'What happened to Health For All by 2000?'

HARARE - With the elections looming so large in our collective consciousness, many policies and slogans are being proffered to the general public, lofty words and heavenly promises are being peddled day in day out.

It saddens us to note that not a lot is being said about the crumbling health sector.

The health of the nation is now an afterthought, something that has been left to NGOs and volunteer groups, in election time a tool in the hand of politicians to win constituencies.

Who will forget our beloved politicians bussing doctors from Harare to go to remote villages to do free treatment on elderly villagers that normally will need to travel a day on foot to see a clinic?

It is very sad to note that this ghost of a system as it now is was at one time hailed as being among one of the best in the developing world. Apparently in 1985 the World Health Organisation declared the Zimbabwean healthcare system as the best in the developing world, this was on the background of a vigorous drive by the government to build and refurbish existing facilities.

With the help of Dr Stamps even before he was a minister, the government had built 321 new health stations, ranging from district hospitals to local clinics, they had also been able to refurbish 550 health stations many of these in the rural areas.

At that time a lot of effort was being put in developing healthcare workers to be able to man these institutions and help people particularly in the rural areas access health care.

Village health workers were trained; nurses were upgraded to clinical officers so that they could do more complicated procedures in the absence of doctors. Those were golden years and we were the envy of the world.

However, this high was short-lived, during Dr Stamps’ second tenure as the minister of Health disaster struck, due to an ill-advised economic structural adjustment programme of the early 90s the country went into a recession and that also took down the healthcare system with it.

Due to the recession fewer funds were allocated to the Health ministry.

The social dimension aspect of Esap meant that some of the people were supposed to start paying user fees so that they could subsidise those who could not afford.

This was the start of the calamity we see ourselves in, some of the people who were supposed to be paying these fees had no capacity to do so and at the end of the day they could not access health care.

Slowly resources were eroded, infrastructure destroyed, healthcare workers morale plummeted so did their salaries and that was the beginning of the brain drain among health care professionals.

Fast forward 15 to 20 years later the system is in ruins.

The country is facing newer healthcare challenges, HIV has blossomed to pandemic levels, newer drug resistant strains of TB are now reported in many centres, sporadic but sustained outbreaks of diarrhoeal diseases are reported in many areas, and infant mortality rates are spiralling out of control, and the government lacks the capacity and the will power to act decisively to restore the once thriving health care system.

Budgetary allocations towards healthcare are not enough to start with, though a percentage rise in the percentage allocated was noted, it was 4,2 percent in 2001 and it jumped to 8,5 percent in 2009.

However, this is not enough, the Abuja Declaration of 2000 says that for there to be meaningful transformation and for countries to realise their millennium development goals the budgetary allocations for health must be at least 15 percent of the total budget.

One does not need to go far to see the impact of these disparities, if you visit any public health facility you will definitely see the signs of this, derelict buildings that are a danger themselves to the lives of patients, demoralised staff who have been known to ask for bribes for them to serve you, and the perennial shortage of drugs and other basic sundries even at the country’s largest hospitals.

Statistics are shocking, reminiscent of the dark ages where everything was a plague, by 2010 90 000 Zimbabweans had contracted cholera in an epidemic that had started less than two years prior and had killed more than 4 000 people.

And according to WHO it was the worst reported case on the continent in recent history.

Presently, Zimbabwe has one of the highest infant mortality rate, it has steadily been rising, in 1990 78 children out of 1000 didn’t live to see their fifth birthday, that figure rose to 94 out of every 1 000 by 2011. These figures were presented by Tendai Biti when he presented the 2011 national budget.
 
Of this number 20 percent of the deaths are due to HIV and Aids, and the remainder mainly to preventable diseases, mostly being diarrhoeal and other conditions related to malnutrition.

Dating back from the 80s the government had always tried, albeit, unsuccessfully, to make healthcare free in government institutions, in the 90s they moved to saying that only the expectant mothers, children under five and the elderly over 60 years would access free healthcare, everyone was supposed to pay.

Those who were poor had to be “certified poor” and have their hospital bills paid by the social dimension fund. But this fund ran dry and now everyone has to pay, around 2008 the situation in hospitals became dire that even the expectant mothers and the elderly had to pay. Consequently many people could not afford to visit their local clinic. Presently it is estimated that 39 percent of all births are home deliveries.
 
Home deliveries have been known to be very dangerous, both for the mothers and their babies and this is one of the contributors to the high infant mortality rates.  

Dr Stamps’ dream of “Health for All by the Year 2000” is now a nightmare.

Presently, efforts are being made to try and reverse these losses, but these problems are colossal and the present efforts are too feeble to turn the tide.

It is also worrying that these efforts are being spearheaded by Unicef, EU and the global fund.

It is interesting to note that most of the money that is coming from these organisations is not going through government because of the level of corruption and looting that was witnessed in previous endeavours, so this money is being administered by private cooperation.

The drawback is this money is targeted, there are only specific areas that it can only be used in, for example the 400 million health transition funds that was introduced by the EU and its partners is only meant for maternal and child health, however there are many ailments that ail the system.

We can write books and teach on this but simple truth is our healthcare system is sick, and in serious need for resuscitation.

Presently there is no political will to tackle our issues, most policies that our politicians implement are just political and do very little to alleviate our plight.

It is time the people of Zimbabwe declare that enough is enough.

If the Constitution gives us the right to life then it’s a criminal offence to let people die because they lack basic health care.

The people are sick and tired of dying and burying their relatives from diseases that are curable.
 
It is time the people get a government that listens not only to politicians but also to technocrats who are needed to formulate workable policies that can turn around this situation, it is time that if a government is labelled “a government for the people” it must listen to the complains and groaning of the people in the street.

The elderly in Muzarabani, the HIV positive in Nyazura, the children in Gwanda and the banker in Borrowdale, broken all need and deserve a government that will serve them, that will guarantee their health and their future.

This opinion piece is by the National Information and Publicity Committee of the United Movement for Democracy — a new political party.Our healthcare system is sick, and in serious need for resuscitation.

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