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‘Poor service delivery drives typhoid’

‘Poor service delivery drives typhoid’

HARARE - Poor service delivery is the key driver of the typhoid outbreak in Harare, city director of health Prosper Chonzi has said.

According to health committee minutes, Chonzi said since January 22, there had been 101 suspected cases, 13 confirmed and no deaths from the disease.

Chonzi said the water and sanitation situation in the city was causing typhoid to resurface after the 2011 outbreak that hit Dzivarasekwa.

In October 2011, the outbreak spread to other suburbs such as Warren Park, Kuwadzana,

Mufakose, Mabelreign and Granary, with 1 175 treated cases.

Contaminated shallow wells were identified as the probable cause due to poor water and sanitation hygiene during the outbreak.

Since the beginning of the year, Harare City Council (HCC) has been having fortnightly water cuts as it conducts repair and maintenance works at Morton Jaffray waterworks and the city’s distribution network.

The city is grappling with poor water distribution in areas such as Greendale, Glen Lorne, Mandara, Mabvuku, Tafara and Budiriro.

“The key drivers are inadequate potable water supply and residents resorting to unsafe water sources like unprotected wells and poor sanitation caused by erratic refuse collection and management resulting in the proliferation of illegal and indiscriminate dumpsites,” Chonzi said.

He added that other causes also included burst sewer pipes, their delayed repairs and sewer outflows into residential areas.

Other drivers of typhoid in Harare also included use of unhygienic sanitation means, like pit latrines in new settlements and emergence of illegal vending and selling of raw fish, meat and sadza under unhygienic open spaces.

Chonzi said to avoid a possible outbreak of the disease, the city had activated its epidemic preparedness and response teams to investigate and trace the origins of all confirmed cases.

“The city will conduct point-of-use treatment of water and distribute aqua tablets to affected households and the community. There will also be water quality monitoring for all water sources,” Chonzi said.

Tafara resident Christine Marenje said the water situation has become so dire that people had begun fighting at the boreholes in the community.

Marenje said her area can go for weeks with no water supply and yet residents are expected to pay for the service.

“Zvinobhowa kuti titerere mvura isipo, kana torwara necholera zvonzi maresidents haasi kuita zvinehutano. Toshanda sei kusina mvura? Haungaudze mwana kuti usarware nemudumbu nekuti hakuna mvura ( It is frustrating to pay for a nonexistent service. When people contract diseases like cholera, they tell us we are being unhygienic yet there is no water. Tell me, how can you tell a child not to get sick because there is no water?,” she said.

Itai Rusike, executive director of Community Working Group on Health, said it is unacceptable that residents continue to be exposed to preventable and treatable diseases like typhoid.

He said the unreliable functioning and prolonged water cuts in Harare leads people to use unsafe alternatives such as unprotected shallow wells.

Rusike added that improving access to water, sanitation and waste disposal should be prioritised in Harare as poor quality water sources undermine health, as do waste disposal in open pits and public sites.

“Harare seems to be hardest hit by typhoid mainly because key dimensions of primary health care (PHC) are much less available and a coherent approach to PHC appears to be missing, despite the increase in preventable and communicable diseases and the rise in urban poverty.

“There is need to develop and implement an efficient and appropriate approach to PHC in Harare through dialogue with urban health services, residents, the local authority and other stakeholders,” he explained.

He also added that waste collection is a billed service by the city, however, residents query whether that money is being channelled to its intended use, or elsewhere.

Rusike said waste management funds should be monitored as such payments should be used for their intended purpose and not abused.

“While residents may contribute to one-off clean-up campaigns to assist with removing waste, this should not replace the HCC’s core obligation,” Rusike told the Daily News on Sunday.

 

Helen Kadirire  •  22 May 2016

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Zim commemorates Cancer Day amid equipment, drug shortages

Zim commemorates Cancer Day amid equipment, drug shortages

As the rest of the world commemorated Cancer Day yesterday, Zimbabwe continues to grapple with shortage of drugs, cancer equipment, specialists, as well as lack of adequate information to rein in the disease, which is largely preventable.

By Phyllis Mbanje

Stakeholders are calling on the government to seriously work on domestic financing of cancer awareness and prevention which falls under non-communicable diseases (NCDs) and treat it with the diligence accorded to HIV and Aids.

“We are not doing much in addressing this sitting time bomb which requires substantial resources to make a meaningful impact,” Itai Rusike, the director of the Community Working Group on Health (CWGH), said on Wednesday.

Treatment of cancer, which is one of the largest killers in the country, has remained quite costly for the average person and public health facilities remain underfunded and overwhelmed by the number of patients.

“While everyone has a right to health, many people from poor resource settings have no means and no access to treatment,” Rusike said.

Cancer is preventable, but due to inadequate information and awareness campaigns, many people come forward late when it is almost impossible to reverse the damage.

According to a report from the Zimbabwe National Cancer Registry (ZNCR), more than 6 000 cases of cancer were recorded countrywide last year and the bulk of these presented in last two stages of the disease.

Of growing concern is the emergence of childhood cancers. They accounted for more than 3% of the cancers recorded in 2013.

According to research done by Kidzcan Zimbabwe, in 2014, 243 new cases of cancer in children were reported and 106 children died from cancer-related illnesses.

“Although childhood cancers (age 0-14) are a rare condition worldwide, the incidence in Zimbabwe is rather high,” ZNCR registrar Eric Chokunonga said.

A shortage of cancer drugs has also been one of the biggest drawbacks.

Last year provincial and district hospitals throughout the country faced an acute shortage of drugs for cancer, a situation which put the lives of many patients at risk.

Cancer Association of Zimbabwe (CAZ) monitoring and evaluation officer, Lovemore Makurirofa said they were worried about the shortages, adding any disruptions in taking cancer medication might result in treatment failure.

“Cancer treatment involves killing off the harmful cells and so if treatment is stopped before the prescribed cycles, cancer might recur,” he said.

Meanwhile, cancer patients might get some relief after the National Aids Council managed to procure medication and reagents worth half a million dollars.

February 5, 2016 in National, News
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Home births decline in Bulilima

Home births decline in Bulilima

HOME births in Bulilima District in Matabeleland South have declined over the past years, a development that is likely to bring down the county’s high maternal mortality rate.

Zimbabwe’s maternal mortality rate stands at 525 deaths per 100,000 live births, according the 2012 census data. The United Nations considers a maternal mortality ratio of less than 100 as low, between 100 and 299 as moderately low, and high when it is 300 to 499.

Speaking during a media tour organised by the Ministry of Health and Child Care, Save the Children and Community Working Group on Health, the sister-in-charge of Sikhathini Clinic Selulekile Dungeni attributed the decline to community involvement in raising awareness about the dangers of home deliveries.

“Sikhathini Clinic caters for more than 6 villages and some villagers still walk up to 14 kilometres to access medical attention.

“However, we’re happy because the communities have worked hard to spread health messages which saw our home deliveries drop from 12 in 2013 when the programme started to four since the beginning of 2016,” said Dungeni.

“The Health Centre Committee (HCC) sponsored by CWGH and Save the Children actively worked towards building a waiting mothers’ shelter and securing water and electricity for pregnant women which has motivated them to come and deliver at the clinic.”

She said the awareness project had also increased the number of men who accompany their pregnant partners for antenatal care.

Andrew Ngwenya, a member of the HCC said they had mobilised villagers who now appreciate the importance of seeking medical attention while pregnant.

He said certain cultural and religious beliefs were a stumbling block to accessing health care in some communities.

Siphilisiwe Tshongwe from Bezu Clinic in Bulilima, Plumtree District about 30km from Sikhathini, said they had recorded zero home births from January 16 and only two last year.

“We used to lose many lives during home births before the HCC came into existence in 2013 as we had no waiting home shelters or community-based awareness programmes,” she said.

She said it was important for pregnant women to deliver at health institutions with the aid of qualified personnel to avoid complications that could cause maternal deaths.

The World Health Organisation defines maternal mortality as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy.

June 2, 2016 Thandeka Moyo in Bulilima
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Drug shortages: A national crisis

Drug shortages: A national crisis

By Tabitha Mutenga, Features and Supplements Editor

drugsAS the donor community is busy trying to ensure that there is enough food for millions of Zimbabweans facing starvation, another disaster that may soon call for the donors’ attention is unfolding in the country’s hospitals.
A massive shortage of basic clinical drugs at major public health institutions is unfolding.
The situation has been described by health experts as dire, putting the lives of many people at risk.
Basic pain killers are unavailable in hospitals and most rural clinics, where the majority of the country’s ever desperate communities live.
Most of the doctors at major referral hospitals are referring patients to private pharmacies, which are expensive.
“There is no point of travelling all the way to Makanda Clinic; all you get is paracetamol. Even if you have malaria you get paracetamol,” said one villager from Rusape, who preferred to be identified as Magreta.
She had gone to seek treatment at Makanda Clinic.
“Medical supplies such as bandages, syringes, cotton swabs and antiseptic are not even available at the clinic,” she lamented.
Villagers who frequently visit the clinic in the hope of accessing treatment concurred with Magreta saying many were travelling to Murambinda Hospital or Rusape Hospital for treatment.
At both hospitals, it is either that they find the drugs being dispensed at the institutions to be out of reach, or they end up being referred to private pharmacies owing to the prevailing shortages of drugs.
As many fail to access treatment at public institutions, hospitals are fast becoming “waiting rooms for death”.
Community Working Group on Health (CWGH) executive director, Itai Rusike, said while government policies on essential drugs and on equity in health have significantly widened treatment access in Zimbabwe, there is evidence that drug access has fallen in recent years, and that drug availability is falling sharply at State hospitals.
“This represents an unfair cost burden on poor communities, but also opens the way for the growth of private unregulated drug markets. Procurement procedures at the National Pharmaceutical Company (NatPharm) are still determined by the State Procurement Board, even though NatPharm is not a typical State department, and this has led to delays in decision-making. Further, NatPharm suffers from lack of adequate funding from the Government of Zimbabwe. As a result, the country is now highly dependent on donor support for its drug supplies,” Rusike said.
NatPharm, the country’s appointed agent for procurement, storage and distribution of medical supplies to public health institutions, is owed US$24 million from as far back as 2009 and only received US$800 000 from Treasury in October last year, making it unable to purchase drugs.
“Drug supplies at rural health centre level are also problematic and are a constant source of client discontent. The approximately 1 500 clinics in Zimbabwe are the last step in a long chain of drug procurement and distribution.
“Communities have had to spend scarce local funds to guard clinics from recurrent theft of drugs and other supplies, particularly when facilities have no fencing, burglar bars or other security. Not surprisingly, even when clinics do not charge fees, people bypass them for more expensive hospitals in towns where they think they have a chance of getting drugs. For the poorest, this is an unaffordable solution,” said Rusike.
A CWGH survey on the 2016 National Budget indicated that communities noted that Treasury should have prioritised provision of essential drugs and improving staff pay and training, especially for workers in preventive services, clinics and district hospitals.
Government’s essential drug policy aims at promoting rational drug use and ensuring the availability of low cost, but good quality drugs.
The Ministry of Health backed this policy with investments in primary health care to strengthen drug delivery to primary care and district services.
These changes were supported by a significant reallocation of resources to and within the health sector.
The policy on essential drugs and generic (brand name) labelling of drugs was applied across the public and private sectors, saving the country significant resources from the mark-ups of brand-name products.
Bulk procurement and local production also reduced the costs of essential drugs.
However, a number of factors have affected drug availability such as resource constraints, currency shortages, losses in supplied drugs, expiring drugs and theft of the drugs.
“Cases of drug theft and leakages out of public services into private practice have been cited. Those cases under police investigation have not resulted in concrete finalisation or quantification of the drugs. Burglary into drug storerooms has also been reported and hospital staff has allegedly been implicated in such acts. At clinic level, drug theft has been reported as a problem in a number of districts and has led communities to hire security guards and build fencing and erect burglar bars,” Rusike added.
Theft and leakages of drugs from the public sector and sales of drugs brought onto the country for personal use are reported to have led to some drugs finding their way into the black and informal markets.
Contraceptives are also being sold on the black market and the problem with such sales is that they are unregulated, making it difficult to ensure quality or appropriateness of drugs, avoid side effects and complications and also problems of resistance that can happen in unregulated use of antibiotics.
newsdesk@fingaz.co.zw

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Zimbabwe agonises over malaria

Zimbabwe agonises over malaria

mosquitoDESPITE efforts to roll back one of the world’s biggest killers — malaria, Zimbabwe is struggling to eliminate the vector of the deadly disease, the anopheles mosquito.
Statistics show that there are more than 400 000 malaria cases among all age groups each year in Zimbabwe, which translates to three percent of the country’s population contracting the disease.
Health and Child Care Minister, David Parirenyatwa, has indicated that over half of the population is at risk of contracting malaria at a time the anopheles mosquito is increasingly resisting the commonly used residual sprays.
This effectively means the southern African nation is not among the World Health Organisation (WHO)’s list of African countries expected to reach the year 2020 target of being malaria free.
By World Malaria Day 2020 only six African countries, Algeria, Botswana, Cape Verde, Comoros, South Africa and Swaziland could be free of malaria.
In Zimbabwe, the disease accounts for between 30 to 50 percent of outpatient attendances in the moderate to high transmission districts, especially during the peak transmission period. Transmission is generally seasonal, starting from around November to the end of May, with the peak period being between March and May.
The primary malaria zones in Zimbabwe are in the northern and eastern regions bordering Mozambique and Zambia.
Malaria is the third leading cause of illness and mortality in Zimbabwe. Of the country’s 63 districts, 47 of those districts are malarial, with 33 categorised as high burden malaria areas.
“It is important to note that malaria is not just a health issue, but a socio-economic one as well. Malaria has a direct impact on a country’s human resources. Not only does it result in loss of life and loss of productivity, due to illness and premature death, it also affects children’s school attendance and social development through both absenteeism and permanent neurological damages associated with severe episodes of the disease,” Parirenyatwa has noted.
Although statistics continuously show a decline in malaria incidences, the disease remains a major challenge in certain districts of Manicaland, Mashonaland Central, Midlands, Matabeleland North and South, Masvingo and Mashonaland East. It also accounts for 30 percent of all outpatient cases and 12 percent of hospital admissions in these areas.
According to Zimbabwe District Health Information System data, approximately 83 percent of all malaria cases and 50 percent of all malaria deaths in 2014 originated from three provinces: Manicaland, Mashonaland East and Mashonaland Central, with 42 percent of all cases and 26 percent of all deaths coming from Manicaland.
Despite these disturbing figures malaria incidences declined by 79 percent from 136 per 1 000 people in 2000 to 29 per 1 000 people in 2015, surpassing the Millennium Development Goals set target of 75 percent decline. Mortality declined by 57 percent from 1 069 deaths in 2003 to 462 deaths in 2015.
Prevention has proven to be the best form of intervention for malaria, with the two most successful methods found in insecticide-treated mosquito nets and spraying insecticides in and around homes.
Community Working Group on Health executive director, Itai Rusike, said the spread of health information and safe living were key to malaria prevention.
“Prevention and management of malaria also depends on early detection and treatment. Communities are primarily using the clinics as their first point of treatment for malaria (public and private), so effective malaria management depends first on the resources at this level,” Rusike said.
WHO describes the mosquito as the greatest menace of all disease-transmitting insects, causing several millions of deaths and hundreds of millions of cases of illnesses around the world each year.
“The high poverty levels in Zimbabwe and wide use of public services by poor households mean that improved malaria treatment depends on improving public sector spending. The current levels of public spending per capita are below levels required to fund a basic system, or for meeting Sustainable Development Goals commitments.
“The shortfall limits public sector service provision, in least resourced and most disadvantaged areas, with consequences for raised mortality, illness and reduced life opportunities in those areas. With government resources overshadowed by private and external funding, there is significant challenge for the public sector to know of and align available funds from all sources towards national goals,” Rusike added.
A number of challenges affecting the country’s drive towards eliminating malaria include a re-emerging malaria vector, the anopheles funestus, which is resistant to pyrethroids — the cheapest indoor residual spraying, forcing the country to introduce organophosphates, which are more effective, but much more expensive.
“Outreach resources are not only limited with respect to malaria spraying. A number of communities do not have a village health worker (VHW) due to the limited numbers of the trained VHWs thereby reducing the interface between the communities and this important cadre who provides the basic care at community level,” Rusike said.
He added that in some instances, very little malaria spraying is reported in some parts of the country, indicating that environmental health technicians have lacked the supplies as well as the transport, leaving households dependent on their own resources.
Malaria is, however, preventable despite killing thousands of people every year particularly pregnant women and children.
newsdesk@fingaz.co.zw

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Call on govt to revise health staffing system, employ qualified personnel

Call on govt to revise health staffing system, employ qualified personnel

October 14, 2015 in Health, National, News

The government should revise its outdated health staffing system and consider the employment of qualified health workers currently sitting at home due to the current freeze on employment.
By Phyllis Mbanje
The Community Working Group on Health (CWGH) said the existing staff establishment does not address the shortage of health personnel in the country.
CWGH director Itai Rusike said the existing staff establishment was not adequate to address the increasing disease burden, population and emerging health threats as articulated in the World Health Organisation’s building blocks for health systems.
Rusike said the growth in population and disease burden necessitated an increase in both numbers and capacitation of health care workers for the provision of sufficient and quality health care services.
“CWGH noted that in some rural health facilities, when the only nurse available goes for a workshop, the clinic is closed,” he said.
Under the current establishment, 23% of all provincial and central hospitals do not have dentists, while most district hospitals do not have the four doctors required.
Some district hospitals were also manned by pharmacy technicians instead of the required degreed pharmacists.
“We also propose that for any staff establishment posts that have been made redundant as a result of advances in healthcare or changes in disease and demographics, be used to a create a new health cadre,” Rusike said.
In their input statement for the national health budget for 2016, CWGH also said there was need to come up with a funding mechanism for the non-communicable diseases (NCDs) which are costly to diagnose and manage.
The Public Health Advisory Board once proposed introduction of earmarked sin taxes to fund NCDS.
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 the disease.
“The proposal by the Advisory Board should be followed through to avoid premature deaths,” Rusike said.
Stakeholders have previously called on the government to increase budget allocation for health and meet the Abuja Declaration of allocating 15% of the national budget to healthcare.
“Countries that are honouring the convention have done remarkably well in improving their overall health outcomes and status,” Rusike said.

 
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Give health sector adequate funding

Robust outreach programmes enable those in areas without established health services to access care and treatment
Itai Rusike Review Correspondent
As government undertakes the 2016 budget formulation process, priority should be given to adequate funding of the health sector to ensure universal health coverage as the cost remains beyond the reach of many Zimbabweans.
The Government needs to honour the Abuja Commitment and allocated 15 percent of the national budget to health instead of the less than 10 percent allocated in 2015.
Six countries; Liberia, Madagascar, Malawi, Rwanda, Togo and Zambia have achieved the Abuja Target proving that we can do it too. Of note is Rwanda which spends at least 23,7 percent of its budget on healthcare.
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 principle that health is a basic and fundamental human right can never be overemphasised, 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.
In the 1980s and 90s, Zimbabwe had one of the best primary health care service models in sub-Saharan Africa but over the years these gains have been eroded by a host of factors including central government’s inability to adequately fund the health sector. 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.
During the same 80s and 90s era the Government funded up to 90 percent of the country’s health care needs. However, for the past 15 years, households have borne the burden of paying for health care through out-of-pocket (OOPs), while the external partners have increasingly contributed to the bulk of public financing for health services in Zimbabwe.
In the past three years, fiscal allocations to the health sector have been decreasing, impacting negatively on the provision of health care with Government citing tight budgetary constraints.
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. Many people are succumbing to preventable and treatable diseases such as tuberculosis, malaria, HIV and Aids, cholera and typhoid.
Communicable diseases still remain a cause for concern accounting for over 62 percent of overall mortality in the country. 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 percent of the health workers have been trained in managing injuries, trauma and other priority NCDs. For diabetes management only 53 percent of the health workers are trained to manage diabetes; all this against a high burden of the NCDs may only a high level of complications and premature or avoidable deaths.
The current National Health Accounts show that patients, through OOPs account for 39 percent of the total health expenditures, followed by the private sector expenditures with 24 percent, external partners with 19 percent and Government with 18 percent.
Presently, external partners through the Global Fund, the Health Transition Fund, The US President’s Emergency Plan for AIDS Relief and Global Alliance for Vaccination and Immunization continue to provide the bulk of the public health financing.
About 98 percent 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. 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 donor dependence syndrome is counter-productive and we urge Government to contribute the majority of the financial resources used in the public health system. The Government needs to therefore increase its domestic funding as this financing mechanism has always proven to be sustainable.
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 the 10km 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.
The Government needs to increase funding for outreach services so that communities in these 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.
Blood products have become expensive and inaccessible to many. A bottleneck analysis by the Ministry of Health and Child Care (MoHCC) shows that 60 percent of the secondary facilities had no blood in their stocks. Some of the facilities could not stock blood because there were no refrigerators, electricity and general poor infrastructure. There is need for the Government to consider other alternatives such as solar refrigerators for storing blood products.
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 trained staff, again leading to complications and avoidable deaths.
A costed new staff establishment needs to be developed by the Ministry of Health and Child Care’s as the existing staff establishment is not adequate to address the increasing disease burden, population and emerging health threats. This is well articulated in the WHO’s building blocks for health systems strengthening. The Government needs to revise the MoHCC 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.
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.
The Government is unable to fill in the current establishment. In some rural health facilities when the only nurse available goes for a workshop, the clinic is closed. Twenty three percent of all provincial and central hospitals do not have dentists. Most district hospitals do not have the four doctors as required in the current establishment. Some district hospitals are manned by pharmacy technicians instead of degreed pharmacists.
The primary care level needs to be funded fully in order to also address non-referrals at the secondary and tertiary levels. There should be 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.
While there are existing Government policies to cushion the vulnerable groups from making catastrophic health payments, senior citizens who are exempted from paying user fees are still paying for other access fees such as ambulance services, blood and medications.
We continue to witness the collapse of some medical aid schemes through the mismanagement of funds whilst leaving their members vulnerable. We 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.
The creation of a National Health Insurance, a process which could have been implemented a decade ago, remains somewhat a non-priority. By urgently addressing this matter Government will reduce the current high levels of catastrophic health spending. The level of consultations that have been done in coming up with the National Health Insurance Bill are not sufficient. In conclusion, community participation matters and health financing, including the budget formulation process give a greater depth to discussion and understanding of the health issues in the country and facilitate appreciation and therefore achievement of the country’s overall health goals.
Itai Rusike is the executive director of Community Working Group on Health, a network of community/civic based organisations whose aim is to collectively enhance community participation on health in Zimbabwe.

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Health Services Board laments 3 000 jobless nurses

October 23, 2015 in National, News
NursesOver 3 000 nurses in the country are not employed at a time most health facilities are operating with skeleton staff, Health Services Board (HSB) chairman Lovemore Mbengeranwa has lamented.
By Phyllis Mbanje
Speaking at the Community Working Group on Health (CWGH) annual conference in Harare on Wednesday, Mbengeranwa said while Treasury had no money to employ more health personnel, the country was facing a critical shortage of nurses.

“There is need to increase the health budget because how can the posts be filled up when Treasury cannot pay them?” Mbengeranwa queried.
The Abuja Declaration states that governments should allocate 15% of their national budgets to health, but Treasury has been falling short on that lately.
Thousands of nurses left the country for greener pastures at the height of the economic crisis between 2005 and 2009.
Most public health facilities were left with skeletal staff and the situation was worsened when the government put a freeze on recruitment, leaving thousands of nurses stranded upon completion of their studies.
Other stakeholders who had gathered for the CWGH conference also raised concern over the problem which was common at most health facilities.
Director of the Women Action Group, Edinah Musiyiwa, challenged stakeholders to question the detaining of women who fail to pay for maternity fees.
“At policy level, user fees for pregnant women have been scrapped, but at the hospitals, it is a different issue. Someone should question that,” she said.
“The maternal mortality rate is still high at 614 deaths per
100 000 live births and such issues of user fees are some of the reasons women end up giving birth at home.”
Recently, the Harare Residents’ Trust reported that women were being detained at Harare Central Hospital after failing to pay for maternity services.

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Health institutions short staffed

November 2, 2015 Local News
Health Reporter
Public health institutions continue to be dogged by a serious shortage of personnel, leading to low levels of service delivery. The situation is further complicated by a decision by Government to build new hospitals across the country although it has frozen recruitment of health workers. Health Services Board chairperson Dr Lovemore Mbengeranwa confirmed the challenges recently.
He told a Community Working Group on Health annual general meeting held in Harare that staff was being moved from existing health facilities to new ones, leading to serious understaffing. “I am sure you are all aware that we need Treasury concurrence whenever we want to recruit new cadres and it is not always a smooth process to recruit new staff,” said Dr Mbengeranwa.
He said there were more than 3 000 unemployed but qualified nurses on the streets and that there was no hope that they would be employed anytime soon. “The situation has not changed but we continue to negotiate with Treasury for opening of more posts so that we absorb all the nurses,” said Dr Mbengeranwa. He said owing to the increased population and disease burden in the country, there was need for more staff in health facilities.
Dr Mbengeranwa said Government, with support from development partners, was working on a survey to ascertain the actual number of nurses or doctors required at each facility at a given time. The last review of staff requirements in the health sector was done in the 1960s.
Nurses Association of Zimbabwe (ZiNA) president Ms Regina Smith urged Government to speed up reviewing of staff compliments and come up with ways of absorbing unemployed nurses. Ms Smith said ZiNA was concerned that the unemployed nurses would have to undergo retraining when they eventually get employment.
“Government should quickly find ways of absorbing the unemployed nurses because if they continue roaming the streets, they will have to undergo retraining, which is very frustrating than the actual training,” she said.

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National Health Insurance Scheme noble, but . . .

October 21, 2015 Local News
Health Reporter
Government should engage in wide consultations on the National Health Insurance Scheme (NHIS) before implementation to ensure its successful rollout, Community Working Group on Health (CWGH) executive director Mr Itai Rusike has said.
Speaking at a science café on Domestic Health Financing organised by the Health Journalists Association of Zimbabwe (HeJAZ) in Harare yesterday, Mr Rusike said the NHIS was a noble initiative but Government should embrace stakeholders’ input for its success.
“We hope once approved, the Ministry of Health and Child Care will not rush to roll it out nationally without proper consultations. It’s a brilliant initiative with a potential to assist the majority of Zimbabweans failing to access health services because of cost barriers,” said Mr Rusike.
Mr Rusike said civil society does not have faith in the proposal that the National Social Security Authority (NSSA) should administer the fund because of its history on investing in failed banks, giving paltry benefits to pensioners and current scandals that have led to the dismissal of its senior management.
“We do not know how far the ministry (Health and Child Care) has consulted with regards to its implementation but we strongly feel it should take a lead in its implementation instead of the proposed National Social Security Authority (NSSA),” said Mr Rusike.
He said although there was need to mull local sources of funding for health, issues of accountability and transparency to those local sources should not be overlooked.
Citing the example of the National Aids Trust Fund, Mr Rusike said there was need for the National Aids Council (NAC) to revive its initial structures which stretch down to the village level to ensure transparency.
“When NAC was in the embryonic form, they used to have structures down to the ward level but all these structures no longer exist. The structures now end with the district action Aids co-ordinators. Who then is NAC accountable to?” said Mr Rusike.
He also urged Government to take seriously yearly reports produced by the Auditor-General, Mrs Mildred Chiri, on the health sector.
“We are yet to see anyone arrested from the results of forensic audits produced by the Auditor-General year in and year out. This is what contributes to effective use of available resources,” he said.
Speaking at the same occasion, planning and donor co-ordination officer in the Ministry of Health and Child Care Mr Gwati Gwati said there was need for contingent measures to health financing in Zimbabwe as the sector was largely donor-dependent.
Mr Gwati said Government has completed work on earmarked taxes such as taxing alcohol, tobacco, mobile communications, mining and value added tax on certain products.
“This evidence (that the country can raise money locally through these initiatives) is yet to be presented to Cabinet by the minister but all work has been completed,” said Mr Gwati.
He said these taxes would enable the health system to put resources together and respond to the health needs of the country.
Zimbabwe is a signatory to the April 2001 Abuja Declaration which recommends at least 15 percent of countries’ national budgets to be channelled towards health.
However, since adoption of the declaration, the country has never surpassed the Abuja target with the highest allocation so far being 12,3 percent allocated in 2011.
Other allocations range between 6 and 9 percent of the National Budget.
These allocations fall far short of the World Health Organisation (WHO) per capita recommendations of $34 as they range between $12 and $29.
According to Natpharm – Government’s sole drug supplier – over 70 percent of drugs in stock are supported by donors.