Inside Zim's health sector, 35 years after independence

HARARE - Zimbabwe commemorates 35 years of independence in eight days time, with her health delivery system in intensive care, a development that hinders the realisation of health for all which is enshrined in the constitution.

The country has struggled to expand infrastructure inherited from the colonial regime resulting in the overburdening of central hospitals.

President Robert Mugabe’s  broke government has been blaming sanctions for the deterioration of services in the country.

Analysts say this unfortunate development came about as a result of misuse of resources and in some instances corruption which has gone on unabated.

The public health sector is riddled with long waiting periods between receiving medical attention and treatment, shortage of drugs, water and sanitation services challenges.

The population of Zimbabwe at independence stood at around seven million but now it stands at 13 million — a situation which has increased pressure on central hospitals.

Health minister David Parirenyatwa states that, apart from population growth, the disease trends have also changed from ravaging infectious to non-communicable diseases — placing a further strain on the system while cases of waterborne diseases, maternal complications and malaria remain a further challenge.

The number of professionals servicing the population continues to fall, together with conditions of service.

Many professionals in the sector have departed the country in search of greener pastures particularly in South Africa, Botswana and the United Kingdom while some have moved to the private sector.

While Zimbabwe has several nursing schools, the nurses graduating cannot be absorbed by the system because of limited fiscal space.

The realisation of the right to health by Zimbabweans as enshrined in the country’s Constitution remains a dream for the meantime, while the elite politicians who have plundered the country’s resources resort to medical tourism.

Health budgets have been declining at a two percent rate since 2013 — defeating government’s constitutional pledge to guarantee progressive realisation of health rights as well as breaching the Abuja Declaration which recommends that at least 15 percent of the national budget be allocated to the sector.

In rural areas thousands still have to travel long distances to seek health care services at community level—and even worse if referred for specialist services which are limited at provincial level.

All those referral costs are being borne by a poverty-stricken population in which 80 percent of the adult population is out of formal employment while nearly 65 percent of households are living way below the poverty datum line.

With the country’s medical costs considered the highest in the region, patients continue to struggle to access quality services, particularly specialist services, because of the inhibitive costs of treatment in both the private and public sector.

Only 10 percent of the 13 million people in Zimbabwe are on medical aid, according to National Social Security Authority (Nssa) — leaving the rest depending on government and mission run institutions which are relatively cheaper compared to the private sector.

Ovarian cancer treatment in Zimbabwe is reportedly pegged at $30 000 while the same process costs $15 000 in India.

A cataract surgery patient needs about $5 700 in Zimbabwe while those in neighbouring South Africa pay half the cost.

Although the public sector recently benefitted from an $84 million loan extended by the Chinese government, many departments are still running on obsolete equipment including malfunctioning incubators.

Donors are providing at least 90 percent of medicines used following the death of the drug manufacturing companies in Zimbabwe’s troubled economic environment.

However, health experts and interest groups have been pushing government to find ways of expanding the local resource base arguing that over-reliance on well-wishers can be disastrous.

Rutendo Bonde of the Zimbabwe Doctors for Human Rights said such a scenario takes away the power of government to control processes leading to the enjoyment of the right to health and can cause serious drug shortages in the event of donor fatigue.

Southern Africa Senior Researcher for Human Rights Watch, Dewa Mavhinga said,“Minister Parirenyatwa should stop being a cry-baby. Zimbabweans expect him to sort out the mess in the health sector. Government is not there to complain, it is there to provide timely leadership that benefits ordinary Zimbabweans”.

Itai Rusike, Community Working Group on Health (CWGH) executive director Rusike communities have been forced to take increased responsibility for looking after the ill through home based care.

Government recently launched a public private partnerships framework—a development which—if implemented properly—could help improve service delivery in the sector through enhanced cooperation.

Some have reservations with the arrangement which they fear can lead to the commercialisation of services in the sector.

Many continue to pray for a change in political leadership in the hope that this could induce new ideas on how to revamp the sector.

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