Siamese twins op wake-up call for govt

THE successful eight-hour operation to separate Siamese twins performed by local doctors at the Harare Central Hospital was a “miracle and mystery”, as President Robert Mugabe described it.

Mugabe expressed shock at the separation of conjoined twins, saying he was unaware that local medical personnel had the capacity to conduct complicated surgery given their limited resources and poor working conditions.

But what Mugabe failed to say was that it was his Zanu PF government which was at least partly to blame for the decline in the health delivery system and massive flight of skilled health professionals, among others, mainly because of its skewed priorities which saw the health sector getting inadequate funding each year.

The budget allocation for the health sector has been dwindling for more than a decade resulting in government failing to meet demands in the sector.

In the 2014 national budget, the Ministry of Health and Child Care got US$337 million which is 8,2% of the total budget allocation and is slightly less than what was allocated in 2013 (9,87% of total budget).

Health budget allocations have been failing to meet the stipulation of the 2001 Abuja Declaration on health that Zimbabwe is signatory to, which requires that 15% of all national budgets go towards health.

While the successful operation has been rightly celebrated for the lives saved and as an indicator of what Zimbabwean medical personnel can achieve, it is sobering to note that according to the Department of Neurological Surgery at Erasmus Medical Centre in Rotterdam (Holland), the first known similar operation was performed in Basel in 1689 and since then such procedures have become commonplace, although a lot of planning and resources have to be mobilised to make them successful.

All of this was lost to Mugabe whose spirituality over the matter was diametrically opposite to the more secular and mundane explanation offered by Bothwell Mbuwayesango, the paediatric surgeon who was team leader of the operation.

“We had close to 50 doctors, nurses, assistants … we needed everyone even the cleaners to be able to separate the twins properly,” said Mbuwayesango, adding, “we worked together very well and the team was all inclusive of Zimbabwean doctors — there was no help from outside.”

Health and Child Care deputy minister Paul Chimedza clearly made a point when he highlighted government’s need to acquire proper equipment for the doctors so that they can “perform well” — given the fact that the first such operation was carried out in this country more than a generation ago in 1983 at the same hospital.

Instead of facing up to this reality of woeful shortcomings in supporting the health, education and other social sectors which have been crumbling despite a good start by his government after Independence in 1980, Mugabe chose to blame “illegal sanctions imposed on Zimbabwe by the West” — a self-serving narrative which continues to ignore the reality of government neglect and endemic corruption in the health services sector which has resulted in massive exodus of demoralised and underpaid staff, as well as deterioration of equipment and in some cases its unavailability.

Even basic drugs like painkillers have been in short supply.
But as pointed out by University of Zimbabwe social scientist Eldred Masunungure and other analysts, Mugabe and Zimbabwean policymakers should be looking inward, doing an honest introspection and re-evaluating their own priorities, especially to ensure scarce public resources are allocated to critical areas like health to ensure difficult but life-saving procedures are regularly performed.

“Irrespective of the huge time-lag between this and the first minor operation in 1983, the success of the operation is still an event that should be celebrated because of the lives saved and the wholly Zimbabwean medical team involved,” said Masunungure. “However, we need to sit down and re-direct our resources to funding health and other social services.”

This is advice that has been volunteered to government on countless occasions, but has not been taken as is shown in the 2014 budget allocations where a huge chunk went to the Defence ministry and other security departments despite the relative absence of security threats since the end of apartheid in neighbouring South Africa in 1994.

The Health ministry was allocated US$337 million out of the US$4,2 billion budget, a figure which is all the more incomprehensible in view of the US$206 million allocated to the Office of the President and Cabinet.
Not only was the latter allocation more than the combined allocations to the ministries of Industry and Commerce, Agriculture, Mines and Energy, which are key to the country’s economic recovery, it is more staggering when combined with the US$368 million given to the Defence ministry.

Hospitals are in a run-down state with poor infrastructure and equipment.

It is difficult to see how the success of the Harare Hospital operation will be replicated when hospitals are failing to perform what should be simpler health procedures as evidenced by the high maternal mortality rate currently pegged at 790 per 100 000 live births, compared to 390 deaths per 100 000 in the 1990s.

This means that eight women die every day while giving birth.

As if that is not enough, 100 children under five years die every day mainly due to preventable diseases, while around a third of them are stunted.

These problems will continue to plague the health sector for as long as government does not prioritise its funding and instead waits for donors whose funding has been dwindling.

Health minister David Parirenyatwa has authorised Mpilo Hospital in Bulawayo to hold a donor conference on August 21 — a testament to the over-dependence on donors.

According to a letter written to Parirenyatwa and seen by the Zimbabwe Independent, Mpilo, which has been in existence since 1957 and is a referral centre for Bulawayo and the Matabeleland provinces, “faces several challenges due to lack of preventive maintenance resulting in infrastructure being broken down and dilapidated”.

“The theatres face challenges of equipment and infrastructure as out of the 12 hospital theatres only four are fairly functional; of the 10 hospital elevators only three are functional with the laundry department having no reliable equipment forcing the hospital to utilise private laundries,” the letter reads.

Although Chinese donors have since assisted with eight renal dialysis machines for kidney patients where there was only one, the situation is still dire with widespread disrepair from leaking roofs to broken down radiotherapy equipment.

The donor conference may well raise the US$15,6million needed to rehabilitate the hospital, but as observed by Bulawayo-based analyst Godwin Phiri, this is “only restorative and not progressive. It will not take the hospital forward to performing operations such as the one (Siamese op) the government is waxing lyrical about”.

In addition, government is still to act on massive corruption unearthed by the National Economic Conduct Inspectorate (NECI) in 2012 where government hospitals were found to be engaging in underhand dealings as well as flouting State Procurement Board (SPB) regulations and procedures in the procurement of medical equipment at Harare, Parirenyatwa and Mutare hospitals, among other health centres.

For instance, according to NECI, in 2009 Harare Hospital officials allowed a company called Axis Medical to up its price for a C-Arm mobile image intensifier to US$72 000 from the US$48 600 it had initially submitted without approval from the SPB.

If government does not take urgent action, the capacity of Zimbabwean doctors to deliver a world-class service will continue to be buried under an avalanche of poor funding, corruption, and dilapidated and out-dated equipment.