BY PHYLLIS MBANJE
The country’s healthcare system has become unsustainable in the face of serious funding challenges and for the umpteenth time, Zimbabweans have to brace for yet another gruelling round of increases in subscription fees for medical aid.
With only about 10% of the population on health insurance, the majority have resorted to public health facilities, which are grossly underfunded and operating in emergency mode.
Recently, the Association of Healthcare Funders of Zimbabwe (AHFoZ) said a number of the providers had approached the association to submit requests for additional or new increases to the current tariffs for various reasons. The increases range from 50% to 400%.
This is barely three months since their recent fees review, which saw upward adjustments of the tariffs by between 30%-40%. Healthcare providers have argued that operating in the current environment has become difficult, forcing them to increase tariffs or risk going under. Since the ushering in of the “new dispensation“, economic challenges have increased, compounded by government’s austerity measures which have only affected the ordinary person on the streets.
Following the issuance of the AFoZ statement, there has been a public outcry, with stakeholders calling on the societies to consult their clients.
“Medical aid societies must consult their members before unilaterally increasing their tariffs to the levels that are unsustainable,” Ital Rusike of the Community Working Group on Health (CWGH) said.
Rusike said the Health ministry, as the regulatory authority for medical aid societies, must also protect the clients, many of who are struggling to survive in the prevailing harsh economic environment.
Last year, AFoZ, which represents all medical aid societies, said it was mooting charging in foreign currency after doctors had started charging their services in US dollars in response to the spiralling costs blamed on the rising inflation.
“The government needs to increase domestic investment and allocate more public financing for health through equitable and mandatory resources such as compulsory national health insurance scheme,” Rusike said.
Cost of healthcare
The cost of healthcare in Zimbabwe remains one of the most high in the region and yet the facilities are substandard, with most public hospitals literally falling to pieces.
Over the years, soaring health costs have denied many people access to medical care.
Most private health institutions are now demanding payment in hard currency or the parallel market equivalent in bond notes or RTGS payments. This has resulted in patients on medical aid now paying huge shortfalls.
In a snap survey, it was found that most private hospitals charge from US$150 before admitting a patient and daily charges can be as high as US$ 100. These do not include doctors and other specialist services.
Although pregnant women are getting free services at public health facilities, many have been forced to seek services at private practice, simply because hospitals have no medicine and equipment. A few months ago, doctors narrated gruelling tales of operating without the basics required of a medical practitioner. The Health minister was told of babies dying unnecessarily because there was not enough medical sundry.
Giving birth at some of the private clinics require one to fork out more than US$300, if not on medical aid. For complicated births which require surgery, one has to part with over US$1000.
It is these exorbitant fees that have forced people to go to the public hospitals which, unfortunately, are under-resourced.
The dilemma being faced by public hospitals is far from over, with many still operating in emergency mode and patients being turned away.
Parirenyatwa, Harare and Chitungwiza hospitals have gone for years with inadequate medicines, obsolete equipment and skeletal staff, with the situation worsening by the day.
During a protest by doctors, they narrated how patients, including babies, were dying due to these challenges which had forced them to now operate in emergency mode in the absence of resources.
Shocking details of bandages being re-used and patients not being given pain killers after surgery were revealed, with the Health minister Obadiah Moyo promising to bring relief to the hospitals. Many also told of how they were working without protective gear, including even gloves.
Meanwhile, the pharmaceutical industry, hard-hit by lack of foreign currency, has been forced to charge in US dollars.
Zimbabwe needs about $400 million per year to meet its drug requirements for both public hospitals and the rest of the health services sector.
Key players in the pharmaceutical industry like CAPS Holdings, which used to contribute up to 75% of local healthcare products, have gone under.
Key among the concerns of stakeholders and health personnel is the seemingly lack of political will to honour pledges and commitments towards the revamping of the health delivery system. Last week, President Emmerson Mnangagwa, following a meeting with a doctors’ delegation, pledged to release funds for the repairing of equipment in referral hospitals.
Currently, radiotherapy machines for cancer patients are not functional at many of the country’s major referral hospitals, Parirenyatwa and Mpilo. Posting on his official Facebook page, the President said, “Today, I met a doctors’ delegation to hear about the challenges they face. Following the meeting, we have released funds to repair key equipment in referral hospitals, while our friends in the UAE are helping us re-equip as we draw up long-term plans to improve service delivery.”
However, many stakeholders and members of the public were not amused and accused the government of being reactionary all the time.
Fungisayi Dube of the Citizens Health Watch said while they welcomed the commitment, they were concerned with previous pledges that were never fulfilled.
“We hope it is not all talk with no results. Did the President have to wait for the doctors to go and meet him directly? Is he not aware of the challenges in the health system,?” she quized.
A Zimbabwean medical doctor based in the United Kingdom, Brighton Chireka, said he hoped this would help put the agenda of the country’s health system on top of government’s priority list.
“This is a matter of life and death, so it is better late than never. Well done to the doctors that have gone to meet with the President,” he said.
However, some were unsympathetic and challenged government officials in particular to instead channel the money they spent visiting hospitals abroad for their treatment towards the revamping of local facilities.
“That money that you and all those wealthy ministers use abroad in hospitals is enough to revive the hospitals. The money you spent on a single trip to Bulawayo recently using that private jet from Dubai was going to change Mpilo in an immaculate way. Please, re-adjust your priorities my President,” said another, in response to the President’s post.
Some urged the government to emulate how South Africa has made sure all medication is free in government hospitals and food is given to a patient according to health specifications.
Recently, it was reported that patients at Neshuro Hospital in Mwenezi, Masvingo were eating sadza with sugar.
“When you see doctors going to see the President directly, it then shows that something is not right, either the Health Services Board does not have any decision-making authority or it has no resources needed to improve the conditions of service for the health workers.
The Health minister recently said they would soon roll out a hospital rehabilitation programme made possible by partnerships.
“We want to make sure that the healthcare facilities are of very high level, providing first-class service. We want to make sure that our customers access affordable services,” he said.
Funding for health, however, has consistently failed to reach the 15% of the national cake as agreed on at the Abuja Declaration.
In April 2001, African Union countries met and pledged to set a target of allocating at least 15% of their annual budgets to improve the health sector and urged donor countries to scale-up support.