The right to health includes access to timely, acceptable and affordable health care of appropriate quality. Entitlements to such rights include the right to a system of health protection that gives everyone an equal opportunity to enjoy the highest attainable level of health.
David Okello
There have been many strides to improve health services delivery, to meet global goals and benchmarks such as Millennium Development Goals (MGDs) in Zimbabwe. However, the country still faces a huge burden of diseases — emerging, re-emerging and neglected tropical diseases.
Human resources for health remain the engine of effective and efficient healthcare systems. The country has remarkably stabilised the brain drain phenomenon of the last decade, partly by introducing staff retention allowances and above all, by training more health personnel.
Nearly all the public sector posts, which were established in the early 1980s for nurses and midwives have been filled.
However, it is regrettable that post establishment has not been revised over the years. It means that there is a surplus of nurses who cannot be immediately absorbed when they are released from the training institutions. At the moment there is clearly a miss-match between disease burden, staff establishment and unemployed nurses.
Therefore, government should urgently find ways of absorbing surplus staff trained at very high costs. We believe with adequate consultations involving all government ministries and other sectors, the surplus health workforce could be absorbed to serve the needs of the population. For instance, a well-developed school health programme based in the education sector could be a ready avenue for absorption of some health staff.
One of the legacies of the brain drain syndrome is that new recruits into services would not be able to access mentorship of more experienced hands. Healthcare left in the hands of less experienced staff adds more concerns about the quality of healthcare services. Other human resources for health concerns relate to the maldistribution of specialist services.
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The bulk of specialist services are concentrated in the capital city of Harare, where there is a vibrant private healthcare practice. Unfortunately, the cost of care in the private sector remains high, making such services inaccessible to many.
These challenges are further compounded by three major barriers in accessing healthcare: distance, out of pocket expenditure, harmful traditions and religious beliefs practices. Government should find ways of taking specialist care to all parts of the country, which, fortunately for Zimbabwe, already has a good network of health facilities.
Today we also face an emerging additional health burden. Instead of diseases vanishing as living conditions improve, socio-economic progress is actually creating unintended conditions that favour the rise of non-communicable diseases. Economic growth, modernisation, and urbanisation have brought side-effects in the form of unhealthy lifestyles.
Worldwide, non-communicable diseases (NCDs) have overtaken infectious diseases as the leading cause of mortality. This shift challenges traditional development thinking, which has long focused primarily on diagnosing infectious diseases and prioritising maternal and child mortality for international action.
NCDs can no longer be conceptualised as a rich-man’s problem, nor can we continue to think of NCDs as the killers of the old and frail. World Health Organisation estimates that 80% of the burden from NCDs now falls on low and middle-income countries, where people develop these diseases earlier, fall sicker, and die sooner than their counterparts in wealthier countries.
The health sector acting alone, cannot protect children, from the marketing of unhealthy foods and beverages; nor can it persuade countries to reduce their greenhouse gas emissions, or get industrialised food producers to reduce their massive use of antibiotics. The national health regulators must be prepared to lead the way to address these growing challenges.
Clearly, the way forward is to fully embrace and start implementation of the new Zimbabwe National Health Strategy (NHS) 2016-2020. The strategy addresses ways of improving healthcare financing that shield patients from catastrophic expenditure.
We are aware that efforts are already underway to design appropriate health insurance schemes that work for those in gainful employment, and also for the unemployed and the poor.
Zimbabwe has begun to put in place strategies for the implementation of the Sustainable Development Goals (SDGs). The new agenda seeks to transform the way the world works. It is gratifying to note that the new NHS fully embraces the SDGs spirit and aspirations. The 13 targets under the health SDG capture the unfinished business of the MDGs, and add important new health concerns of universal relevance, such as non-communicable diseases, mental health, and road safety.
The best way to deal with the NCDs onslaught requires a robust NCD multi-sectoral approach to tackle the risk factors involved — including sedentary life style, tobacco use, alcohol abuse, and unhealthy diets.
On the HIV and AIDS scourge, we cannot win this battle if we do not sustain our current efforts in prevention that will close the tap of new infections and mean fewer new people requiring treatment.
We need to sustain and even do more on prevention than what we are doing currently — step up the pace.
Community health system is a critical resource to improve population health. Community health workers are the lynchpin between communities, especially rural, and local health services. They usually mobilise households in activities that foster promotive, educative, and preventive health behaviour.
Health information is another most important tool for public health planning. In a country like Zimbabwe where the private health sector — for-profit and not for-profit — is vibrant and taking care of a huge proportion of the population, there is need to explore how health information can be fully captured and reflected in the national statistics.
Let’s work together to achieve the highest health standard for all Zimbabweans, after all it is their fundamental rights.
David Okello is the representative of World Health Organisation in Zimbabwe
