funeral policies.
• Stigma associating hospitalisation with terminal illnesses and subsequent death.

Thus, the uniqueness of this initiative in the context of health citizenship is, therefore, in the following ways:

• Leveraging on the diasporans across the world to contribute to health access in their own country of origin.
• Mobilising communities and local health networks to act in contributing to access to care for all.
• Changing the community concept of dignified death and burial to that of quality years of life.
• Changing stigma associated with hospitalisation.

Implications for medical and health education

The Rugare Medical Centre initiative underscores the importance of fostering a sense of health citizenship and social accountability in health professional education and medical schools. This could be through curriculum components that emphasise the role of health professionals in addressing health equity and access challenges.

Opportunities for international medical experiences and service-learning should be integrated into health professional and medical education. This will help expose students to diverse health care contexts and inspire them to be health citizens who can transform health systems.