THE country’s health sector has been plunged into dire straits as poor remuneration and working conditions drives qualified health professionals into the diaspora where they are being employed as simple nurse aides, health experts have said.
The country has over the years recorded a mass exodus of skilled workers, who have opted for menial foreign jobs owing to poor remuneration back home.
Currently, the country has lost at least 3 000 nurses to the UK alone in the past two years.
Salary negotiations have yielded little and have resulted in perennial job action and deadlocks.
Community Working Group on Health executive director Itai Rusike told NewsDay that skilled health professionals are opting to do care work outside the country simply because government is failing to pay health workers decent wages.
“One of the major challenges facing Zimbabwe’s public health care system is brain drain. Doctors, nurses and pharmacists have left and continue to leave the country to destinations like the United Kingdom, Australia and New Zealand. In fact, Zimbabwean health professionals are now found in nearly all countries, including non-traditional destinations such as Dubai,” Rusike said.
“It is very unfortunate that senior, highly-qualified and experienced health professionals are now opting to do a Red-Cross short course on care work so that they can quickly get the work visa permit for the UK and leave the country with their spouses and children with very little chances of coming back any time soon.
“The country has failed to stabilise the brain drain for a number of decades, and recently some clinics in the capital city have closed for lack of staff. Health care workers continue to be trained but fail to fill in the posts established in the 1980s, let alone the posts and establishment required to deal with the current population, disease epidemiology and health and development targets.”
Public Service International sub-regional secretary for Southern Africa Tichaona Fambisa said: “This is a serious problem because what this means is that poor countries like Zimbabwe are subsidising the health systems of developed countries. Health professionals are trained in the country and after that they leave to serve other countries. Government should make sure that they invest more in public service so that public sector workers and health workers can earn decent salaries and fail to find reasons to migrate.”
Efforts to get a comment from Public Service, Labour and Social Welfare minister Paul Mavima were fruitless. But speaking to NewsDay last week; Mavima said government was in the process of increasing salaries for health workers to slow down the exodus.
THE year 2022 was eventful in the health sector, where outbreaks of diseases considered medieval such as measles and polio overtook the two-year global pandemic, COVID-19, in terms of deaths in a short space of time.
The country also witnessed a reduction in maternal deaths, and introduction of the eye strategy in the wake of increased eye conditions, mainly catalysed by diabetes.
Below are some highlights of the health sector in 2022.
COVID-19
The year 2022 started off on a positive note as COVID-19 cases had dropped compared to the same period the previous year, where fatalities of the dreaded pandemic increased in the blink of an eye, with many deaths recorded from the onset of the pandemic.
As such, the year was quite stable regarding COVID-19 with cases fluctuating, but with decreased deaths.
Government, as of Wednesday June 22, 2022 scrapped the night curfew. Opening hours for shops, bars and restaurants were extended.
Masks were also scrapped during the course of the year for fully vaccinated individuals in outdoor settings. However, for indoors, they remained mandatory.
The lifting of the curfew and wearing of masks was for the first time since the onset of the pandemic in 2020, although the curfew had many variations depending on the magnitude of crisis over the two-year period.
However, towards year-end in December, cases of COVID-19 began to soar in the country.
During the final post-Cabinet briefing for 2022, Information, Publicity and Broadcasting Services minister Monica Mutsvangwa said over 200 new cases and six COVID-19-related deaths were recorded in the country in the previous week.
Government said it was on high alert and would increase testing and screening at ports of entry after reports that China had been hit again by a COVID-19 outbreak.
Measles
Four months into 2022, another health crisis emerged, this time originating from Mutasa district in Manicaland province, an area largely dominated by apostolic sect members.
Measles, a medieval disease whose return on April 10, 2022, raised questions over the country’s health security, was at the centre of the crisis.
The disease, that was considered long forgotten, re-emerged in the country, with a rapid and fatal spread.
It overtook COVID-19 in terms of fatalities, which were way above in comparison with the period of inception.
By September 2022, more than 750 children had died of measles, prompting authorities to hastily put a plan in action, which entailed introducing a measles vaccination programme that began in September.
This was after more than 2 000 people, including adults, had been affected by measles as of August 17, 2022.
By August, measles had claimed the lives of 157 children, all of them were not immunised against the disease.
During the immunisation programme, government mainly targeted apostolic sects, especially in the Mutasa area, where they dominate, encouraging them to warm up to vaccination, which they eventually did.
In October 2022, according to Manicaland provincial medical director Munyaradzi Mukuzunga, the province recorded zero measles cases.
There was a generally low incidence of measles for the same period countrywide.
Polio
In October, the country launched a polio vaccination campaign to guard against the disease that had been detected in neighbouring Mozambique, although no case has been reported locally to date.
A follow-up vaccination exercise was done from December 1 to 4 this year as the country sought to intensify immunity from the disease.
Diabetes
Cases of diabetes were on the rise during 2022, mainly Type 2.
Health and Child Care deputy minister John Mangwiro said: “General statistics show an increase because there is massive rural-to-urban migration. Westernisation of diets is also contributing to the increase. There is need to have a lot of awareness and campaigns and more stories about diabetes. There is need to encourage people to get tested and know how to deal with the condition.”
HIV and Aids
For 2022, the major highlight was the country winning the bid to host the International Conference on Aids and STIs in Africa to be held in December next year.
After winning the bid, National Aids Council chief executive officer Bernard Madzima said: “Winning the bid was a big step in the positive direction as we have been recognised in Africa as a leader in terms of the HIV programme. Our country also recorded successes as per the global HIV report, which says we achieved the 2025 targets of 95-95-95 midway through the projected time. We are very proud of that as a country. We are also happy that we managed to curtail and to incorporate issues of COVID-19 in HIV programming, thereby averting the anticipated increase in deaths due to the comorbidity of HIV with COVID-19.”
The other good thing that happened in 2022 was the Global Fund replenishment.
President Emmerson Mnangagwa pledged US$1 million funding for the Global Fund 2024-26.
“We have contributed to the Global Fund as a country and we are proud of that,” Mnangagwa said.
Overview of the health sector
Health expert Josephat Chiripanyanga said: “In 2022, our health delivery system generally improved. We look back to 2020 and 2021 and see the challenges that we had from the devastating COVID-19 pandemic. It was difficult for us to achieve some of the goals that we had in terms of achieving the Sustainable Development Goals for 2030 because most of the resources were being channelled towards COVID-19.”
He said with COVID-19 milestones having been achieved, there was now need to look after the elderly and chronic patients.
“Treatment has improved significantly and access to health facilities has improved. Generally, the health of our people has improved. In 2021, we had a significant number of neonatal and under five deaths which got to about 5 000 for the whole year, which was very high. We hope this year the figures will be lower than that because there has been an increase in access to health.”
Community Working Group on Health executive director Itai Rusike said: “Zimbabwe is currently grappling with a massive health worker exodus due to low remuneration and poor working conditions in the hospitals, among other health system challenges.
“The once well performing and envied health system is visibly failing to serve the needs of the citizens, as evidenced by closure of clinics and significant reduction in services offered at hospitals across the levels.
“Some central hospitals’ statistics now resemble district or lower-level facilities at a time when the need for health services has increased due to huge disease burden and population increase.”
Rusike said Zimbabwe’s health sector continued to be in the doldrums due to a plethora of challenges.
“The country’s health financing has consistently been well below the 15% proportionate funding from the fiscus since the Abuja Declaration of 2001. Regular power outages at health institutions have added to the disruptions in the few available health services, while at ports of entry there is scanty information available on public spaces about the disease profiles in the districts, provinces and the nation at large,” he said.
“There are continuous health worker strikes that impede access to health as people are not attended to when they seek health services at healthcare centres during strikes. Add to that, the institutions do not have adequate medicines due to inadequate supplies and pilferages as the poorly paid healthcare workers try to make a living within the workspace.
“The weakened and overburdened health system has benefited from the government wide response to COVID-19, but its frailty amidst the huge global challenge after COVID-19 emerged has proved a tough test to nation’s health security agenda.”
MATERNAL and neonatal mortality remains a health concern in Zimbabwe, Community Working Group on Health (CWGH) has said.
CWGH director Itai Rusike told NewsDay Weekender that the country remains off target towards meeting the 2030 United Nations (UN) goals to reduce maternal and neonatal mortality.
“Despite the high coverage of births by a skilled attendant and institutions delivery, maternal mortality remains high at 462/100 000 live births,” Rusike said.
“In addition, the high HIV rates among pregnant women at 14,3% increases the risk of mother-to-child transmission of HIV. Furthermore, neonatal mortality has remained stagnant for the past decade at 321/1 000 live births and under five mortality remains high at 65/1 000 live births.
“Likewise, besides being a priority, preventing the death of newborn babies remains a challenge and the country is off track to meet the Sustainable Development Goal (SDG) target by 2030, that every country should have a neonatal mortality rate of 12 or fewer deaths per 1 000 live births.”
Maternal mortality in Zimbabwe is 363 per 100 000 live births, according to the preliminary results of the 2022 housing and population census.
According to Rusike, while this is an improvement from the 614/100 000 live births for maternal deaths recorded in 2014, the slow rate of improvement indicates that Zimbabwe is unlikely to meet the SDG target for reducing maternal mortality.
Complications during pregnancy and childbirth are leading causes of death and disability among women of reproductive age.
“Most of these deaths are caused by a handful of conditions, from which death is largely preventable. Almost 95 % of our maternal and perinatal death cases are deemed to be avoidable,” Rusike said.
“This speaks to the issue of the quality of care at the point of care in our hospitals. This also highlights the importance of investigating the state of healthcare institutions with the view to devise probable interventions to improve quality of care.”
The Private Voluntary Organisations (PVOs) Amendment Bill, which has been criticized by opposition parties and civic groups for muzzling government critics and narrowing democratic space, has gone a step closer to becoming law after sailing through the Senate. It now awaits Presidential accent to become law.Opposition legislators and human rights activists want the controversial Bill canned amid fears that if passed into law in its current state will further shrink the country’s democratic space and lead to closure of several NGOs perceived as anti-government.However, in supporting the Bill, Zanu PF legislators described the Bill as a necessary tool to whip ‘rogue’ NGOs and CSOs into line.
#CWGHinCommunities– Community Monitors in Chiwundura and Masvingo receive training on the use of Kobocollect Application to collect data, analyse, engage & respond to rumours & misinformation on COVID-1,
THERE are fears that the recently signed Health Service Amendment Act could trample on the rights of health workers.
Speaking to NewsDay, Community Working Group on Health executive director Itai Rusike said the Act is neither democratic nor consultative.
He said workers in the public health sector are now disadvantaged in several ways, since now they cannot strike and bargain collectively.
“It is unfortunate that health workers are caught in the middle of a system that is slow to respond to their needs and ethical pressures not to take collective job action,” Rusike said.
“The unpopular Health Services Act will most likely exacerbate the exodus of health workers from the country thereby putting extra pressure on those who will remain on their jobs.”
He urged government to address the conditions of service for health workers to plug the brain drain.
While there are no exact statistics on the number of health professionals who left the country in 2021, the Zimbabwe Nurses Association put the figure at just over 2000.
Last year, government announced plans to ban doctors and nurses from embarking on job action lasting more than three days under new proposed amendments to the Health Services Act.
THERE are fears that the recently signed Health Service Amendment Act could trample on the rights of health workers.
Speaking to NewsDay, Community Working Group on Health executive director Itai Rusike said the Act is neither democratic nor consultative.
He said public health sector workers are now disadvantaged in several ways because they have no right to strike and they cannot engage in collective bargaining.
“It is unfortunate that health workers are caught in the middle of a system that is slow to respond to their needs and ethical pressures not to take collective job action,” Rusike said.
“The unpopular Health Services Act will most likely exacerbate the exodus of health workers from the country thereby putting extra pressure on those who will remain on their jobs.”
He urged government to address the conditions of service for health workers to plug the brain drain.
While there are no exact statistics on the number of health professionals who left the country in 2021, the Zimbabwe Nurses Association put the figure at just over 2000.
Last year, government announced plans to ban doctors and nurses from embarking on job action lasting more than three days under new proposed amendments to the Health Services Act.
The Health Services Act was enacted in February 2005 to provide for the establishment of the Health Services Board (HSB) and the transfer of persons engaged in public health service delivery from the Public Service Commission to the HSB.
Under the Act,, worker representatives who face charges of inciting nurses and doctors to unlawfully down tools could be jailed for three years in what authorities argue is necessary to ostensibly “instil discipline” in the health sector.
HEALTH experts have called for equitable health access for marginalised groups such as rural people, women and children.
This comes as the world yesterday commemorated the International Universal Health Coverage (UHC) Day, which falls on December 12 annually.
Community Working Group on Health executive director Itai Rusike said a country’s health system should work for everyone regardless of their financial status.
“Equitable health coverage puts women, children, adolescents, and the most vulnerable first because they face the most significant barriers to essential care. We all deserve a health system we know will be there for us throughout our lifespan. Trusted health systems provide high-quality services in primary care clinics and hospitals, equip and support frontline community health workers, and offer transparent health,” Rusike said.
He said Zimbabwe was affected by a decline in standards at the country’s major referral hospital, as well as the brain-drain in key personnel.
“UHC goes hand-in-hand with empowering communities to build healthy environments that promote holistic physical, mental and social well-being. Investing in #HealthForAll is the backbone of a prosperous society. Increasing public financing for health and reducing out-of-pocket health costs save lives, build resilience against pandemic threats, and advances Sustainable Development Goals beyond health.
World Health Organization (WHO) director AMR Global Co-ordination Haileyesus Getahun said challenges threatening a “healthy future for all” could not be addressed by the healthcare sector alone, but by a united and collaborative multi-sectoral response to ensure health security for everyone.
“The one health approach is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems. It recognizes that the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and interdependent,” Getahun said.
In August this year, WHO expressed concern over Zimbabwe’s slow pace in improving UHC, which is part of an initiative to ensure everyone has access to proper health services.
HEALTH experts yesterday said Finance minister Mthuli Ncube’s $473,8 billion budget allocation towards the provision of health care services was grossly inadequate to fund the sector’s critical needs.
Ncube announced a $4,5 trillion budget on Thursday with 11% going towards health. Community Working Group on Health executive director Itai Rusike said the health sector remains grossly underfunded.
“The health budget remains grossly inadequate to fund the critical needs in the health sector,” Rusike said.
“The current health financing model remains unsustainable as it heavily relies on external financing as well as out-of-pocket spending.”
“In spite of the huge external support from development partners, there is still a huge financing gap in the health sector in the country which calls for greater innovation and commitment by the government to sustainably address it.”
Dental Private Practitioners Association of Zimbabwe president Johannes Marisa said: “The health sector budget is an improvement from last year but of course when you are benchmarking with the Abuja Declaration you still realise that it falls short of the stipulated 15%.
“We hope the budget is going to address the mass brain drain that is underway in Zimbabwe where we are losing experienced and skilled workers to greener pastures.”
In April 2001, African Union countries met in Abuja and pledged to allocate at least 15% of their annual budgets to improve the health sector and urged donor countries to scale up support.
Years of underfunding of the country’s health sector was laid bare when COVID-19 hit the country as acute shortages of critical and lifesaving equipment such as ventilators and intensive care beds were exposed.
Some South African officials have accused Zimbabweans of straining that country’s health sector.
In his 2023 national budget, Ncube the allocation to health was meant to improve health provision.
“In 2023, the budget has set aside 11% of total expenditures towards the health sector notwithstanding financial constraints, Government is committed to the provision of quality health services, as evidenced by the ongoing construction and rehabilitation of health facilities,” Ncube said.
“In 2023, the budget has set aside 11% of total expenditures towards the health sector and the objective is to eventually meet the Abuja Declaration of 15%. This is necessary to attain Vision 2030 of becoming an upper middle-income economy.”
“In 2023, the sector is projected to receive US$212,9 million from the development partners towards the same areas.”
Ncube admitted that the health sector has been hard hit by mass exodus of health professionals.
“Government is, however, addressing this challenge through continuous review of both monetary and non-monetary incentives in order to attract and retain medical personnel.”
