THE 2015 National Budget statement will be announced amid growing calls for Finance minister Patrick Chinamasa to allocate adequate resources towards the health sector which is facing numerous challenges.
Matters of health affect every Zimbabwean — rich or poor — but over the years budgets have been announced in Parliament with the largest chunk of the cake going towards ministries such as Defence, which some people feel is not necessary as there is no war in the country, while education and health are cross-cutting issues.
According to the 2001 Abuja Declaration on Health, countries which make up the African Union pledged to increase government funding for health to at least 15% of the budget.
However, according to the World Health Organisation (WHO), by 2011 only two African countries, South Africa and Rwanda, had reached the 15% target, while other countries were unlikely to meet it by 2015.
“Overall, 26 have increased the proportion of government expenditures allocated to health and 11 have reduced it since 2001, and in the other nine countries there is no obvious trend up or down,” WHO said.
“Many African Union countries are going to struggle to reach the health MDGs [Millennium Development Goals] as a result, and those commitments are still badly needed. The lingering financial crisis in donor countries also means that some countries are likely to further reduce the dollar values of their disbursements until their economies start growing again. It is therefore important to consider ways to develop new sources of funds and examine more critically how to improve the efficiency of health spending, while always protecting the poor and vulnerable.”
A Zimbabwean expert on health issues, Itai Rusike, said poor funding of the health sector in the country was likely to severely affect achievement of the three health-related Millennium Development Goals (MDG 3, 4 and 6).
These MDGs are to do with reducing child mortality by reducing the number of under-five children who die by two-thirds by the year 2015; to improve maternal health by reducing the maternal mortality ratio by three-quarters by the year 2015; and to combat HIV/Aids, malaria and other diseases through halting or reducing the spread of HIV/Aids by 2015, as well as to halt or reverse the spread of malaria and other major diseases by 2015.
Rusike, who is also the executive director of the Community Working Group on Health (CWGH), in his position paper on the 2015 Health budget allocation said that in order for government to effectively implement the Zimbabwe Agenda for Sustainable Socio-Economic Transformation (ZimAsset) economic blueprint, it was imperative to address the social determinants of health. He said without health there was no socio-economic development for the country, and that addressing the key determinants of health will spur the country on a positive growth trajectory.
“Failures in MDG three, four and six mean loss of lives from avoidable diseases (HIV/Aids, malaria, tuberculosis), other communicable diseases, and conditions such as pregnancy, malnutrition and infancy,” Rusike said.
“The question is, of what value does the country derive from ratifying international treaties on health, while continually reneging on their implementation and hence delivery of the proven effective interventions?”
Rusike said it was worrying that Zimbabwe had failed to achieve a healthy population despite it being signatory to health protocols like the Abuja Declaration on Health, and despite health care provision being a constitutional right for Zimbabweans.
Section 29 (1) of the Constitution stipulates that the State must take all practical measures to ensure the provision of basic, accessible and adequate health services throughout Zimbabwe.
Section 29 (2) also reads: “the State must take appropriate, fair and reasonable measures to ensure that no person is refused emergency medical treatment at any health institution; and 29 (3) “the State must take all preventive measures within the limits of the resources available to it, including education and public awareness programmes, against the spread of diseases”.
But, Rusike in his paper maintains that health indicators for the generality of Zimbabweans have improved a little, while the best indicators were reported just before the advent of HIV/Aids in the late 1980s to the mid-1990s and thereafter there was a decline.
He urged government to honour its commitments to ensure adequate health dollars from the 2015 National Budget onwards as well as to craft its own set of developmental goals that strive for sustainable well-being for all.
“Health specific goals should aim to maximise healthy lives at all stages of life with clear strategies of contribution by other sectors to health, in line with provisions of its constitution,” he said.
According to Rusike, Zimbabwe achieved its highest health budget of 9,6% in 2010, while in some years the health budget was as low as 2,4%, far less than what was agreed in Abuja.
“In 2013 the Health Budget allocation was 9,8% of the total government allocation, missing the 15% Abuja target by 5,2%. The 2013 budget allocation responded to 52,6% of the Ministry of Health and Child Care requirements, while this dropped to 47% in the 2014 budget allocation, which has left the ministry with an unfunded gap of 53%,” he said.
“Of the requested $712 million — based on requirements — the health ministry was allocated only 47%, that is, $337 million inclusive of salaries, leaving an unfunded gap of $375 million.”
Rusike said a number of major donors like Global Fund and the Health Transition Fund had funded maternal health, HIV/Aids and child health.
“However, these funds are disease specific and inadequate especially in the face of increasing challenges of the high communicable disease burden imposed by the persisting adverse environment of poor water, sanitation and hygiene, non communicable diseases including cancer and injuries, which are not catered for under the current financing arrangements by donors,” he said.
Apart from poor environmental conditions, socio-economic issues like high employment is said to have forced people to end up in the informal sector, resulting in a few people having access to health insurance (medical aid).
Rusike said the situation where 70% of the productive age groups were now engaged in informal economic activities not only resulted in deepening poverty through job insecurity and losses, but it also resulted in the dumping of foreign sub-standard foodstuffs, drugs and medical supplies whose quality could not be guaranteed.
“This situation has also contracted the number of medically insured people, thus exposing an even greater proportion of the population to out of pocket and catastrophic expenditure on health. The socio economic situation exposes the population to diseases and conditions associated with poor incomes, overcrowding and poor service delivery,” he said.
“In addition, unregulated urbanisation has resulted in overloading of the old poorly maintained public health infrastructure and overloaded underfunded systems like roads, refuse collection, sewerage and so on.”
Rusike said the sewerage and water reticulation systems remained unimproved despite the fact that the National Shelter Indicator survey indicated 20% of households in Harare were living in backyard illegal sub-standard structures.
“Tuberculosis related to poor housing and poverty persists in the population and now includes the resistant, multi drug type. Work-related injuries due to poor health and safety provision also persist,” he said.
“Poor road engineering, lack of a national transport system resulting in the bulk of goods moved on roads instead of railways, and poor regulation of drivers including young boys in charge of commuter omnibuses also contributes to health problems.”
To ensure the health sector was adequately funded, the Community CWGH recommended that government increases its budget allocation to the Ministry of Health and Child Care to a situation where it fulfilled the 15% requirements by the Abuja declaration on health financing.
CWGH said government should also provide a full health worker establishment which is responsive to the population health needs, the disease burden and distribution of its health service institutions, and which was in line with the constitutional provision of health care as a right.
Health and Child Care deputy minister Paul Chimedza told the National Assembly last week that it had been difficult to get a full complement of nurses in the country’s hospitals and clinics because of the government freeze on nursing posts.
“The government freeze was lifted at the end of this year and we can take in 680 nurses and after that the establishment will be full. There are almost 4 000 nurses in the street and as a ministry we have put in proposals to increase the establishment which has not been reviewed since 1980 in order for it to respond to the disease pattern,” he said.
“The ministry realised we might not get all the staffing proposals we put and we rekindled the plan of having some of our nurses on a government to government arrangement so that we post them to other countries that required them in order not to keep them in the streets.”
The CWGH said it was imperative to incentivise key personnel to work in districts and also to avail specialists at Provincial and city health levels, and in addition to ensure the provision of quality services through effective management at hospitals and health centres.
“Community involvement mechanisms at all levels of health care provision, capacitation and monitoring should be strengthened. A significant larger share of the health budget should go to the district level,” the health lobby group said.
“Government should improve domestic fiscal underfunding for health and the shrinking donor pool of funding for health and revitalise the drive for a national social health insurance in order to minimise catastrophic spending on health through provision of a pre-payment mechanism for both informally and formally employed citizens.”