Increase funding to health for attainment of Universal Health Coverage
Government must allocate more funding to the health sector in the 2017 National Budget to ensure that the country achieves universal health coverage (UHC) that continues to elude the majority of Zimbabweans.
For years, inadequate funding for health care has meant that the country has been unable to realise its full potential for providing sufficient and quality services to people. With increased funding to health, Zimbabwe would be able to deal with the current disease burden, address human resources shortages, access to medicines and build more facilities to reduce the distance patients travel to seek health services.
The country needs to progressively move towards meeting the Abuja target of not only allocating 15 percent of the National Budget to health, but actually spending that allocated amount on the sector. It has been noted that in the past years, the Government would allocate funds to health, but would disburse much less to the sector to make any meaningful impact.
Fifteen years after African governments committed themselves to the Abuja Declaration in 2001, only six countries have been able to meet the target. These are Liberia, Madagascar, Malawi, Rwanda Togo and Zambia.
Rwanda, which was involved in a devastating civil war for several years, already spends at least 23,7 percent of its national budget on health care, a percentage that is three times more than what Zimbabwe allocated to healthcare in 2015.
Presently the Zimbabwe Government, which relies heavily on donor funding, has cited a shrinking fiscal space for failing to meet the Abuja target. It is therefore advisable for the country to seek innovative domestic ways of funding the health sector as relying on foreign funds is a national security risk should the donors withdraw support for any reason.
With a narrow revenue generation base, the Government must consider the introduction of “sin taxes” on commodities such as tobacco and alcohol not only as measure of raising funds, but a way of reducing the consumption of harmful products.
It should be emphasised that reaching Sustainable Development Goals (SDGs) requires a sustained momentum in funding the country’s health care system. The current resources nexus shows that the tertiary and central level health facilities attract more funding than the lower levels as a result of the intensity of their services.
While there has been some improvement in Maternal, Neonatal and Child Health (MNCH) indicators, infant, U5s and maternal rates remain a cause of concern as the current rates are too high compared to regional rates. The Government is far from achieving its target of 326 deaths per 100 000 live births by 2020 although maternal mortality declined from 960 live births in 2010 to 651 in 2015.
It should also be noted that poorer households continue to endure disproportionate losses in infant, child and mortality as compared to the richer households so more funding should go towards primary level care.
The current ratio of over 70 percent funding for curative services and less than 10 percent funding for preventive services will not see the country moving towards reducing further the rates of maternal and child mortality.
Lower levels of care handle more patients than the tertiary and central level facilities and it is therefore prudent that a significantly larger share of the budget should go to the district level. The idea of building district hospitals in areas such as Harare, Bulawayo, Wedza and other parts of the country to alleviate the burden of patients at the central level remains a critical requirement. This must be supported by increasing or reviving health grants to urban councils to lower their user fee charges to more affordable levels.
A huge number of patients in the country are still enduring unbearable long distances to access primary health care facilities. The Government therefore needs to increase funding for outreach services so that communities in remote areas and newly resettled areas can also have access to care.
It is also important to resuscitate community support structures such as ward health teams and ward development committees as well as remunerating community health workers well especially village health workers.
There is evidence which shows that socio-economic and geographic inequalities and inequities are hampering access to health services especially for non-communicable diseases (NCDs) such as cancer services.
The State should come up with a clear position on treatment of NCDs. It is important that the State decentralises services and subsidises their treatment costs to lessen the burden on the poor who are the majority.
The creation of a national health insurance (NHI), a process which started in 1991, remains a noble idea but it would be more appropriate if the management of this body is given to the National Aids Council (NAC) given their experience in managing the Aids Levy.
However, there is still need for more inclusive consultations with stakeholders to come up with a comprehensive Bill. Health insurance is currently dominated by a well-established but poorly regulated private sector, serving only 10 percent of the country’s population and is under threat due to increased job losses.
The cost of blood products has become expensive and inaccessible to many. A bottleneck analysis that was carried out by the MoHCC shows that 60 percent 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.
Surveys on human resources and infrastructure have identified huge gaps in terms of human resources 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 percent of facilities in the whole country have TB diagnostic testing equipment while 44 percent of facilities have functional glucometers and strips for diabetes testing and screening.
It is also important to review the staff establishment to reflect the current environment. Zimbabwe is still using a staff establishment of 1983 when the country’s population was 7.5 million but that has since doubled and the disease burden has also increased.
Therefore, there is urgent need to review the staff establishment in order to reduce work overload and burnout health workers.
With the current staffing scenario, the Ministry of Health and Child Care must be exempted from the proposed staff rationalisation which is being spearheaded by the Ministry of Finance and Economic Development to reduce the Government’s unsustainable wage bill.
The health ministry is understaffed and desperately needing to fill in critical staff posts for it to enable to provide basic health care services. For example, 23 percent of all provincial and central hospitals do not have a dentist, most district hospitals do not have four doctors as required in the current establishment system while some are manned by pharmacy technicians instead of degreed pharmacists.
Itai Rusike is the Executive Director of Community Working Group on Health.