Providing Healthcare in a Country like Zimbabwe

For my family this was also a concern and when we decided that we were no longer “Europeans” but Africans in every sense of the word, except the colour of our skin, this was an unknown to be faced.

In fact, we need not have worried as what has emerged in the country is a dual system – a private healthcare industry that can do just about whatever you might need, no delays and world class attention and care at a reasonable price. When I had a health crisis in 2008, I was able to see a Neuro Specialist on demand in Harare and when he diagnosed a serious problem after a brain scan, that required a surgical procedure that could not be done in Zimbabwe, I found myself in UNITAS, a private hospital in Pretoria and in the hands of a superb team. While I was in surgery, they spoke French to a surgeon in France and American to a surgeon in Texas who had done this procedure before. Today people needing procedures, fly to Zimbabwe for attention.

After Independence we built a hospital in every District of the country and established a national network of referral hospitals where specialist treatment could be obtained. As with Education, the Church maintained hospitals in many areas, and this helped. In addition, local authorities established over 1600 basic healthcare clinics where people could go at minimal cost for care and attention. As was the case with education, by 2000 we had a system of healthcare that met the basic needs of our people.

After the economic and political crisis from 2000 to 2008 when we became, effectively a “failed State”, the main casualty was not just education but the healthcare system. We trained Doctors and Nurses and just as quickly they left the country. Our State owned and operated hospitals became morgues where people died. We had the highest mortality of women in childbirth in the world and record rates of premature death among children. I can remember going to the Cemetery near one of our stores and witnessing the long rows of child burial sites. Our life expectancy crashed.

Since then, the situation has improved a bit, but our State owned and operated hospitals are still in a sorry state. The Church based hospitals are better but have never been well funded and staffed.

We are not alone, the much-lauded National Health Service in the UK is in a real mess. Millions of people waiting to get even basic care and attention and it seems to be a bottomless pot financially. In the USA, they have perhaps the most expensive health care system in the world funded by a health insurance system that is rotten and carries massive overheads. The US penchant for litigation simply make this situation worse. When I had a member of staff in the US on business and he had an accident and broke a leg, we were stunned by the cost and told the medical team to do what was needed for him to travel and we would do the rest here.

Our private medical system is funded, in the main, by Medical Aid Schemes to which we contribute financially every month. The turnover of this system is about US$1,5 billion a year and it supports perhaps 750 000 people out of our national population of 15 million – 5 per cent of our population – maybe a bit more, but not by much.

The rest of us depend on a national healthcare system funded by Government – local and central. The national budget for this purpose in probably about US$1 billion, or about US$70 a year per capita. This is totally inadequate to fund a system that is as large as ours. The International Community helps – especially the Americans who provide another US$300 million a year for special needs – Malaria control, Aids pharmaceuticals and so on. This aid has been a real life saver in a country where we have over a million people with full blown Aids.

It is generally recognised that we should be spending 20 per cent of our healthcare budgets on Public Health, this system has virtually collapsed in recent years. The great emphasis is on funding our hospitals and this means that primary healthcare, which is the most important component in the system is also under funded. We cannot print money so adjusting budgets will not really work, we are spending about as much of our tax receipts as we can on health.

This topic has been perhaps the most contentious subject in US politics for the past two decades because the US system left perhaps a third of all Americans without access to the health system. Obama tried to rectify this, and his efforts may be reversed by the Trump administration. How do we, in a poor, developing nation create a system that will give all our people access to a system where they can get basic health care and help in an emergency?

I was one of the people who argued that the State should, like South Africa, provide third party insurance for all motor vehicles. You have to have this to get a licence. It was being collected by the private insurance industry and was virtually just revenue for them. A year ago, this was adopted by the State, and it is now collected by ZINARA, the road authority. I suggested at the time that some of this money be used to create an “accident fund” which would pay for the medical needs of accident victims. This has not been done and it would make a big difference for the many who are injured each year in road accidents.

In my Constituency, when I was a Member of Parliament I had two basic healthcare clinics. The one had 12 beds in three wards, an outpatient’s facility and a small surgery. A lady could have a baby there and they had three staff who visited sick persons at home and monitored public health threats. They operated on bicycles. A senior nurse ran the Clinic with a doctor visiting once a week to see specific cases. Serious cases were sent to the local hospital. It could attend to 80 or 85 per cent of the needs of the Community and you could walk there.

If we had 2500 of these in Zimbabwe, we could meet the basic needs of every person with a referral system for the more serious cases. This would reduce our dependency on hospitals and all of these clinics could be managed by the Community with elected Boards. A system of communications using something like Starlink and a central referral office in Harare staffed by a doctor would allow the Clinic staff to consult a doctor 24/7 when required.

A simple Medical Aid Scheme run locally where every Citizen served by a Clinic could be registered and make a small monthly contribution based on ability to pay. All those who could not afford the basic fee to have this paid by the State on a monthly basis. Registration based on annual audited accounts, meeting the standards required and periodic inspections by health inspectors. Such a system could be extended to District Hospitals, to whom patients such as a woman who needed specialist support in childbirth could be referred with the Clinics Medical Aid Scheme covering the cost. All District Hospitals to be privatised and run by elected Community Boards.

When the recent public health pandemic occurred, the private sector organised a call centre in Harare with 120 volunteer doctors to provide free advice to individuals. Econet provide free call numbers. They were dealing with 5000 calls a day. The State cannot do that, we can.