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Gvt To Blame For Recurrent Doctors Strikes- CWGH

FAILURE by government to come up with a pro poor national budget which priorities basic health needs, is the leading cause for perennial strikes by medical doctors and other health staff, the Community Working Group on Health (CWGH) has said.
By Michael Gwarisa
Within a single year, doctors have twice embarked on nationwide strikes that have crippled operations at all major health institutions resulting in the untold suffering of patients and possibly numerous deaths that could have been avoided.
CWGH Executive Director Mr Itai Rusike said it was shocking that doctors were striking over the same issues they downed tools for early this year a development which shows lack urgency and seriousness of behalf of government.
“What is most disturbing and worrying is that the doctors are striking over the same issues that they were demanding in March this year and which the government had publicly pledged to address to ensure normalcy in the health sector. Then like today, the doctors are protesting against the severe shortages of medicines in public hospitals, poor working conditions, dilapidated infrastructure and obsolete medical equipment.
“They are also demanding that they be paid in foreign currency to cushion themselves from the worsening economic decline characterized by rising prices of basic commodities and high inflation. The Community Working Group on Health (CWGH) is worried that these are the same grievances that government pledged to address in March this year — together with the provision of non-cash incentives like free duty car imports for doctors – but nine months down the line nothing has come to fruition,” said Rusike.
He reminded that it was government’s national obligation to see that its citizens have access to quality and affordable health services as guaranteed in section 76 of the country’s Constitution. And that responsibility can only be achieved when health personnel like doctors, physicians and nurses are working normally.
“Section 76 further states that, “No person may be refused emergency medical treatment in any healthcare institution,” but presently the hospitals are turning away critically-ill patients because there are not doctors to attend to them and key departments have been shut down.”
He also took a swipe at Health and Child Care minister, Dr Obadia Moyo being literally blind to the real issues facing doctors and dwelling more on petty legal issues.
“It is shocking that the Health Minister Obadiah Moyo dwells on the legality of the job action than solutions as if he is reading from his predecessor’s script. No responsible and accountable Minister or government would turn a blind eye to a crisis of this magnitude or wishes it away. We are in this health crisis Minister because your predecessor used to behave the same way: burying his head in the sand than tackling the issue head-on.
“Leadership and management support at the highest level is also pivotal as health workers are motivated to perform and long standing grievances simply should not be allowed to build up and promises made must be fulfilled.
For the past five years or so, the doctors have been promised non- cash incentives whenever they strike but when they resume work those promises were not fulfilled, instead they got threats,” said Rusike.
He also deplored failure to prioritise issues of welfare, incentives and allowance of doctors which says should neer be ignored by any serious government with health workers at heart.
“CWGH feels that the issue of non-cash incentives such as duty-free vehicles, housing stands and opportunity for career growth has to be prioritized. The vehicle duty assisted framework and other incentives agreed upon between the government and doctors last year should be implemented immediately to enable them to respond to medical emergencies timeously.
“It should be highlighted that the situation obtaining in the health sector contradicts President Emmerson Mnangagwa’s statement in September this year when he said his administration prioritized health and the well-being of all Zimbabwean citizens. CWGH pleads with President to intervene to address the crisis in the health sector to prevent unnecessary suffering and avoidable deaths.”
According to CWGH, the health workforce is central in any health system and gaps in adequate health workers are cited as one barrier in efforts to achieve health and development in Zimbabwe.
“Both for quality and equity, health systems need highly motivated health workers who are satisfied with their jobs, stay at their stations, deliver quality services and communicate well with clients.
“It is disheartening that the strike by doctors comes at a time when new cases of suspected cholera deaths are also being reported in areas such as Chiredzi and Mt Darwin. The current situation spells doom for the country especially now when there is a critical shortage of basic medicines; some sold pricey in foreign currency and worsening economic meltdown. This means more suffering and deaths for the ordinary Zimbabweans who cannot afford to get foreign currency. ”
The strike also comes at a time the country’s emergence services have been grounded due to poor funding from central government. A number of ambulances do not have basic equipment or adequately trained staff to take care of patients during transit, also complicating their recovery or risking fatalities in transit.
Emergency departments are under resourced, without adequate equipment and staff to cope with the critically ill patients coming to them, including patients who have delayed seeking care until they have an acute emergency.
“CWGH would like to reiterate that in the absence of an enticing salary, the government must find ways of supplementing with other non-cash incentives as heath workers do not only seek financial incentives but also personal development, better housing, specialization and guaranteed welfare of their children. Such incentives create stabilizing influence, compared to the more rapid effects of financial incentives.
“This is why CWGH has been calling for a pro-poor, inclusive and sustainable national budget framework that prioritises people and their basic needs especially health. However, it is worrying that allocation on the health care in the 20019 budget as a percentage of total expenditure continues to account for a small share of national spending. This year, the health sector got about 8.9% way below the 15% Abuja target. This is a clear sign of lack of political commitment in addressing problems in the health sector.
“While we do not condone job actions that cause deaths and human suffering, but we also strongly feel that there must be speedy, fair and impartial procedure for resolving disputes. We fear that the longer the strike takes, the more patients suffer or die, and the likelihood of other health personnel such as nurses joining the job action increases. This is not the time for promises anymore but long-term solutions.”

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More doctors join strike

More doctors yesterday joined the on-going strike, defying a government message to call off the job action.

BY VANESSA GONYE/EVERSON MUSHAVA

The doctors have been on strike since Saturday to protest poor remuneration and the deteriorating health situation in the country.

“Only four out of 91 doctors came for work and I think the rest are waiting for talks between the doctors’ association and the employer over the issue of solving their problems before they report for duty,” Harare Central Hospital CEO Nyasha Masuka said.

Parirenyatwa Hospital and public health institutions in Manicaland and Bulawayo faced similar situations, with Mpilo Central Hospital and United Bulawayo Hospital keeping their out patient departments closed.

The Zimbabwe Hospital Doctors Association (ZHDA) yesterdya also distanced itself from utterances made by former member, Patrick Mugoni, who “represented” doctors at a meeting with the Health minister on Monday and appeared on the national televison urging doctors to go back to work.

Mugoni, who was ZHDA secretary-general until a few weeks ago when he was removed from office through a vote of no confidence for being partisan, is said to have met with Health minister, Obadiah Moyo on the pretext that he was representating the association and subsequently announced that doctors should resume duties with immediate effect while their grievances have not been addressed.

ZHDA said Mugoni was a bogus agent and not one of their own.

“The Zimbabwe Hospital Doctors Association wishes to advise members of the medical profession, the media and the public at large of the futile attempts by one Patrick Mugoni, who appeared on ZBC purporting to represent ZHDA. The concerned doctor has been fired from the association for bringing the name of ZHDA into disrepute and violating the constitution of the ZHDA.”

“Dr Patrick Mugoni was suspended from the ZHDA after ‘crying’ while addressing the Zanu PF rally in Gweru. The ZHDA executive urges all stakeholders to ignore his utterances and any communication on the industrial action will be made through the information department,” ZHDA said in a statement.
ZHDA also promised to have Mugoni examined by colleagues in the profession and to give him psychological help and counselling, if needed.

Mugoni is infamous for weeping on national television after the doctors were awarded a pay hike in March. He said at the time he had been overwhelmed by emotions.

Zimbabwe Nurses’ Association (Zina) secretary-general, Enock Dongo, speaking on behalf of the Health Services Board yesterday said health workers were still negotiating with government.

“We are still negotiating with government, doctors are a single union that has downed tools, we appreciate that they have a genuine cause,” Dongo said.

Cabinet yesterday said it did not deliberate on the issue of the doctors’ strike.

“We did not discuss about the doctors’ strike because the Health minister told us that he talked to the them and that they have agreed to go back to work,” acting Information minister Mangaliso Ndlovu said yesterday.

The doctors expressed concern at the Health minister’s conduct.

“We wish to set the record straight that the industrial action that started on the 1st of December 2018 is still ongoing and the healthcare crisis in the country has reached an unprecedented critical level. Instead of addressing what is now perceived as a serious national health crisis, the Minister of Health seems to display an ‘I do not care’ attitude and ‘it is business as usual’ approach.

“We are even greatly disturbed that the minister went on national television in the evening of (Monday) to misinform the whole nation that the ongoing industrial action has been called off. He went on to acknowledge there is a serious shortage of vital medicines in public hospitals but nothing was being done,” ZHDA said.

Other stakeholders also laid into the Health minister for not handling the issue professionally.

“It is shocking that the Health minister Obadiah Moyo dwells on the legality of the job action than solutions as if he is reading from his predecessor’s script. No responsible and accountable minister or government would turn a blind eye to a crisis of this magnitude or wishes it away. We are in this health crisis minister because your predecessor (David Parirenyatwa) used to behave the same way: burying his head in the sand than tackling the issue head-on,” Community Working Group on Health director Itai Rusike said.

“We would like to remind the government that it has a national obligation to see that its citizens have access to quality and affordable health services as guaranteed in section 76 of the country’s Constitution. And that responsibility can only be achieved when health personnel like doctors, physicians and nurses are working normally,” Rusike said.

Meanwhile, Moyo at a Press conference revealed that President Emmerson Mnangagwa has unveiled a $25 million drug facility, with about 100 000 tonnes of medicine set to arrive from India.

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Health budget slated as ‘grossly inadequate’

Helen Kadirire

HARARE - Zimbabwe's 2019 health budget remains grossly inadequate to fund the critical needs in the sector, the Community Working Group on Health has said.
CWG executive director Itai Rusike told the Daily News that government continues its over reliance on development partners, which raises the spectre of a health emergency should donor funding be withdrawn.
His remarks come as Finance minister Mthuli Ncube last week announced the 2019 National Budget with $694,5 million or nine percent of the budget allocated to the sector against the 15 percent stipulated under the Abuja Declaration.
“In nominal terms the health budget appropriation has remained largely stagnant at about 9 percent. The percentage is, however, far less when you take into account the effect of inflation,” Rusike said.
“Moreover, the bulk of the resources will be channelled towards financing employment costs at 66 percent leaving very little for capital expenditures. Government must demonstrate its commitment to health by at least meeting the Abuja Declaration benchmark.”
In April 2001, the African Union countries met in Abuja and pledged to set a target of allocating at least 15 percent of their annual budget to improve the health sector and urged donor countries to scale up support. Years later, Zimbabwe has dismally failed to reached this target.
“Development partners are expected to complement 2019 Budget appropriations. The Global Fund for instance is expected to provide US$75 million,” Rusike said.
“The high dependency on external financing is unreliable, unpredictable, unsustainable and highly dependent on the political environment, raising concerns on the sustainability of health financing and the vulnerability of government’s budget should external funding be withdrawn,” Rusike said.
He said government also spends a relatively small share of its gross domestic product (GDP) on health care.
The CWGH director highlighted that lower levels of per capita health expenditure indicate that health expenditure in the country is insufficient to guarantee adequate access and quality of services.
Rusike emphasised that the inadequate public financing of health has resulted in an overreliance on out-of-pocket and external financing which is highly unsustainable.
He also said, as usual Treasury allocates more towards Defence and Home Affairs which do not provide any meaningful development to a country.
“Defence and Home Affairs spending continue to account for a predominant share of the total budget crowding out critical sectors such as health and social protection.
In the 2019 National Budget the ministry of Defence was allocated $547 million up from $420,4 million while the ministry of Home Affairs received $518 million up from $435,5 million.
“Countries that are doing well both regionally and internationally are reducing defence and security expenditure to allow for the 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. Developed countries spend relatively more on health than they spend on defence while developing countries spend relatively more on defence than they spend on health,” he said.

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Govt, council should stop blame-game on cholera

GOVERNMENT and local authorities have been urged to ensure provision of basic water and sanitation infrastructure in order to effectively deal with the cholera and typhoid outbreaks, the former which has claimed the lives of 30 people countrywide and affected over 5 000.
BY VENERANDA LANGA
The Community Working Group on Health (CWGH) yesterday reproached government and local authorities over continuously playing the blame game, saying they must concentrate on restoring infrastructure and social services to save lives.
“The cholera outbreak highlights the failure of government to maintain basic public health standards,” Itai Rusike, the CWGH executive director said.
Rusike said the main problem was that in most urban residents go for months without tap water, forcing them to dig shallow and unprotected wells and boreholes that can be contaminated by raw sewage flowing from burst pipes.
“Cities, once the epitome of good hygiene, have now been turned into big communal villages. Practically and in the short-term, people need clean water – they need adequate aqua tablets, they need boreholes; they need water bowsers as a matter of urgency,” he said.
Rusike said local authorities were in charge of all water delivery, sewerage and refuse collection and were the recipients of all rates paid by residents that expected proper service delivery, yet there were reports that they were diverting money paid by residents to buy luxury cars and giving each other loans.
He said Zimbabwe needs consistent supply of clean water in urban areas if the country is to end the burden of waterborne diseases.
Most of Zimbabwe’s water and sewer pipes are archaic as they were constructed during the colonial era and have not been refurbished for the past 38 years.
ZimRights in a statement also said cholera and typhoid were hygiene-related ailments fuelled by poor water reticulation systems in Harare, apart from lapses in personal hygiene.

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Sustainable funding mechanism critical for healthcare

CWGH@20 - Giving a health story the cutting edge: Investigative journalism to promote transparency and accountability in the health sector workshop in Bulawayo, Zim

The red flag raised by the Community Working Group on Health executive director Itai Rusike on the need for government to present a sustainable funding mechanism to ensure renal patients can have access to effective and consistent free renal services at the country’s public hospitals could not have come at any better time.

Editorial

In fact, we believe government should heed the advice to save unnecessary loss of life countrywide.

It is a good thing that the government has rolled out this programme to provide free renal dialysis to financially-disadvantaged citizens, who are not on medical aid cover.
However, what is more critical is ensuring that the programme is sustainable. This means the need for a clear long-term and sustainable funding mechanism is critical otherwise without that, the noble programme may flounder due to lack of financial resources.

It is not in doubt that the costs of health services in Zimbabwe have become too exorbitant that even people on medical insurance are struggling. Given that access to health is a basic and fundamental human right, it is important to ensure that something is done in this regard.

Multitudes of patients always dig deeper into their pockets to access the critical service, but given that the general cost of living in the country has skyrocketed, this, indeed, is not sustainable. It is against this backdrop that government should consider coming up with a clear and sustainable funding mechanism so that it goes beyond mere political grandstanding while thousands of citizens continue to suffer.

Currently, renal dialysis costs between $150 and $200 per session and this is way beyond the reach of majority ordinary Zimbabweans who are struggling to eke out a decent living against the backdrop of a harsh economic environment.

Clearly, the government must show that it feels for the majority poor people and ensure that they get the help they require. It is quite unfortunate that the government is now offering free renal dialysis to disadvantaged patients using money collected under the Health Levy Fund, which is supposed to cater for drug shortages and obsolete equipment in hospitals.

This is a sign of gross indiscipline, which can only be cured once the requisite mechanism of funding the health costs of those in need of renal dialysis is in place. This needs to be looked into as a matter of urgency.