Perennial power cuts choke health delivery system

“The worst was seeing a new-born baby dying, and I couldn’t do anything because we didn’t have any source of power,” David Masara, nurse-in-charge at Budiriro Polyclinic in Harare, said.

His account is a tip of an iceberg on the impact of the country’s rolling power cuts on the health sector.

The perennial electricity power shortages have seriously affected the health delivery system countrywide.

Key service areas including surgical operations, life support systems, drug storages, scans, X-rays/ medical tests and examinations as well as in-patient and out- patient units have been affected.

In some institutions, expecting women have been made to bring their own lighting before admission.

However, the challenge is being averted by the recent Solar For Health initiative that has seen over 1 000 health facilities across the country being equipped with solar units as back-up in case of power cuts.

“The issue of lack of power is no longer an issue at all. Pregnant women can deliver their babies in stable conditions after the installation of the solar system,” said Masara.

In some instances, especially in rural areas, the solar systems have come in as sole power supply system.

The Solar For Health programme is being implemented by the Health and Child Care ministry in partnership with the United Nations Development Programme (UNDP).

The project is largely funded through the Global Fund.

According to the UNDP, several thousands of Zimbabweans are now enjoying reliable health services as a result of the programme.

Global Fund project manager, Emmanuel Boadi, said power is of great importance in the health sector and they would continue assisting the government to ensure that institutions have uninterrupted supply.

“Since 2017, we have installed 1 044 systems in health facilities with 19 ongoing installations,” Boadi said.

“We will continue to mobilise resources to ensure all health facilities have solar power connectivity.

“We also want to assist the Ministry of Health and Child Care in the short and long-term, to have a sustainability plan.”

Addressing journalists during a recent tour of Chivi district, local medical officer Onward Tendaupenyu, said the solar intervention had made it possible to attend some cases at their hospital, minimising referrals.

“Before the Solar For Health intervention, we had no back-up and we would refer patients in labour to Masvingo General Hospital. We are now able to do caesarean sections (C-sections) here (Chivi District Hospital), so we have had an improvement, Tendaupenyu said.

He said the intervention has been helpful in reducing challenges on maternal health.

“On average we do about 10 C-sections per week. We normally had problems with emergencies during the night. We are now saving on what we would have used in referring patients,” he said.

“We are now saving on 100 litres of fuel and over $100 for staff allowances per week. We are also doing evacuation of retained products after miscarriage, and appendicitis operations among other things requiring uninterrupted power service.”

Acting Matabeleland South provincial medical director, Andrew Muza, said the intervention has been a great help in health service delivery.

“We have 117 of our health facilities on solar back-up through UNDP and partners. There has been improved patient care in terms of quality. We now have 24/7 service provision and other systems depending on power like the expanded programme on immunisation  and the electronic health record  system have also been connected making it easier to do our duties,” he said.

Bulawayo City Council’s health department director, Edwin Sibanda, said the programme had eased the burden on service delivery as most of their services rely on power.

Towards the end of last year, the country was exposed to further challenges as the power crisis worsened, leading to more lengthy and untimely power cuts.

Intermittent or unreliable power sources put most patients’ lives at risk and made health service delivery a nightmare.

The Solar for Health initiative also contributes to extended hours of operation, and better retention and recruitment of healthcare workers in remote settings, ensuring effective, safe healthcare.

At Mhandamabwe rural health centre, attending to patients during the night was risky as they did not have electricity.

Acting nurse-in-charge at the clinic, Petunia Tshuma, said the challenges lessened when the clinic was initiated into the programme where they now have uninterrupted power supply from the installed solar system.

“Prior to the intervention, we relied on solar lamps and torches in the event that we ran out of the normal back-up. Our challenges have lessened as we are no longer having problems in storing our medicines and we no longer meet obstacles in doing our duties during the night,” she said.

Community Working Group on Health  executive director Itai Rusike said solar energy is more efficient for the rural health centres and the hard-to-reach communities.

He said solar energy assists with vaccine cold chain management and cold storage facilities to maintain vaccine integrity and avoid vaccine wastage.

“Solar energy can also assist in the reduction of maternal mortality that remains high in Zimbabwe and it can also be a motivation factor for the health workers and their families with electrical gadgets such as television sets, refrigerators, mobile phones, electrical irons etc,” Rusike said.

“The government should partner with the development partners, NGOs and the private sector to strengthen the health delivery services and improve the quality of care by investing in solar energy in clinics.”

 

Community Working Group on Health: Bringing Civil Society into Health Financing

Background

In 2001, African Union heads of state committed to allocating 15% of their annual budgets to health sector financing through the Abuja Declaration. However, in 2022, Zimbabwe’s health budget was only 10.6% of total spending. Inadequate public financing for health means Zimbabweans are largely forced to pay out-of-pocket if and when they have the personal funds to do so in order to access health care. The country’s health sector is also extremely fragile given its reliance on foreign aid and shifting donor priorities, which the World Bank reports accounted for nearly 56% of health expenditures in 2020. No country has made significant progress toward universal health coverage without relying on public funds to support the dominant share of health sector costs. Given these financing gaps, many Zimbabweans lack access to basic primary health care services like reproductive, maternal and antenatal care; contraception; and newborn and child nutrition (nearly one in four children under five experience stunting).  

Bringing Civil Society into Health Financing

 

For decades, the Harare-based Community Working Group on Health (CWGH) a network of Zimbabwean civil society and community-based organizations has been working to change this paradigm and improve government accountability by expanding community participation in public health policies, and participating in the development and monitoring of health budgets. In its role as the host and coordinator of the World Bank’s Global Financing Facility (GFF) Civil Society Organization (CSO) platform in Zimbabwe, CWGH has worked to ensure that CSOs and youth-led organizations (YLOs) are at the table with government to shape and inform the development and implementation of Zimbabwe’s investment case to mobilize domestic resources for sexual, reproductive, maternal, newborn, child and adolescent health and nutrition (SRMNCAHN).  

Zimbabwe’s GFF Steering Committee with partners from PAI and the World Bank.

Impact of the Work

Since 2021, the GFF has provided CWGH with grants to support its advocacy work, including developing Zimbabwe’s GFF 2022-2025 CSO Strategy, which is comprised of a shared work plan and a monitoring and evaluation framework that facilitates member collaboration, evidence-based advocacy and alignment of advocacy efforts.  

In 2022, CWGH gathered community and civil society inputs to develop a domestic health financing position paper that was submitted to Parliament, the Ministry of Finance and the Ministry of Health and Child Care and advocated for increased health spending in the national budget. Traditionally, the national health budget has been formulated by technocrats at the ministerial level without direct input from the community. Participation at the community level in budget formulation gives greater depth to the discussion and facilitates achieving the country’s overall health goals. Thanks to the community participation enabled through CWGH’s position paper, Zimbabwe’s government increased spending on health and child care from 10.6% of total public expenditure in 2022 to 11.2% in 2023.  

CWGH’s 2022 Universal Health Coverage Day commemorations in Bulawayo, Zimbabwe.

The GFF CSO platform has also enabled civil society to provide input into Zimbabwe’s 2021-2025 National Health Strategy (NHS), which identifies 11 health priorities, including SRMNCAH-N and health financing reforms that rely more on public financing and the creation of a national health insurance scheme. To pay for the implementation of the NHS, CWGH also facilitated civil society engagement in developing the investment case for the National Health Strategy (2021-2025). These strategies are essential for domestic resource mobilization and transitioning Zimbabwe’s health system from one dependent on external financing to a self-sustaining and equitable system.  

In 2023, CWGH received a new GFF grant to continue its advocacy work on domestic resource mobilization for SRMNCAH-N services and maintain civil society’s role in monitoring the implementation of the NHS and investment case. 

Zimbabwe wins top post at Africa Union Summit

Zimbabwe wins top post at the Africa Union Summit:

                                                         

Parliamentarians from various African countries gathered to discuss health financing in Africa. The meeting, held on 11th and 12th July 2023 in Nairobi,At the sidelines of the African Union Summit resulted in the creation of the Parliamentarian Task Force on Domestic Resource Mobilization for Health in Africa. The task force aims to engage parliamentarians in their respective countries to mobilize national resources for health, strengthen community health, achieve universal health coverage, and address funding gaps for HIV, Tuberculosis, and Malaria.

Zimbabwe was represented at the meeting by Hon MP Dr Mathew Nyashanu, Hon MP Dr Ruth Labode, Hon MP Daniel Molokele, and Mr Itai Rusike. Hon MP Daniel Molokele from Zimbabwe was elected as the Co-Chairperson of the Parliamentarians Task Force on Domestic Resource Mobilization for Health in Africa, alongside Senegal.

The donor community is advocating for sustainability and wants countries to prioritize health as a national development goal. They aim to drive political will and encourage governments to allocate a larger share of their budgets to the health sector while decreasing reliance on external aid. This shift towards a sustainable and self-reliant health financing model is spearheaded by GFAN Africa, which prioritizes the long-term development and resilience of countries’ health delivery systems. This initiative will help countries respond better to future health emergencies like COVID-19.

DECLARATION BY THE PARLIAMENTARIANS TASKFORCE ON DOMESTIC RESOURCE MOBILIZATION FOR HEALTH IN AFRICA ON THE SIDELINES OF THE AFRICAN UNION SUMMIT

THE NAIROBI DECLARATION 2023

PREAMBLE

We, Parliamentarians from Cameroon, Côte d’Ivoire, DRC, Ghana, Kenya, Niger, Rwanda, Senegal,

Zambia and Zimbabwe, gathered in Nairobi on 11th & 12th July 2023 at the sidelines of the

African Union Summit, to reflect and discuss health financing in Africa.

Cognizant of the need to formalize genuine collaboration between parliamentarians and Civil

Society, we propose for an effective advocacy program on sustainable domestic resource

mobilization for health in Africa, through a platform for exchanging information, sharing best

practices, strengthening political and synergies.

Our recommendations, resulted in the creation of the Parliamentarian Task Force on Domestic

Resource Mobilization for Health in Africa, with the objectives of engaging parliamentarians in

their respective countries on issues such as the mobilization of national resources for health;

strengthening of community health; universal health coverage; and addressing gaps in funding

for the fight against HIV, Tuberculosis and Malaria. We, therefore, unite our voices in support of

this declaration:

CONTEXT

The African Union member states have subscribed to a solid normative legal framework on the

right to health; they have committed to its Agenda 2063, whose aim is to transform the potential

threat posed by the expected doubling of its young population by 2050, into a «demographic

dividend», bringing economic growth and higher living standards, and they also subscribed

to the Sustainable Development Goals (SDGs), which aim to significantly increase the health

budget to ensure that everyone benefits from universal health coverage (UHC).

Heads of state and government have also made declarations and commitments on health

financing, notably at the 32nd Ordinary Conference of the African Union in Addis Ababa in

February 2019, during which they endorsed the deliberations of the African Leaders’ Meeting

(ALM) and adopted declarations in favor of mobilizing domestic resources for health financing

in Africa.

Notably, many African states are struggling to meet their commitments to mobilize domestic

resources, yet investing in health is investing in human capital, creating stable jobs, stimulating

economic growth and reducing inequalities.

While investments in community health programs are cost-effective, we note with concern the

lack of prioritisation and adequate budgets for the same. These investments contribute to the

reduction of health inequalities, ensuring access to basic services for vulnerable and marginalized

populations; they deliver high quality services and improve overall health outcomes and hence

need to be prioritised.

We acknowledge the support and collaboration of these partners.COMMITMENTS

We are committed to advocate for :

  • Domestic resource mobilization for health including push for the move from commitment

to action, co-financing of Global Fund and other development partners programs for HIV,

TB and Malaria, to build equitable and resilient health systems, focused on people centered

approach and integrated health services (addressing HIV, TB and Malaria and other health

issues based on people’s needs and disease burden);

  • Community Health system strengthening, including ensuring a recognized status for

Community Health Workers, financing of Community Health Strategy, support for community

led responses, and incorporation of community, rights and gender considerations in HIV, TB

and malaria programming;

  • Incorporating universal health coverage as a goal in national health policy frameworks,

strategically connected to broader inter-ministerial priorities such as emergency

preparedness, social stability, climate, economy and finance;

  • Bridging financial and implementation gaps of HIV, TB, Malaria, Health Systems Strengthening,

Pandemic Prevention Preparedness and Response and Community Health Systems in the

National Strategic Plans for the countries;

  • Establish a space for exchange and sharing of good practices among parliamentarians from

different regions of Africa;

  • Create synergies with civil society on Domestic Resource Mobilization for Health in Africa.

RECOMMENDATIONS

That African governments, in a multi-sectoral approach, work in concert with parliamentarians,

civil society and the private sector to implement sustainable strategies for mobilizing domestic

resources and for a significant increase in health budgets, given that a healthy nation is

indispensable to Africa’s socio-economic transformation, as envisaged in Agenda 2063.

African governments, with the aim of achieving universal health coverage by 2030, accelerate

the institutionalization of community health agents to ensure the sustainability of their actions.

This means formalizing their integration into health systems, professionalizing their training and

mobilizing the resources needed to pay them.DECLARATION_MP_Nairobi_ENG

Nairobi, July 12, 2023

The government has a responsibility to provide accessible and supportive drug rehabilitation and counselling facilities.

UHC Day Celebrations

DRUG abuse is now a humanitarian disaster that is inflicting harm to the young generation, perpetuating violence and poverty especially among the low-income and vulnerable communities, health stakeholders have said.

Speaking to NewsDay, Community Working Group on Health  executive director Itai Rusike, said there is need to focus on social support structures.

“We can only solve our current problems that have resulted in the surging drug abuse, overdose and deaths through a public health approach. The government should invest in proven services and care to address substance abuse and mental health needs,” he said.

Rusike said there is need to also invest in youth-friendly drug rehabilitation and counselling services instead of placing the burden of care on families who lack information and tools to respond to the scourge.

“Families should get greater support from government and other stakeholders to promote communication and to help those facing drug abuse challenges. We need to prioritise prevention of drug abuse and tackle the drivers of drug abuse.

“The root cause of drug abuse in Zimbabwe is lack of jobs and enterprise opportunities, recreation facilities and opportunities for young people to participate in decisions affecting their lives,” said Rusike.

President Emmerson Mnangagwa said government would come up with tougher laws to deter drug dealers from preying on youths.

For Youths by Youths team leader, Wilbert Jena, said there was need to continue raising awareness against drug and substance use through different strategies including youth friendly strategies.

CWGH Director Itai Rusike Joins High-Level National Dialogue on Health Financing , Switzerland

The CWGH Director, Mr. Itai Rusike, was invited to and attended a panel discussion on domestic health financing in Africa with the theme “Advancing Health Financing Reforms through Inclusive Dialogue: National Health Financing Dialogue in SADC Countries”. The event was attended by Ministers of Health, policymakers, development partners, and other CSOs. It took place on May 25th, 2023, in Switzerland.In his words he said “We are pleased to have had the opportunity to hold a productive dialogue meeting in partnership with the Parliament of Zimbabwe, civil society, and the Zimbabwe Union of Journalists. Our delegation from civil society included representatives from various constituent groups from across the country, as well as traditional leaders who serve as custodians of primary health at the community level, and community health workers who have a direct interface with the community. In Africa, community health workers play a crucial role as trusted team for health interests. The media was also invited to this meeting to help prioritize health stories and understand health financing processes. We have come together to issue a joint statement that we hope to present at the international dialogue. It is important for Zimbabwe to continue holding inclusive high-level national dialogues, and we look forward to further follow-up from Parliament and the media. Any support to push for this national level effort would be greatly appreciated.” Watch the video

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