Govt should urgently resolve dispute with doctors

HARARE - Morale and motivation of medical personnel require urgent attention, even in the midst of economic challenges.

A legacy of poor policies over years has left healthcare devastated. 

The current junior doctors’ strike is just but one of many ills.

The new dispensation ushered hope of a change of direction in healthcare delivery. 

However, the failure to allocate 15 percent of the 2019 National Budget to the Health ministry is construed as lack of commitment to health by government.  

Government has assured that genuine change is here and that the country’s healthcare delivery system will be mended. 

Unfortunately with 12 months since the new dispensation’s takeover and based on the prevailing situation some skeptics believe this is a continuation of the past.

Lack of trust in local healthcare delivery is confirmed when our political leaders seek medical help from outside the borders. 

It suggests they have no confidence in their own healthcare system. Issues of cost and quality of service remain a major concern. 

President Emmerson Mnangagwa has a mammoth task in transforming healthcare delivery. 

But to achieve this he must promote economic reform first. Only when this is done will Zimbabwe have a shot at improving the healthcare system. 

Without sorting out the economy and getting the much needed international cooperation it is a “wild goose chase” in so far as health delivery is concerned. 

Healthcare deserves attention because of direct implications on economic development. 

Among the to-do list during his tenure is addressing key challenges in public healthcare delivery which caters for 70 percent of the population. 

The current junior doctors’ strike confirms much remains undone as Zimbabwe’s health sector is still understaffed and overburdened. 

We have a serious manpower shortage in the health sector, with a doctor-to-patient ratio of more than 1:25 000, if you factor in junior doctors against a World Health Organization recommended ratio of 1:600.

The high disease burden from preventable diseases is characteristic of inadequate health financing. 

With almost US$9 billion of domestic debt and almost the equivalent in foreign debt Zimbabwe has had to rely on funding agencies to support public services to the tune of over USD240 million annually in the past. This has assisted healthcare delivery.

To address these challenges, the government will need to first establish economic stability. This has to be top priority but it does not mean everything else waits.

Second, there must be government prioritisation in financing the public healthcare system together with developing a comprehensive health strategy that targets the greatest health problems. 

It starts with Zimbabwe adhering to the 15 percent Abuja agreement on health budget allocation. Such investment will improve health services and outcomes although international support will still be critical. 

To achieve this Zimbabwe must take re-engagement seriously not only with the traditional partners but new ones too. 

If a combination of these subsists healthcare delivery will have the tools to make some progress.

The reported figure by the minister of health amounting to USD85 million annual requirements for medicines and drugs is doable if Zimbabwe sets the right priorities.  

Third, there is need to recognize that grievances can be resolved through dialogue and not threats. Communication with doctors must be on going. For this to happen, the right people with the right scope and frame of mind need to be tasked with these crucial and delicate responsibilities. Any other way will not get the desired consensus.

We start with how the current junior doctors’ strike is being handled. The current situation in which junior doctors on strike have been issued with suspension letters has put a search light on the Health Service Board. Who are they? What do they do? What is their composition? Whose interest do they serve? What is their mandate and to whom are they answerable? These form part of the issues in this discussion. 

The Health Service Board was created through an Act of Parliament, Health Service Act (Chapter 15:16 No. 28/2004). 

The Act provided for the establishment of the Health Service Board which became operational on the 1st of June 2005 as per statutory Instrument 88B of 2005. 

In terms of the Health Service Act section 5, membership of Board shall consist of a full-time Executive Chairperson; and not less than three full-time and not more than two part-time members appointed by the Minister. 

The majority of members shall be chosen for their ability and experience in health service delivery or administration but the Minister shall appoint as a member at least one person registered as a legal practitioner in terms of the Legal Practitioners Act (Chapter 27:07). 

While it is important to understand and know how these choices are whether there are checks to show transparency and that basic governance issues are adhered to for now the appointments done by the previous minister of Health are as follows:
* Dr Paulinus Sikosana is the chairperson of the Health Service Board. He is a medical doctor with more than 20 years’ experience in Public Health Medicine, health systems strengthening, strategic planning and health sector reforms in developing country settings.  

* Professor Auxilia Chideme-Munodawafa is vice chairwoman at the Health Service Board (HSB) appointed in June 2018. She is a registered nurse and a PhD holder.  

* Dr Stanley Mungofa is a full time board member at the Health Service Board and appointed in June 2018. He is a physician with experience in Public Health and the health sector having worked at various Zimbabwean health institutions from junior hospital clinician rising through ranks at District and Provincial levels for 25 years. 
* Ms Mercy Sibongile Gwaunza is a part time board member at the Health Service Board appointed in June 2018. She is a registered legal practitioner with wide- ranging experience in areas of legal practice, commercial law, labor law, civil litigation and arbitration. 

On paper we have the right people with correct credentials. Does the problem lie somewhere else? Is it politics or just wrong work ethic or issues of trust? Government needs to review the title of executive chairperson to executive director to improve on structure, conduct and performance of the HSB. 

According to a press release of December 23, 2018 the junior doctors are aggrieved at the HSB taking the dispute to a labor court at a time they thought grievances were being attended to and dialogue was progressing well. This smells of poor communication and lack of clarity. 

With the strike in day 38 this should have been handled better and the blame is being put on the HSB by the doctors who allege that they will not be intimidated to go and work under current hazardous and psychologically stressful conditions until their grievances are addressed. 

On the other hand government says the most urgent and serious issues raised by doctors have been addressed. 

The Zimbabwe Hospital Doctors’ Association has dismissed claims by the government it has medical stocks at the country’s supplier of drugs and other medical necessities. But surely this issue requires government and the doctors to visit premises and establish the truth.

The doctors have disagreed with figures published by government as salaries of USD 1 800. The association claims that its members take home an average monthly package below this, with most of it being the on call allowance of around $1 000 which a doctor is paid at an hourly rate for working non-stop during inconvenient hours of the night. 

Again this is an issue that can be resolved between the two as figures don’t lie.

The major question is whether this should have been a matter of the courts in the first instance. Could there have been a better way outside court processes to amicably resolve the dispute? The answer is yes! 

The HSB is accused of playing politics with a very straightforward issue of employee grievances. Poor communication between the ZHDA and HSB has contributed. Better communication is needed in future. 

Whether the HSB should be answerable to the ministry of Health or be appointed by the minister of Health requires scrutiny. The alternative is that they derive their terms of reference and appointment from elsewhere. 

These are some of the structural changes needed to make this body more effective and transparent in its dealings involving health personnel. 

An opportunity to improve healthcare delivery lies in stabilising the economy and showing government commitment in 15 percent minimum Abuja agreement allocation to health. There is need to urgently review the whole remuneration structure for health personnel. 

For this to happen, a consensus must be reached on implementation of various reforms to enhance healthcare delivery.  This will take the form of salaries and other employment benefits, infrastructure and equipment upgrades, personnel establishment, medicines and drug availability, restructuring of hospitals chain of command among other challenges.

Doctors appear unhappy about non-medical personnel being appointed to positions of CEOs of hospitals. This practice has been tried and tested elsewhere in the developed world and is known to work. Why should it fail here if adequate checks and balances are implemented? The Trust hospitals in USA and UK are run by competent Administrators. 

Healthcare is an integral part of our national progress and the current challenges bedeviling healthcare delivery need urgent resolution. The bigger problem lies in lack of commitment. 

Solutions do not lie in court processes and action or dismissing doctors. To the contrary they reside in genuine negotiations which birth realistic sustainable solutions that strengthen the capacity for healthcare delivery.

While international capital can assist with the turnaround of our healthcare delivery system more attention should be accorded to how current resources are being deployed. Monitoring usage of resources through technology will add value while reducing costs.

The reality is as people are being turned away from hospitals in the absence of doctors Zimbabwe cannot be open for business. Health is priority number one.  

We call upon both government and doctors to conduct constructive negotiations that put people first and come up with an agreed delivery timeframe. It must be 
recognised not all the demands will be met at once and negotiations are a give and take.  

If both government and doctors are serious, a solution will be found. The way these negotiations are currently being handled is the wrong way. Is it time for a neutral third party to come in? May be it is, given the lack of trust between the two parties.

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