Q: The challenges in the public health sector and, indeed, the health industry at large are not new as they have been with us since the early 1990s. As the CWGH, do you have confidence in the ability of the current administration to resolve them?
A: Now that the elections are over, the people of Zimbabwe expect the fulfilment of the election manifesto, in which the new government promised massive improvement in health infrastructure; more health personnel; accessible and affordable medicines; free medical care for cancer patients; at least one hospital per district, improved health services in resettlement areas, reduction of hospital fees by 50% and pursuing the Health for All policy, among others. For this reason, the Community Working Group on Health (CWGH) network would like to urge the government to immediately shift focus to real developmental issues, particularly taking into account the dire need of improving health service provision for the benefit of ordinary Zimbabweans as articulated in the pre-elections.
Q: To revive the health sector, what are the most critical issues that need to be attended to?
A: It is undeniable that the deplorable state of the country’s health system requires urgent attention, especially giving priority focus to revitalizing the PHC system and addressing the social determinants of health to achieve UHC, thus enabling every Zimbabwean equitable access to essential quality health services without facing financial hardships. Zimbabwe needs sustained investments in primary health care to revitalise the health system to close gaps in access to services and to address the causes of ill health.
Presenetly, infrastructure in hospitals is dilapidated, some is obsolete; medicines and supplies are in short supply; doctors, laboratorians, pharmacists, paramedics and nurses are inadequate and poorly motivated. And this against a background of sustained paltry funding to the sector from national fiscus is of major concern. The problems in the health sector are compounded by the very high prevalence of largely preventable diseases as well as behaviour, lifestyles, environmental and basic water and sanitation issues.
The quadruple burden of disease, (communicable, non-communicable, injuries, HIV, maternal, peri-natal, neglected tropical diseases, cancers) is unmatched by the institutional and health staff skills to adequatey manage and these have individually or in combination translated into premature and excess mortalities across the ages. Therefore, the health system must be strengthened in accordance with the World Health Organization’s six building blocks and the over ambitious SDG targets, to respond to this huge burden of disease, and enable the country to reach its full developmental trajectory.
Q: The Hippocratic Oath sworn to by doctors and other health professionals demands that they observe certain ethical standards, among them safeguarding lives. Notwithstanding, we have seen strikes taking place over and over again, thus placing lives in great danger. Are junior doctors justified to take the course of action they have (strike)?
A: The ongoing strike action by the health workers is legitimate but insufficient to address the overall deterioration of Zimbabwe’s public health delivery system as the public health concerns remain at the periphery. The combination of limited resources, increasing stress and reduced salaries is an inflammatory one. In the absence of a good industrial relations system, this has been met with patience by the workforce; but that patience is limited, as demonstrate by the current strike action. Doctors accept that they should not put their patients at risk by engaging in industrial action, but they also feel very strongly that there must be a speedy, fair and impartial procedure for resolving disputes. Long-standing grievances simply should not be allowed to build up.
Q: If you were to be asked to briefly give a word or advice to the two parties in this dispute – government and the junior doctors – what would you say to them?
A: We would like to remind the government that giving false promises to the doctors will not address the concerns at hand. There is need to tackle the problems with the seriousness they deserve and stop giving political statements. Dialogue is the only way to save lives of patients in dire need of medical attention. Threatening to fire a the doctors will not address the concerns at hand but will only escalate the crisis. Health workers should also not put their patients at risk by engaging in industrial action.
Q: It has become difficult for patients to access drugs since these are now being sold in United States dollars even though very few locals earn incomes in foreign currencies. Are we not condemning patients to death by allowing pharmacies to charge in greenbacks? What could be done about it?
A: We urge the government to urgently avail enough foreign currency to the pharmaceutical industry to enable patients to access their life-saving medications which they are failing to buy because most pharmacies are demanding payment in foreign currency. It must be highlighted that about 90% of the country’s workforce earn their salaries and wages in local currency — the bond note — and demanding payment in foreign currency practically means denying people their right to health as enshrined in the Constitution. The few pharmacies that are still accepting bond notes have since quadrupled their prices at levels of parallel market rates. These prices are beyond the reach of ordinary Zimbabweans, 90% of which do not even have medical aid insurance cover, hence have no safety net at all. As a result many patients, some with chronic illnesses, have not been taking their medication in the past three weeks due to distorted high prices and the demand for payment in American Dollars. Additionally, the impact of devaluation and the runaway inflation has rendered people’s salaries meaningless in the face of the current high and unstable prices of commodities, including those of various medical procedures.
If the situation continues for a day longer, many patients will develop serious health complications after failing to access medicines, a situation which will cost their lives. There are patients with chronic illnesses such as diabetes, arthritis, HIV/AIDS, Asthma, on dialysis and hypertension, who should not miss their medication.
It should be highlighted that already some patients are taking cheaper substitutes from the unregulated parallel markets for drugs which might have serious side effects later due to its questionable efficacy while others have turned to faith healing, herbal and traditional medicines out of desperation. It should also be noted that already there are thousands of patients dying in pain in their homes or health institutions because they cannot access or afford the cost of drugs such as morphine to ease pain. Their relatives and loved ones are watching them die in pain because they are also equally helpless.
Q: In your view, are the authorities now on top of the situation in containing the outbreak of cholera in Harare and typhoid in Gweru given that it has been long since we last reported new cases of the plagues?
A: The recurrent outbreaks of cholera and typhoid gives a poor reflection of the health and development status of the country. The threat and risk of other typhoid and cholera outbreaks exists for as long as the conditions for transmission persist. Therefore as CWGH, we are still encouraging boiling of water at household level and treatment of water using treatment chemicals where possible. We appeal to the Local Authorities to collect garbage regularly and to treat water and sewage effectively. We need to continue emphasizing to communities the importance of food and personal hygiene and especially promoting hand washing.
Cholera or typhoid vaccine remains a complimentary measure and not a replacement to WASH interventions, and these need to be implemented even as the population receives vaccination.
Q: What is the role of the CWGH in the resolution of challenges besetting the health delivery sector?
A: In recent years, many countries have adopted Universal Health Coverage (UHC) as national policy priority and have committed to directing government funding towards that goal. Ensuring sustainable progress toward UHC means that Zimbabwe’s public health financing system must routinely generate sufficient, and largely domestic, resources to achieve health sector objectives within its macroeconomic and fiscal context. It is not only the level of government health spending that matters for sustaining health systems that can meet UHC goals, but also the efficient and equitable use of those funds. Public budget revenues, as well as the public financing systems that manage those funding flows, therefore play a crucial role in directing money efficiently, equitably and effectively towards UHC goals and other health priorities.
Q: Since you formation in 1998, do you think the CWGH is succeeding in giving communities a voice on issues that affects them?
A: The story of the CWGH is one of increasing and widening confidence within civil society of the right to act, of the ability to act and of the issues to act on. This has begun to generate some tangible health gains for communities in a situation of general decline in health. The CWGH builds on the lessons learned from the exceptional health gains based on primary health care and community mobilization in Zimbabwe in the 1980s. Given the withdrawal of those gains in the 1990s, it adds the new understanding that these gains are not a privilege but a right, one that demands active community organising, advocacy and control within health systems. The challenge for the CWGH is thus to ensure that real improvements in public health are irreversibly sustained by an informed public that protects its rights to health.
Q: There has been so much debate around the 2019 national budget presented by Finance minister Mthuli Ncube last month with players in the health sector grumbling over the budget allocated to the Ministry of Health. What is your take on this issue?
A: In nominal terms, the health budget appropriation has remained largely stagnant at about 9%. The percentage is however far less when you take into account the effect of inflation. The health budget remains grossly inadequate to fund the critical needs in the health sector. Moreover, the bulk of the resources will be channelled towards financing employment costs leaving very little for capital expenditures. Government must demonstrate its commitment to health by at least meeting the Abuja Declaration benchmark of 15%
Q: What does the future hold for Zimbabwean communities in light of what has been happening in the health sector?
A: The right to health will be obscured by other economic and political concerns. It has become evident that a wider constituency for health is needed if the right to health is to be asserted within competing for economic and social priorities. The CWGH has brought this wider constituency together, linking workers, women, residents, churches, informal traders, human rights groups and others and engaging with the equally wide spectrum of authorities that influence health.