CURRENT events in the Ministry of Health make a sad reading. Most nurses are still insisting on working reduced hours or having salary increments. Unfortunately, the government remains adamant that it is unable to meet these demands. This unfortunate situation has arisen at a time when there are shortages of drugs in public hospitals, mainly district and provincial hospitals.
Eddie Mahembe &
To understand this, we need to be cognisant of the impact of the health status of a population on other sectors and the economy at large.
Impact of unhealthy citizenry
An unhealthy population negatively impacts economic growth. This was established through a cross-country macro-economic study, which estimated a reduction in gross domestic product, attributable to chronic diseases, of 1% to 5%, depending on how populous the country is (World Health Organisation, 2006).
Indirectly, health affects economic growth through its influence on education, which consequently affects the future earning potential of people. Healthy children will perform better in school, thus improving their earning potential in future. In addition, a healthy family is likely to have both parents employed since there will be no ill children to nurse. This improves financial and material resources to look after and educate the children, hence improving their standard of living.
With this understanding of the importance of health and its impact on economic growth, we can move on to assess how Zimbabwe is performing in terms of the population’s health status. The best way to gauge this is to consider key health indicators.
The table (pictured) provides a snapshot of selected key health indicators for selected countries as provided by the World Health Organisation (WHO).
The table (pictured) paints a gloomy picture of Zimbabwe’s health status compared to her neighbours. The clearest indicator of the health crisis in Zimbabwe is the “maternal mortality ratio per 100 000 live births”: 458 children are dying compared to 119 in South Africa.
All the other countries are better ranked on all indicators except Zambia, which is the least ranked on “nursing & midwifery personnel density” and “under five mortality rate”.
Of concern is the “medical doctors per 10 000 population”, which is around 50% less, compared to neighbours Botswana and Namibia and less by 75% of neighbours South Africa and Zambia.
In the same vein, “nursing and midwifery personnel density per 1 000 population” is less than that in Botswana and Namibia by 50% and less than that in South Africa by almost 78%.
The two later indicators described above capture the proportion of health professionals to the population. These are the health professionals who have been at the centre of controversy with their parent ministry. Their continued disengagement from work, due to alleged incapacitation, exacerbates the situation.
It is against this background that the authorities must seriously engage health professionals to come up with sustainable solutions to the current challenges.
In solving these challenges, lessons may be drawn from our peers who are performing better in terms of key health indicators. As alluded to before, it is also important to note that the current health challenges have a knock-on effect on education and the combined effect will limit the country’s capacity to achieve Vision 2030, as expounded by the current administration.
South Africa, for example, has the second-best Human Development Index (HDI) of 0,7, after Botswana with 0,72. The HDI measures the population’s welfare by taking into consideration key dimensions of:
l Long and healthy life;
l Access to education; and
l Decent standard of living.
South Africa has managed to upgrade its HDI over the years and one of the factors behind the improvement in HDI is the increase in general government’s expenditure on health by an impressive average annual rate of 5,2% from 1993 to 2017.
The increase in government spending in health outstripped population growth in real terms, hence it led to real growth in per capita terms from R1 430 (US$93) in 1993 to
R3 206 (US$209) in 2017.
Trends in the South African health sector show that the turn of the millennium brought with it marked improvements in salaries, wages and benefits of health workers.
This led to an increase in the real wage bill, which more than doubled between 2006 and 2015 fiscal years. The major drivers in the early years were salary and wage increments, as well as recruitment of additional health workers.
Later on, from 2007 onwards, growth in real wage bill was driven by substantially higher salaries, as a result of a new remuneration structure — Occupation Specific Dispensation (Ajam, Black, Jansen, Stuart, and van der Merwe, 2019).
High level recommendations
It is evident from the above that South Africa took a giant leap to financially cushion her workers in the health sector. This has also been one of the pull factors that have seen many health professionals emigrating from Zimbabwe to South Africa in search of greener pastures.
To address this, the government needs to put in place deliberate policies, one of which must be the payment of real living wages to health professionals and restocking most public hospitals with drugs.
Failure to address these challenges will leave the authorities with a mammoth task in trying to achieve the goal of inclusive growth, which is the main thrust of the National Development Strategy (according to the Budget Strategy Paper).
Basic economics teaches us that in a simple production function, output is a function of labour and capital therefore, an unhealthy labour force will stifle production, which will consequently retard economic growth.
Mahembe and Tazvivinga are development economists. The views expressed in this article are the authors’ personal views. These weekly New Perspectives articles are co-ordinated by Lovemore Kadenge, immediate past president of the Zimbabwe Economics Society. — firstname.lastname@example.org or mobile +263 772 382 852