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Train soldiers, police into nurses

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Recently, Deputy Minister of Health and Child Welfare Dr Douglas Mombeshora was quoted in the media as saying Zimbabwe was going to export nurses. The arrangement would be in the form of bilateral or country-to-country contracts. The move follows the lifting of the bonding of nurse graduates and withholding of diplomas by the ministry since 2009.

At least 1 060 graduate nurses are jobless awaiting the initiative. The government’s failure to employ more nurses due to lack of fiscal space is cited as a major factor. However, a healthy society in a way is a developed society.

This issue is a matter of life and death, of priority or lack of it, of strategy and policy wantonness as well. In the history of post-
independence Zimbabwe, our education system has produced some of the finest brains that have become leaders at regional and global institutions.
Equally, our security forces have demonstrated regional and global competence at African Union and United Nations peace-keeping missions. Both the security and health sectors are recruiting trainees every year, yet all army and police graduates are employed as soon as they finish training even though the government claims it is unable to take in new employees.

Is that supposed to mean then that the security sector is more important than national health and people’s lives — especially when the country is not at war or under threat of any? In fact, the security sector does recruit at least twice a year, doesn’t it?
Equally, teacher training colleges are also recruiting trainees every year and the graduates get employed immediately.

How many people are dying because there are no nurses to attend to them? How many maternal deaths occur just because pregnant women deliver without the attendance of trained midwives? What is the patient-nurse ratio today? What is the population-soldier ratio today? What is the population-police ratio today?

Very striking is the increase in the maternal mortality rate (MMR) by 73% from 555 to 960 deaths per 100 000 live births between 2005/6 and 2010/11. The current MMR is the equivalent of 13 full 74-seater buses carrying pregnant women that get involved in fatal accidents with all passengers dying on the spot!

Isn’t that a national disaster? If a real bus crashes and a dozen people die on the spot, the country declares the accident a national disaster. Why is it not the same or even more with maternal deaths?
It is also clear that the high MMR is due to shortage of midwives as evidenced by the decrease by 30% in the number of women giving birth in the attendance of a skilled midwife.

Although the infant mortality rate has fallen by 5%, the child mortality rate has increased by 21%.
Looking at the 2012 National Budget, employment costs of the security sector are higher than health, suggesting one of two things or both: either the security sector is paid better salaries than health or the security sector employs more people than health.

Using rough estimates of civil servant salary ranges and working with an average salary of $400 per month, I estimated the army and the police using the 2012 National Budget estimates to sum up to around 90 000 officers combined.

The Nation Master website posts a figure of about 40 000 soldiers in Zimbabwe. This figure agrees with my own upper bound estimates standing at 45 164 soldiers (while my conservative estimate is 34 000 soldiers) and
44 620 police officers. These figures translate into one soldier per 266 civilians and one police officer per 269 civilians.

It is not surprising that government is failing to employ more nurses as budgetary allocations to the health sector have declined. Zimbabwe has about two doctors per every 10 000 patients and seven nurses per every 10 000 patients. It is quite incredible to note that we roughly have 37 soldiers per every 10 000 civilians and the same is the case with the police/civilian ratio.

Combined, there are 74 security officers per every 10 000 civilians. Vacancies in the security sector — whether existing or not — are being filled and investment in national political security is increasing. The security sector combined outpaces our expenditures in higher education, health care, transport, agriculture, power and energy.

Data from the The National Health Strategy for Zimbabwe 2009-2013 reveals that the vacancy levels for nurses exceed 80% while 69% is the vacancy level for doctors. A good proposal, in the absence of fiscal space, would be for the government to change the recruitment policy of the security sector.

Those to be recruited must be having entry qualifications for nursing so that after completing security sector training, they are comprehensively trained as nurses and midwives as well. The training should not be voluntary as is the current norm, but compulsory.

The main idea here is that during years of peace like the past 25 years or so, the security staff will be working as nurses and midwives. Once there is war, they can be called up to take up arms and fight. This way two birds fall by one stone.

The best way to deal with the current dilemma would be to redirect security forces to the health sector whereby the Defence and Home Affairs budgets are shared with Health.

That would mean existing schools of nursing are used for training already employed or just graduated security personnel into nurses and midwives.
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