Reform the cure for health delivery system

IT is unfortunate that debate on the state of the country’s health services provision has been muted.  Recently the state media reported that contracts for medical professionals who were part salaried by the Global Fund had expired. 

This essentially means until further negotiations, the professionals that are overseeing infectious disease treatment will be earning the US$190 that the Ministry of Finance has said it can afford. 

I am not writing in order to make a case for workers in the Ministry of Health though their plight, like that of other public servants, is a serious cause for concern. What is increasingly apparent are the serious challenges that are facing the health provision services in our country.  Indeed the Minister of Health will point out the fact that government has a refurbishment programme for at least four of the major referral hospitals. 
And I am sure this refurbishment intends to look at rehabilitation of not only the hospital buildings, but also issues of bedding, linen and the like.  What is missing from all of this is the value and purpose of the health system. The value and purpose in our country’s instance would be universal access to health care with the understanding that access to health is a fundamental human right that would equate to the right to life of every Zimbabwean citizen.

This may sound abstract but it underpins why we should have a public health system in the first place. In the early years of our national Independence, we sloganeered about “Health for All” without really examining what we meant by it.  Access to health was not considered a human right by those that were then in power and those that are in power now.  Those that now comprise the inclusive government have decided, albeit with good intentions, to try and return our hospitals and other medical services to the “good” state that they assumedly were in before 2000.  This approach is a mistaken one.  Prior to 2000 and even before the now infamous unbudgeted allocation of compensation money to war veterans, the health system was structured in a manner that compromised the wellbeing of the majority of our citizens.  Because the government had adopted Economic Structural Adjustment programmes, it had begun the process of disinvesting in health service provision ostensibly in order to cut government expenditure. In doing so, the government clearly indicated that it did not deem it a priority to value the health of Zimbabwean citizens. 

With the advent of the inclusive government, one would be forgiven for thinking that perhaps things have changed.  The policy framework has sadly not shifted from state disinvestment in the health system. The allocation of money for the refurbishment of some hospitals only serves to address the symptoms and not the actual problem with our health delivery system. Many times, patients have been refused treatment at Parirenyatwa or Mpilo because of the failure to pay for medication.  So one can arrive at the hospital, but still not be treated until specific payments for service are made at the evident risk of death.

Further still, the government has decided to outsource health service provision to a myriad of non-governmental organisations under the pretext that it has no money. Its assumption is that these NGOs have the capacity to provide the bulk of critical care in HIV and Aids, maternal or child health.  The truth of the matter is that the NGOs function on the basis of intermittent funding with stringent conditions that may not meet the value and understanding of access to health as a human right.  In some instances, the government has to respond to shortages of critical medication such as ARVs without having had a clue about the status of supply and distribution of the same.

It is now imperative that we begin to value the lives of Zimbabweans by moving away from a national health policy that relies mainly on attempting to put out fires as opposed to preventing them.  This begins by way of valuing the lives and well being of all Zimbabweans.  Even though it is not in the constitution, we must begin to operate with the understanding that access to health is a fundamental human right that should be treated with the utmost urgency.  The issue for the inclusive government is not merely to attempt to stabilise the health delivery sector.  It should be to imbue the latter with values that point to the importance of providing services for all, whether rich or poor. 

This would entail reforming the health services sector not for the purposes of state disinvestment or privatisation.  Instead, it must be a priority for the government to ensure that all of our major referral hospitals are not just refurbished but function on the proviso of treatment first rather than treatment after profit.  If we allow our health institutions to function like private corporations we devalue human life for the sake of profit.  And the end of it all will be a very sick nation.
Takura Zhangazha can be contacted on kuurayiwa@gmail.com.

By Takura Zhangazha

 

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