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HARARE – The health sector’s $520 million 2018 budget allocation remains too low, despite Finance minister Patrick Chinamasa having increased it from $454 million, Health minister David Parirenyatwa said.
He said there was a lot of damage, wear and tear at the hospitals that needs to be fixed.
“Our target was $1,1 billion, it’s still not sufficient if you look at the number of repairs that are needed in our hospitals, just as an example.
“Before I touch medicines, if you look at how many laundry machines countrywide have broken down, the X-Ray machines that need to be replaced, the laboratory equipment that need to be addressed. Parirenyatwa said.
“We cannot replace all the laundry machines in all the hospitals in one year; we need to phase it and all that needs a big budget, so that budget to me is insufficient.”
Zimbabwe’s hospitals have been crippled by lack of medicines and equipment, which has in the past resulted in the suspension of some surgical operations at some major hospitals.
In trying to solve the situation, government introduced a health tax on airtime to boost revenue collection for drugs and equipment procurement, which according to Parirenyatwa has so far fetched $22 million.
Community Working Group on Health executive director Itai Rusike said the revised budget allocations were not adequate to meet a lot of challenges and that it still fell below “the Abuja Target of 15 percent of national budget that should be allocated to the health ministry.
“Access to allocated funds has also remained an issue in previous years as a result of limited flows of funds into the fiscus and other issues to do with absorption of funds.
“However, the need to prioritise the health sector when funds are disbursed from the fiscus has to be emphasised with the ministry of Finance,” he said.
“Civil society organisations have advocated for a pro-poor budget and a budget that promotes the principles of primary health care while moving towards the realisation of universal health coverage. We have also advocated for budget policies that reflects the country’s commitments to the international laws, norms and commitments such as the Right to Health, the Abuja Target and the Sustainable Development Goals.”
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RECENTLY, a bombshell was dropped by Finance minister Patrick Chinamasa when he told Parliament that he nearly transferred $20 million collected for the Health Levy Fund to the Consolidated Revenue Fund due to the Health and Child Care ministry’s failure to use it.
BY VENERANDA LANGA
MPs were shocked by Chinamasa’s statement, as the country’s health sector is in dire straits, with lack of adequate infrastructure and drugs.
The fund is financed by Zimbabweans who are charged five cents per every dollar of airtime, which is channelled towards the health sector, and while the Health ministry has been keeping the money under wraps, patients are struggling to get proper treatment at hospitals due to lack of drugs and blood supplies, which are very costly at $120 to $140 per pint.
“The five cents charged in every dollar of airtime managed to collect $20 million to date,” Chinamasa disclosed to the National Assembly.
“However, my disappointment was the Health ministry’s very slow rate of absorption, where we ended up threatening them that if they do not use the money, we will put it into the Consolidated Revenue Fund.”
While this was happening, the country’s budget has been failing to meet the 15% allocation towards Health, as stipulated by the Abuja Declaration.
Health minister David Parirenyatwa later explained the issues surrounding the Health Levy Fund, saying it collected
$22 million, adding that from that figure, $16 million would go towards the purchase of drugs and other accessories.
“I am quite certain that within the next few weeks, there will be a sizeable difference in terms of supply of medicines in our institutions.
The challenge that we have is that we could have used more money, but the constraint has been foreign currency allocation,” he said.
In Parliament, MPs have been fighting in Parirenyatwa’s corner to ensure that the Health ministry gets a sizeable budget.
Initially, Chinamasa had allocated
$454 million to Health, but MPs in the National Assembly refused to pass the whole budget unless the allocation was increased.
Their position worked, and the Finance minister increased the Health budget to $520 million, begrudgingly though.
“I will increase the Health budget to at least $520 million, and please, let us not dish out money which is not there, because if the revenue is there, I will even allocate the Health ministry $2 billion. What is going to happen with my compromise is that something is going to lose out and I do not know which allocation will be affected,” Chinamasa said.
Health sector analyst and Community Working Group on Health (CWGH) executive director, Itai Rusike said the $520 million revision of the Health budget would increase the per capita (per person) allocation for 2018 to $33 from the measly $24 before the health budget was increased.
“The revised 2018 health budget has remained largely uninspiring given that it still has not addressed critical issues that were raised during the budget consultations. Despite pressure from a wide section of society and Parliamentarians, the health budget still falls massively short of the needs of the health sector,” he said.
“The revised $520 million allocated to the Health and Child Care ministry for the 2018 fiscal year represents about 9,8% of the total budget, slightly more than what was allocated in 2017 and still remains below the Abuja target of 15%. The estimated per capita budget allocation for 2018 is $33, which is still far less than the World Health Organisation recommended minimum per capita expenditure of $86.”
The health expert said universal health coverage could only be achieved by coming up with sustainable and innovative domestic health financing strategies, such as revisiting the national health insurance as the economy recovers.
He said the revised budget still failed to provide a specific line budget for the purchase of ambulances, which are a critical component for hospitals’ referral systems and can cause unnecessary deaths if they are not readily available, as well as for purchases of cancer and non-communicable diseases equipment.
Rusike said the budget needs to prioritise prevention rather than emphasising allocation of more resources to curative services.
“Despite the country battling with a typhoid and cholera crisis, we are still not putting more money on preventive services. The budget allocation to the health sector is inadequate in the time of rising diseases and mortality levels, particularly those allocations to preventive diseases,” he said.
To further grow the Health budget, Bulawayo South MP Eddie Cross (MDC-T) suggested that electronic transactions such as swipe should be taxed five cents per dollar.
But Chinamasa refused to implement it, saying the tax is already in place. The Treasury boss said if he further taxed electronic and swipe transactions, then people would desist from using plastic money.
A report by the Parliamentary Portfolio Committee on Health presented by Binga North MP Prince Dubeko Sibanda (MDC-T) in Parliament on the Health ministry’s 2018 budget said the committee recommended that the National Pharmaceutical Company (NatPharm) be recapitalised to enable it to purchase drugs in bulk.
“Bulk buying of drugs will help to ensure a stable supply of drugs to public hospitals. Pharmacies also stand to benefit through buying drugs from NatPharm at lower prices,” he said.
The cost of drugs in the country had gone up by 70% in October 2017. Parliament also recommended that the government considers giving incentives to drug-producing companies, so that they produce locally and curb foreign currency flight through imports.
There were also recommendations that the Reserve Bank of Zimbabwe should prioritise foreign currency allocations to pharmaceutical
companies.
“We also recommend that the staff establishment in the health sector, which was last revised in 1982 when the population was only seven million, be revised so that it matches with the disease burden and also matches the size of the population that we have,” Sibanda said, adding that the current employment freeze should exempt the health sector.
Parliament also feels that to further grow the Budget, sin taxes must be introduced on alcohol and tobacco, as well as levied on sugary foods, so that the collected funds go towards treatment of non-communicable diseases.
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Health fee scrapping brings relief
Pregnant mothers, children under five, and adults over 65 years are now exempt from medical fees
The year 2018 began with Government implementing remedial health policy as part of the 100-day economic stimulus plan to make health services accessible to all. Included in the plan is the scrapping of medical fees for infants, senior citizens, pregnant and nursing mothers and slashing the price of blood to $50 at State-run institutions.
The reprieve has been made possible by a more generous budgetary allocation from Treasury, which has brought relief to many in these times of economic hardships. Many have applauded and welcomed this move saying it will make health services accessible to vulnerable populations in line with global commitments on universal health coverage.
This remedial policy, though plausible, has been there since 1980 but had not been fully implemented due to shortages of funding. Executive director of Community Working Group on Health, Mr Itai Rusike, indicated that the recent user fee removal was an advancement of a policy formulated in 1980. The policy was encumbered by a number of weaknesses which Government must address with speed.
“In 1980 a policy of free health care for those on low incomes (below $150, $220)was introduced, and user fees were reduced as a financing source,” he said. “It seems the plan will now be put into action. The policy position on user fees has always been that those who can afford to pay for services should do so but those who cannot should be exempted,” he said.
“He noted that the policy was crippled by the prevailing unemployment rates. The swelling numbers have made the discretionary process of separating deserving persons difficult. Managing exemption from fees has been difficult and costly, with some consequent injustices in who was exempted,” said Rusike.
“In 1990, more emphasis was placed on fee collection although after evidence of high dropout from services, user fees in rural primary health care services were suspended in 1995. The Medical Service Act (1998) gave the Minister the authority to fix fee at Government and State aided hospitals,” said Mr Rusike. He said despite it being a helpful measure from the government, the policy of user fees was viewed as a hindrance to the nation because those who could afford better health standards ended up settling for the free services.
“The National Health Strategy for Zimbabwe 1997-2007 was aimed at free treatment for the majority but also stated that the policy of free health creates a disincentive for people to join medical insurance schemes.”
He added; “Poor people thus faced a variety of de facto barriers: the falling real value of threshold for free care, transport costs, private purchase of medicines due to drug stock-outs and poorly functioning exemption schemes. At the same time higher income earners obtained a number of tax funded public subsidies, including tax relief for medical insurance subscriptions and free services due to difficulties with determining earnings and a treat-first, pay later practice, he enlightened. Even though the policy adjusted in most urban centres, it has never changed in the rural areas.”
“Pregnant mothers, children under five, and adults over 65 years are exempt from fees up to district level but this has been mainly funded by development partners through the RBF funded by the World Bank and the Health Development Fund (HDF), a basket funded by multiple donors that pooled resources in an effort to achieve the complete removal of user fees for the above vulnerable groups.”
He said lack of funding hindered policy implementation, which if not sufficiently addressed can still affect today’s 100-day economic plan. The question has been how the implementation will differ with the old times? There have been concerns about how the government is going to fund the health institutions since the majority of the people are to get the free service? Are health standards going to remain the same under the reduced payments?
Government has assured the nation that there will be no hitches in services, instead sights are on improvements. Minister of Health and Child Care Dr David Parirenyatwa said resources were being mobilised to smoothen the implementation of the idea.
“We want to make sure that all health services are not only available, but also accessible to everyone. We have availed a subsidy of $4,2 million to the NBSZ (National Blood Service Zimbabwe) for them to meet some of the costs associated with blood collection and processing.” There is a budgetary allocation useful for this goal.
“Government is collecting at least $4 million every month from the cellphone levy, the majority of which is used to procure medicines. A five percent allowance is deducted from every $1 worth of airtime bought and is then channelled towards the Health Levy,” said Dr Parirenyatwa.
“Despite the anxiety around the new implementation matrix, hospitals have positively complied with the implementation for many patients have confirmed to the reality of this episode.
“We really appreciate the government’s efforts in making the health services accessible because many were failing to meet the hospital bills leading to a number of people dying,” said Charity Kanhanda, a patient at Parirenyatwa hospital.
“As women we acknowledge the love and appreciation the government has given us as mothers of the country since we are getting everything at maternity for free.” Many also applauded the government’s reduction of blood prices.
“We now have a good government with people at heart. We are so thankful that the government is fulfilling all its promises because I actually bought blood at $50, which is a better price than before,” said Brian Chimboza of Warren Park.
Stimulated by the nation’s response to the implementation, the Permanent Secretary for Health and Child Care, Dr Gerald Gwinji, commended the government’s effort considering the challenges it has been facing towards the implementation. He added; “The main challenge for implementation has been availing commodities and equipment in the face of low budgetary support. Some mechanism must pay for this service when it is eventually availed as free service to the categories of clients.”
“Fears on the implementation of the idea may not be around for long. We have over the years strategised and built support around care for children under five and pregnant women both from government and partners,” said Dr Gwinji. Key challenges which have been plaguing the idea are in the process of being ironed out.
“The main issues were around commodities and this has been largely addressed through various funding mechanisms. The Health Levy, dedicated to commodities like medicines and medical sundries has come in to further strengthening this position,” he said. Dr Gwinji comented on the government’s health budgets that had distressed some citizens considering the economic challenges the nation is facing.
“We have also had slightly better budgets this time around. Putting all this together we feel we have gone over the threshold where we really can support other clients with Assisted Medical Treatment Orders support.
“Going forward, the health financing policy, if fully supported, will create further opportunities for sustainable health care financing from diverse sources of revenue,” assured Dr Gwinji. Health care was one of the most discussed issues within the previous administration.
Concerns with access were raised on numerous occasions. This intervention is likely to bring reprieve to citizens who have been struggling to access health services because of financial constraints.
In extreme cases, hospitals detained new mothers until they had settled their maternity bills. Situations of that nature may be on their way out if the new policy is fully implemented for the benefit of pregnant women, children under five and senior citizens.
Paidamoyo Chipunza and Sheillah Mapani Features Writers
Harare faces lawsuit over poor water quality
Paidamoyo Chipunza Senior Health Reporter
Harare City Council faces a possible class lawsuit by residents who fear their health has been compromised by being forced to consume visibly contaminated water supplied to their homes by the local authority.
The residents, through the Harare Residents Trust (HRT), a non-profit organisation, have called for the immediate resignation of city officials in charge of water and councillors who exercise oversight over the portfolio for failure to protect their interests.
In an interview with The Herald yesterday, HRT director Mr Precious Shumba said local authorities had a legislative and constitutional duty to provide potable water to residents. He said failure by councillors to ensure residents got adequate supplies of clean water was unpardonable, calling for their immediate resignation.
“Their failure to ensure that residents get sufficient potable water means that they have failed to deliver and hence must not entertain hopes of being retained in their positions. They do not deserve to represent the ratepayers, because they lack an appreciation of what really satisfies the electorate,” said Mr Shumba.
HRT, he said, had prepared submissions that it will take to the Parliamentary Portfolio Committee on Local Government, Public Works and National Housing, including ministries responsible for public health, water and sanitation, to express ratepayers’ displeasure with council’s performance. Mr Shumba urged residents to collect samples of tap water for testing as part of evidence-gathering to be used to sue Harare City Council.
“We are urging residents to take samples of their municipal tap water for tests with the Standards Association of Zimbabwe (SAZ)so that there is evidence of the water status, which we shall be using to sue the City of Harare if it is established that their water has negative implications on people’s health,” said Mr Shumba.
It is however, believed that prosecuting HCC without amending the relevant law will be difficult. Community Working Group on Health (CWGH) executive director Mr Itai Rusike urged the Ministry of Health and Child Care to finalise revision of the Public Health Act, which he said had loopholes that make it difficult to prosecute local authorities for giving residents dirty water.
CWGH is a community-based organisation formed in early 1998 to lobby on health issues. Through the envisaged amended Act, the Ministry of Health and Child Care wants to make it an offence to fail to provide clean water and sanitation to the public.
“There are a number of problems in the environments of health in the capital city, Harare. Unreliable water supplies, prolonged water cuts, uncollected garbage — all lead to unsafe alternatives, which are detrimental to health,” said Mr Rusike.
He said increased cases of diarrhoeal diseases in the capital relative to other cities were clear evidence that the general uncleanliness of the water and the environment in Harare were taking a toll on residents’ health.
“Clean water supplies and environment conditions underlie many of the health problems in Harare and they should be dealt with with the seriousness they deserve.”
Recently, HCC Mayor Councillor Manyenyeni attributed the inadequate water supplies to a shortage of treatment chemicals such as aluminium sulphate, sulphuric acid, HTH Chlorine and activated carbon. He noted that foreign currency shortages are making it difficult to import the critical chemicals.
Statistics from the Ministry of Health and Child Care, Harare tops other cities and towns on diarrhoeal diseases in the country, and this is attributed to inadequate water supplies and poor sanitation facilities. Last year, the city struggled to contain a typhoid outbreak that emanated from Mbare and later spread to other high-density suburbs.
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Govt to subsidise healthcare for the vulnerable
Government will use the Health Levy, which has so far received $22 million, to supply vital medicines and medical sundries required by health institutions to implement the free user-fee policy for vulnerable groups, Health and Child Care Secretary Dr Gerald Gwinji has said.
The Health Levy is money realised from a 10 percent cellphone levy deducted from every $1 worth of airtime which was introduced by Treasury last year, half of which is channelled towards health.
Responding to questions on Government’s source of funding for a successful free user-fee policy, which has been in existence since 1980 but was not being implemented due to inadequate funding by Government for health institutions, Dr Gwinji said medicines and medical sundries consume the bulk of institutions’ budgets.
He said a mechanism was required to meet costs of medical care for the elderly, children under five years of age and pregnant women following a recent directive by his ministry to all institutions to ensure that patients in these categories did not pay for basic health care.
“The main challenge for implementation has been availing commodities and equipment in the face of low budgetary support. It is true that some mechanism must pay for this service when it is eventually availed as free service to the identified patients,” said Dr Gwinji.
Dr Gwinji said Government, together with its partners, had over the years strategised and built support for the care of children under five years and pregnant women. He said the main issues in addressing these challenges had always been provision of medical commodities.
“The Health Levy, dedicated to commodities like medicines and surgical sundries, has come in to further strengthen this position,” said Dr Gwinji.
He said this year, the health sector also got a better budgetary allocation compared to previous years, which he said would enable the free user-fee policy to become a reality.
“Putting all this together, we feel we have gone over the threshhold where we really can support the categories (the elderly, pregnant women and children under five) with access to service as per Government policy,” he said.
Medicines, vaccines and other consumables worth over $11 million have already been ordered. Dr Gwinji said Government would however continue to advocate for adequate funding for social welfare to enable the health sector to effectively assist other patients outside these categories but were unable to meet the costs of medical care.
Dr Gwinji said going forward, if the current health financing policy was supported, it could create further opportunities for sustainable health care financing through diverse sources of revenue spelt out in the policy. The health financing policy gave birth to cellphone taxation and has other suggestions for mobilisation of domestic financial resources.
Health institutions contacted for comment on the scrapping of the user-fee policy said they had already effected the directive. Harare Central Hospital chief executive officer Mrs Peggy Zvavamwe said: “So far, everything is going on well and we have been assured that we will also get extra allocations to cover costs of these identified patients, who are no longer paying for medical care.”
She concurred with Dr Gwinji that medicines and medical sundries consumed the bulk of their budgets and that should Government meet these costs for the vulnerable groups, the burden would be lighter for health institution in the country. Community Working Group of Health executive director Mr Itai Rusike said while the free user-fee policy had always been in place, its implementation got mixed at various levels of care.
He said in some instances, patients would receive free consultation fees but would have to pay for medicines or other required services. Mr Rusike implored Government to increase funding for health including grants, for the country to effectively implement its policies.