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Health care reels from underfunding

THE year 2017 has been a nightmare for the country’s healthcare system, which continues on a downward spiral, and with an allocation of US$408 million in the 2018 national budget, the future remains bleak.

By Wongai Zhangazha

Health minister David Parirenyatwa, soon after being inaugurated, told journalists that his sector needed more than US$1,1 billion annually to improve resources availability.

Although the US$408 million was a 45% increase from the US$281 million allocated in 2017, it is still a far cry from the African Union (AU) target of 15% budget allocation set in 2001 by member states.

The year, like previous ones, has seen massive drug shortages, strikes by doctors and nurses, inadequate public financing and over-reliance on out-of-pocket and external financing, inadequate public infrastructure and ill-equipped hospitals and healthcare staff shortages.

In February, junior doctors at public health institutions went on strike after the government failed to meet their demands for a review of on-call allowances from US$288 a month for the lowest-paid doctor to US$720.

Recently, nurses at Chitungwiza General Hospital went on strike, complaining about the absence of surgical essentials like oxygen, drugs, and food, fuel, gloves and mattresses. The strike ended after government allocated a rescue package of US$60 000 to cater for pharmaceuticals, food and other provisions.

Last week, United Bulawayo Hospitals (UBH) nurses downed tools citing lack of stationery, syringes and drugs, among other basics at the health institution.

Services offered by private doctors and institutions are still very expensive with general practitioners charging not less than US$25 as consultation fees while specialist doctors are charging between US$50 and US$200.

Charges at public hospitals are lower at US$15, a fee still beyond the reach of many people. The situation is worse for those managing chronic illnesses like diabetes, hypertension, cancer, HIV and Aids and kidney complications. X-rays cost anything from US$50 upwards with MRI and CT scans costing up to US$500.

A number of renal patients have died after failing to access services due to the excessive cost of treatment. A dialysis session costs between US$200 and US$250 at private facilities while at public hospitals it is between US$80 and US$170.

Cancer treatment — chemotherapy — has remained very expensive, with costs ranging from US$100 to US$1 000 per session (depending on disease progression) despite it being one of the leading killer diseases in the country.
Zimbabwe Association of Doctors for Human Rights secretary-general Evans Masitara said the country’s health delivery system remains in the intensive care unit, with the three pillars of an efficient system, namely infrastructure, manpower and material resources, being found wanting.

“The old structures inherited in 1980 have hardly expanded despite population growth. The year 2017 witnessed another strike by nurses and doctors seeking better remuneration. The brain drain by skilled professionals continues and shortages of essential medicines remain a problem. We suffered two typhoid outbreaks and several lives were lost due to this preventable disease,” Masitara said.

“Corruption remains rife in procurement processes in public health institutions. The Ministry of Health should deal decisively with corruption in government institutions especially in procurement and private-public partnerships which have seen exorbitant prices being charged at public institutions.”

He said there are some positives with the launch of the health fund, which is collected from cellphone airtime, managing to mobilise US$18 million that was used to buy medication.

“We hope that other innovative funding models can be implemented moving forward, to prevent over-reliance on donor funding for health. In 2018, we hope the government continues working towards achieving universal health coverage,” Masitara said. “Funding for the critical healthcare sector should increase. The resuscitation of local pharmaceutical manufacturing plants should be prioritised to provide medication at reasonable prices and avert drug shortages.”

Zimbabwe Hospital Doctors Association president Edgar Munatsi said the year 2017 saw public health institutions facing a lot of challenges.

“Over the past years public health institutions have been getting only small proportions of the budget and this is very problematic. This means that the cost of the healthcare is being transferred to the poor patient; in fact, most of the costs,” Munatsi said.

“Corrupt practices have also been rampant this year where influential people related to hospital officials get tenders to provide certain services, for example running private pharmacies at public institutions. The end result will be the public health facility deliberately not stocking medicines and patients end up buying at the private pharmacies.”

Munatsi said since the junior doctors’ strike early this year, some of their demands have not been met, especially availability of employment after completing their studies.

“Government created 250 posts which are likely to be filled beginning of next year and there is no indication that it will create more posts. We need more posts, considering that (National Science and Technology University) Nust is producing doctors next year and Midlands State University is on its way. While the increase of doctors is a good thing because that allows rural public health institutions to have more doctors, there is need to create more employment facilities.”

He said the health budgetary allocation was too low.

“The money allocated is still very low from the target of 15% set in the Abuja Declaration considering that 33% of the budget comes from donor aid. What is important for us is to see the improvement of the health service delivery in rural areas which this budget lacks. Neo-natal and maternal mortality rates are very high in rural areas and this is an area that needs commitment,” Munatsi said.

Community Working Group on Health (CWGH) director Itai Rusike said government spent US$21 per person on health care in 2017.

“The Government also spends a relatively small share of its gross domestic product (GDP) on health care. Lower levels of per capita health expenditure indicate that health expenditure in the country is insufficient to guarantee adequate access and quality of healthcare. Per capita health allocation stands at US$21 down from US$24 in 2016. This implies that government will spend an average US$21 per person on healthcare in 2017 which is grossly inadequate. The per capita allocation is much lower when you remove the employment cost component,” Rusike said.

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