Are health sector reforms our long-waited saviours?

Johannes Marisa

guest column:Johannes Marisa

REFORMS are carried out in any sector of the economy in order to solve peculiar problems which may have arisen.

The health sector has been marred by incessant strikes, corruption, understaffing, resource shortages, among other challenges.

There has been finger-pointing with workers blaming their employer, the Health ministry, while government thinks the employees are being greedy.

Patients are, therefore, caught in-between. For sure, mortality increases as a number of medical procedures are suspended.

It was in August 2020 when the new Health minister, Vice-President Constantino Chiwenga announced that he was restructuring the health sector.

The reform of the health system normally refers to fundamental and purposeful change at all levels of the system.

Such change, in essence, is holistic in nature and is typified by the implementation of comprehensive or global structural changes, involving amendments to health policies and institutional arrangements.

This is distinct from a situation where piecemeal changes are made in the structure.

A survey I carried out among the health workforce in the last few days showed that very few people in the sector knew what exactly will be happening in the health sector in terms of restructuring.

Many health workers now view the restructuring as mere witch-hunt and my fear again is that if the reforms are seen as an imposition from above, the chances of failure are very high.

Normally when reforms are being implemented, the major stakeholders should be involved in the change process.

There should be clear understanding about what exactly needs to be done if full co-operation is to be expected. The following questions should thus be answered:

lWhat has necessitated the reforms and what are the objectives?

lWhat specific components of the health system will be reformed?

lWhat will be the extent and nature of the reforms?

lWhich stakeholders should be involved in the reform process?

lWho are the drivers of the reform process?

lWho will be affected positively or negatively by the reforms?

lAre the requisite financial, personnel and material resources readily available to undertake the reforms?

Considering the delicacy of the health sector, reformers should also bear in mind the possibility of unintended consequences and not merely focus on the results they aim for.

This is the reason why prior consultation and engagements should be done so that the process is not seen as an imposition.

The World Health Organisation in 2007 came up with an analytical framework for assessing the performance of health systems.

These building blocks are interdependent, so shaking off one of them will disturb the other ones. The blocks are:

lService delivery

lHealth workforce

lHealth information systems

lMedicines and drugs



Their health workforce is a critical component of each and every health system.

The discharge of duties is determined by so many factors which include the availability of the tools of trade, extrinsic and intrinsic motivation, governance et cetera.

So many work boycotts or strikes in the past have been attributed to poor remuneration and loss of motivation.

Therefore, whatever the Health minister is doing to reform the health sector should recognise the health workers and put them at the centre of the exercise.

The theories of motivation should be borne in mind and these include Maslow’s hierarchy of needs, Alderfer’s ERG theory, Herzberg’s two factor theory, McClelland’s achievement and motivation.

The reforms, therefore, should never be seen as punishment or infringement of personal rights of the health workers, but as solutions to perennial problems bedevilling the health sector.

If all stakeholders come together after noble consultations and engagements, there will be easy acceptance of the reforms.

We do not want a situation where unnecessary time and resources are wasted on battles between the employer and the employees. Failure to handle the medical sector properly can result in the following:

lPoor patient outcomes as sensitive specialities like neurosurgery, cardiothoracic surgery can cancel operations if there are inadequate resources like intensive care beds for post-operative care.

lAccelerated brain drain as medical staff will migrate out of Zimbabwe in anticipation of better working conditions elsewhere. We do not want mass exodus of workers as we desire our people to work for our country.

lChances of litigation will be high if employees feel that their rights and privileges are trampled upon. Section 65(1) of the Constitution states that every person has the right to fair labour practices and standards and to be paid a fair and reasonable wage while section 65(4) states that every employee is entitled to just, equitable and satisfactory conditions of service.

Section 65(3) states that every employee has the right to participate in collective job action (except for security services) including the right to strike, sit in, withdraw their labour and to take other similar concerted action, but a law may restrict this exercise in order to maintain essential services.

Let us all put our hands and heads together for the benefit of the nation. Motivation is key in the health sector!