I passed a billboard on Friday which said “Government fires hundreds of Doctors”. My gut reaction? How stupid that is! We spend tens of thousands of dollars giving a child a primary and secondary education over a period of 16 years.
At the end of that period out of about 400 000 school leavers, we end up with a tiny minority who have survived to their 6th Form years, survived the toughest exams in the school world and emerged with sufficient points to get admitted to the most prized University programme there is – medicine. We then put them through a first degree and then a tough medical training which lasts another 7 years – 23 years of study and sacrifice by the student and parents.
Then we demand that they do an internship in a State-run medical facility before they can escape into the lucrative private sector. Many elects to go on to specialise. Our medical training has always been world-class – why I do not know, but our doctors and nurses find ready acceptance outside the country. Just yesterday I saw a BBC programme on the NHS where the commentator was saying they have a 100 000 vacancies which they cannot fill and arguing for a priority immigration policy – made for Zimbabwe!!
Do we have a surplus of doctors, absolutely not!! We produce a surplus of nurses but they find ready demand outside the country and are a valuable export commodity because they send money home. But not our doctors and if they leave, it’s for good, life out there is just so much better.
Their reward in our system; long hours of work, lousy living quarters, poor food and a paltry salary. Would I strike for better conditions – sure?
The problem is a Government who will not look at the system itself and work out what is wrong, why can the system not provide a decent living and other rewards for a young man or woman who has become a medical doctor? We are spending a lot of money on our medical system – much more than people think, but are our priorities right. Pari Hospital in Harare is world-class – 2400 beds, all the necessary facilities but without committed and well-trained staff, it’s just another run down Government-owned building. Without doctors, it’s a glorified morgue where people go to die.
What are we spending on medicine as a country – first the State contribution which is about 8 per cent of the National budget – let’s say US$500 million a year. The international Community just about double that – another US$500 million, the Faith-based organisations put in another perhaps US$100 million, but the elephant in the room is medical aid – we contribute about US$1,2 billion a year to our medical aid schemes and it covers about 10 per cent of the population. The Diaspora probably contributes another US$700 million. That adds up to US$3 billion a year. Per capita that is not a lot of money at just over US$200 a year.
But international experience tells us it is how you spend that money that makes the difference. In the States they spend over 25 per cent of all State resources on the most expensive medical care system in the world and half the population get very poor service – millions no service at all and that is why we got Obamacare. The UK is much the same but coverers everyone and even so, it is going broke because the State cannot meet the full cost of the level of service provided.
Perhaps the best examples of a health care system that hits all the buttons in even a low-income country, are found in the Far East – China has an amazing system, Taiwan even more so. The Cuban system has long presented the third world with an alternative to the Western models, which we simply cannot afford.
But do we look outside to see what lessons we can learn, no, we fire our most precious possession, our trained and skilled children who are just starting a lifetime of service in the medical world and without which you cannot have any sort of system? We have to think out the box.
The first thing we need to look at is how we provide medical care. When I was an employer I would prefer to send my staff in a vehicle to a Mission Hospital 200 kilometres from Harare simply because I knew that when they got there they would be treated as human beings. The equipment might be old, but it was worked, the sheets on the bed worn, but they are there and they are clean.
Just try an experiment and go and sit in the emergency unit of a State hospital near you. It will shock you as you watch people who need urgent attention, being ignored. Perhaps one light bulb in the room, a hard bench with rows of sleeping people who have been there for hours. Even if you get into award and receive treatment, hygiene and food are a constant problem and when finally, you are released, the hospital will delay sending their bill for treatment for anything up to two years, in my experience. If you need something to treat the patient, the Nurses will offer to supply for a price, perhaps even medicine from the Hospital stores themselves.
That is not a problem of resources, its management and motivation. You cannot fix that by throwing more money at the system – you have to change the way the system works. Mission hospitals work, not because they have more money, no, they work because there is a thing called the Christian ethic at work and because the people running the hospital are totally dedicated to doing so.
In the private sector, it is no better often, I had a friend who had a heart attack at home at three in the morning, was rushed to a private hospital and had to wait for me to arrive after 6 am to pay a substantial sum in USD and local currency before they would admit him. He died in reception. This week a nearby couple in their eighties were attacked at home and robbed – she died and he was denied access to emergency treatment by the same hospital because he could not pay, his children out of reach. Both would have had no difficulty in paying the hospital in due course but for them its Cash upfront or nothing.
How do we solve these intractable problems? For me, the first priority should be how do we, a poor third world country, give everyone automatic access to emergency health care and advice? I personally think the Taiwan system may be the best – give everyone basic medical insurance funded by a small national contribution per capita. This could be reinforced by a national disaster fund financed by a small proportion of third party insurance cover. The contribution by individuals to the national health insurance scheme should be supported by a State subsidy paid out against a means test.
Then we need to convert all State-funded medical institutions to community managed and run organisation with elected Boards and each self-financing. We need then to revert to what we used to do is provide a local community based primary health care clinic within walking distance of every Zimbabwean. This would not cost a great deal and 85 per cent of the medical care needs of the whole population could be met at this level at a very low cost. Again all such centres should be State-funded and Community Managed. Using modern communications technology, we could provide 24 hours’ consultations with a doctor at all such primary health care institutions.
The wealthy can always look after themselves, our concern should be how to give every person medical care with dignity and quality and to reward our professionals to the level that their training and positions demand. I think that is possible, but not if we do not change the system.