Consultations were crucial before legalizing marijuana – CWGH

THE Community Working Group on Health (CWGH) has expressed concern over government’s failure to hold public consultations before legalizing mbanje or cannabis (marijuana) at a time the country is grappling with the problem of drug abuse, especially among the youth.
HealthTimes Reporter

CHWGH Executive Director, Itai Rusike told HealthTimes that the lack of consultation on such critical matters by government would plunge the nation into some irreversible future problems.

“While the organisation does not doubt or discredit the medicinal benefits associated with cannabis, it is the lack of consultations and the social destruction that is likely to occur in the long-term that worries us most.

“The government last week gazetted a $50 000 licence fee for people wishing to produce cannabis and cut prison terms for those caught illegally dealing in the substance. It should be highlighted that Zimbabwe is already grappling with the problem of drug abuse, with the youth taking all sorts of substances including mental health tablets (blue tablets) glue, musombodhiya (strong alcoholic drink), bronclear (bronco), alcohol and cocaine just to get high,”,” said Rusike.

He added that by legalizing, the government is creating a bigger national problem that far outweigh both the medicinal and economic benefits of the substance to the natio.

The societal destruction will be unfathomable while the cost of rehabilitating thousands of people will be unbearable to a government already struggling to fund its health sector. He also said is it was contemptuous of the highest order for the Ministry of Health and Child Care (MoHCC) to legalise the production of cannabis without consulting the communities that would bear the effects of the move.

“It would have been proper for such an important national policy to be brought before Parliament to deliberate on its merits and de-merits on society than just imposing it. The government must have carried out thorough research in countries where cannabis is legalized. By legalizing the substance, the government has put the country on the spotlight for the wrong reasons.

“Zimbabweans wishing to travel to international destinations will be subjected to unnecessary scrutiny, suspicion, searches and monitoring just like the drug barons/mules from the opium producing countries. We are taking the “Zimbabwe is open for business” mantra too far. The high licence fees of $50 000 to produce marijuana entails that it is only the rich commercial farmers that will be able venture into this seemingly lucrative business sidelining the small-scale and communal farmers”

He blasted the fees structure which he says excludes the poor communal farmers meaning that issues of equity were not even considered when this policy was adopted.

“CWGH, as a community-based organisation that promotes community participation in health, put strong emphasis on community engagement and involvement in decisions that affect the welfare of communities in general.”

CWGH Warns Gvt Over Firing Nurses…Urges Parties To Engage In Dialogue

THE Community Working Group on Health (CWGH) has called on government to engage in talks with bodies representing Nursing staff before proceeding with the drastic action of terminating their employment.
HealthTimes Reporter

In a statement in response to Vice President, retired General Constantine Chiwenga statement which announced the termination of employment for more thousands of nurses who participated in the industrial action, CWGH Executive director Itai Rusike said dialogue was the only way forward under the current situation.

“The dismissal of the nurses, which was surprisingly endorsed by the highest offices, clearly shows the new dispensation’s lack of tolerance, patience, negotiating and dialoguing skills.

“Labelling the strike “politically-motivated” when everyone can clearly see the naked causes of the job action points to insincerity and hypocrisy at its highest order. Empty promises, militant stance and piecemeal solutions will not address the causes; we need lasting solution because the health workforce is central to a proper health delivery system. Our leaders should not see political shadows where there are none,” said Rusike.

He added that the new political administration must be reminded that Zimbabweans, including the striking nurses, had high hopes of a better future when it took over the levers of power but now they are frustrated as they see their hopes varnish like morning due. Remember, the future of Zimbabwe depends on decisions you make today.

“CWGH feels that health worker grievances must be dealt with by the Health Services Board (HSB) and the Ministry of Health and Child Care (MoHCC). Why in the first place set up the HSB then fail to give it autonomous and adequate resources to be able address the worsening conditions of health workers as per regional standards?

“As it is, the Board is just draining the fiscus through fat monthly salaries, huge allowances and luxurious vehicles without executing its mandate. It is worrying that the Board does not have independent capacity to make decision that have a bearing on the welfare of health workers because the Health Services Act stipulates that any decision that has a bearing on the Consolidated Revenue Fund must be agreed upon with the Ministry of Finance.

“This actually renders any negotiations or agreements with the HSB meaningless and waste of time. We call upon the government to give HSB the power and resources it deserve for it to properly execute its mandate because at the moment it is a just a feeding trough.”

He also said the strike has a serious impact on the already strained health sector which does not have enough medical personnel, drugs and equipment.

“The absence of nurses in health institutions at a time there are frequent outbreaks of diseases such as typhoid and cholera as well as shortages of medicines of chronic illnesses means more deaths of ordinary Zimbabweans.

“The strike also comes at a time the country’s emergency services have been grounded due to poor funding from central government. In the interest of the suffering and dying patients, the CWGH calls upon the striking health workers and the government quickly ensure that normalcy returns in the country’s health institutions,” added Rusike.

He said the politicking and blame-gaming will not resuscitate the country’s broken and non-functional public health delivery system and only sincere dialogue will let us out of the current health dilemma.

Gvt Should Come Clean On the Free Blood Initiative Financing-CWGH

… as fears of politicisation of health products grows
The Community Working Group on Health (CWGH) has commended government for
making blood and blood products free in public health institutions beginning next month, but expressed concern over the unclear funding mechanism for the drive.
By Michael Gwarisa

CWGH executive director Itai Rusike said the high cost of blood has been one of the major barriers that prevented ordinary Zimbabweans from accessing and enjoying their health entitlements and rights as enshrined in the country’s Constitution which stipulates that health is a right.

He however said government should come clear as to how they intend to fund the free blood subsidy.

“However, notwithstanding the good intentions, the public would however like to know how the government – already saddled by external debt and a collapsing national economy – will fund the subsidy on blood? Where is the money coming from?

“Will the money come from national fiscus, AIDS Levy, Health Levy or Health Development Fund? Is
the subsidy funded by external partners? For how long? And how sustainable is the free blood
initiative?” said
He added that without answers to the above queries, CWGH remains concerned about the feasibility and
sustainability of this very nobble initiative because such a pronouncement has to be backed with a
strong financial purse.

“What measures has the government put in place to make sure blood will always be available given that it has been always in short supply even when being sold? Making a pronouncement without explaining the modalities is not enough.”

He added it was critical for the Ministry of Health and Child Care (MoHCC) to come out clean and explain the source of funding and the sustainability of this noble initiative for the sake of transparency, accountability and good governance.

“We fear that free blood initiative will go down the “user fee policy” of pregnant mothers under 5s and those aged 65 years and above which remained in most areas a political pronouncement.

“In 1980 free health care was introduced for those on low incomes (below $Z$150, then worth US$220). The policy position on user fees has been that those who can afford to pay for services should do so but implementation of the principle has been mixed.”

Meanwhile, the policy of free public sector care at rural clinics is still in force, although most mission and local authority clinics do not follow it hence this has been mainly funded by development partners through the Results-Based Financing (RBF) funded by the World Bank and the Health Development Fund (HDF) a basket fund by multiple donors such as DFID, EU, Swedish Government and the Norwegian Government.

However, in some health institutions mothers continue to be detained after delivery and Child Birth Records being withheld at public health institutions after failing to pay fees.

“It is against this background that CWGH demands that government explains fully the source of funding and the modalities to avoid the pitfalls of the “user fee policy” which has not been fully embraced and implemented for the benefit of the vulnerable groups it is supposed to serve.

“We need a separate budget line allocation from the national health budget to fund the free blood
policy to public health institutions!!!”

He however said the move to make blood free would lessen financial strain on patients and preventing avoidable deaths that have been occurring in the country as patients failed to access blood because of its high cost.

“The government’s subsidy on blood therefore comes as relief considering the high number of people that are dying in public hospitals after failing to buy blood while families have been disposing priced possessions for a song to save the lives of their loved ones.

“It is commendable that government has since last year been gradually reducing the cost of blood to
ensure that it is within the reach of the ordinary person from $150 a pint in 2016 to the current $50
a pint, with the ultimate aim of making it totally free by next month.”

He added that the free blood initiative was a welcome move as it shows the government’s political will and total
commitment to Universal Health Coverage (UHC), which entails all people and communities accessing health care without financial hardships.

Concern over delay of renal unit opening

The Community Working Group on Health (CWGH), a health delivery services pressure group, has expressed dismay over the continued failure to operationalise the renal unit at Masvingo General Hospital, saying the situation was making life difficult for kidney patients in the province.

Efforts to open the unit have stalled several times in the past few months amid allegations of red tape and bureaucratic bungling by officials at the provincial health referral centre.

CWGH provincial chairperson Mrs Entrance Takaidza last week called on the Ministry of Health and Child Care to ensure the unit is opened as a matter of urgency.

“As an organisation which stands for patients’ rights, we are perturbed by the delays in installing a renal unit at Masvingo General Hospital.

“This is happening at a time when the number of patients with kidney disease is increasing,” said Mrs Takaidza.
She said it was worrying that the Ministry of Health and Child Care has made several promises in the past over the opening of the renal unit at Masvingo General Hospital.

“We were told the machine (dialysis) was supposed to start working by end of last month, with some personnel having already been trained to operate it. However, a month down the line, nothing has happened and this is making life hard for patients in need of dialysis services.’’

Mrs Takaidza said kidney patients continue to fork out their hard-earned money to travel either to Harare or Bulawayo for dialysis services, yet the renal unit was lying idle at Masvingo General Hospital.

At Makurira Memorial Hospital, which is privately-owned, a dialysis session costs more than $150, while the average cost at Government-owned hospitals is about $60.

Masvingo provincial medical director Dr Amadeoas Shamu said opening of the renal unit was being hindered by outstanding minor works.

He admitted that its operationalisation was taking too long.

“The machine has been installed and personnel trained. However, we cannot start operating the machine now because there are minor works that need to be done before dialysis sessions begin,” said Dr Shamu.

The dialysis machine at Masvingo General Hospital was acquired from China under a government-to-government agreement in 2016, which benefited all major health referral institutions in the country’s 10 provinces.

Walter Mswazie Masvingo Correspondent

Public Health Act (Amendment) Bill: Community participation crucial

Itai Rusike Correspondent
The opportunity afforded to Zimbabweans to provide input into the supreme health law of the country is refreshing.
It is important to have communities come out and participate during the public hearings on the Public Health Act (Amendment) Bill to ensure that their views and perceptions have been incorporated into the final Bill and that it addresses community needs as enshrined in the nation’s Constitution.
Following a number of public health blunders that have seen resurgence of previously controlled diseases, unnecessary death, disability and suffering of Zimbabweans, it is imperative to have a shared vision and mission for public health across national stakeholders, including a shared understanding of the purposes and objectives of a public health law and the scope of public health action.
The role of communities should be to demand environmental, infrastructure and structural provisions to promote health for all in urban, rural, farming, mining and institutional spaces.
Zimbabweans must use this opportunity to ensure the development of a law that is not simply a means for controlling nuisances, but a tool for promotion of healthy conditions, for co-ordination of health activities and for improving the dialogue and relationships across public health authorities for the attainment of the country’s vision and mission for the health and well-being of its citizens.
In the developed world, health promotion is a high national priority that sits in the Prime Minister’s Office and ensures the provision of a healthy environment for all citizens and the attainment of health in its totality through targeted initiatives such as healthy cities, lifestyles, food etc.
Community concerns regarding gaps in the gazetted Public Health Act (Amendment) Bill
Community level mechanisms and functions
• Although Health Centre Committees (HCCs) have been legally recognised in Section 17, they are not represented in the District Health Team in Section 16 for feedback to and from the communities. Therefore, we strongly recommend that community involvement mechanisms need a representation mechanism in the district health team as the district government council in addition to the hospital management board, which oversees functionality of the district hospital.
• HCCs were fully captured. However the role of Village Health Workers (VHWs) and other community-based workers is not satisfactorily and explicitly stated in the act except for Section 137 sub-section 1(b) in a general statement that says “The minister may make regulations providing for: Recognising and providing for the roles of non-state actors and communities. Thus provisions for the VHWs could be detailed soon after Section 17 of HCCs.
• This is important because VHWs do not have an association or representation like other health cadres and yet they are the backbone of all community health programmes, hence the need for legal backing in order to be given priority. Include specific inclusion of the broad roles and functions of VHWs, including how they relate to other community-based workers (home-based carers, family planning distributors, OI/ART/Dots coordinators, school health coordinators, malaria spray operators etc)
• Section 28: The Bill is silent on the Health Centre staff establishment. It is therefore crucial to have a specific clause in the Bill that speaks to issues of the ideal healthcare establishment that looks realistically to the country attaining universal health coverage and the SDGs given that the current staff establishment was determined using the 1982 population statistics and when the disease burden was very low.
• Although it is covered in the Health Services Act, it should still reflect in the Public Health Act (Amendment) Bill so that the two are harmonised and be in tandem with the Constitutional provisions of leaving no one behind.
• Section 3: The Minister of Health and Child Care as a competent authority and the custodian of the Public Health Act should enforce the Act by demonstrating adequate powers supported with resources than has been the case under the current law.
The minister requires the legal muscle and needs teeth to bite so that perennial offenders of well-articulated and scientifically proven public health provisions, interventions and standards, such as the City of Harare, other local authorities and individuals can be brought to book and potential public health disasters averted before loss of life as has so far been the case and without fear or favour.
Itai Rusike is the executive director for the Community Working Group on Health

Health ministry bemoans poor budget

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.”