National environment should promote a serene health service delivery

Johannes Marisa


Health and development are symbiotic hybrids of each other, so it is prudent to enhance public health if national development is to be realised particularly for developing countries where the health care system is underdeveloped, fragile and vulnerable. Zimbabwe has suffered from massive brain drain since the days of Economic Structural Adjustment Programme, a neo-liberal policy introduced in 1991 with the aim of reducing State interference in the economy.

Thousands of well-trained nurses left for greener pastures, same with doctors, pharmacists, radiographers and many more professionals.

The nation should embrace the remaining medical professionals who have dedicated their lives to serving the nation. Many have shown great patriotism and it does not mean that they cannot leave this nation to work overseas. Our nation needs us and it was obvious during the COVID-19 attacks that we have resolute and candid medical practitioners that stood tall to defend the nation. A lot of lives were saved despite the limited resources that were in place. For sure, health professionals deserve plaudits for the work they did. In Italy, there were statues erected in honour of the health workforce.

It is a pity that many health professionals are grumbling at their workplaces. There are many tribulations and transgressions that impede the smooth functioning of health professionals in both private and public sectors. Impediments are coming from a lot of regulations which I believe are not necessary especially during this time of COVID-19 where extraordinary measures are needed to counter such an extraordinary virus. The Health Professions Authority (HPA) is the regulator of all medical professionals and this organisation acts professionally, doing its inspections professionally, creating cordial relations with its members, understanding the problems bedevilling the health personnel. I have not heard any complaints about this hard-working organisation from members of the private practitioners, so hats off to the HPA administration for the sterling job. The same credit goes to the mother regulator of doctors, the Medical and Dental Practitioners Council (MDPCZ). I remember when I was starting private medical practice when I got strong support from the council. Life was made easy and things have been flowing quite easily because of the way the council executes its duties.

However, problems arise when the medical practitioners meet other regulators, some of them deliberately throw spanners on our way. What we desire to see is a robust health service delivery which will benefit the entire country. Harare City Council has not cooperated with health practitioners on a number of issues and I wonder why the council does not want to maintain a good working relationship with medical practitioners. Instead of showing a paternalistic leadership, there is high degree of vindictiveness as if the so-called implementors come from Mars. We noted with concern the following:

  • Harare City Council makes use of Harare Municipal Medical Aid Society (HMMAS), a medical aid scheme that many practitioners are not accepting because of its failure to honour claim forms. Council employees see misery when accessing medical care at private institutions as there is no trust anymore between service providers and this particular society. Who is in charge of this medical aid society? If we are to deliver the basic right of life, why not correct the ills of this medical aid society?
  • City health department has made life difficult for private practitioners and until now, the food handlers certification issue is still raging on. My colleague, Cletos Masiya, has been at loggerheads with city health department that has sent its so-called inspectors to clients that he signed for. We should never be treated as kindergarten students for things that we are legally mandated to do or perform as medical practitioners.
  • The city fire brigade is busy with enforcing its so-called regulations. What is mesmerising is the way the inspections are carried. The Health Professions Authority, our mother regulator, respects private property and book for inspections, but city council employees bump into practices even when the owner is not around or in the midst of consultations with patients. If law enforcement agents need to acquire a search warrant from a criminal’s premises, why is it not supposed to be the norm in private premises? What is surprising is the arrogance on issuing out penalties for slight mistakes which could have been avoided by frank negotiations. A number of businesspeople have been penalised for possessing old fire extinguishers. We are not fire experts, therefore, teach us first and see if we do not comply.

If council is doing all it is doing in the name of promoting health, then I see the reason why there is a lot of nauseating garbage at Mbare Musika. The embarrassing debris at that public place is a recipe for disaster as there are high chances of cholera, typhoid, dysentery outbreaks. The way city council is running shows that there are many people who are just sleeping on duty and are not serious about proper service delivery considering the precarious state of Harare.

We want collaboration and not conflict!

  •  Johannes Marisa is president of the Medical and Dental Private Practitioners Association of Zimbabwe. He writes here in his personal capacity.