Author: clarency

HARARE – Public hospitals could be driven towards the brink of closure through the implementation of a long-standing government policy compelling them to offer free treatment to expecting mothers, children under the age of five, and citizens above the age of 65 years.

This follows a recent directive issued by the ministry of Health and Child Care to all public health institutions that had hitherto been allowed by the administration of former president Robert Mugabe to recoup all their expenses from patients regardless of age or special condition in order to stay afloat.

But with elections around the corner, President Emmerson Mnangagwa’s government has dusted the files by enforcing the policy under the guise of implementing the ministry of Health’s 100-day action plan.

Health experts are, however, alarmed by the directive.

They feel there is urgent need to first secure funding to subsidise the public hospitals that were generating essential cash flows from hospital fees levied on expecting mothers, senior citizens and children under the age of five.

In the absence of government support, they warned that patients could in the end pay a heavy price for it since the levels of health care in public institutions could further deteriorate, leading to the possible closure of some of the facilities.

Community Working Group on Health executive director, Itai Rusike, said the major impediment towards the implementation of the long-standing policy had always been lack of resources.

“We can only achieve this if we increase the domestic funding towards health and increase the budget allocation to at least 15 percent of the total budget as required by the Abuja declaration,” he said.

“The health sector used to be second after Education (in terms of budgetary allocations but) now it has been relegated to number five,” Rusike told the Daily News.

Rusike said there was real and present danger that most facilities could be forced to close if additional resources are not found to bridge the funding gap.

“So what we need is action not just talk. Yes we welcome the directive because it will promote health-seeking behaviour among the population but there is also the danger that there won’t be quality services,” he added.

In the 2018 National Budget, Finance minister Patrick Chinamasa allocated a measly $454 million towards the health sector, against the required $1,3 billion.

Out of that vote, $297 million is expected to go towards employment costs while and $119 million would be for operations and maintenance.

To bridge the gap, government is pinning its hopes on a $239,6 million support from development partners.

In his budget analysis, Prosper Chitambara, an economic expert, averred that not much was being done to guarantee quality of healthcare.

“Per capita health allocation stands at about $30 in 2018 up from $22 in 2017 and about US$24 in 2016. The inadequate public financing of health has resulted in an overreliance on out-of-pocket and external financing which is highly unsustainable,” he argued.

“The per capita allocation is much lower when you remove the employment cost component. The per capita health allocation is lower than the Sadc average of $146. Per capita health allocation is $650 in South Africa, $90 in Zambia and $200 in Angola.”

Most government programmes are being supported by development partners through initiatives such as Resource-based Financing and the Health Development Fund.

Rusike said it was not sustainable to continue relying on donors since some of the programmes will be coming to an end.

He said it was more sustainable for government to consider introducing a national health insurance scheme where everyone contributes.

The Zimbabwe Association of Doctors for Human Rights said government should increase its investments into the health sector.

“No woman should die while giving birth. Increasing access to care by limiting barriers that is user fees et cetera by pregnant women should be coupled with increased investment in the sector by the government,” the association said on its Twitter account.

The issue of free user fees dates back to 1980 when Zimbabwe gained its independence from Britain.

Back then, it was easy to implement the policy because it was backed by an Act of Parliament.

At the time, the policy also covered workers who were earning less than ZW$150 per month and could not afford paying for health services.

In order to cushion the health institutions, government used to release a subsidy to the Department of Social Welfare, which was billed by hospitals providing services to the under privileged.

It was also the trend back then for health facilities owned by local authorities and churches to receive grants from international partners to enable them to provide services to vulnerable groups.

However, these have not been getting any grants for the last 20 years or so.

When the situation in public hospitals turned ugly, government made a complete U-turn on the policy to enable them to recoup their expenses from patients.

Interestingly, towards the 2008 elections, the populist government of Robert Mugabe made another policy change.

It was announced that there would be free treatment for under-fives and those over 65 without any Act of Parliament to support the directive.

This resulted in a situation whereby mothers were detained at hospitals for failing to settle their bills.

In the case of citizens above 65 years of age, while there were not asked to pay for admission fees, they were made to pay for other services such as the cost of x-rays.

The year 2018 brings high expectations of resurgence — politically, socially and economically, with Zimbabweans’ hopes buoyed by the ushering in of a new dispensation led by President Emmerson Mnangagwa.

For Zimbabwe, this year should see free and fair elections, improved health sector, enhanced agricultural production and social services delivery. Political analyst Mr Eldred Masunungure said the new political dispensation and new leadership had brought major expectations from the populace which the Government was expected to fulfil.

“It is, however, impossible to fulfil all the expectations within a short period, but already we have seen major changes within the health sector. The major expectation is free and fair elections. The new President has already spoken of free and fair elections and we hope the election process will produce tangible and uncontested results,” he said.

Mr Masunungure said many people in and out of Zimbabwe and even the diplomatic corps and international financial institutions are looking forward to robust re-engagement discussions.

“We hope the issue of elections and delivery of social services will be on the zanu-pf leadership goals and manifesto. We expect improvement in education and the health sector, which was on the verge of collapsing. There has been shortage of drugs and personnel. We expect a quick turnaround.

“We are grateful that already user fees have been scrapped on hospital charges for children under five, maternity and elderly patients and we hope things will continue to improve in the health sector. We also expect physical infrastructure — the state of roads should be improved and the projects to rehabilitate roads should be completed,” he said.

Stakeholders in the agriculture industry are optimistic of the year 2018. Zimbabwe Farmers Union director, Mr Paul Zakariya said the appointment of the new minister of Lands, Agriculture and Rural Resettlement, Chief Air Marshal Perrance Shiri (Rtd) was a welcome development.

“The minister has already given hope to the agricultural industry by calling for stability on farms and encouraging both local and foreign investment. Practical measures have been made also to create space for active involvement of the private sector in the industry.

“Attention is being given not only to crops, but support has also been extended to livestock sector as well. Government has launched Command Livestock programme and farmers are very expectant,” he said.

Mr Zakariya said the development of local markets through the resuscitation of Cold Storage Company would play a major role in the commercialisation of small holder agriculture. He said there was huge potential to grow the sector and the inclusive approaches that were being encouraged by Chief Air Marshal Shiri (Rtd), if followed through, would certainly bear fruit.

“Agriculture remains the backbone of the economy with very other industry deriving its life from that sector,” he said.

Agriculture economist, Mr Midway Bhunu said stakeholders in the sector were expecting the finalisation of the land audit to put land to production.

“We also expect finalisation of land tenure issues, bankability of 99-year leases and issuance of leases to farmers. There should also be policies to promote investment in cash crops — tobacco, cotton, coffee and horticulture. Prompt payments to farmers under Command Agriculture should also continue in 2018,” he said.

Community Working Group on Health executive director Mr Itai Rusike said civil society was looking forward to seeing efficient use of resources allocated to the health sector by plugging the leakages. He said these leakages should be plugged through strengthening health governance structures and improvement of accountability and transparency.

“We expect to see a functional public health delivery system from the current broken health services that the people can trust and have confidence in,” said Mr Rusike.

He said Government should also finalise the Public Health Act Amendment Bill, which has since been gazetted for debate in Parliament. He said the loopholes in the current Act have seen local authorities such as the City of Harare taking advantage by pumping dirty water to the residents without facing any consequences.

“We expect to see the health sector moving towards realisation of universal health coverage and not leaving anyone behind through prioritising domestic health financing, acknowledging and recognising the role of community health workers, access to essential medicines and having a clear user fee policy backed by law and adequate resources,” said Mr Rusike.

In line with universal access to health, Government has since scrapped hospital fees for infants, senior citizens and pregnant women. The cost of blood has also been revised downwards to $50 a unit with effect from today. The Zimbabwe Republic Police recently admitted to inadequate supervision and unbecoming behaviour of some members as having eroded public trust, faith and confidence in the force.

Addressing senior officers in Harare, Acting Police Commissioner-General Godwin Matanga said they would not hesitate to resuscitate the National Development Committee and to empower the Inspectorate Unit to enhance supervision of police activities at all levels.

Godwin Matanga

“There is a well-known Shona saying that, ‘kugona chivi kuzvituka’. May I therefore urge all of us to self-introspect, accept that our challenges emanate from lack of inadequate supervision and unbecoming actions by some of our members, which have no doubt eroded public trust, faith and confidence in the police service,” he said.

“The young police officers need our constant and regular guidance so that they do not stray and malign the good name and image of the police service.”

Acting Comm-Gen Matanga said refresher, developmental and induction courses would be conducted with renewed vigour so that all officers have in-depth knowledge of police work. Customer satisfaction, professionalism, respect, courteousness and restraint, Acting Comm-Gen Matanga said, would be the epitome of all police activities.

CWGH Analysis of the 2018 National Budget Health Implications

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.