ZIMBABWE’S health delivery system remains literally in intensive care. Harare Central Hospital one of the country’s prime referral units continues to grapple with a shoe-string budget and hogged the limelight after reportedly shutting down all elective surgical procedures after medical stocks plummeted.
Richard Chidza
NewsDay Weekender Senior Reporter Richard Chidza (ND) last week caught up with the health institution’s clinical director, George Vera (GV). Below are excerpts of the interview:
ND: You are likely feeling the financial crunch that has hit Zimbabwe for years. How are you running this institution?
GV: The little funding that we have is coming from our patients. We are not getting sufficient funding. We have too many patients and not sufficient funding. We have too many people falling within the band of social welfare, like children under five years and people over 65 years, road accident victims and most referrals from other hospitals from across the country, including from Parirenyatwa [Group of Hospitals].
Everyone, who comes here, even those who cannot pay, but are supposed to, we welcome them. We have a national obligation to accept everyone. We are bound by government policy, 80% of the people who come here cannot pay and we cannot do anything about it.
ND: But are you owed any money by individuals and institutions?
GV: We are owed $25 million and $3m of this by medical aid societies. One of the medical aid societies has been servicing its debt, now it is down to about $400 000 and they are putting pressure on us to accept their patients.
- Chamisa under fire over US$120K donation
- Mavhunga puts DeMbare into Chibuku quarterfinals
- Pension funds bet on Cabora Bassa oilfields
- Councils defy govt fire tender directive
Keep Reading
ND: Government has for years frozen recruitment of nurses how has this affected you?
GV: Naturally, we have staff members who have resigned, retired and some left us by natural wastage — we would have wanted to replace these. The establishment we have is 20 to 30 years old and was meant for a smaller population, but now Harare has grown and generally the referrals coming from other provinces have also grown.
ND: The issue of maternal and infant mortality is an emotive one, but there are reports of unnecessary deaths at this hospital. What is the situation like?
GV: All the complicated issues come to Harare Central Hospital, we are the go-to place, but some of the cases are referred late, so our mortality rate tends to be higher than the national average. We deliver 1 500 patients every month and that includes around 400 Caesarean sections in the same period.
ND: The Health Transition Fund has assisted a lot of health institutions. Have you benefited?
GV: The Health Transition Fund has helped with staff morale because it means a new pay packet for them over and above their usual salaries. It is encouraging, it is now known as the Heath Development Fund.
ND: Do you think the Chitungwiza Central Hospital model would be ideal for Harare?
GV: This is a completely different ball game, Harare Central Hospital accepts referrals even from Chitungwiza itself, so it would not work here.
ND: Now, could you explain what happened with the reported suspension of surgical operations a few weeks ago?
GV: We were very surprised by the noise that issue raised. We were rationalising our operations just for a weekend. We had looked at out of stock medicines and realised we would run short before the following week.
It was a Friday, we had to prioritise things. We were short of cash because we owe our suppliers about $2,5m and could not run the hospital at full throttle.
The memorandum was an internal communication telling doctors of our situation and that we had decided for that weekend to prioritise things like maternity cases and emergencies and other cases had to wait for the following Monday just to make sure we were in control of the situation.
We were not sure we would get our supplies in time, but somehow, people took it the wrong way and thought we had closed all surgical operations.
ND: There are also reports of the management team and doctors here colluding with private pharmacies and laboratories, to force the public into buying medical supplies outside the hospital. What is your response?
GV: It is a perception borne out of the fact that we run out of supplies and other essential services, people think we are stopping services in order to push private business outside the government system.
A lot of people have realised that Harare Central Hospital and the health delivery system has problems with suppliers and generally cash. They have gone on to establish pharmacies, laboratories as well as X-ray facilities outside.
When we do not have particular medicines, we then refer people outside, which then is misconstrued as collusion. There is no way a hospital like this can collude with anyone
ND: At what capacity is Harare Central Hospital operating?
GV: We operate at over 100% every day and, in fact, our wards are running at something like 120% everyday to the extent that some of our patients are being kept at the casualty section because all our beds are occupied.
We see 550 patients a day and we have 1 200 patients admitted on each given day. Harare Central Hospital is at the very end of the health delivery chain and we are supposed to absorb that which all the other facilities cannot take in.
ND: You have been accused of sitting on scan and X-ray equipment. Is this true?
GV: When these things come here, they have to be custom-built into our existing system. We had to break down a wall and make sure ordinary people are shielded from the anticipated radiation. These are serious safety issues to be considered. We got the equipment, but Harare Central Hospital is old we had to go through the special licensing process as well. We were desperate for this kind of machinery. I am happy to say now that we got our licence and the equipment is working.
ND: What must Zimbabweans appreciate about Harare Central Hospital?
GV: Zimbabweans must understand that the only qualification they need to be admitted at Harare Central Hospital is that they are sick. When their money runs out, the medical aid has exhausted and they are probably old that every other institution has rejected them, this hospital will be there for them.
We have tried to make follow-ups on people who have failed to pay, but Zimbabweans have developed a tendency to provide us with fictitious addresses. We have realised it is expensive to chase after a non-existent debtor. At some point, we were accused of detaining people. It is a difficult situation, but life has to go on and Zimbabweans expect us to deliver.
We can only do as much as the little resources at our disposal can allow us. We get a lot of assistance. Without donors, we would be in a lot of trouble. We want to pay tribute to some individual citizens, corporates and individuals as well, who appreciate the strategic position that this institution occupies.
We make mistakes here and there, but this is a national institution that Zimbabweans must be proud of. Let us continue to communicate to find ways of making it a better place because some day soon, we will need its facilities. ND: Have you tried to get the government to take over your debt?
GV: We are always engaging and understand the situation that government finds itself in. Other hospitals have the luxury of referring patients to us, but we do not have that.
