CWGH Input into the 2016 National Health budget

BUDGET INPUT – HEALTH SECTOR 2016

Introduction
The Community Working Group on Health (CWGH) is a network of community/civic based organisations whose aim is to collectively enhance community participation on health in Zimbabwe. The formulation of the National Budget is one area that the CWGH noted required the greater input of the community who happen to be the tax payers. Traditionally the National Health Budget has been formulated by the technocrats at the ministerial level without the direct input or suggestions from the community. Over the years CWGH has been increasingly advocating for community involvement in budget formulation. Community participation in health matters and budget formulation gives a greater depth to the discussion and understanding of the health issues in the country and facilitates achievement of the country’s overall health goals.

The principle that health is a basic and a fundamental human right can never be overemphasized, particularly now that the Constitution has clearly stipulated that health care is a right of every Zimbabwean. For any country to be successful it must guarantee that every individual in that country has access to health, which is affordable, available and of high quality. Community participation matters and health financing, including the budget formulation process gives a greater depth to discussion and understanding of the health issues in the country and facilitates appreciation and therefore achievement of the country’s overall health goals. It is heartening to note that the country has enshrined the individual right to health in the new constitution.

The Ministry of Health and Child Care’s mandate in line with the national vision states that “The Government of Zimbabwe desires to have the highest possible level of health and quality of life for all its citizens, attained through the combined efforts of individuals, communities, organisations and the government. The vision will be attained through guaranteeing every Zimbabwean access to comprehensive and effective social services”. It is this vision which guides our beliefs and values as a community based organization that promotes primary health care philosophy and approach; hence the annual submission of a position paper on the national budget.

The Current Health System Status
Zimbabwe’s public health system provides a comprehensive package from primary to quaternary level services. The primary level is the clinic or health facility and rural hospital with a few admission beds, referring to the secondary or district level where there are at least 3 doctors, and theatre facilities, to the provincial level with 2 or more specialists, and the quaternary level which is the central hospital, with all services including training of high level professionals. The public health delivery system comprises central government, local government and church related hospitals, the latter two being grant aided, (annual support grants and personnel costs) and providing the health services as a delegated mandate from the MOHCC. In the 1980s and 90s the country had one of the best primary health care service models in Sub-Saharan Africa. However, over the years these gains in primary health care have been eroded by a host of factors, and chief among them the inadequate funding of health from the central government. For
example most rural and urban area primary services are provided by local government and church related institutions, but inadequate grant support has negatively affected the provision of these services. The resettlement of people as a result of the land reform placed people in remote areas or areas which did not have health facilities and adequate sanitation, pushing them beyond the benchmark of 10 km radius from a clinic. Communities in these new areas have either use a lot of out-of-pocket money to travel to access care or in a worst case scenario decide to forgo seeking any health care services at all.

Overview of the Burden of Disease
The inadequate funding for health care has meant that the country has been unable to realise its full potential of providing sufficient and quality services to its people. The country has struggled with a huge burden of disease, oftentimes referred to as quadruple in nature. That is, the high burden of tuberculosis, malaria, HIV and Aids, the other communicable disease – cholera typhoid and other epidemic prone disease, the Non-Communicable diseases, and the neglected tropical diseases. It has seen a sharp increase in the general mortality. However in other areas
that are mainly funded by external partners such as Maternal and Child Health have seen a steady improvement in health status as mortality rates have gone down (Figure 1), while those that are not such as NCDs remain an albatross around the MoHCC’s neck as shown in the panel of figures below (Figure 2).

Figure 2: Burden of Disease Communicable and Non-Communicable Diseases
Communicable diseases still remain a cause for concern for the country. They still account for over 62% of overall mortality in the country. HIV and AIDS remains one of the leading causes of burden of disease in Zimbabwe. The current leading causes of death are HIV and AIDS followed by lower respiratory infections, diarrheal diseases and neonatal and preterm births. While the current causes of morbidity and years of life lost as result of disability are HIV and AIDS, low back and neck pain, depressive disorders iron deficiency anaemia and skin diseases.
Since 1990 life expectancy has been reduced from 63.1 years to 54.1 years for males and 67.7 years to 57.9 years for females
Socioeconomic Situation
Over the last 15 years the economy has suffered immeasurable damage. Its domestic and foreign debt has grown to unsustainable levels affecting the country’s ability to attract the much needed international finances. Agriculture production for most essential commodities, except for tobacco has gone down affecting the food security and livelihoods of a lot of households. The advent of dollarization made it even worse as the country became uncompetitive on the international market. Although prices of essential commodities and health services have began to go down as evidenced by the current deflation, most still remain priced beyond the majority of the people in
the country. Household food security has been negatively by poor harvest yield of food commodities. The poor performance of the economy has also led to the closure of a number of companies in all sectors of the economy. This has culminated in the reduction of aggregate production and loss of work, and this has in turn negatively affected both the government’s finances and the general social welfare of the people. The few remaining operational companies are currently restructuring and rationalising their workforce leading to massive job losses and the
resultant massive social problems. These job losses have exacerbated an already precarious situation as regards the health status of the population. Against this background we continue to witness rising Out-of-Pocket (OOP) expenditures for health and a generally low level of utilisation of health services by most households at a time when they need the service most. Chronically ill patients who require constant supplies of expensive medications have been hit hard. Studies on financial and benefit incidence analysis have shown that the poor household and
vulnerable population groups contribute relatively more to taxes, but get relatively low health benefits and disproportionate access to critical health services*.

Overview of the Health financing
During the 1980s and 1990s, the government funded the bulk (up to 90%) of the country’s health care needs. Funding was also relatively adequate in the urban areas, but not quite so in the rural areas. However, for the past fifteen years patients or households have borne the burden of paying
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Institute of Health Metrics and Evaluation, country profile for Zimbabwe 2013
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CWGH Input into the 2016 National Health budget
for health care through OOPs, while the external partners have increasingly contributed to the
bulk of public financing for health services in Zimbabwe.

The current National Health Accounts show that patients, through OOPs account for 39% of the
Total Health Expenditures (THE), followed by the private sector expenditures with 24%,
external partners with 19% and government with 18%. External partners
3
through the Global
Fund, the Health Transition Fund (HTF), PEPFAR and GAVI continue to provide the bulk of the
public health financing. About 98% of the drugs in the public health system are funded by
external partners. These include Anti-retroviral treatment medications (ART drugs), TB and
Anti-malarial drugs and primary kits for Maternal Neonatal and Child Health (MNCH) services.
External partners also continue to provide critical medical equipment at both the primary and
secondary levels of care in order to strengthen the country’s primary healthcare service delivery.
Although external partner funding and support is channelled off-budget
4
, most of the funding and
commodity support goes through established government entities in order to sustain them and
strengthen their capacities. For example, most of the drugs pass through the National
Pharmaceutical Company (NatPharm), which gets paid some nominal fees for storage and
distribution fees. These have continued to support its operations against a background of low
funding from the government. The government of China has also supported the MoHCC with a
loan of over US$89 million. The loan has largely been in the form of provision of critical
hospital equipment. However, in the medium to long term over-reliance on external partner
support will be counter productive. The government needs to therefore increase its domestic
funding as this financing mechanism has always proven to be sustainable. In view of all these,
whichh we feel have contributed to non- achievement of the Abuja targets and the soon to be
reported MDGs, therefore threatening the achievement of the SDGs, we have a few
recommendations for consideration in 2016:

3
4
USAID, DFID, SIDA, Irish AID, NORAD, European Union, GTZ
Off-budget funds do not pass through the Ministry of Finance for allocation; hence are not reported in the National
Budget.
Recommendations from CWGH for the 2016 Budget

1. On provision of health services

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CWGH Input into the 2016 National Health budget
 Staff establishment: A costed new staff establishment needs to be developed by the
MoHCC. The CWGH urges the Government to revise the MoHCC’s 1980 health worker
establishment levels in order to reflect the current workload this needs urgent review to
alleviate the staff shortages and consider employment of qualified health workers that are
sitting at home due to the current freeze on employment. The existing staff establishment
is not adequate to address the increasing disease burden, population and emerging health
threats, and this is well articulated in the WHO’s building blocks for health systems
strengthening. In essence the growth in population and disease burden necessitates an
increase in both numbers and capacitation of health care workers for the provision of
sufficient and quality health care services. For example CWGH noted that in some rural
health facilities when the only nurse available goes for a workshop, the clinic is closed.
However, even with the current establishment levels, the government is still unable to fill
in the current establishment. For example 23% of all provincial and central hospitals do
not have dentist
5
. Most District Hospitals do not have 4 doctors as is required in the
current establishment. Some district hospitals are also manned by pharmacy technicians
instead of the required degreed pharmacists.
 Using old establishment posts to create a new health cadre: CWGH also proposes that
for any staff establishment posts that have been rendered redundant as a result of
advances in healthcare or changes in disease and demographics, be used to a create a new
health cadre.
 Strengthening the Referral System: The primary care level needs to be funded fully in
order to also address the non-referrals at the secondary and tertiary levels. The CWGH
also supports the idea of having district hospitals in Harare and Bulawayo in order to
alleviate the burden of patients at the central level. Health Grants to urban local
authorities for supporting primary health care delivery need to be provided on time and
also increased. This will enable the local authorities to lower their user fee charges to
more affordable levels.

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MoHCC Bottleneck Study, 2015
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CWGH Input into the 2016 National Health budget
 Fund for Non Communicable Diseases (NCDs): There is need for the government to
devise a funding mechanism for the NCDs, which are costly to diagnose and manage.
Proposals by the Public Health Advisory Board to introduce earmarked sin taxes to fund
NCDS need to be followed through. Currently only 9% of the health workers have been
trained in managing injuries, trauma and other priority NCDs. For diabetes management
only 53% of the health workers are trained to manage diabetes
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; all this against a high
burden of the NCDs may only a high level of complications and premature or avoidable
deaths.

 Emergency medical services: Ambulance fees are unaffordable and in some instances, if
there is no assurance that someone will pay for that ambulance, the ambulance will not be
dispatched leading to complications and death. Further, the state of most of the public
facility ambulances is of concern as there are inadequate basic equipment including
oxygen and infusion during patient transit and adequately staff, again leading to
complications and avoidable deaths.

 Support for Primary and Secondary Level of Care: A significantly larger share of the
budget should go to the district level to support health facilities and the first referral level.
Basic health infrastructures in urban, informal, resettlement and rural areas need
improvement. While there has been some improvement with MNCH indicators, Infant,
under 5, and maternal mortality rates remain a cause for concern and current rates are still
high compared to the regional estimates and previous country estimates. Poorer
households continue to endure disproportionate losses in infant, child and mortality as
compared to the richer households. CWGH therefore encourages more funding for
primary level care. The current ratio of over 70% funding being allocated for curative
services and less than 10% funding being allocated for preventive services, will not see
the country moving towards reducing further the rates of maternal and child mortality.

2. Selected Programmes

 Health Services Outreach: A number of patients are still enduring unbearable long
distances to access primary health care facilities. The Government therefore needs to

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MoHCC Bottleneck Study, 2015
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CWGH Input into the 2016 National Health budget
increase funding for outreach services so that communities in remote areas and newly
resettled areas can also have access to care. To encourage nurses to do these outreach
services, the government must also consider improving conditions of service and
providing incentives to them to work in remote areas.

 Results Based Financing (RBF) and the Health Transition Fund (HTF) – At the very
short term the RBF/HTF programmes have improved the health outcomes of a number of
facilities in the country. However, the little amounts for incentives that some clinics are
getting from the RBF remain a cause for concern. Some facilities are receiving as little as
US$20 per quarter resulting in low morale and in the process compromising service
provision. These small amounts have also increased the gap between those facilities that
are receiving more and those that are receiving less. The RBF/HTF programme may need
to further review and refine its incentive system to address some of these discrepancies.
Communities should be involved to better support the health workers and jointly plan for
improved services while advocating for more resources. Tensions between RBF Local
Purchasing Agencies and Health Centre Committees have also developed due to some of
these small awards being given to some facilities increasing the vulnerability of the
facilities and their respective communities.
 Vulnerable Populations and Assisted Medical Treatment Orders (AMTOS: While
there are existing government policies to cushion the vulnerable groups from making
catastrophic health payments, there is still insufficient government counterpart funding
for Maternal and Child Care and for the Assisted Medical Treatment Orders (AMTOS)
programme. Government promised the RBF programme US$5 million for this fiscal year
as counterpart funding, but up until now it has not disbursed the full amount. Some
patients have failed to honour their payments often times resulting in institutions
commencing legal proceedings against them (Debt collection and attachment of
household properties). Senior citizens who are exempted from paying user fees are still
paying for other access fees such as ambulance services, blood and medications.
Counterpart funding for the RBF programme needs to be increased in order to cover
some of these unaffordable but critical services. These funds must also be disbursed on
time so that efficient provision of services is not affected.

3. Drugs and Sundries

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CWGH Input into the 2016 National Health budget
 Essential medicines: For imported drugs, bulk purchasing mechanisms should be
strengthened through supporting NATPHARM. Increased funding to NATPHARM will
enable it to continue to capitalise its operations so that it can increase its capacity for cost
effective bulk procurement, storage and distribution. Availability and distribution of
medicines is still a huge challenge, hence accountability mechanisms of the distribution
chain should also be put in place and monitored by communities and by MoHCC to
prevent leakages of drugs purchased at reduced prices. CWGH therefore supports
increased funding for NATPHARM operations so that patients do not get drug
prescriptions in order to access medications from private pharmacies. Adequate funding
of this critical arm of the health care will enhance and improve availability and its
medicine distribution chain and management and in the process also curtail the growth of
the counterfeit drug market.

 Paediatric AZT drugs: The MoHCC bottleneck study estimates only 38% of the
facilities have paediatric AZT. National AIDS Levy Funds, in particular the new funds
directly targeted for district level activities could also be used to improve the availability
all paediatric preparations including of AZT in health facilities.

 Blood Products: Blood products have become expensive and inaccessible to many
. A
bottleneck analysis that was carried out by the Ministry of Health and Child Care shows
that 60% of secondary facilities were found to have no blood in their stocks. Some
facilities could not stock blood because of unavailability of fridges, electricity and
general poor infrastructure. There is therefore need for the government to consider other
alternatives such as solar refrigerators for storing blood products. The Zimbabwe
National Blood Transfusion Services (ZNBTS) Company is considering introducing
Nucleic Acid Testing (NAT) for blood screening. The NAT has higher sensitivity and
specificity for detecting multiple bacterial and viral infections than the current
technologies being used. NAT also reduces the window period by which results are
known, making it more cost effective. There is therefore need for government to provide
funding for rental capital or for the procurement of required NAT machines. More

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MoHCC Bottleneck Study, 2015
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CWGH Input into the 2016 National Health budget
funding will also be needed for ZNBTS to develop a comprehensive national blood
management system.
 Kits for Emergencies Response: The MoHCC bottleneck analysis revealed that only 16
district hospitals have kits for any emergency response, while only 50% of the staff has
been trained for outbreak detection and response. There is therefore need to assign a
budget for strengthening the country’s outbreak detection, preparedness and response.
4. On Infrastructure and healthcare technologies

 Capital Budget and facility rehabilitation: The limited capital budget leaves the
government with little room to provide new infrastructure, carry out major refurbishment
in some and improve the existing ones. Current expenditures have accounted for more
than 80% of the MoHCC budget, leaving inadequate funds for the capital expenditures.
There is therefore a need for the government to increase the MoHCC’s capital budget,
especially the funds allocated for the targeted infrastructure rehabilitation programme.

 Health Technologies: Surveys on human resources and Infrastructure have identified
huge gaps in terms of human resources availability and health care technology
availability; there is therefore a need to move towards ensuring that agreed normal levels
and types of human resources are available and financed at the district level, as well as
ensure that the minimum healthcare technology is found at the district level. For example
only 47% of facilities in the whole country have TB diagnostic testing equipment, while
44% of facilities have functional glucometers and strips for diabetes testing and
screening.

5. Health Financing

 On Strategies for increasing fiscal space: CWGH supports the Government position on
the need to reform the civil service in order to harvest the much needed fiscal space
. In
particular the CWGH supports the rationalisation of wages in line with the current fiscal
sustainability plan agreed between the government its partners; for example the removal
of duplication and redundancies that impact on the overall efficiency of the system and

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IMF Country Report April 2015
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CWGH Input into the 2016 National Health budget
the creating of relevant new cadres using the old establishment. CWGH therefore
strongly supports the Government’s commitment to cut expenditures for non-priority
current and capital spending to free funds for other important issues. The CWGH also
supports the effective and efficient coordination of Aid by one single entity so that AID is
channelled where it is needed most.

 Honouring the Abuja commitment: A decade and half after Abuja, only 6 countries
(Liberia, Madagascar, Malawi, Rwanda, Togo and Zambia) have achieved the Abuja
Target of allocating at least 15% of their annual national budgets to healthcare. Of note is
Rwanda which spends at least 23.7% of its budget on healthcare, three times more than
what the Zimbabwean government allocated to healthcare for the 2015 fiscal year. For
example Rwanda and Malawi have done remarkably well in improving their overall
health outcomes and status. Other countries such as Mali and Ethiopia who are moving
towards realising the Abuja commitment are also doing well in reducing maternal
mortality. The government therefore needs to honour the Abuja Commitment and
allocated 15% of the national budget to health.

 On-Budget support: Government achieved more favourable health outcomes when it
provided more funding than its partners. It also achieved more health gains for the
population when the partners channelled their funding through its systems rather than offbudget.
This is evidenced by its achievements in the 1980s-90s, a period characterised by rapid gains in the health indicators. For example, the government managed remarkable reduction in infant and under 5 mortality rates. If external financing is channelled through the Ministry of Finance, hence through the National Budget it will reduce parallel systems and increase efficiency in the allocation of the funds.

 National Health Insurance: CWGH supports the creation of a National Health
Insurance, and bemoans that this process which could have been implemented a decade
ago remains somewhat non-priority. We urge government to urgently address this matter
and reduce the current high levels of catastrophic health spending, especially given the
fact that the medical insurance industry which at its best only covered up to 20% of the
population has been allowed to rot and throw more households into high OOPs.
World Health Organisation on meeting the Abuja Targets

CWGH Input into the 2016 National Health budget Furthermore, CWGH recommends the management of the proposed NHI be given to the MoHCC instead of the Ministry of Public Service, Labour and Social Welfare. The
CWGH is of the opinion that unlike the Ministry of Public Service, Labour and Social Welfare, and the MoHCC has enough Acts under its portfolio to oversee the smooth running and management of such an important fund. The CWGH also expresses concern on the level of consultations that have been done in coming up with the bill. CWGH
therefore advocates for adequate and inclusive consultations with stakeholders as input into the NHI and a monitoring mechanism be put in place at the outset to ensure this process is not stalled again.

 Public-private partnerships (PPPs) – Two notable institutions, Mpilo hospital and Chitungwiza hospitals are good examples of state institutions that have ventured into PPPs, with Chitungwiza hospital recording some key notable successes. For example its partnership with Jet Lab in 2013 enabled it to acquire an endocrinology analyser
equipment then valued at over US$900 000. The hospitals also entered into joint ventures with other private players in the areas of radiology, catering services, mortuary and pharmaceutical departments. While these initiatives are commendable, CWGH notes with concern the slow privatization of these institutions, particularly Chitungwiza hospital. This could in the future negatively affect the provision of services at these institutions. CWGH strongly supports these initiatives and the government’s commitment to PPPs. However these initiatives must strengthen the ‘first P’ rather than the ‘middle P’; thus recommending the strengthening of the Public Health system first so that it can deal with the Private sector from a position of strength. The CWGH also supports the participation of the government and civic organisations in the negotiations of some of these joint ventures and PPPs.
 Achieving Universal Health Coverage (UHC): The UHC comprises provision of quality health services through essential health services coverage and financial coverage for the whole population. As the WHO notes, the road to UHC is by no means smooth. Achieving UHC requires capacities in many areas. UHC crosses boundaries, UHC is
multi-sectoral and UHC is a process. UHC requires that the government increases its level of domestic funding to make much greater efforts to reach the Abuja Target, which MoHCC administers a total of 16 Acts – Statutory Instrument 27 of 2014.

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CWGH Input into the 2016 National Health budget aimed at achieving 60% then 80%. UHC now requires 100% and requires that the government works towards sustained and innovative financing for health, alongside the
monitoring of key health indicators; cumulative and sustained effort on measures of best addressing the new Sustainable Development Goals (SDGs). Therefore the CWGH encourages the government to honour its commitments in order to achieve UHC.

 AIDS Levy: At the beginning of 2015, National AIDS Council allocated US$5 million from the AIDS Levy funds to be distributed equally to all the provinces for various projects. The funds were distributed based on approved operational plans from the various providers of services. However noble this new initiative maybe, there is need to
strengthen its governance and accountability structures so as to curb any mismanagement of these funds. There is also need to develop an equitable method for allocating the funds based on needs, disease burden and other related factors. The MoHCC’s latest bottleneck study estimates that about 43.5% of communities and households have low food security. There are various areas in the country where people on ART need to be provided with food packs.
6. On Governance and Accountability Public Finance Management (PFM): CWGH supports the amendment of the Public Finance Management Act that seeks to increase accountability of government structures.
For example user fees collected by the major Central Hospitals are not reflected in the MoHCC’s budget. This creates loopholes in the management and accounting of these funds. There is need to set aside funds for the training of personnel in PFM.

Findings of the Auditor General: The government has reaffirmed its commitment to

follow up on findings from the Comptroller and Auditor general on ministry
expenditures. The CWGH supports this and urges the Ministry of Finance and in
particular the MoHCC to treat this as urgent and make a follow up on the Comptroller
and Auditor General’s recommendations from the 2014 Audit Report and other previous
audit reports Report Parliament Portfolio Committee on Health, 2015
Corporate Governance Bill: CWGH fully supports the Government’s restructuring of
parastatals through the enactment of the Corporate Governance Bill for strengthening of
its accountability structures.

Independent Board to Regulate Medical Aid Societies (MAS):

We continue to witness the collapse of some schemes, mismanagement of funds and the uncompetitive behaviour
of other MAS leaving their members vulnerable. MAS that have embarked on vertical integration of medical services have negatively affected the services of individual providers of care such as doctors and pharmacists. These single owner operations have been exposed to the unfair competition and uncompetitive behaviour by some of these
MAS. CWGH therefore supports the MoHCC’s efforts of coming up with a Bill for the creation of an Independent body to regulate the work of the MAS. There is need for stakeholders to support this noble initiative and for the MOF to set aside funding for the consummation of this body.

On Socioeconomic issues
 Sustainable Development Goals: The CWGH supports the realization of all the 17 Sustainable Development Goals (SDGs) and advocates for funding to support the realization of these goals. Unlike the MDGs which according to WHO, were often fragmented and led to silo approaches, the SDGs follow an integrated approach, encompassing a multi-dimensional and inter-sectoral approach. The SDGs have a broad set of 13 indicators for health, with other health issues incorporated in other SDGs. It is also encouraging to note that UHC is intrinsically linked to the SDGs with a specific health target; “achieve UHC, including financial risk protection, access to quality and essential health care services and access to safe, effective, quality, and affordable essential medicines and vaccines for all”. For effective realisation of SDGs the country’s economic policies such as the ZIMASSET, the socio-political policies should therefore be used to promote the realization of these goals. The CWGH supports the crafting of realistic and measurable short-medium-to long term targets that can be tracked to assess progress.

 Social determinants of health: Health services should strengthen community health systems and work with communities and all other stakeholders to tackle social determinants that drive the epidemics of communicable diseases and hinder access to health care services. Access to safe clean drinking water is a fundamental human right and there is need for wider consultations on the issue of pre-paid water meters as they have a potential of creating a barrier on access to water thereby increasing the risk of diarrhoeal and other waterborne diseases. The need for Zimbabwe to address the social determinants of health becomes more imperative if the NCDs burden is to be addresses.

 Water supply: Water supply is a challenge at a number of clinics (RHCs) which do not have proper water supply systems. Heavily pregnant mothers are asked to bring their own water whilst waiting to deliver at these facilities. There may be need for partnerships between private businesses and local authority to ensure there is water supply at health facilities.

 Food Security: A deliberate policy to increase the budget of other sector ministries that have direct impact on people’s welfare such as agriculture, mining and transport must be encouraged. At least 10% of the national budget must go towards financing agriculture, specifically the smallholder farmers.
 Loss of employment: Loss of employment leading to loss of earnings will lead to a fall in private health contributions. This is likely to cause many of the former workers to use their own savings for accessing care or decide not to access care at all. CWGH notes that the burden of this loss of employment will likely be heavier on the part of patients who were accessing ART using private schemes and those who would be forced to relocate to rural areas.

It is the CWGH’s humble request that these community submissions be taken into consideration when the 2016 National Budget is being formulated.

For further information, please contact:

The Executive Director
Itai Rusike (Mr)
Community Working Group on Health (CWGH)
312 Samora Machel Avenue
Eastlea
Harare
Zimbabwe

Tel: +263-4- 498 692 / 498 983 / 498 926
Cell: +263-772 363 991
Email: itai@cwgh.co.zw / cwgh@mweb.co.zw
Website: http://localhost/test/
Twitter: @itairusike
Facebook.com/CWGH