Will the Health minister act?

THE tears and emotion of one specialist consultant are more than just that. These are tears that capture the decay of our healthcare delivery over the past 20 years. 

Yes, Dr Azza Mashumba’s tears captured the dire situation with drugs, medicines, basic consumables and equipment in our public hospitals.

As of 2000 per capita health financing was USD 8,55 as compared to USD 23,6, which had been recommended by the Commission of Review into the Health Sector in 1997. By the beginning of 2008 it had been further eroded and stood at only USD 0.19 signifying a collapse of our health system.  
This paper captures other strategic issues beyond funding that have for decades crippled the health sector. Rumours and allegations of corrupt tendencies in and around procurement have dogged the sector for too long and should now be addressed. This is no secret. Will the minister act?

The minister of Health, Obadiah Moyo a few days ago admitted to have inherited empty drug, medicines and consumables shelves.
Our healthcare system is beset with many challenges some of which have been cited in our previous conversations. 
These date back to his predecessor David Parirenyatwa who served as minister of Health from 2002 to 2009 and again between 2013 and 2018. 
Prior to this he was deputy minister of Health under Timothy Stamps. It is therefore fair to observe that most of the healthcare challenges ballooned under his tenure as he effectively served for 12 years as minister, an unwelcome overstay in one portfolio. 
In 2013, an official investigation titled “Investigations Report on the Procurement Processes” by Government Hospitals under the Targeted Approach by the National Economic Conduct Inspectorate (NECI), revealed that public hospitals were riddled with massive corruption, underhand dealings as well as the flouting of State Procurement Board (SPB) regulations and procedures in the procurement of medical equipment. 

The report covered several public hospitals including Parirenyatwa, Harare, Mpilo, Mutare, Gweru Provincial, Masvingo Provincial, Marondera Provincial and United Bulawayo Hospitals. 
True that funding has always been the biggest challenge. The allocation to health in 2019 was US$695 million. Allocation in 2018 was US$408 million, although it was a 45 percent increase from the US$281 million allocated in 2017, it was still a far cry as the then Health minister Parirenyatwa lamented that his ministry needed more than US$1,1 billion annually to improve resources availability. 
Funding on its own will not change the face of healthcare in Zimbabwe. Some serious attention must be given to other value chain activities among which are structural. There is work to be done. 

To have conversations around our current healthcare situation in the absence of the goings on in the past 20 years will not provide the prescription to get rid of our sickness.
 The challenges are embedded not just on funding but corrupt cartels that circled the health sector for over two decades. No amount of additional funding will resolve the current healthcare crisis if the fundamental challenges are not addressed.
Natpharm is a player in drugs and medicines provision and the minister should ensure the institution is well-resourced.
Besides funding, the health sector has structural problems. We previously highlighted the need for a budget that is allocated on an institution by institution basis in light of reality on the ground.
Some question marks have arisen over the role of the various Health Boards including the Health Services Board (HSB).

Governance issues remain a major concern. Going by history, it appears the Health Service Bipartite Negotiating Panel (HSBNP), guided by Statutory Instrument III of 2006 has not produced results. 
We also observe that taking each other to court does not always result in sustainable solutions to disputes of this nature. It must be avoided at all costs. 
Since 2000 doctors and nurses have been on strike at least once every two years essentially over the same issues. This is worrisome and indicative of the Health Services Board poor administrative abilities and commitment by Government to resolve these perennial issues. It is unacceptable because we are talking of lives here. 

In most cases over the period government action has often been described as inadequate, slow and insensitive to the implications of the strike on the right of citizens to healthcare.
The issues are well spread and at one public hospital nurses downed tools because of the absence of surgical essentials like oxygen, drugs, and food, fuel, gloves and mattresses. 
During the 31-day industrial action by junior and middle level doctors in around March and April 2018 few doctors, who reported for duty and certified deceased patients reported an increase of 50  to 70 percent in deaths over the period, with the most affected being victims of road traffic accidents, children and expecting mothers with labour complications. 

In previous strikes doctors have called for the immediate dissolution of the HSB, as they are clearly sleeping on duty. 
Corruption within the sector continues to dent any efforts towards revival. In the past the Zimbabwe Hospital Doctors Association has alleged that corrupt practices have been rampant where influential people related to hospital officials get tenders to provide certain services, for example running private pharmacies at public institutions.
The end result is the public health facility deliberately not stocking medicines and patients having to buy at these private pharmacies. 
These compounding challenges have compromised patient care thus putting patients’ health and lives at risk at the many institutions which are supposed to restore health and life.  
Funding remains the single biggest challenge but the budgeting process must address this without Members of Parliament playing their critical oversight role. This has not happened and it has left the minister hugely exposed. It’s a national crisis and must be treated as such.

As we journey towards improving our health delivery attention must be given towards modernising and computerising our health systems. This in itself curbs corruption, assists with stock control and provide the much needed audit trails. In short robust systems to support evaluation and monitoring of expenditure will make a huge difference. 
The two percent mobile platform tax that is raising approximately RTGS$90 million per month must be immediately utilised for this purpose to stabilise the current situation.  The launch of the health fund, a precursor to the mobile tax which was collected from cellphone airtime was mobilising US$18 million which was directed towards medication procurement. 
The current two percent should be allocated more towards health needs. With the right commitment this is very possible. This is new money that can be and should be redirected and allow government to speed up the purchase of equipment and other critical medical supplies in short supply and affecting work and endangering patients at public hospitals.

But this was not a strike as reported by the media and the increasingly powerful social media highway. The senior doctors have themselves indicated this is not a strike. This however, is a significant development because it is the first time senior doctors have taken this stance as previous promises on the junior doctors’ grievances have not been fulfilled.  
One of the major grievances behind the December 2018, 40-day junior doctors strike was the persistent shortage of basic essential drugs, equipment and sundries.
Senior Doctors who in fact are specialist consultants stepped in and persuaded the junior doctors to return to work in good faith that the parent ministry would improve the supply of the basic consumables. 

The minister needs to evaluate reported information on worsening medical consumables and drugs.
Since January 2019 the doctors have been unable to resume normal service, especially in the areas of anaesthesia, surgery and critical care due to the absence of basic drugs and consumables. Even attempts to improvise have failed. Rewind to 2004, there were reports of doctors turning curtains into bandages and around that time over 2000 nurses left the country because of poor working conditions and wages.
Parirenyatwa, the largest referral hospital is indeed revealing.
Surgical doctors are only operating on elective patients twice a month. Statistics show that for January and February this year, they have operated less than 20 percent of the elective cases compared to the same period in 2018.
For emergencies cases the time taken before the patient goes to the theatre is now longer as their relatives must privately source for the necessary supplies. 
In addition, patients with simple conditions like appendicitis and diabetic foot ulcers are going for days without required antibiotics leading to further unnecessary complications. 

There are serious price distortions in the market which the minister should attend. 
For example co-payments are required in some institutions and not in others. Some medical aid cards accepted and whilst others are not.
This puts the system of medical aid in disrepute because all medical aid organisations are registered with the ministry of Health on an annual basis. 
The issues raised by senior doctors are justified. In short, the consultants made it clear that they are unable to continue offering quality service under such circumstances as this endangers the life of patients and therefore needed an urgent meeting with the minister of Health. 

For example, during a meeting with Moyo, plastic and reconstructive surgeon, Faith Muchemwa, revealed that her unit did not even have betadine antiseptic, painkillers and bandages.
 As a result, nurses and doctors were resorting to washing bandages and reusing them over and over which results in multiple cross infections.
Mashumba indicated that the theatre in the maternity unit she heads has not been working for a while forcing doctors to delay caesarean operations, sometimes with fatal results. 
She lamented that her job was not to certify dead babies but to save lives.
Dr Guzha, a gynaecological oncologist working with cancer patients at Harare Central Hospital and Parirenyatwa, cited the absence of cancer drugs and that young patients expecting help are frequently turned away. 

They just do a diagnosis and send them home to die even in situations that can be avoided.
In 2017, there were reports of shortages of critical drugs affecting the country’s major hospitals. Parirenyatwa Group of Hospitals wrote a letter noting that unless supplies of Atracurium, improved they would be forced to suspend surgeries. Atracurium is a major anaesthetic medicine that is used in surgery.
The Health minister has dismissed the reports of a strike and acknowledged meeting specialist doctors to hear their concerns with a view of addressing them. 

He has revealed that the government has secured US$1 million from the ministry of Finance to be used to buy drugs and equipment for public hospitals. As a part solution to getting a common position on key deliverables the minister has instituted a health assembly that includes consultants, doctors and all nursing staff. It has to meet on a continuous basis and come up with solutions to the problems within the ministry such as drug supply, equipment, medicines and working conditions. 
Under such circumstances pledges of free maternal, child healthcare will not materialise.
Government has confirmed that children under five, pregnant women and those over the age of 65 are entitled to free healthcare. But this is not happening and has not happened for years now.

These challenges are real but Moyo with the support of Cabinet can ride this wave. 
We call for redoubling of commitment and efforts in putting this matter to rest. While countries like Botswana and South Africa among many others have shown empathy by donating medicines, drugs and related medical consumables more is expected from our government.
Shortages should be a thing of the past, so should strikes by our doctors, nurses and other healthcare staff. 
This is the difference we expect from the current minister of Health to the previous one. This is the difference expected from the current new dispensation.
Doctors are human and feel our pain as they strive to deliver under very difficult conditions.
l Gwinyai and Majongwe are from Health Decisions Consulting (Private) Limited. ebsite:healthdecisionsconsulting.org


    Comments (1)

    Uzibhalela umsuzo. Ungubani wena ? , ungu dokothela senior level , ungumpathi wenkampa yezemali ele US$100Mn yokunikeza izibhedlela ?, kumbe uyazisuzela je ? , consulting yangapi...ungazake wasebenza pandle kwesikhorokhoro leso. Uzangena ejele.

    Standards Agency. - 19 March 2019

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