Auxillia Mnangagwa’s ambush hospital visits

The unannounced visits (accompanied by news cameras) by the First Lady Auxillia Mnangagwa to Harare Central, Mpilo Central and United Bulawayo hospitals have generated considerable media attention and debate about the motive, usefulness, and the potential impact on health service delivery across the country.

By Fortune Nyamande & Dewa Mavhinga

A closer scrutiny of the visits is necessary to address wrong and unfortunate conclusions made in some sections of the media that laziness, arrogance and incompetence among health-care workers is the major cause of the poor services in health facilities.

We argue that lack of resources and equipment in hospitals and other health institutions is the main challenge.

Secondly, supervision of health-care workers must be carried out in a well-defined framework, with clear objectives, and by competent supervisors within the existing government supervisory and support frameworks.

Thirdly, primary accountability for health-service delivery rests with the Minister of Health and Child Care, David Parirenyatwa, who has been in the post for several years now.

Lastly, we highlight some practical examples of what goodwill ambassadors in health-care, like the First Lady, can do to bring the hidden challenges in the public health system to the attention of the policymakers without creating further animosity between the public and health-care providers.

Zimbabwe has an average of 16 doctors and 72 nurses per 100 000 people with a vacancy rate in the health sector of around 50% (Ministry of Health Information Sheet, 2010 and Zimbabwe 2009 to 2013 National Health Strategy). These figures, when read together with average salaries for Zimbabwean doctors ($500) and nurses ($350), high disease burden from HIV and Aids (HIV prevalence 13,5%), rising non-communicable diseases burden and rampant shortages of basic and essential medicines across most public hospitals, point towards a miserable state of affairs in the health sector.

The health sector allocation in the national budget has been fluctuating between 5% to 8% against a target of 15 % as set out in the Abuja declaration. In other words, our health-care budget per person is just around $100 per year!

These structural challenges in the staffing, salaries, staff retention, workload burden, ability to provide quality and timely care result in huge inefficiencies in the health-care system. There is an urgent need to address the structural challenges first, before singling out long-suffering health-care workers for blame.

Obviously, health-care workers must adhere to the provisions of the Zimbabwe Patients Charter jointly developed by the Consumer Council of Zimbabwe and the Ministry of Health. The charter espouses the principles of hospitality, confidentiality, privacy, non-discrimination, choice and access to redress of patient’s grievances (www.hpa.co.zw).

On the other hand, the government must provide an enabling environment for health-care workers to discharge their duties efficiently and effectively. It is all too easy, in the face of propaganda and sensationalism, to take a blinkered, parochial or insular approach that places all blame for inefficient service delivery on health-care workers.

Ambush or spot checks in health-care facilities in Zimbabwe are not a new phenomenon. The late former Health minister Herbert Ushewokunze in the early 1980s used to carry out regular unannounced hospital visits to evaluate the quality of care and services. But in this case, the visits were carried out by a legitimate responsible minister, whose authority is derived from the country’s laws.

Secondly, the visits were carried out after the government had set out a deliberate orientation towards prioritising health care in the national budget, as reflected by the high health spending per capita in the same period. President Emmerson Mnangagwa’s government should first set out clear priorities, and have the relevant Health minister lead in implementing urgent changes, and thereafter, carry out spot checks.

Otherwise what is the purpose of ambush checks on hospitals to denigrate health-care workers who simply do not have the much-needed resources and equipment to deliver quality health services?

Most Zimbabweans live in absolute poverty and patients frequently fail to pay for services in public health institutions.

Often, for a patient to be treated, or for surgical procedures at public health institutions, first they have to go and buy from private sources all the required equipment and medicines before they are attended to. Zimbabwe’s public hospitals lack supplies as basic as stationery!

In this context, Auxilia’s unannounced visits should aim to improve the health-care system. A good starting point for the First Lady, which can still be done, would be to convene, under the auspices of the Health ministry, an all stakeholders’ conference, to hear out different groups, including patients, policymakers, the community, and health-care workers on the challenges they face and what can be done to improve the situation.

Parirenyatwa can provide key health documents to the First Lady, such as the National Health Strategy for Zimbabwe (2016 to 2020), developed through a participative and consultative process involving significant contributions and support from various individuals and institutions.

Parirenyatwa must utilise the highly skilled technocrats in the Health ministry to implement a more focused support and supervision strategy to health care facilities that is more objective and results-oriented, as outlined in the National Health Strategy document. An ideal support and supervision visit must aim to address, at a minimum, the following issues: in-depth review of existing health programmes, problem solving at the visited facility, referral system review, administrative systems review, community participation review, staffing issues, and information systems review.

The recent hospital visits by the First Lady lack most, if not all, of the above pillars and are being conducted by individuals without an express legal authority and technical capability to meaningfully carry them out.

Auxillia has shown some positive energy through her ambush hospital visits, what needs to happen now, is to channel that energy in ways that improve health-care services, and ensure that such visits are coordinated and supported by technical experts and are comprehensive in scope and focus.

It is unfair and unwarranted to demonise Zimbabwe’s few and over-burdened health-workers who have resisted the temptation to seek greener pastures beyond our borders, and stayed on to work within a health system brought to its knees by years of ruinous economic policies.

We must all salute our unsung heroes, the health-care workers who, despite all the difficulties, and lack of resources, still do their best to work. Health-care workers must be supervised and supported objectively and with respect, as they are partners in turning around Zimbabwe’s health-care system in this “new” dispensation.

Fortune Nyamande is the spokesperson of the Zimbabwe Association of Doctors for Human Rights (ZADHR). Email: fortunyamande@gmail.com

Dewa Mavhinga is Human Rights Watch Southern Africa director. He writes in his personal capacity.

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9 Comments

  1. Commander Guvamatongo

    While we appreciate the sacrifice by our short-staffed and ill equipped medical personnel, there is room for improvement in terms of positive attitude and better PR with patients. I guess this is one of the issues a lot of us are concerned with and what the Frist lady wanted to see for herself. If medical personnel have bad attitude towards clients even if they are fully equipped, it will make no difference.

  2. Her ambush visit will do nothing to improve service delivery in hospitals. The childrens wards at all hospitals in Zimbabwe are characterized by old metal cots whose white paint has chipped away over the years. The walls are bare. The walls in a childrens ward should be bright and sunny with animal and cartoon print or such wallpaper to motivate, cheer and brighten the recovery of these kids. The money that the government spends ferrying this first lady in heavy motorcades could cover those costs, easy. It is so pointless and wasteful.

  3. Our nurses, clerks, cashiers, tellers etc in hospitals, clinics, councils, banks, parastatals etc genearally have an attitude problem. Nyika yanga yafa veduwee

  4. Lets try to get to the root cause. It was because of the corrupt Mugabe. What do you expect to see on a hungry worker working without drugs, Linen, and cleaning detergents. Seeing patients dying everyday because of lack of drugs and support also will make one have bad attitude. Our Government need to improve. Mai Mnangagwa should not just visit but she should come up with solutions also.

  5. uhmmmm

    a simple question…………

    is it the first lady’s duty to make visits or maybe it is yet another simple way of getting allowances like we complained with the former governance?

    INSTEAD OF SPYING ON PEOPLE IN THE PUBLIC SECTOR,WHY CAN’T THEY BUY MORE EQUIPMENTS AND IMPROVE THE HOSPITALS?

    I STILL WANT TO KNOW THE DUTIES OF THE FIRST LADY IN THE GOVERNMENT.

    PLEASE NEVER TAKE IT PERSONAL,I AM ONE OF THE CONCERNED ZIMBABWEANS.

  6. The She-Crocodile is ambushing the sick and vulnerable poor and having the poor photographed in compromising positions. All for her own selfish photo album. The She Crocodile must go and kiss and mate with the Male Crocodile and not humiliate the sick and vulnerable by having their photos splashed on international media.

    These patients have a right to privacy and Human Rights? Where are the so-called Lawyers for Human Rights when the rights of the poor are abused for the sake of a photo opportunity by an attention-seeking she-crocodile?

  7. I buy the idea of the first lady sometimes we nead a radical approach when dealing with issues.Recently i have a sister who gave birth alone whilst nurses areignoring her and she is developing some problems, this in not an issue of resources but attitude and calling for the job.Thumbs up for the first lad,however the minister should be pragmatic to revamp the health sector!

  8. Yes most nurses need to improve their public relations even tough they are working under difficult and taxing conditions. They should be humane and show the human part of them, not to be so vulgar and intimidating to patients

  9. I dont know if we have the health inspectorate. If we dont surely we need one. Attitude is the problem with these nurses. They got into the profession for the love of money and not for the love of the people. Surely that is what it is considering the high levels of unemployment in Zimbabwe. We have few nurses and lots of gold diggers in the profession. People who sell the scarce drugs just to make an extra dollar etc. Surely the first lady is right. Lets not just oppose for the sake of it. Even Parirenyatwa should be ashamed of the findings. He should pull up or ship out.

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