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Health delivery system back on the ropes

LAST week Zimbabwe lost youthful and popular television personality, Tendai Chitsinde, who died while giving birth to her first child.

Elias Mambo/ Elizabeth Dumbreni

According to her brother, Cliff Chitsinde, she went into labour last Monday, but developed complications and was moved to the intensive care unit at Mbuya Nehanda Maternity hospital.

A scheduled Caesarean section was called off because hospital staff felt normal delivery was possible. But on New Year’s Eve she gave birth but the baby died soon after. An hour later she started complaining of pain and died the following day.

This sad incident where both mother and child died has brought to the fore the declining health delivery system in the country.

Besides Zimbabwe (then Rhodesia) being a signatory to the Alma-Ata Declaration in 1978, the country’s health delivery system keeps crumbling resulting in a high maternal mortality rate currently pegged at 790 per 100 000 live births, compared to 390 deaths per 100 000 in the 1990s, which means eight women die every day while giving birth.

In addition, 100 children under five years die every day mainly due to preventable diseases, while around a third of them are stunted. The health sector has remained stuck in a time warp as donor-funded drugs have dried up and service delivery continues to fall due to understaffing and poor remuneration. The Alma-Ata Declaration emerged as a major milestone of the 20th century in the field of public health, and it identified primary healthcare as key to the attainment of the goal of health for all, but 36 years after signing the declaration Zimbabwe’s health delivery system shows signs of decline instead of improving.

Only a decade ago Zimbabwe’s public health system was ranked among the best in sub-Saharan Africa. But like the rest of Zimbabwe’s economic and social fabric during a decade-long socio-economic crisis, the health delivery system has alarmingly deteriorated.

During the days of the inclusive government, the National Health Strategy for Zimbabwe was adopted and the health sector received a major boost when the United Kingdom announced a contribution of £74 million (around US$120 million) to support maternal and child health.

This was a five-year health sector recovery plan which sought to reverse the decline in the performance of the country’s health delivery system, especially as it impacted on universal access to primary healthcare by vulnerable populations.

The goals of the plan included tackling the levels of health financing and thus improving access to basic medical equipment and essential medicines; taking steps to attract and retain health workers in the public health sector and laying the foundation for an investment policy to fund the rehabilitation and development of the health services infrastructure.

During that period Zimbabwe enjoyed temporary improvement in which changes within the health sector were notable as drugs were donated by the international community and hospitals revived their day-to-day activities.

However, soon after Zanu PF’s controversial July 31 election victory which ended the unity government, the public health system took a nosedive resulting in hospitals failing to dispense basic drugs such as anti-retroviral drugs, the throwing lives of more than 600 000 people into danger.

The health sector has also been severely affected by declining budget allocations.

Zimbabwe is signatory to the Abuja Declaration in which African countries agreed to commit 15 % of their national budget to health.
In the 2014 National Budget, health was allocated US$337 million, accounting for 8,2% of the total vote. This is less than the 9,87% allocated in 2013.

Local analyst Alexander Rusero said despite the political bickering in the inclusive government, the health sector had registered gains.
“While there was too much politics during the inclusive government, the health sector was revived,” Rusero said. “From 2005 to 2009, taking your son or wife to a local hospital was like giving them a death sentence because you knew they might not return alive,” he said.

“If no action is taken then the country will be thrown back into that era of uncertainties and danger,” said Rusero.

Hospitals in the country are unable to undertake the most basic operations because of shortages of anaesthetics, sutures, and other essential supplies. Health officials at Parirenyatwa hospital, one of the main referral hospitals in the country, said the laboratory has virtually shut down, X-ray materials, injectable antibiotics and anticonvulsants have run out while emergency resuscitation equipment is not functioning.

Hospitals are also failing to dispense basic drugs such as antibiotics and pain killers, forcing patients to turn to private pharmacies and clinics which are too expensive for the majority.

Prior to the July 31 elections, Zanu PF threatened to disengage from the Western donor-funded Health Transition Fund which revived the health delivery system during the inclusive government’s tenure between 2009 and 2013.

Sekai Muchambadova of Glenview 3, who lost two children during child birth, said the health system in this country is so bad because it favours the rich. She described Harare Central Hospital’s maternity section as hell.

“I went through hell at the hands of Harare Hospital nursing staff and lost two babies on two occasions, in 2011 and in 2012. In 2012 I went into labour and was admitted at the hospital on December 2, where each time I complained of pain the nurses would either ignore or scold me. They did not bother attending to me until I gave birth two days later. Unfortunately, my child died because of the nurses’ negligence,” Muchambadova alleged.

Social commentator, Godwin Phiri said the government has a mammoth task to revive the health delivery system.

“The challenges in the health sector are symptomatic of the broader problems facing the nation,” Phiri said. “The Zanu PF government will be kept on its feet because its success in running this government will be measured by the way it revives the health delivery system, among other major targets. At the present moment government has to act swiftly to save thousands of people it is condemning to death by its failure to prioritise health,” he said.

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