Itai Rusike Correspondent
The opportunity afforded to Zimbabweans to provide input into the supreme health law of the country is refreshing.
It is important to have communities come out and participate during the public hearings on the Public Health Act (Amendment) Bill to ensure that their views and perceptions have been incorporated into the final Bill and that it addresses community needs as enshrined in the nation’s Constitution.
Following a number of public health blunders that have seen resurgence of previously controlled diseases, unnecessary death, disability and suffering of Zimbabweans, it is imperative to have a shared vision and mission for public health across national stakeholders, including a shared understanding of the purposes and objectives of a public health law and the scope of public health action.
The role of communities should be to demand environmental, infrastructure and structural provisions to promote health for all in urban, rural, farming, mining and institutional spaces.
Zimbabweans must use this opportunity to ensure the development of a law that is not simply a means for controlling nuisances, but a tool for promotion of healthy conditions, for co-ordination of health activities and for improving the dialogue and relationships across public health authorities for the attainment of the country’s vision and mission for the health and well-being of its citizens.
In the developed world, health promotion is a high national priority that sits in the Prime Minister’s Office and ensures the provision of a healthy environment for all citizens and the attainment of health in its totality through targeted initiatives such as healthy cities, lifestyles, food etc.
Community concerns regarding gaps in the gazetted Public Health Act (Amendment) Bill
Community level mechanisms and functions
• Although Health Centre Committees (HCCs) have been legally recognised in Section 17, they are not represented in the District Health Team in Section 16 for feedback to and from the communities. Therefore, we strongly recommend that community involvement mechanisms need a representation mechanism in the district health team as the district government council in addition to the hospital management board, which oversees functionality of the district hospital.
• HCCs were fully captured. However the role of Village Health Workers (VHWs) and other community-based workers is not satisfactorily and explicitly stated in the act except for Section 137 sub-section 1(b) in a general statement that says “The minister may make regulations providing for: Recognising and providing for the roles of non-state actors and communities. Thus provisions for the VHWs could be detailed soon after Section 17 of HCCs.
• This is important because VHWs do not have an association or representation like other health cadres and yet they are the backbone of all community health programmes, hence the need for legal backing in order to be given priority. Include specific inclusion of the broad roles and functions of VHWs, including how they relate to other community-based workers (home-based carers, family planning distributors, OI/ART/Dots coordinators, school health coordinators, malaria spray operators etc)
• Section 28: The Bill is silent on the Health Centre staff establishment. It is therefore crucial to have a specific clause in the Bill that speaks to issues of the ideal healthcare establishment that looks realistically to the country attaining universal health coverage and the SDGs given that the current staff establishment was determined using the 1982 population statistics and when the disease burden was very low.
• Although it is covered in the Health Services Act, it should still reflect in the Public Health Act (Amendment) Bill so that the two are harmonised and be in tandem with the Constitutional provisions of leaving no one behind.
• Section 3: The Minister of Health and Child Care as a competent authority and the custodian of the Public Health Act should enforce the Act by demonstrating adequate powers supported with resources than has been the case under the current law.
The minister requires the legal muscle and needs teeth to bite so that perennial offenders of well-articulated and scientifically proven public health provisions, interventions and standards, such as the City of Harare, other local authorities and individuals can be brought to book and potential public health disasters averted before loss of life as has so far been the case and without fear or favour.
Itai Rusike is the executive director for the Community Working Group on Health
Itai Rusike Correspondent