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: firstname.lastname@example.org
Dewa Mavhinga is Human Rights Watch Southern Africa director. He writes in his personal capacity.