HomeOpinion & AnalysisFeature: Maladministration, funding challenges hamper mental health care

Feature: Maladministration, funding challenges hamper mental health care

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BY PHYLLIS MBANJE
MENTAL health (MH) delivery in Zimbabwe is mired in gross maladministration and poor funding, compromising standards.

An investigation has exposed a dysfunctional mental health delivery system, which is fraught with financial mismanagement, corruption as well as severe underfunding.

Despite overwhelming evidence that mental health has become a huge challenge fuelled by rampant abuse of drugs and illegal substances such as crystal meth, the facilities established to cater for patients have turned out to be inadequate to handle the large number of patients.

According to the World Health Organisation (WHO), Zimbabwe has been buckling under the pressure of mental illnesses induced by rampant drug abuse, with the number of patients spiralling out of control.

COVID-19 also contributed to many people suffering from mental challenges due to increased stress and having to cope with loss of employment and income, compounded by uncertainties surrounding the disease.

The two psychiatric units at Sally Mugabe and Parirenyatwa hospitals have recorded an increase in mental patients since onset of COVID-19, the bulk of which are drug and substance addicts.

In March, it was reported that hospitals were now sending violent patients to Chikurubi Maximum Security Prison because they are not equipped or capacitated to handle them.

Admission of patients to hospitals has become a mammoth task because of a lack of resources to cater for them.

Meanwhile, mental health care institutions such as Bulawayo’s Ingutsheni and Ngomahuru Psychiatric Hospital in Masvingo are experiencing a prolonged stay of patients.

This has implications on costs and quality of services provided while feeding, clothing and caring for them.

Gross mismanagement coupled with corrupt practices has seen facilities being run to the ground.

Sadly, there have been cases of some patients dying while trying to flee from the terrible conditions that they live in.

Relatives of the patients have been forced in some instances to engage in corrupt practices amid reports that relatives of some patients admitted at Ngomahuru Hospital were paying between US$140 and US$200 for admissions.

Speaking on the nexus between a poorly run health system and all the other services which include mental health, Medical and Dental Private Practitioners Association of Zimbabwe president Johannes Marisa said the problem of capacitation was a major issue.

“It is incontrovertible that the health sector is in dire need of capital injection if the country is to remain afloat medicine-wise,” he said.

Capacity problems, he said, were very common in the public health system.

“These usually emanate from simple leadership incompetence, corruption, maladministration, poor funding or misplaced priorities,” Marisa said. “It is sad that the country continues to lose lives because of mere incompetence.”

Currently, Zimbabwe has only 12 institutions that offer mental health services.

From this lot, Ingutsheni Central Hospital is the largest. The country only has 19 psychiatrists and 35 clinical psychologists against a population of over 15 million.

The State of the World’s Children 2021, a report by the United Nations Children’s Fund (Unicef), says that a mere 2% of government health budgets is allocated to mental health spending, which translates to less than US$1 per person.

This is despite the glaring fact that there is an upsurge in the demand for mental health services, especially young people between the ages of 10 and 19.

This situation is a spin-off from the inadequate health sector budget allocation.

The 2021 national budget of Zimbabwe failed to allocate the 15% of the total budget to the health sector despite signing to the Abuja Declaration commitment made in 2001 by African heads of state.

The declaration stipulated that governments should commit 15% of their annual budgets to funding health.

But when Finance minister Mthuli Ncube presented Zimbabwe’s 2022 national budget on November 25 last year, the health ministry was allocated $117,7 billion against a total budget of $927,3 billion.

This translated to a mere 12,7%, which the minister deliberately overstated as representing 14,9% of the budget.

Findings from a comprehensive system analysis in Zimbabwe drawn up by Kushinga organisation revealed the startling fact that mental health services have “no fixed line budget and were inadequately funded by the government”.

For years, the responsible authorities have not availed adequate funding to finance critical interventions such as research on mental health in response to excessive drug abuse in the country.

Of note is the fact that despite Zimbabwe having comprehensive interventions such as the Mental Health Act, Mental Health Policy and Mental Health Strategy, these have sadly not been fully implemented due to inconsistent commitment and lack of fiscal support.

“Lack of requisite qualifications is hampering good administration,” Marisa said.

“Some office-bearers do not hold any management qualifications, yet they are involved in management duties on a daily basis.”

Against such illicit financing and corruption, stakeholders have made a clarion call for adequate resources to fully implement the long-awaited Whistle-blower Protection Bill approved by Cabinet in March.

During a Transparency International Zimbabwe consultative workshop on whistleblower protection in Bulawayo, Prisca Dube, from the Zimbabwe Lawyers for Human Rights (ZLHR), said: “Whistleblowers are an important part of society as they expose corruption which is one of the violators of human rights.”

Meanwhile, the “MH in the workplace” intervention spearheaded by the Health ministry and WHO has been rolled out to address the gap within most companies which have very limited MH and Psychosocial Support (MHPSS) services offered in the workplace.

“MH in the workplace is a game changer as it will enable us to reach out to more people who need MHPSS services in Zimbabwe,” said Friendship Bench director, professor Dixon Chibanda.

WHO Zimbabwe’s MH specialist Debra Machando, said: “MH challenges are a risk for lost workforce productivity due to premature death, missed days from work  and impaired job performance.”

  • This report is part of the investigative journalism initiative by the Voluntary Media Council of Zimbabwe and Friedrich Naumann Foundation.
  • Follow Phyllis on Twitter@pmbanje

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