Day: December 19, 2017

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Health expenditure continues to dwindle

ZIMBABWE will this year spend a measly $25 per person on health, while government expenditure on health continues to fail to reach the 11,3% of Sub-Saharan Africa’s average, and 15% of the national budget as stipulated by the Abuja Declaration.
BY VENERANDA LANGA
The amount of $25 that government will spend on each person this year is a drastic drop from $62 per capita in 2013 (World Health Organisation statistics) which government spent per person, and $58 per capita in 2014, as well as $48 per capita in 2011.
The figures show that health allocations per capita in Zimbabwe have drastically dwindled in the past years.
Community Working Group on Health (CWGH) executive director Itai Rusike, in a post-budget analysis, said government allocations on health had continued to be low (7,7% of the total health budget).
This, however, is a slight increase from 6,7% in 2016, but it is still inadequate as the health infrastructure needs serious rehabilitation, as well as the acute shortage of drugs that patients experience at health institutions in the country.
In the 2018 National Budget statement, Finance minister Patrick Chinamasa allocated $408 million to health, while more money was allocated to Defence ($420m), Home Affairs ($435m), Lands and Agriculture ($497m), and the highest allocation went to Primary and Secondary Education ($905m).
“Per capita (per individual person) health expenditure in the country is insufficient to guarantee adequate access and quality of healthcare as per capita health allocation stands at about $25 in 2018, up from $22 in 2017 and about $24 in 2016,” Rusike said.
“Per capita health spending is $650 (US dollars) in South Africa, $90 in Zambia and $200 in Angola, and the inadequate public financing of health has resulted in an overreliance on out-of-pocket and external financing which is highly unsustainable.”
As a result, government would continue to rely on donor funding with development partners expected to pump in $239,6m, with Global Fund injecting $173,8m, Health Development Fund ($58,1m), and Global Alliance for Vaccines and Immunisation ($7,7m).
While Zimbabwe continues to fail to fund health care to the Abuja convention stipulations, other countries like Malawi, Rwanda, Madagascar, Togo and Zambia have managed to reach the Abuja
target.
“In Rwanda and Uganda, they drastically reduced defence and security budgets in recent years to allow for scaling up of pro-poor expenditure on human and infrastructure development. Military and security spending have been shown to retard development by diverting government resources that could be put to better use. In fact, development, not military deterrence, is the best strategy for a safer society,” Rusike said.
He said developed countries spend relatively more on health, while poor developing countries like Zimbabwe spend relatively more on defence.
Zimbabwe spends about 6% of gross domestic product (GDP) on defence and security and only 2% on health.
“The United States spends 6,6% of its GDP on health care and only 3,8% of its GDP on defence. Japan spends 1% of its GDP on defence and 6,5% of its GDP on health care. Germany spends 1,4% of its GDP on defence and 8,6% of its GDP on health. Eritrea, on the other hand, spends 19,4% of its GDP on defence and only 3,2% of its GDP on health,” Rusike said.
He said while there was a slight improvement in the 2018 health allocation, it was still inadequate to cover the health needs of Zimbabweans.
Health minister David Parirenyatwa recently said he needed over $1 billion.

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CWGH Releases Position Paper On 2018 Budget For Health

The Community Working Group on Health (CWGH) has released its proposed position paper regards the 2018 Budget for health requirements.
Amongst other things, CWGH implored government to allocate at least 15% of the National Budget to health care in line with the Abuja Declaration target.
“Empirical evidence has shown that a 1% increase in public spending on health care reduces child and maternal mortality rates while improving life expectancy.
“To boost public spending on health without undermining fiscal sustainability government must explore a number of options for innovative domestic and sustainable financing. These options include: broadening the tax base through introducing incentives to mainstream the informal sector into the formal economy,” said CWGH.
Other options include corrective and wealth taxes. Enhancing tax administration is also vital.
CWGH Input to the 2018 National Health Budget

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Health activists fret over second line ARVs

THE Community Working Group on Health (CWGH) has urged Government to prioritise the procurement of second line antiretrovirals whose availability has been affected by shortages of foreign currency.
In a statement, CWGH executive director Mr Itai Rusike said if the situation is not addressed urgently, the country will end up losing some of the gains achieved over the years.
The shortages will definitely compromise the health of about 35 percent of the estimated one million people on second line treatment as they will default on taking their medication.
“Limited availability of ARVs impedes patient initiation, adherence and poses a major barrier to the fight against HIV/Aids,” said Mr Rusike.
The shortage of second line ARVs come at a time when the World Health Organisation (WHO) has warned of drug resistant HIV as an emerging threat in developing countries.
Nac board chairperson Dr Everisto Marowa recently said while resources have been set aside for the procurement of ARVs and other related products, the actual procurement has been adversely affected by foreign currency shortages.

@thamamoe        December 14, 2017 Local News     Thandeka Moyo, Health Reporter
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‘Matapi flats should be destroyed’…David Parirenyatwa

Pressure is piling on Harare City Council to decisively deal with the perennial typhoid outbreaks with Health minister David Parirenyatwa calling for the demolition of Mbare’s Matapi hostels.

This follows an outbreak of typhoid in the highly-congested hostels early this week with 21 cases detected so far.

Parirenyatwa said he was shocked at the filth and poor services in the area.

“There is uncollected garbage, overflowing raw sewage and no running water. This is a conducive environment for diseases like typhoid to thrive,” he said during a tour of the hostels on Thursday.

Parirenyatwa said the hostels should be demolished as they were now inhabitable.

“Yes, we will treat and put measures to deal with the cases, but if situations like this persists, we will not win this war,” he said.

The Community Working Group on Health (CWGH) challenged the city to urgently address the key drivers of typhoid in order to permanently stop future recurrence.

“The situation on the ground indicates that while infrastructure is present, it is old, poorly functioning and poor availability of safe water leads to sourcing of water from less protected, informal sources,” said CWGH director Itai Rusike.

He said it was surprising that council was planning to introduce a typhoid vaccine in a bid to prevent future infections without adequately addressing the key drivers of the disease.

“It has been noted that the recurrent outbreaks of typhoid in Harare are being caused by erratic supply of clean water, supply of contaminated drinking water, burst sewer pipes and poor hygiene,” Rusike said.

He said the typhoid vaccination should only complement service provision and should not be taken as the main intervention strategy in the fight against the outbreak.

The Combined Harare Residents’ Association (CHRA) also implored Harare City Council to address the major drivers of typhoid and prevent needless loss of lives in the capital.

“CHRA is concerned that typhoid continues to spread across Harare mainly as a result of acute water shortages, poor sanitation, raw sewage spillages and uncollected garbage,” the residents’ group said.

“Of major concern is the fact that Harare City Council has apparently failed to prioritise service delivery with $10 million out of the $12 million collected monthly going towards obscene salaries for council staff. Service delivery has largely suffered due to the fact that council is allocating most of its financial resources to overpaid salaries.”

CHRA said as a result of council’s failure to prioritise service delivery, residents had been exposed to diseases such as typhoid and cholera.

“This unfortunate development comes at a time Harare City Council has proposed an increase in water tariffs, a development that is likely to worsen the already dire situation for residents especially given the current economic environment,” CHRA said.

The Community Water Alliance also argued the problem was linked to the quality of water the council is supplying to residents.

But council insisted the fresh typhoid outbreak reported in Mbare early this week was not linked to the city’s erratic water supplies but a direct result of unhygienic conditions in the suburb.

“The outbreak has nothing to do with chemicals, if anything our coverage of water delivery has improved. Typhoid is all about hygiene,” council spokesman Michael Chideme said, adding there was no need for residents to panic as the local authority had stocked adequate water treatment chemicals.

"It is professionally unacceptable that the situation was allowed to deteriorate to these levels when the country has the Ministry of Health and Child Care (MoHCC) and the National AIDS Council (NAC), institutions that jointly superintends over the procurement and distribution of the
living-saving drugs. Both institutions must have raised the red flag well before the situation reaches this crisis point if proper monitoring procedures were in place.

"The major constraint to procurement in 2017 has also been the availability of foreign currency to procure ARVs. Foreign currency supplies from the Reserve Bank of Zimbabwe can lag behind for as much as 4-5 months," said Rusike.

Meanhwile, Rusike added that there was need to advocate for more immediate policy attention to be given to significant obstacles in drug access, including foreign currency supplies to Natpharm, timely payment to Natpharm of debts, adequacy of trained pharmacists in government service, improved management of drugs with an information system that provides timely information on drug availability, improved equity in the distribution of available drugs with greater support of drug supplies to primary care level.

"There are a number of factors affecting drug availability. It appears that at primary care level the level and quality of staffing, expertise and resources is currently too low to provide for the basic requirements of a drug procurement and management system. Higher levels of the health system are also not adequately supporting quality and supply in this level of care.

"Resource constraints and foreign currency shortages have also limited supplies at higher levels. There are also shortages due to losses from supplies that have been obtained. This occur when drugs expire or are stolen."

Government spending on health had declined in real terms and is currently concentrated in hospitals, particularly at central level. There is disproportionately high expenditure on staff and health infrastructure as compared to other recurrent inputs such as pharmaceuticals and maintenance, resulting in the general shortage of medical consumables. The shortage of foreign currency has undermined efforts to maintain a supply of affordable ARVs.

There is evidence that drug access has fallen in recent years, and that drug availability is falling, most sharply at the clinic services that form the frontline of the health care system with the community. This represents an unfair cost burden on poor communities, but also opens the way
for the growth of private unregulated drug markets.