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Health sector crying out for overhaul

Although the country’s health sector is expected to start enjoying a resuscitation following the nod by Treasury to the Health Services Board (HSB)

Although the country’s health sector is expected to start enjoying a resuscitation following the nod by Treasury to the Health Services Board (HSB) proposal to reopen the doors of employment, analysts have warned that only a complete system overhaul will inject new life into the comatose sector.

Report by Phillip Chidavaenzi

In 2010, Treasury imposed an employment freeze in the civil service arguing that the salary bill was unsustainable. The freeze came against the background of a critical shortage of nurses in the country’s hospitals and clinics.

Public Service deputy minister Andrew Langa explained that since government was working on a limited budget, there was need to keep the freeze in place in 2012. “The government’s position is clear. We are working on a very limited budget that does not allow us to recruit as we may want in any sector. We have been struggling to pay civil servants,” he was quoted saying.

During that time, it was decided that the vacant posts would not be filled in and all those who left the sector through retirement, death or resignation would not be replaced. This saw the number of vacant posts increase astronomically.

The freeze was however lifted after extensive lobbying by the HSB. According to the board’s executive director Ruth Kaseke, 1 200 of the posts have since been taken up by nurses after the thawing of the recruitment freeze.

Prior to the new recruitment drive, out of the 11 151 general nurses required in the sector, only 9 930 were in employment. This placed extensive pressure on nurses working in the public sector as they had to be stretched to cover the gap.

Health and Child Welfare minister Dr Henry Madzorera said the development affected health institutions in both urban and rural areas and the huge need compelled them to engage Treasury.

“We have new clinics and hospitals that have been constructed and need staff, so the need for us to apply was just inevitable,” he said.

The HSB was forced to constantly engage government so that they could secure an exemption since the health sector was a critical and labour-intensive sector.

The freeze had had a negative impact on the sector, according to Kaseke. She said health professionals in the field were “burning out” as a result of understaffing.

“They work extra hard and some of the long queues experienced at public health institutions and the snail speed can be a result of this,” she said.

According to HSB human resources manager Nornah Zhou, the waiting period for nurses in need of employment has now been reduced to just six months from two years.

“Treasury has allowed us to replace nurses whenever there is need and this is unlike in the past when trained nurses could spend up to two years sitting at home,” she said.

The current health budget — under the $3,8 billion national budget — is fairly competitive at $381 million compared to other sectors such as education ($1 billion), defence ($101,4 million) and agriculture ($159,4 million).

During the first decade of independence, the health delivery system was well funded and quality health services were affordable to those in need of medical assistance.

Due to the poor remuneration and lack of basic medical amenities, many experienced nursing professionals started migrating from the public health institutions to the more lucrative private sector.

Several private clinics and emergency rooms that have sprouted around the country charge more than public health institutions and subsequently pay more than the public hospitals and clinics. Some pay as much as $700 per month.

According to Madzorera, the Health Transition Fund (HTF), a multi-donor funding mechanism to support the health system in Zimbabwe which started in 2011, had eased the burden in the sector.

“Human resources are the heartbeat of our health system. An appropriately trained, skilled and well-motivated workforce is a critical component required for the efficient delivery of health services,” he said. “Health workers need to earn a living, just like all the other professionals.”

Although the HTF has boosted the health sector with a $435 million pledge between 2011 and 2015, analysts say there was need to look at a comprehensive approach like an increase in budget allocation to guarantee the sector’s stability.

Health has always been so critical that it is guaranteed in the country’s new Constitution, signed into law on May 22 this year by President Robert Mugabe.

In Section 2. 18 (1), the governance charter obliges the State to “take all practical measures to ensure the provision of basic, accessible and adequate health services to the population”, and in Section 23.1 obliges the State to ensure that “everyone has the right to have access to basic health-care services provided or funded by the State”.

Although recruitment in the health sector has begun, according to the Millennium Development Goals progress report (2012), the challenges facing the sector transcended the human resource factor.

The report however notes that there is hope. It says: “It is hoped that this situation will be greatly improved by 2015, given that the Government of Zimbabwe and the donor community have assembled a Health Transition Fund (HTF) aimed at improving maternal, new–born and child health and nutrition; increasing the availability of medical products, vaccines and technologies; increasing human resources for health; and improving health policy, planning and financing.”