Nurses, environmentalists slam doctors

HARARE - Doctors have come under siege from nurses and environmental health practitioners (EHP) in hearings of the Public Health Act (Amendment) Bill, with the latter two arguing they perform more duties but are not recognised in managerial positions.

In public hearings heard across the country to update the Act to current trends, nurses and EHPs said administrative positions awarded to doctors can equally be held by them.

According to certain sections of the Bill, only fully qualified and registered medical practitioners can become provincial and district health officers, to the irritation of nurses and EHPs.

The Bill also states that the permanent secretary in the ministry of Health should also be a registered doctor as they will be the chief health officer.

Zimbabwe Nurses Association (Zina) president Smangaliso Mafa said the current Act discriminates on the appointment and elevation of nurses to posts of directors.

Mafa said nurses are treated as second class professionals yet they constitute and perform the bulk of the work at any health care institution.

He said there are some very qualified nurses who can take up the post of permanent secretary and PHO, however, they are sidelined.

“Administrative posts in the Bill are very discriminatory to non-medical practitioners. But what needs to be understood is that most of these posts do not require clinical expertise, which most nurses can do even better than doctors.” 

“The Act should include all health professionals in positions of power. Most of the qualifications needed are a Master’s degree in Public Health which nurses and pharmacists have however they are not considered for such posts,” Mafa said.

The Zina president argued that in other countries in the region other healthcare professionals are in managerial positions such as permanent secretaries and directors.

He added that nurses who had spent more than five years in a healthcare facility were more qualified to take up managerial posts than recently qualified and inexperienced medical doctors.

Mafa also emphasised the need to abolish the Health Services Board (HSB) arguing that it does not benefit anyone in the healthcare profession.

“If the HSB is abolished nothing will change in terms of duties. Nurses will not even feel its absence because they have not gained anything from its establishment.
Another issue is also that senior nurses should be retired for others to take up posts instead of them only relinquishing their positions because of death,” he said.

Environmental Health Practitioners Council of Zimbabwe Chinhoyi representative Sandra Chikore said qualifications in public health should be mandatory for all and not optional.

She said in cases of environmental health cases, the qualified EHP should be allowed to carry out their duties without interference.

“Inspections of buildings and other environmental health related issues should be done by a qualified EHP and not a doctor. EHP’s know what to look for and what to recommend. Doctors should stay in their clinical positions,” she said.

Bindura housewife Letwin Kanyama argued that while provision of health was a right according to the Constitution, the Bill provided it as a privilege.

Kanyama argued that government before issues of remuneration and ambulances was concerned they should at least make sure that medicines were available in all public healthcare institutions. 

“Section 3 of the Bill says that the minister shall subject to the Act shall within the limits of available resources endeavour to ensure the provision of essential health services and functions. Already the Bill is running away from its Constitutional obligations by giving disclaimers to people. That should not be.

“Provision of healthcare should not be an option. It is a necessity which government should provide. People pay a lot of taxes every month and that money should go towards provision of healthcare. We should not beg to be treated,” Kanyama said.

Community Working Group on Health executive director Itai Rusike said public infrastructure should conform to Constitutional standards that is, all houses should be adequately serviced before they are occupied.

He added that compulsory child immunisation and public health interventions such as deworming and vitamin A supplements should be provided regardless of religious affiliation.

Rusike also said local authorities should have an appreciation of public health competencies to effectively carry out their duties as mandated.

“Local authorities should be adequately supervised by the ministry of Health as well as the respective parent ministries, that is, environment for water, sewerage and solid wastes, local government for regulated and healthy urbanisation and secretary for health for the health directorates of local authorities in order to avoid the current pitfall where health disasters have resulted due to limited capacity and public health understanding by office bearers,” Rusike said.

The Act which was drafted in 1924 and had its last amendment in 2001 was long outdated as it still included diseases such as diphtheria, glanders, sleeping sickness, the plague and scarlet fever.

Disease profiles such as cancer and HIV are still absent in the current Act despite the rise in cancer cases over the last decade.


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