The country’s public health facilities are experiencing an upsurge in the number of patients, posing serious challenges to quality service delivery with admitted patients now being housed in physician bays while others are spending hours queuing in corridors.
This follows a dramatic increase in medical fees in private practice as well as medical aid contributions. In the past few months, most medical aid insurers upped their monthly charges, making it impossible for the majority of citizens to continue using medical aid facilities.
The increases were brought about by the general rise in the cost of health services that the country has been experiencing. Drug and sundry costs have trebled, while hospital fees have increased by at least 100%.
Pharmacists, who have not been getting adequate foreign currency, are now demanding payment in hard currency. Medical aid schemes upped their contribution rates to stay afloat.
First Mutual wrote to its clients informing them that it was hiking contribution rates by 35%.
“Scheme has been absorbing the costs while continuing to engage service providers in an effort to find a viable solution. However, we have noted that our members still face challenges with card acceptance and shortfalls,” the company said.
Cimas raised its members’ contribution rates by between 20 to 30% from February.
Many patients are now opting for public hospitals which are cheaper, but under-equipped.
During a recent visit by NewsDay to some public hospitals like Harare Central, Parirenyatwa and Chitungwiza, the wards were packed.
Relatives of patients at Harare Hospital said they were not amused by the fact that government was not paying attention to public health institutions which needed serious expansion to accommodate the rising number of patients.
One of the oldest referral hospitals, Harare has struggled with overcrowding for years.
Parirenyatwa Hospital, which has also been swamped by patients who can no longer afford medical care elsewhere, has been experiencing financial challenges.
Parirenyatwa Hospital spokesperson Lenos Dhire said they were receiving an unusually high number of patients at the institution.
“We confirm that we are experiencing an upsurge of patients presenting to the hospital. Although the situation is posing some challenges, our physicians and nurses are doing everything possible within their capacity to ensure that all the patients receive treatment,” Dhire said.
On Monday, Chitungwiza Hospital spokesperson Audrey Tasaranarwa said all wards were full.
Health stakeholders have implored government to address the underlying causes of the sudden influx of patients.
“Medical aid patients cannot afford the services being charged, which can be as high as US$150 for one night admission. Those on medical aid will be told that your funds have been exhausted and to top up in US,” Fungisayi Dube of the Citizens Health Watch, said.
She added that these challenges show the need for a relook at issues such as health financing which would make it possible to build another hospital.
Community Working Group on Health director Itai Rusike said the facilities were overburdened mainly because of the poor referral system since the two metropolitan provinces do not have district and provincial hospitals, forcing patients to come there instead.
“This calls for the revival of the debate on setting up a national health insurance scheme. We can learn something about sustainable health financing schemes from countries like Rwanda.
Healthcare tariffs condemned
Barring of injured from emergency services slammed
Junior doctors ‘arm-twisted’ to shelve strike
More doctors report for duty
Free maternity services require solid funding
THE heavily pregnant woman lying on the floor in a maternity ward at Harare Central Hospital stretches out her hand to greet First Lady Auxillia Mnangagwa.
BY PHYLLIS MBANJE
An unidentified expecting mother at Harare Central Hospital (right) has to make do on the floor due to shortage of beds in the maternity wing
For the briefest moment, the woman forgets about the hard, cold and uncomfortable surface and basks in the glow of being in the presence of “greatness”.
A wide grin splits her youthful face and she nods her head as the First Lady whispers some congratulatory words.
But once the colourful parade and its entourage has moved on, reality sinks right back in and once again the pregnant woman and her colleagues in the overcrowded maternity ward crouch back into their makeshift beds on the floor.
Harare and Parirenyatwa hospitals’ maternity wards, just like in most public health facilities across the country, are swamped with patients and many have resorted to sleeping on the floor.
This follows the scrapping of maternity user fees in accordance with the government policy.
During a tour of Harare Hospital’s maternity wards on the side-lines of the handover of the refurbished maternity wards by the First Lady recently, there was quite a huge number of women using floor beds.
This sad scenario apparently has become the norm in public hospitals.
Harare Hospital has a carrying capacity of around 100 women, but is currently being stretched to accommodate between 150 and 200 women. This also means pressure on the ablution facilities.
The government’s policy on free maternal health has seen a lot of women seeking help at the country’s major referral centres, Harare Central Hospital and Parirenyatwa.
Council clinics are still charging maternity fees and so many women will end up at government health facilities which are offering these for free.
A tour of Parirenyatwa also revealed the same problems. Maternity wards are full to capacity with many women using makeshifts beds.
“We handle births exceeding 20 in one night and this weighs heavily on the staff that have to work extra to contain the situation,” said a nurse who declined to be named.
She said the staffing levels had not increased and the wards had not expanded to cater for the overwhelming number of women.
“This will ultimately compromise services because the staff will be exhausted from handling so many women.
The women, however, had mixed reactions. Some were quite happy to even have the floor bed as long as they were not paying for it.
“I did not have the maternity fees for the council clinic where I stay so I came here to Parirenyatwa,” said a young first-time mother showing off her baby.
However, others felt that it was dehumanising to sleep on the floor and if they had a choice they would not agree to the set up.
The hospital’s public relations manager Linos Dhire said indeed the maternity wards were overstretched but they could not turn away pregnant women.
“The floor beds have been adopted to manage the ever increasing number of pregnant women who come for the free services. It is a good policy, only that the space is not big enough,” he said.
Community Working Group on Health director Itai Rusike said the abolishment of user fees should be backed up by provision of adequate resources.
“The blanket removal of user fees for pregnant women without clear vetting mechanisms for those that can still afford to pay presents a high risk of suffocating the public health delivery system,” he said.
Rusike also said government may need to seriously look at the long outstanding issue of building district hospitals in major cities to decongest the central hospitals.
“Resources must trickle down to the primary care level to avoid the assumption that the higher levels are better funded and better equipped,” he said.
“Unfortunately, it is not clear on how the ministry is going to fund the gap as pregnant women and under five children constitute the majority of the patients.”
Since 2009, the Health ministry has not been allocating significant resources for maternal and child care services.
This has created an over reliance on donor pools which are not sustainable.
Rusike said the free user fee policy for pregnant women and children under five should not just be political rhetoric.
“The health broken institutions need support with resources from the national budget. We need to protect the dignity of patients once they are admitted in our health institutions,” he said.
Speaking on the issue, Fungisayi Dube from the Citizens Health Watch said the policy was not practicable.
“It cannot be operationalised. It is sad and I do not think there is an effort to change things yet.”
Not The Time For Blame Game- CWGH
THE Cholera outbreak obtaining in Zimbabwe is not a platform to politically outfox each other or exhibit political muscle and prowess as lives are at stake, Community Working Group on Health executive director, Itai Rusike has warned.
By Michael Gwarisa
Commenting on the prevailing Cholera outbreak, Rusike said in as much as the rising number of Cholera deaths and infections exposes the government’s poor disaster mitigation mechanisms or perhaps the lack of political will, this was no time to shift blame on each other but to work together as a progressive force against Cholera.
“Other than declaring the cholera outbreak, that has so far claimed 25 lives and infected 3 700 people, a state of emergency, government response has been lukewarm and at a snail’s pace. Outbreaks of gigantic proportions like these require a very swift national response through raising awareness, treatment and restoration of basic social services. It is appalling that in 2018, people are still dying of such a primitive and preventable disease.
“The Community Working Group on Health (CWGH) calls for a concerted approach among key stakeholders that include the government, local authorities, residents associations, corporate world and the donor community to address the pandemic to save lives. It will be grossly irresponsible and dereliction of national responsibility for the government to allow the situation to degenerate to the 2008 levels where cholera claimed over 4500 lives and left several thousands affected,” said Rusike.
He added that the most worrisome aspect of the epidemic was the fact that the Cholera was that of a drug resistant strain bacteria which could hamper all the efforts if no solution is devised sooner.
“It is terrifying to hear that the strain of cholera bacteria that was isolated in patients in Harare has been determined to be resistant to first line antibiotics Ciprofloxacin and Ceftriaxone. A situational report prepared by the Ministry of Health and World Health
“Organization has painted a grim picture of the challenges facing the city of Harare at the moment saying 2 million people are in danger of co-infection of both cholera and typhoid. With resistance to first line medication it becomes imperative that the government source alternative medicine.”
He also took a swipe at government for neglecting the cholera crisis for the love of lavish lifestyles.
“The US$1m availed by government – criticized for its unquenchable propensity of spending on luxury cars for the Chiefs than important national issues – is not only paltry but an insult to relatives and friends who have succumbed to cholera, typhoid and other waterborne diseases in the past days.
“The cholera outbreak highlights the failure of government to maintain basic public health standards. It is a terrible consequence of failing to invest in and manage both its basic water and sanitation infrastructure and its health system. In most urban centres, residents go for months without tap water, forcing them to dig shallow and unprotected wells and boreholes that have been contaminated by raw
sewage flowing from burst pipes.
“Cities, once the epitome of good hygiene, have now been turned into big communal villages. Local authorities are in charge of all water delivery, sewerage, and refuse collection. They are also the recipients of all rates paid by residents who expect proper service delivery. Authorities must be held accountable to all these preventable an avoidable deaths. We have also heard with dismay, how City authorities are diverting money paid by residents to buy luxury cars and giving each other loans for personal gain,” he said.
He emphasized on the need for clean water in the short term so as to avoid new infections and reinfections in the cholera epicentre areas.
“Residents need adequate aqua tablets, they need boreholes; they need water bowsers as a matter of urgency. The MoHCC, the city fathers together with residents associations and other stakeholders must increase public health awareness programmes and improve public engagement forums to disseminate accurate information to residents.
“In the long term, Zimbabwe needs a consistent supply of clean water to all its people and in urban areas, replace the old water pipes that are letting sewage sip into the water reticulation system to permanently stop future outbreaks. Remember, most of these water and sewer pipes were laid during the colonial era and no effort has been made to replace them 38 years after independence.”
He also urged the Ministry of Health and Child Care (MoHCC), who are the custodian of the recently signed Public Health Act (PHA), to utilize the new law to deal and prevent the outbreak of preventable diseases such as cholera and typhoid. The revised Public Health Act should not just remain on paper but fully implemented and enforced to address the public health concerns.
“The network would like to applaud the corporate world and the donor community for chipping in with material and financial resources in an effort to stop the outbreak. We, however, would like to quickly point out that overreliance on external assistance is not sustainable for any country especially in Zimbabwe where, in most cases, political considerations supersedes all other considerations.
“For years now, Zimbabwe has been failing to adequately provide for the health sector resulting in the outbreak of archaic diseases. It has never met the 15% Abuja target despite acceding to the Declaration over a decade ago. The country is endowed with several kinds of mineral resources that it should not struggle to fund its health delivery system. It has gold, diamonds, platinum, lithium, nickel, chrome and several other at its disposal but surprisingly it is failing to adequately utilize them. This clearly points to poor prioritization or poor governance and lack of accountability as the resources are channeled to less needy areas to satisfy personal political needs.”
He also said that the failure, or perhaps lack of political will, to prioritise funding the health sector gives credence to the widely-held perception that government has been acting that way because most of the political elite are not treated locally but airlifted abroad, even for minor ailments, at the taxpayer’s expense.
“Only the poor are “treated” at local clinic where there are no medicines. Surely, how do you explain the “manmade deaths” to medieval diseases such as typhoid, cholera, the absence of emergency services and now the likely deaths from TB, which is treatable in this day and age”
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.
Govt, council should stop blame-game on cholera
Sustainable funding mechanism critical for healthcare
