Inside Zimbabwe’s crumbling healthcare sector

• There is a shortage of basics such as bandages, syringes, and painkillers in government hospitals in Zimbabwe.
• The health sector takes the third largest chunk of government budget but falls below the Abuja Declaration target.
• There were 3 500 registered doctors, of which a thousand were specialists in 2019.

When Zimbabwean strongman Robert Mugabe died in a Singapore hospital aged 95 in 2019, it became one of those textbook examples of African leaders who die in foreign hospitals while health services back home are dilapidated because of corruption and poor government planning.

By the time of his death, he had been dislodged in a coup in November 2017.

Around that time Mugabe spent six months in a Singapore hospital, one of the coup leaders, now vice president doubling as health and childcare minister retired army general Constantino Chiwenga, was also shuttling between hospitals in South Africa and China, fighting for his life.

Last week in Parliament, opposition legislator Tendai Biti of the Citizens Coalition for Change spoke about his family’s experience seeking healthcare at one of the biggest government hospitals in the country.

He said:

His grandfather’s hospital experience coincided with the uproar caused by Limpopo Health MEC Dr Phophi Ramathuba accusing Zimbabweans of causing a strain on the South African health sector.

An unrepentant Ramathuba told News24 that Limpopo did not receive enough funds for health – and believed foreigners were worsening the situation.

But according to a News24 fact check, data from the Limpopo health department shows it is not foreign nationals who are “killing” the health system.

Mounting medico-legal claims, lack of consequence management, irregular expenditure and shocking vacancy rates were to blame for the limited resources.

The national Department of Health refrained from commenting on Ramathuba’s comments, but said healthcare services for foreign nationals was an issue under discussions at SADC meetings.

“This does not mean that all services are free, because only primary healthcare services are provided free of charge, but higher levels of care are subject to a fee,” a statement said.

The department noted it would be gathering information about the incident for a report to be submitted to Health Minister Dr Joe Phaahla who is currently out of the country.

As for the state of Zimbabwean hospitals, Biti has demanded the Zimbabwean government address the nation on what it intended to do about the poor state of the country’s hospitals.

“So, we ask that the health minister be summoned to this august House to present a status of our health and how the government is going to deal with this urgent issue,” he said.

If Biti’s plea was to be considered that would mean Chiwenga would have to appear in Parliament.

With poverty endemic in Zimbabwe, an estimated 70% of the population survive below the poverty line, and 34% are living in extreme poverty.

That means they cannot afford healthcare and their needs are placed on the government’s fiscus.

Health sector budget

In the 2022 budget, the health sector got the third largest allocation behind agriculture and primary and secondary education.

The budget for health accounted for 12.7% of the entire national budget. This allocation is below the 15% agreed upon by African countries in 2001 at the Abuja Declaration.

The declaration was part of Africa’s initiative to fight diseases like HIV/Aids, cancer, and malaria.

According to the UN, African countries spent R144 to R2 193 per capita on health, compared to high-income countries that spend above R68 000.

Up to now, fulfilling the Abuja-set target has been a challenge for many African countries. Zimbabwe’s ministry of health spends 70% of its budget on curative services such as curing diseases.

But the non-communicable diseases (NCDs) budget was reduced from 1.9% in 2020 to 0.3% in 2021.

According to the UN Children’s Fund (Unicef), this was a bad move.

“To achieve the National Development Strategy, the target of reducing non-communicable diseases mortality rate to less than 5% by 2025, the government should increase funding for NCDs instead of reducing it,” Unicef said in its latest health sector budget brief for Zimbabwe.

In 2021, donors provided about R9 billion towards the health sector, outpacing the government’s allocation.

Health sector staff compliment

According to Zimbabwe’s Health Services Board (HSB), the country’s health sector comprised private, public, and mission (church-run) health centres.

Private health consists of private hospitals, clinics, and surgeries. Public health comprises government hospitals and clinics in major cities, towns, provinces, and districts. The sector also consists of rural and urban councils’ clinics and health centres.

There are also mission health centres in schools and colleges.

The Zimbabwe Medical Association estimated in 2019 there were 3 500 registered doctors in the country, of which a thousand were specialists.

For a population of 15 million, the number of doctors is inadequate. As such, one doctor could attend to 80 patients a day, and because of the number of patients, a patient cannot get more than five minutes with a doctor, and that is not enough.

In February, the HSB noted more than 2 200 nurses and doctors left the country in 2021 with most of them going abroad.

Corruption

A 2011 report by Transparency International on Zimbabwe’s health sector said the major corruption concerns were public procurement corruption, nepotism, theft of essential medicines, bribery, and absenteeism by the medical health workforce.

The report added “75% of the respondents in the study expressed a lack of confidence in Zimbabwe’s public healthcare sector and 81% pointed out that they have witnessed or experienced various forms of corruption”.

The biggest corruption scandal under President Emmerson Mnangagwa’s government yet is in connection with the awarding of a multimillion-dollar contract for Covid-19 medical supplies.

A tender worth more than R1 billion was given to Drax International LLC, a company linked to members of Zimbabwe’s first family.

The scandal resulted in the health and childcare minister, Obadiah Moyo, being removed from office.

The Zimbabwe Anti-Corruption Commission failed to successfully charge the former minister.