By Byron Mutingwende
Health is a basic fundamental human right recognised under the global development agenda as one of the crucial priorities that governments must address.
Speaking at a meeting on the Sustainable Development Goals (SDGs), John Ngirazi, the Executive Chairperson of the Community Working Group on Health (CWGH)said that the health sector was facing a plethora of challenges which should be addressed as a matter of urgenecy in order to attain the global development agenda.
“Ladies and gentlemen, our country is going through a serious economic crisis and social unrest and the health sector has not been spared. There are no drugs in our health centres; there are no enough nurses and doctors to take care of the sick.
“It is very worrying that Zimbabwe has over 3 500 qualified nurses sitting at home – they are jobless – but there no enough nurses in clinics. Some nurses have skipped the country for greener pastures. As CWGH, we believe it is high time the government unfreezes health posts and revise the staff establishment so that it speaks to the current disease burden and population increase,” Ngirazi said.
Zimbabwe is currently faced with a severe water crisis as a result of the current El Niño induced drought and yet Water, Sanitation and Hygiene (WASH) are some of the most basic needs for human health and survival. That is despite the fact that only seven years ago, the country witnessed one of the worst cholera outbreaks in the country that killed over 4 000 people.
“As I speak here, the country is on the verge of another cholera outbreak as most urban and rural homesteads have gone for months without safe drinking water. The right to water entitles every citizen to sufficient, safe, acceptable, physically accessible and affordable water for personal and domestic uses.
“It becomes even more depressing when some of the country major referral hospitals – Parirenyatwa, Mpilo, UBH and Harare Central Hospitals – the epitomes of national health –endure water crisis seriously compromising the effectiveness and efficiency of health service. A situation where hospitals operate without water is too risky to contemplate as it exposes patients to disease outbreaks.”
It is unfortunate that a few weeks ago, some referral hospitals had scaled down surgical operations and other service provisions due to serious shortages of drugs, water, electricity and medical equipment. Chronically ill patients, who require constant supplies of expensive medications and monitoring, were hardest hit.
There was concern that since the Abuja declaration in 2001, Zimbabwe has not been able to allocate at least 15% of its national budget to health as per the commitment.
Ngirazi bemoaned the fact that the country relies on donor funding and urged the need to devise innovative domestic ways of funding its health systems. The inadequate funding for health care has resulted in the country failing to realise its full potential of providing sufficient and quality services to its people.
The country has struggled with a huge burden of disease. Zimbabwe has high prevalence of TB, malaria, HIV and Aids, communicable disease – cholera, typhoid and other epidemic prone disease and the Non-Communicable diseases cancer, hypertension and diabetes.
But Chief Ruzani from Wedza, born Nicholas Ruzani, said some of the health conditions were caused by lifestyle patterns which included excessive drinking, smoking and promiscuity.
“People should go back to eating traditional foodstuffs like rapoko, sorghum and millet. Exercising alos keeps one fit and equally important is the need to shun promiscuity to avoid contracting sexually transmitted diseases,” Chief Ruzani said.
CWGH noted that user fees continue to be applied in an ad hoc manner and vary depending on the service provider. Infant, under 5s and maternal rates remain a cause for concern. The country is far from achieving its target of 326 deaths per 100 000 live births by 2020. At 651 deaths per 100 000, maternal mortality rate remains unacceptably high.
The deteriorating health situation has been worsened by the food crisis that affected over 70% of households in the country. It should be noted that some patients are defaulting on their medications because of lack of food.
“Notwithstanding this, we continue to witness rising Out-of-Pocket expenditures for health a situation that has led to general low level of utilisation of health services by most households at a time they need the services most. Some patients don’t even go to clinics anymore opting for divine intervention from Pentecostal churches.
“Even the 10% of our population covered by medical aid societies have not been spared by the current crisis. Some medical institutions turn away holders of certain medical aid societies yet they would have paid their monthly subscriptions, others incur huge shortfalls. CWGH supports the creation of a National Health Insurance but bemoans that this process which could have been implemented a decade ago remains somewhat a non-priority.”
CWGH reiterated the fact that the Public Health Act Amendment Bill and the Medical Aid Society Bill have taken too long to come to fruition. The health advocates urged the Ministry of Health and Child Care to push the relevant authorities for the Bill to be brought to Parliament for debate and passage.
That should be coupled by the need for the urgent alignment of the health policies to the Constitution. Addressing the plight of village health workers (VHWs) should be expedited since they are the foundation of primary health care in the country.
A health economist in the ministry of health and child care, Gwati Gwati said that the National Health Sdtrategy (2016-2020) emphasised on financing for universal coverage.
Judith Kaulem, the Director of Poverty Reduction Forum Trust said that health is an enabler in the attainment of sustainable development goals.
Kaulem called for integrated implementation in programming for health in linking it to issues of education, climate change and so forth in pursuit of leaving no one behind.
“No goal shall be considered achieved without achieving other goals. Thus there is the need for partnerships to work together for skills and knowledge transfer across the various sectors. We need to demystify the issues of sustainable development so that they talk to the needs of all. We need to address all the barriers affecting the provision of health,” Kaulem said.
Getrude Avortri from the World Health Organisation (WHO) said that achieving and sustaining Universal Health Care (UHC) can be done through a revitalized Primary Health Care (PHC) approach and sustainable service delivery through strengthening of the health systems.
“We are seeking for the achievement of the unfinished Millenium Development Goals relating to reduction of maternal, newborn, child and adolescent mortality; and strengthening sexual and reproductive health. There is also the need to reduce the burden of AIDS, TB, malaria, Neglected Tropical Diseases (NTDs), hepatitis, and other communicable diseases,” Avortri said.
Avortri added that community directed strategies, which build upon the core principles of PHC are effective and efficient models for delivering integrated health interventions.
“Such approaches ensure that health interventions reach people who need them most and that the communities are consulted during formulation stages. Even in health facilities, patient/client engagement and involvement helps improve health outcomes, and ensures better experience at a lower cost,” she said.