Key health reforms strengthen emergency care

Source: Key health reforms strengthen emergency care – herald

Debra Matabvu and Rumbidzayi Zinyuke

PRIVATE healthcare facilities will now be mandated to admit and stabilise emergency patients for at least 48 hours before transferring them to a Government health facility, even if the patient cannot afford the cost of treatment.

This follows the signing into law of the Medical Services Amendment Act by President Mnangagwa this week, a move expected to strengthen patients’ rights and improve access to life-saving treatment.

The new law, which amends the Medical Services Act [Chapter 15:13], introduces sweeping reforms that redefine the obligations of healthcare providers while expanding legal protections for patients and health workers.

The Act states: “A private health institution shall admit any patient who is suffering from a condition which causes an immediate danger to the life of the patient for a period of not less than 48 hours for the purpose of stabilising the patient before transferring him or her to a Government health institution which has the capacity to provide the required medical treatment or care, if he or she is unable to afford treatment on the same terms and conditions as other patients admitted in the private health institution.”

The legislation also empowers the Minister of Health and Child Care to request private hospitals to make specialist facilities available to patients initially admitted at Government institutions during emergencies or where public hospitals lack the necessary equipment or expertise.

To facilitate implementation, the Act allows the Minister and private health institutions to conclude agreements for recovering all or part of the treatment costs from either the patient or the State.

Heads of private health institutions or health practitioners who unlawfully refuse emergency treatment are liable to a fine not exceeding Level 8 — US$500 or the equivalent in ZiG — or imprisonment for up to one year, or both.

The emergency treatment provision is expected to end the long-standing practice in which some critically ill patients were denied admission or treatment by private hospitals because they could not immediately pay deposits or medical fees.

By making emergency stabilisation compulsory, the law seeks to ensure that inability to pay does not become a barrier to life-saving medical care while strengthening cooperation between public and private health institutions during medical emergencies.

Healthcare providers are now required to explain a patient’s condition, available treatment options, the benefits, risks and costs of each option, as well as the consequences of refusing treatment. The information must, where possible, be communicated in a language the patient understands and in a manner appropriate to the patient’s level of literacy.

The Act expressly provides that, “A patient has the right to participate in any decision affecting his or her health and treatment,” reinforcing patients’ autonomy in medical decision-making.

The legislation also introduces legal protection for health professionals against abuse in the workplace.

It states: “A health care provider may refuse to treat a patient who is physically or verbally abusive or who sexually harasses him or her.”

However, the Act requires that every refusal be formally documented and reported through the head of the institution to the Permanent Secretary responsible for health, who may issue binding guidance on handling similar cases in future.

This provision recognises growing concerns over violence and harassment directed at health workers while balancing those protections with oversight to prevent arbitrary denial of medical care.

The legislation further strengthens the principle of informed consent by prohibiting health services from being provided without a patient’s informed consent except in clearly defined circumstances, including medical emergencies where delays could result in death or irreversible harm, public health emergencies, or where legally authorised representatives provide consent on behalf of incapacitated patients.

According to the new law, parents or guardians are now prohibited from preventing children from receiving health services that are in the child’s best interests.

“It shall be unlawful for any parent or guardian of a child to prevent a child from receiving any health service which is in the best interests of the child concerned, or to withhold consent for any health service in contravention of section 60(3) of the Constitution,” reads the Act.

“Any person who contravenes (this) subsection shall be guilty of an offence and liable to a fine not exceeding Level 8 or to imprisonment for a period not exceeding one year or both such fine and such imprisonment.”

To improve continuity of care, health institutions are now required to provide patients with discharge reports upon leaving the hospital, containing information prescribed by the Minister after considering the treatment provided, the patient’s prognosis and follow-up care requirements.

“A health care provider must provide a patient with a discharge report at the time of the discharge of the patient from a health institution and the report shall contain such information as may be prescribed.

“In prescribing the information in terms of subsection (1), the Minister must have regard to — (a) the nature of the health service rendered; (b) the prognosis for the patient; and (c) the need for follow-up treatment.”

In another major reform, all patient medical information is now protected by strict confidentiality provisions. Health records may only be disclosed with the patient’s written consent, where required by law or a court order, or where non-disclosure poses a serious threat to public health.

Health institutions are also required to establish secure systems for storing patient records and preventing unauthorised access. The Act criminalises the falsification, unlawful alteration, destruction, copying or unauthorised access to patient records, with offenders liable to fines or imprisonment.

To improve accountability, every health institution must establish and publicly display a complaints procedure that allows patients to report grievances and have them acknowledged and, where necessary, referred to the appropriate authority.

The Permanent Secretary for Health has also been given powers to institute disciplinary proceedings or other sanctions against health care providers and institutions that fail to comply with the new legal standards, including breaches relating to informed consent, confidentiality, discharge procedures and patients’ rights.

The new law is expected to align Zimbabwe’s health care system more closely with constitutional guarantees on the right to health while setting clearer standards of practice for both public and private health institutions.