ONLY a decade ago, Zimbabwe’s public health delivery system was ranked among the best in sub-Saharan Africa.
Elias Mambo/Elizabeth Dumbreni
But like much else in the country, the system is still struggling to rebound as the country’s stubborn economic malaise shows disturbing signs of worsening.
Despite marginal improvement during the days of the unity government in which drugs were donated by the international community and hospitals revived their day-to-day activities, the health delivery system is once again under tremendous strain as hospital equipment gives in due to lack of maintenance due to inadequate funding, while some lies idle due to staffing shortages as qualified personnel desert government institutions for greener pastures.
During the tenure of the unity government between 2009 and 2013, 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.
The five-year plan 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 levels of health financing to improve 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.
However, after Zanu PF’s contested July 31 election victory, the public health system took a nosedive resulting in hospitals failing to dispense basic drugs such as anti-retroviral drugs (ARVs), putting lives of more than 600 000 people into danger.
Currently, the major reasons for preventable deaths in public hospitals are a shortage of staff, medication and equipment.
The country’s major referral hospitals such as Harare Central Hospital, Parirenyatwa Group of Hospitals, Chitungwiza Central Hospital, Mpilo Central Hospital, Ingutsheni Hospital and United Bulawayo Hospitals continue to struggle to varying extents.
Most of the hospitals are said to be using obsolete medical machinery, with Harare Central Hospital’s X-rays and ultrasound machines down most of the time due to persistent water shortages at the hospital.
The hospital gets water at most three times a week, but only in the afternoon.
This has resulted in the hospital turning away many patients, resulting in a large number of them on a waiting list for the service as the majority cannot afford the US$30 to US$40 X-ray fees charged by private institutions.
Although theatres at the hospital are functioning, they are operating well below capacity due to equipment and staff shortages.
Harare Hospital is said to be charging a US$50 admission fee upfront before a patient is attended to, and nurses at the hospital said they were not attending to patients without cash up front, a practice now obtaining at other hospitals.
The hospital is owed about US$16 million by patients since 2009.
The Health ministry’s allocation in the 2014 Budget was US$23,8 million which was gobbled up by a US$36,4 million debt to various suppliers accrued last year.
“We have been barred from attending to patients who do not have money,” said a senior nurse at Harare Hospital on Tuesday.
“Guards have been assigned to check receipts for fee payment before patients are treated.”
In fact, Harare hospital now has a ward (room 20) specifically for detaining those that have failed to settle their hospital bills and security guards keep a watchful eye on the ward to ensure no one leaves without producing proof of payment.
Elsewhere, despite improvements in availability of state-of-the-art equipment in theatres, Parirenyatwa Hospital also faces challenges in servicing the equipment.
The hospital, which has a medical, surgical, paediatric and a maternity section in the main complex, is looking for funds and expertise to service its equipment.
Chief executive officer of the hospital, Thomas Zigora, told a visiting parliamentary delegation last week they were negotiating with a South African company contracts for maintenance of the equipment and spares, raising questions as to why there was no provision for maintenance of the equipment by the supplier.
While Parirenyatwa is quite well-equipped Zigora said its biggest hurdle was the shortage of staff to handle the equipment as there is a serious shortage of oncologists, radiographers, physicists and nurses. Junior doctors working in Zimbabwe’s public health institutions are reportedly earning only US$283 per month, way below the poverty datum line of about US$560.
Cancer treatment also remains beyond the means of most Zimbabweans as it can cost up to US$2 500 for treatment for four to six weeks.
Built in 1957 Mpilo Hospital was meant to cater for Bulawayo urban, which had a population of 100 000 at the time. This figure has grown to almost one million people while the hospital is also a referral centre for patients from Matabeleland North, Matabeleland South, the Midlands and Masvingo — a combined population of about six million people.