Devaluation and the sustainability of health delivery system today

guest column:Johannes Marisa

The continuous loss of value of our currency has adversely affected the health delivery system with some services being scrubed because of unbearable costs. I am sure it is very fair to thank the resilient and buoyant medical staff in our country who have soldiered on despite the economic quagmire. These cadres have shown great commitment and patriotism whether in government or private practice. There should not be acrimony of whatever sort between government and its medical staff as so much commitment, diligence, assiduity have been shown by the remaining medical staff in our country. It doesn’t mean that all of us cannot seek greener pastures in countries like England, Australia, New Zealand. Germany, Russia, no, but the feeling of leaving our own country with our friends, relatives and fellow countrymen deters us from migration. This is our dear Zimbabwe.

Zimbabwe has about 90% of its citizens not on medical insurance cover, meaning a higher degree of vulnerability as most people will end up resorting to user fees. Those who are on medical aid are finding the going difficult, with a double tragedy as premiums are deducted monthly from their salaries and cash payments are demanded by service providers as tariffs that have been gazetted are said to be below expectations.

As the exchange rate continues to sour, the health delivery system continues to shake with blame games being the order of the day. Patients usually rush to point fingers at service providers, service providers keep their eyes open on medical aid societies, some of which do not even desire to pay the little they owe. The laboratories are some of the worst affected at the moment because they are not getting timely and passable payments from health funders, their reagents require foreign currency to import because they are not manufactured locally.

So many tests have been removed from medical aid cover because of the respective costs of running such tests, with the strain landing on the patients again. Health funders argue that they cannot cope with the exchange rate, especially the black market one which cruises at supersonic speed. This is highly understandable considering that salaries have been sluggishly moving, hence it will be a catastrophe to increase monthly premiums as this measure would totally wipe the payslip. What a pity!

The soaring exchange rate has left service providers like doctors bearing the brunt as well. Like laboratory scientists, majority of doctors are languishing in abject poverty at the moment. It should be known that one medical aid society, which boasts of being the largest in Zimbabwe, pays a meagre 75 RTGS as initial consultation for general practitioners which if converted at black market rate, will be less than US 2,50. That money is not enough to buy toiletries for patients at the surgery or clinic. The staff needs bus fare to and from work and salaries while local authorities need their licence fees. The regulatory bodies would also require their licence fees, failure to pay will attract stiff penalties. This has resulted in the mushrooming of backyard surgeries with no skilled staff or legal registration. It is not surprising that so many people flock to these backyard clinics because they cannot afford the proper medical rooms. The whole cycle continues to move and the poor becomes poorer. The nurses are not spared either. The moral has just vanished with those in government deciding to come to work twice weekly, thus compromising health delivery. The blame game starts amongst colleagues in the same industry. It was all over in the Press in the last few days that nurses were blaming doctors for the collapse of the health system. Yes, thinking can be different, but for Enock Dongo to blame doctors for such calamities means he has nothing to say at the moment. How can one side run hospitals like the Zina president was postulating that even without doctors, the hospitals will run smoothly. Let us say the truth for the benefit of the nation. Our health delivery system needs combined effort, nurses on one side, doctors on the other, pharmacists there, scientists and many more occupying their respected positions.

We are all the stakeholders of our health delivery system, so we ought to put our heads together.

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Therefore, measures should be put in place to stabilise the exchange rate if health delivery system is to remain afloat. All the stakeholders risk extinction in future with medical aid societies facing a bleak future while patients continue to suffer.

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