Solutions lie in appreciating the importance of health issues

HARARE - While the perception is that Zimbabwe’s healthcare is in intensive care progress has been made on some health outcomes. 

The challenges are considerable but with discipline, consistency and focus we have the tools to turn this situation around. 

Are there solutions? 

Yes. 

Solutions lie in appreciating the importance of health. It is important to adhere to the Abuja Declaration as the starting point. 

Further, we must craft a healthcare policy framework that places health at the centre of economic development starting with the budget allocation. 

Beyond that, we must create awareness and proactive measures focusing on personal health. Improving the quality and effectiveness of primary healthcare would combat secondary and tertiary healthcare related ailments/complications which will have a positive effect on healthcare delivery in general. 

Firstly, we must fully understand our current circumstances. The sector has since year 2000 lost personnel fuelled by poor salaries and conditions of services for doctors, nurses and other health personnel. 

The failure to employ locally-trained doctors, nurses and other health skills is a problem. It poses questions over our ability to create opportunities. Unemployment within the health sector is not about lack of demand for services. 

Unicef reported a 30 percent vacancy rate in 2016. Demand for health services far outstrips supply many times over. 

It is explained by how resources are allocated. Implementing Abuja would address part of the challenge with employment, infrastructure and supply of medicines. 

The math is simple — 15 percent of 2019 budget of US$8,2 billion is US1,2 billion for health excluding development partners funding. 

An additional US$250 million from development partners sets the health budget at US$1,5 billion sufficient to make a huge difference in health delivery. If done consistently for 5 years Zimbabwe’s healthcare will rebound to our 1980s and 1990s standards. 

Development partners continue to play a critical role as they channel their resources through the UNDP Global Fund as well as Health Development Fund administered by Unicef.

These resources have assisted with HIV/Aids, TB and malaria initiatives, procurement of medicines and pharmaceuticals as well as payment of retention allowances to health sector staff. 

Presently, the bulk of government disbursements are going towards employment costs. Of the $248,6 million government has disbursed for the 2017 health budget about US$215,1 million representing 86,5 percent is employment costs related. 

This leaves very little for other critical expenditure lines.

In line with these initiatives, the ministry of Health must identify other development partners outside the usual pool of EU, DFID, Sweden, Swiss, Gavi and others. India, China, Japan, Brazil and Russia can improve health infrastructure, skills and medicines supply. 

Not just hospitals and their infrastructure but also accommodation for doctors and nurses in districts areas. 

Financial resources are inadequate but we impress the importance of allocation and utilisation. 

We advocate for strong systems which consolidate healthcare delivery and quickly identify and rectify variances and deviations, for example a strong healthcare regulatory board supported by strong legislation and code of conduct. 

The roles of the Health Services Board and Health Professions Authority (HPA) of Zimbabwe must be revisited. While blame is sometimes on absence of strong legislation, the problem is sometimes governance and noncompliance by those tasked with these responsibilities. 

Secondly, there is a need to confront real issues. Issues of failure by medical aid societies to honour patient obligations and fights between service providers and funders are just a tip of the iceberg. 

Focus must be on wider issues in the sector’s value chain rather than focusing on sections of it, for example corporate governance, policy frameworks and accountability at both public and private sector levels. 

What is the future of healthcare in Zimbabwe and what must be done now to achieve it? Do we have a clear health policy and vision that is attainable and whose results can be measured?

The success in health delivery lies in the commitment and action plans implemented. The crafting of the national budget at 15 percent is the starting point. Use of biometrics and modernising ICT infrastructure in public hospitals and including Medical aid societies will address losses through fraud. While absence of specific laws designed to deal with healthcare fraud in the country is an issue it is also possible that these institutions lack personnel and systems that address these challenges. 

Third, there is need for dialogue among key stakeholders in the health delivery system. Disagreements between service providers and medical aid societies and insurers over tariffs for various areas of services provided and delays in payment for services rendered. Providers also cite conflict of interests by medical aid societies and insurers when they build, own and run medical and dental clinics, health emergency transport services, hospitals, pharmacies, laboratories, radiological centres, rehabilitation units, optician clinics and other related health centres. This is managed healthcare which has worked in other countries. We must explore why this seems to be a problem here in the best interest of both parties. A clear code of conduct will address challenges and ensure a more effective healthcare system. 

Fourth, the issue of resource allocation and utilisation is important. There is justification for higher allocations of above US$1 billion for health. However, sound systems must be implemented to ensure that the available resources are appropriately utilized and accounted for to realize the full benefit of their purpose. This demands effective monitoring of all health programmes and expenditures. Fixing the healthcare problem demands systems upgrade. Likewise private companies can reconsider their healthcare models to be cost and value effective by adopting in house tailor made packages to cut costs and improve service quality. 

Efforts to improve healthcare delivery have been slow. However, since July 2017 the ministry of Health reported recruiting 1 600 nurses and another 400 due for recruitment to cushion the acute demand for nurses. This will not suffice and suspension of nurses’ training programme recently announced is a worry. There is a vacancy shortage of 8 000 nurses in public health institutions but we have 4 000 unemployed nurses. 

The shortage of midwives in the country has contributed to the high maternal deaths. There are 6 000 midwives in the public sector and 700 in the private sector. We have a low per capita nurse ratio while district hospitals should be manned by four medical officers but such is not the case.  

The revival of the National Pharmaceutical Company of Zimbabwe is a positive development to ensure supply of drugs and medicines especially to public institutions. The allocation of US$1 million in the 2018 health budget and almost US$10 million for NATPHARM warehouses in Bulawayo, Masvingo and Mutare is positive. It guarantees availability of affordable and essential drugs and medicines. 

Zimbabwe needs a new healthcare strategy to address the complex issues in the sector. Zimbabwe has a weak health care system despite its strong health infrastructure but despite this statistics reveal some significant achievements. While the changes we are advocating place centrality on government and public sector alone the private sector and development partners must be given room to play their value adding roles. Government must show commitment with budget allocation. It is the first crucial step.  

Ernest Gwinyai and Alex Majongwe are from Health Decisions Consulting (Pvt) Ltd. Website: Healthdecisionsconsulting.org

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