At first glance Zimbabwe’s public health system has undergone a renaissance since the dire days two years ago when shortages of drugs, staff and equipment were the norm.
Chitungwiza Central Hospital, a public referral hospital in the dormitory town of Chitungwiza, about 25km north of the capital, Harare, recently opened an eye clinic, jointly funded by the Chinese and Zimbabwe governments, allowing it to provide services free of charge.
At the official opening, attended by representatives from both governments and graced by the guest of honour, President Robert Mugabe, staff assisted waiting patients with courtesy and efficiency, although some were turned away and asked to come back once the ceremony was over.
But this was not the norm, said John Mushangi (42), an insurance broker who rushed his 15-year-old son to the facility after he was hit by a car and suffered head injuries.
“We waited for more than three hours before being attended and during that time my son was bleeding heavily. There was no reason for the hospital staff to take so long because there were few patients in front of us (in the queue),” he said.
The student nurse told Mushangi that his son required an intravenous drip, but the room where the equipment was stored was locked and the staff member responsible had left for the weekend with the keys.
“It’s obvious the health system has improved from what it was at the beginning of last year (2009), as hospitals have more equipment and drugs are more available, but the main problem is now with the attitude of hospital staff to their work. Juniors lack supervision and senior staff don’t bother about the welfare of patients,” Mushangi said.
Low morale among workers at public health institutions was a contributing factor.
“While drugs are more available, and there are more nurses and doctors in hospitals than two years ago, service delivery in the national public health sector is still crippled by poor salaries,” said Japhet Moyo, deputy secretary-general of the Zimbabwe Congress of Trade Unions.
“The government is paying health staff peanuts and as a result workers dedicate their time to moonlighting, are usually absent from their workstations, and tend to give flimsy excuses to be away from work,” Moyo said.
The labour organisation is demanding a minimum salary of $500 per month for health workers.
Although there were frequent power outages, the emergency generator at Chitungwiza stood idle because “the accounts department did not leave money to buy fuel”, said a nurse who declined to be identified.
A nurse at a Harare hospital that caters to low-income communities said a nurse with four years’ experience was paid less than a cleaner, and service delivery suffered because of low pay.
“Morale is very low due to the poor salaries . . . We feel that the government is failing to recognise our importance. The result is that most of us are paying lip service to our work, and it is unfortunate that the sick suffer for the sins of our employer,” said the nurse, who declined to be identified.
A junior nurse’s basic monthly salary is $150, but even modest accommodation in the low-income suburbs costs more than that for a family of four.
In an attempt to stem the brain drain of skilled medical personnel, humanitarian organisations such as the UN Children’s Fund (Unicef) and the Global Fund to Fight Aids, Tuberculosis and Malaria, introduced a monthly supplementary allowance for public sector health staff in 2009, which ranges between $150 and $500.
But the Harare hospital nurse said the supplementary allowance had become irregular, and “we have not received it in the last four months”.
Micaela Marques de Souza, spokesperson for Unicef Zimbabwe, said that Unicef had started the funding process with $5 million in January 2009, but “funding is scarce”.
After four months “it (the allowance disbursement) was then picked up by the UK Department for International Development and Global Fund, and it is still running today. Health workers still receive their allowances but are sometimes paid quarterly. The allowances should continue until early 2011,” De Souza said in a written reply.
The Global Fund was not available for comment.
The Harare nurse said low wages had sometimes led to staff accepting bribes from patients for quicker treatment and hospital admission, and selling ARVs that were available for free to HIV-positive people. Such conditions were leading to growing disillusionment and a new wave of health staff searching for work in other countries.
Innocent Makwiramiti, a Harare-based economist, said the economy was still performing poorly and the government did not have the resources to improve salaries for health workers.
“Civil servants, on the other hand, feel that the government has its priorities wrong and believe that they should get a bigger share of the cake,” Makwiramiti said. “They protest by giving shoddy service.”