Bonding wont heal health system
THIS week Health minister David Parirenyatwa announced that health personnel trained at government institutions would be bonded to the state for a period equivalent to the time it took to train them to stem the brain drain.
The haemorrhaging of skill in the health sector has been problematic for Zimbabwe, which has over the past five years lost a large number of doctors, pharmacists and nurses. Aggressive recruiting of health professionals by Europe and North America and countries in the region is depriving Zimbabwe of vital skills.
Statistics are anecdotal at best because doctors leaving the country do not seek to have their names removed from their professional registers. Studies have however shown that of 1 200 physicians trained in Zimbabwe in the 1990s, only 360 were left by 2001. The rate of emigration has accelerated since then as graduate doctors escape the harsh reality of living in a class way below their qualifications and status in society.
Even without specific figures, the extent of the brain drain is easy to fathom. Paediatricians, neurologists, specialist surgeons, cardiologists and dermatologists have become an endangered species in the country. In government hospitals patients can wait for days before they are attended to by specialist staff.
The patient-to-doctor ratio continues to balloon. The United Nations Development Programme’s Human Development report for 2004 says Zimbabwe has about six doctors per 100 000 people. It says the country is committing less than 3% of its GDP to the health delivery system. Up to 39% of the population is undernourished, it says.
There are more not-so-good indicators. In 1975 life expectancy was 56 years but the figure has since dropped to 33. Zimbabwe’s infant mortality, once the envy of most African countries only five years ago, is going up and is believed to be above 7,5 of all live births.
This week Health permanent secretary Elizabeth Xaba said maternity mortality in Zimbabwe was too high at 695 per 100 000. Government has proffered ox-drawn ambulances as a solution to pregnant rural women’s access to healthcare. Not in the 21st century please Elizabeth!
Then there is the high HIV infection rate of 24%, which has pushed the already overstretched state hospitals to the wall.
The deteriorating health conditions are in sync with the growing deprivation of an already poor population. The sad reality is that poor health status keeps the poor in poverty and poverty keeps them in poor health, thus worsening the vicious cycle. Poverty is one of the main causes of reduced life expectancy in Zimbabwe. As much as 70% of the population is living on below US$2 a day.
Lack of accommodation has resulted in overcrowding which has increased the spread of respiratory diseases such as tuberculosis and asthma. The risk of diarrhoeal diseases has also increased in urban areas due to poor water quality, as there is no foreign currency to import chemicals for water treatment. Waste disposal in urban areas has become erratic due to inefficiency and lack of equipment. Unemployment has pushed female juveniles into prostitution with its attendant dangers.
Government’s resettlement programme has not helped the situation either as new farmers do not have access to primary healthcare. Child immunisation programmes have suffered major setbacks in resettlement areas.
Public health institutions are offering limited services due to poor funding, worsened by lack of balance of payment support. The cost of accessing health services has meanwhile continued to rise. Only this week private doctors increased consultation fees to as much as $400 000 per visit.
The health delivery system is sick and Parirenyatwa, who got the poisoned chalice from his predecessor Timothy Stamps, has continued to treat the symptoms.
Parirenyatwa believes tethering doctors and nurses to hospital beds will improve the country’s health delivery system and reduce the emigration rate. This is not the first time government has promised to bond health personnel. As way back as 1997 when the exodus started to pick up, government said it would bond nurses. The president of the nurses association then, Clara Nondo, responded: “That will not work as long as government does not address the primary causes why professionals in the health sector are trooping out of the country daily. Bonding will not stop the brain drain because it’s about bread and butter issues and not patriotism.”
Working conditions emerge as the single most important pre-disposing factor for health professional to leave. Salaries of health workers have remained poor while working conditions have deteriorated, as equipment and protective clothing are not being replaced. Doctors working long hours have complained that they are exposed to dangerous situations as fatigue-induced errors can result in them contracting diseases.
The government has taken every opportunity to denounce those leaving the country as sell-outs. It is a dangerous attitude.
The long and short of it is that bonding doctors by itself will not staunch the brain drain so long as the working conditions and the political situation in the country remain unstable.