THE Zimbabwe national budget should cease prioritising military expenditure and channel funds towards the ailing health sector in order to reduce internal conflict from disgruntled healthcare workers.
By Michael Gwarisa
Giving an analysis of the 2020 Health Budget, Community Working Group on Health (CWGH) Executive Director, Mr Itai Rusike said the 2020 budget has remained static and largely uninspiring and the humongous allocation of fund to the military was worrisome.
While the Ministries of Basic Education and Health got the second and third highest votes after agriculture, their allocations at 13.3 percent (primary and secondary education) and 10.1 percent (health and child care) still remain below the Dakar Declaration (20 percent) and Abuja Declaration (15 percent) targets respectively.
“The combined vote to military and the security sectors remain worrying for a country that is at peace. Renowned scholar, Professor Paul Collier from Oxford University shows that military expenditure retards development by diverting government resources that could be put to better development use. He argues that military expenditure is not an effective deterrent of rebellion, and, if it is reduced in a coordinated manner across a country then external security interests would be unaffected,” said Mr Rusike.
He added that resources freed by reduced military expenditure can be used to enhance development which in turn would reduce the risk of internal conflict.
“The 2020 Health Budget has remained static and largely uninspiring given that it has not addressed the critical issues that we raised in our Pre-Budget position paper. It falls far short of the Abuja Declaration Target of 15%. Moreover, there is greater emphasis on the allocation of more resources to curative services at the expense of preventive services and it is also very silent on how it would respond to the doctor’s incapacitation crisis and the conditions of service for health workers.
“It is inconceivable and unconscionable that in a country which has faced a cholera epidemic, severe typhoid outbreaks amongst other serious and fatal environmental diseases we continue to give little priority to preventive health services. The ability of the health sector to deliver and organize the health services needed to manage the increasing disease burden faced in Zimbabwe depends on a reasonable per capita allocation to health.”
He also said the current dispute between the hospital doctors and government was a culmination of a build up over the years of an inadequate balance between spending on salaries and on the resources and supplies needed for the effective professional practice of personnel, a contraction of real wages in the sector and an inadequate industrial relations system to manage these issues.
“It is extremely difficult to see how a nominal increase on salaries in medical services will enable the Ministry of Health to deal with the growing dissatisfaction with salaries and the attrition of personnel.
“The decline in real terms of public health funding over the years has come in the wake of Government’s implementation of the economic reform programme which endeavors to reduce Government expenditure. In light of this, the Ministry of Health needs to put in place an efficient system in drug procurement, stock management, distribution etc. to ensure that drugs are available where they are needed.”
Meanwhile, government has proposed to increase the excise duty on tobacco by reviewing the specific rate from ZWL$50 to ZWL$100 per 1 000 cigarettes. According to CWGH, these additional resources mobilized by this increase in ‘sin taxes’ must be channelled towards the public health sector.
Government allocation on health and child care as a percentage of total public expenditure rose to 10.1% in 2020 up from 7% in 2019. However, the Abuja target still remains an elusive target for the country.
Total government expenditure on health as a percentage of total government expenditure is less than 15 percentage (Abuja target) over the period 2012-2020. The Sub Saharan African average is 13 percent. The Government also spends a relatively small share of its gross domestic product (GDP) on health care projected at 1.9 percent in 2020 down from an estimated 2.8 percent in 2019.
“The inadequate public financing of health has resulted in an overreliance on out-ofpocket and external financing which is highly unsustainable. Development assistance towards the health sector is projected at US$360,745,139 in 2020 up from US$316,224,754 in 2019.
“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.”
He added that about 90 percent of the health vote is allocated towards primary health care and hospital down from 91.2 percent in 2019; about 6.7 percent is allocated to public health (up from 4.4 percent in 2019); and about 3.7 percent is appropriated towards policy and administration in 2020 down from 4.4 percent in 2019.
However in terms of the primary health care and hospital care appropriation about 64.9 percent is employment costs related with 35.1 percent being capital expenditure (see Table 6). About $335 million was allocated to rural health centre and community care; $1.2 billion was allocated to district/general hospital services; $915 million to provincial hospital services; and about $1.2 billion to central hospital services.
“The district and community health systems are the foundation of the national primary health care system. In terms of public health, Government appropriated about $96 million to the fight against communicable diseases; $129 million to non-communicable diseases; about $98 million to research and development; and about $76 million to family health as shown Table 7.
“These amounts are grossly inadequate to deal with the scourge of the communicable and noncommunicable disease burden.”