Source: ‘Govt working to improve primary health care’ – The Standard January 6, 2019
As the country reflects on the cost of the month-long industrial action by junior doctors that has crippled operations at public hospitals, Health and Child Care minister Obadiah Moyo (OM) says government faces a huge task of transforming the health system beyond welfare issues that have been raised by the medical practitioners.
In an exclusive interview with The Standard’s senior reporter Xolisani Ncube (XN), Moyo said the government of President Emmerson Mnangagwa inherited a crisis-ridden health sector which has a myriad of challenges, among them infrastructural, medicinal and welfare problems.
Below are excerpts from the interview:
XN: Honourable minister, can you tell us the current situation in our hospitals from a government view in relation to the ongoing strike by doctors?
OM: Well, I don’t want to talk about the strike because we have people who are in talks with the doctors. I don’t intend to appear as if I am trying to hijack or blame anyone on the matter. I might end up being misquoted and this could cause problems for the progress that has been made so far. The Health Services Board (HSB) has been mandated to engage the affected parties, so it would be fair if we are to allow them do their work without influence or commenting unnecessarily.
XN: But you could tell us the state of our health services without discussing the issues of the strike. Let us talk about the issues to do with medicines, do we have enough for the citizens, especially those who suffer from chronic illness?
OM: We are waiting for delivery of more drugs as you might be aware, we are coming from holidays. We have purchased drugs that should ensure our hospitals are turning. I am talking about essential drugs. We have also capacitated Natpharm to deliver these drugs across the country. Our thrust is to ensure that we have drugs for every need and the drugs are affordable to our people. The delivery I am talking about is different from the ones we received recently. We have also acquired protective clothing and all necessities that are required by medical staff to operate in our hospitals. I would like to thank the presidium for coming in and assisting in ensuring that we have enough stock for our people.
XN: The issue of affordability of health services by ordinary citizens has remained a challenge given the state of the economy. Zimbabwe remains one of the few countries yet to fully implement effective universal health coverage (UHC), as government what are you doing to ensure that no one dies due to the cost of accessing health services? We have countries such as Kenya that have made UHC part of their health policy.
OM: I agree with you. We have a challenge in dealing with universal health coverage. For many years government promoted primary health care across the country and probably what we have to look at is the quality and effectiveness of the policy. Our desire as the ministry is to ensure that everyone who needs a health service can access it for less or no cost. We are looking at telemedicine as a policy to ensure that we are able to cut the costs of travelling and other things so that health care is as cheap as possible. We are also looking at exploration of means to fund UHC given the state of our economy which is highly informal with fewer prospects of payroll deductions as a viable funding mechanism. In short, the UHC in Zimbabwe has to depend more on government general revenue than payroll and that has to be taken into the context of the state of our government. We need to look at this issue holistically and find mechanisms to push it through. Yes, we have the airtime tax, but it is not enough to get the drugs we need. We need equipment, we need clinics and hospitals for an effective and reliable UHC. We also need to address the issue of fraud and other unnecessary leakages that could hinder effective funding for the health sector. As you may be aware, the World Health Organisation reports that between 20-40% of healthcare funding is wasted through fraud and inefficiency. We have to close the gaps and put every dollar to good use.
XN: Hon minister, whatever funding mechanism may be chosen for UHC, the issue has been that the scheme should not leave out those without the capacity to contribute. Access to healthcare services should be purely based on need and not the ability to pay. How do you intend to ensure that even those in remote areas are not deprived of the health services?
OM: As I said, we are looking into this issue seriously and exploring all options available given the state of our economy.
XN: The success of UHC depends on the ratio of nurses to patient or doctors to patient, which many say is very high. We have very few health personnel in our system against a growing population, what are you doing to address that challenge before we even talk of clinics and equipment?
OM: As you might be aware, government has opened up opportunities for recruitment and we are still lobbying for more to join, but we are limited by the ability of the treasury. We are also looking at the quality of our personnel so that we can be able to provide a world-class health package.
XN: What is the current ratio of health personnel to the population? Do we have enough or sufficient people to run our health centres and attend to the populace?
OM: It would be difficult for me to give you statistics from the head, but I think and I know government is working towards that. We need to have a sustainable ratio.
XN: You talked of telemedicine as a way forward in addressing the issue of UHC, do we have the equipment to undertake this initiative and what is government doing to address the issue of accessibility of the internet and the software, especially in rural areas where many are living on less than a $1 a day?
OM: We have been doing pilot projects to assess the project, but we strongly believe it could help in ensuring that healthcare accessibility in rural is improved. As you might be aware, patients endure longer appointment commutes and have trouble accessing life-saving consultations for specific diseases or chronic care plans. But telemedicine offers better and timely access to consultations and specialists. Patients can address healthcare issues quickly with real-time urgent care consultations and learn about treatment options within minutes. Patients can even be referred to the specific specialists they need, regardless of location, so with this, we are going to achieve UHC. We have improved internet connectivity and we have to tap into opportunities created by this.
XN: Lastly, can you give us the cost of the strike by doctors so far?
OM: As I said, I don’t want to talk about that at the moment because these are matters that form part of discussions between doctors and HSB. Please let us avoid talking about that issue. All I can say is as government, we are committed to ensuring that the welfare of our personnel is looked after. We are committed to ensuring that we deliver quality health services to our people. We have to understand this fundamental, we inherited a system with too many problems and we are solving them. We have so many issues that need to be fixed from drugs to welfare; equipment to research and the list is endless. We are prioritising primary health services.