https://www.sundaymail.co.zw/a-tough-health-year-gone-by
A tough ‘health’ year gone by
Doctors’ absence prolongs patients’ suffering
ORDINARY citizens whose pockets are not deep enough to afford private medical care continue to bear the brunt of the ongoing stand-off between medical doctors — who have been on industrial action for over two months now — and government.
People with various ailments are gambling with death as many have since stopped going to seek medical attention at public hospitals, where they are routinely turned away due to the unavailability of doctors.
Hope in the public health system recuperating and going back on its feet has been lost and the pain has been worst felt by chronically ill patients who rely on the doctors’ services from time to time.
Faina Guruuswa (not her real name), has suffered from anal cancer for 11 years, having been in and out of hospital since 2008, seeking services to at least ease her recurring ailment.
The growth is often cut, but it grows again at a slightly different spot. She has had to become a permanent resident at one of the country’s biggest health institutions, where she is being attended to.
When NewsDay visited her, she was fearful that speaking to the media would attract severe backlash from hospital authorities.
Sometime in September soon after the doctors downed their tools, she had to go for an incomplete chemotherapy treatment.
Chemotherapy treatment may be a single drug or a combination of drugs. The drugs may all be given on a single day, several consecutive days, or continuously.
Guruuswa was given three doses, instead of five, and was told it was just a favour being accorded her since doctors were on strike.
Such is the case for many in her situation. Scheduled treatment is no longer guaranteed, further worsening their situation as cancers are bound to spread rapidly.
Guruuswa said she was now living in uncertainty over how long she would be stuck at the hospital awaiting services in the face of the doctors’ prolonged strike.
“My condition started in 2008 soon after I started anti-retroviral treatment. I developed small pimples in my anal area and I sought treatment which was not entirely successful,” she said.
Five years down the line, she said it started growing again and she received medical attention, but it recurred again in 2015 and she had to go to Karoi General Hospital to have it removed.
“The growth started again and in 2016, I went to a bigger provincial hospital for another operation, but the growth wasn’t completely healed and I was in excruciating pain. I have had to live on painkillers until now. I am on morphine to help ease the pain,” she said, barely being able to conceal the pain gnawing at her as she narrated her ordeal.
She came to Harare in winter this year because she felt she was now being a burden to her sister, who had accommodated her in Chiredzi, but was also struggling.
Things turned for the worst when the doctors’ strike began and her dream of ever getting better have been shattered.
“Things have changed. Before this, we did not have problems getting treated. It was timely and straight-forward,” she recalled.
Guruuswa has had to endure the harsh economic conditions and is living off the hospital after authorities availed a shelter for those in her situation at the Annex Psychiatric Unit.
She, however, keeps holding on to the last straw of hope that the doctors will return to work and she gets her scheduled treatment before things turn for the worst.
A visit to Parirenyatwa Group of Hospitals on Thursday evening last week proved that things were far from normal.
As the NewsDay crew sat in the casualty area trying to figure out how people were being served in the wake of the ongoing doctors’ strike, one of the senior doctors finally came after close to two hours of waiting.
“Doctors are on strike, but I am here to assist you with your next step,” the doctor said.
He told one woman who had brought a young man who had drunk poison, to take him back home and force him to drink lots of water because there was no doctor to deal with his condition.
Two women who had a baby with an ulcer on the thumb were told to rush to a private practice as their case was an emergency, which, under normal circumstances, would have been quickly dealt with at the hospital.
Several others were told to go back home.
Zimbabwe Hospital Doctors Association spokesperson Masimba Ndoro told NewsDay that while they drew no pleasure in seeing their patients suffering, the onus was on government to ensure that the basic right to health was upheld.
“We really want to be with our patients. We don’t draw any pleasure from their suffering. It is quite sad that people are being deprived of their right to health as a result of the impasse.
“It is the government’s responsibility to make sure that people are accorded quality health. The government should quickly come to terms with regards to accepting that we have a problem,” he said.
Community Working Group on Health (CWGH) executive director Itai Rusike said the ongoing impasse between government and the doctors was taking its toll on patients and there was need to resolve the crisis urgently.
“CWGH is greatly worried by the incapacitation crisis and prolonged impasse between the doctors and their employer, which has resulted in untold suffering of patients and even deaths that could have been avoided under normal circumstances,” he said.
“While we acknowledge the genuine grievances of the doctors and the financial position of government, we would like to urge the two parties to put patients first and at the centre of their dialogue to save lives and stop the suffering.”
The doctors have remained adamant and have vowed not to return to work until government offered a meaningful remuneration, among other things.
Government has already fired 211 striking doctors after conducting disciplinary hearings, albeit boycotted by the medical practitioners.
At least 516 doctors face the axe as the disciplinary hearings continue.
Meanwhile, Guruuswa’s life, and that of other patients in critical conditions, remain in the balance.
Chaos as govt fires over 200 doctors
GOVERNMENT yesterday fired 211 doctors at public hospitals for going o strike to demand better pay, with another 500 at risk.
Doctors have been on strike since September 3 demanding salaries that are indexed to the United States dollar to escape triple digit inflation that has ravaged wages.
The Health Services Board fired the doctors after holding disciplinary hearings which the striking doctors did not attend and said it planned to hold another round of hearings for at least 516 out of the 1 601 doctors employed in the public sector.
The Zimbabwe Hospital Doctors Association, which represents junior and mid-level doctors, has accused government of intimidation to force its members to return to work.
Health Services Board (HSB) executive chairman, Paulinus Sikosana yesterday said the disciplinary hearings were set to continue.
“To date, 279 doctors have been served with charge letters, 213 hearings completed and 211 doctors found guilty of absenting themselves from duty without leave or reasonable cause for days ranging from five or more,” he said.
“The 211 doctors found guilty have been discharged from the health service. Three doctors appeared in person before the disciplinary tribunals and two doctors had their determinations reserved pending verification of their cases.”
Sikosana said at meetings aimed at ending the impasse, doctors had “demanded the pegging of their salaries to the prevailing interbank rate as a precondition for their return to work.”
Zimbabwe is facing its worst economic crisis in a decade, with inflation, estimated at 353% in September, playing havoc with salaries and prices.
Community Working Group on Health (CWGH) executive director, Itai Rusike said the decision by government was very frustrating considering efforts made to facilitate dialogue with hope of reaching an amicable decision that is comfortable for both parties.
“We have been facilitating dialogue for the past two weeks only to wake up to this. How do you negotiate for dialogue when on the other hand you are holding a knobkerrie? The government is not sincere and its attitude is uncalled for and unnecessary,” Rusike said.
“This intimidatory attitude is not the way to go. The Constitution gives them the right to withdraw their labour and firing the doctors in a country with poor health standards will not improve the situation.”
He said they had done their part in trying to get the two parties to dialogue in search of a solution to the impasse.
“We thought that the government was going to set aside the hearings and uphold dialogue. Without human resources we cannot achieve universal health coverage,” he said.
ZHDA executive members said they were not commenting on the latest developments for fear of victimisation.
“Senior doctors remain incapacitated and hospital drugs and equipment remain inadequate. No meaningful service is being offered at central hospitals,” the union said in a statement.
“Training of both undergraduate and postgraduate doctors has been severely impacted by lack of clinical teaching.
“Flexi-hour system remains in place as policy. This has greatly affected quality and continuity of patient care Junior and middle level doctors have been dismissed from work for not being able to report for duty due to incapacitation. Some on maternity leave and others who are training outside the country have also been served with letters accusing them of absenteeism.
ZHDA said the ‘punitive disciplinary hearings’ should stop while the dismissals must be reversed.
“Robust dialogue in good faith should take place with key stakeholders to help direct the capacitation of the workers and the public health institutions. These must be given timelines to yield results,” ZHDA said.
BY VANESSA GONYE
Zimbabwe runs out of contraceptives
BY VANESSA GONYE
Public hospital doctors have lashed out at the Health Services Board (HSB) for firing 77 doctors since Tuesday. Addressing Zimbabwe Hospital Doctors’ Association (ZHDA) members and the media at Parirenyatwa Group of Hospitals yesterday, the association’s vice-president Masimba Ndoro said the move by government was costly, especially on citizens who have no healthcare givers.
“This is an abnormal situation which requires solutions not to waste taxpayers’ money. It is a move we have anticipated; we knew they would take that route as we started our strike. It will not capacitate our doctors and it won’t change the situation in our health system,” he said. Ndoro said the doctors would stick to their guns even in the face of more threats from their employer until they reach a reasonable agreement.
ZHDA acting secretary-general, Tawanda Zvakada said the decision of the HSB was proof that they were not in their right senses and as an association they would wait for them to come to their senses and reach a meaningful conclusion on the matter that has been hogging the limelight for a number of years.
“We hope this is the last strike, we want a long-lasting solution to prevent these impasses and we have proposed that the salary is paid at interbank rate to avoid situations where our earnings are eroded just a month after they would have been reviewed,” he said.
ZHDA treasurer-general Tapiwa Mungofa, questioned HSB’s credibility as they have diverted from their mandate of representing them and to act on issues that pose a threat to their calling.
“The decision to fire doctors came as dismay to the doctoring profession; the HSB is mandated with a very simple task, but it’s a shock they have been barbaric, firing the few doctors the country has,” he said. Mungofa said the doctors remain open and available for dialogue.
Community Working Group on Health (CWGH) executive director Itai Rusike said the dismissals will neither address the problems affecting the doctors nor boost their morale.
“CWGH has learnt with great concern the dismissal of the doctors that are currently affected by incapacitation. We strongly urge the government to find amicable ways of dealing with the doctors’ incapacitation crisis without sacrificing the health of the masses,” Rusike said.
He said the country has a pathetic doctor-patient ratio that has left the available human resources stretched to the limit, thereby compromising quality of care.
“We implore the HSB to reconsider its decision and fully take advantage of the dialogue process being facilitated by CWGH,” Rusike said.
Rusike called on the two parties to find amicable ways of dealing with such problems while prioritising the lives of patients and the general public that depend on the public health institutions.
Trevor Chivandire, one of the fired 77 doctors, said as professionals who have their country’s interests at heart they were going to try and re-engage their employer and would try other avenues if the move does not yield results.
Dialogue needed to break doctors, govt impasse
Doctors and their employer have been urged to engage in an honest dialogue aimed at ending the current impasse which has halted operations in public hospitals and created chaos in the private sector which is being swamped by patients.
The Community Working Group on Health (CWGH), which is mediating between the Zimbabwe Hospital Doctors Association (ZHDA) and the Health Services Board (HSB), said there was need to resolve the matter urgently.
“We are saying to the government let us open the dialogue doors by setting aside the disciplinary hearings and give dialogue a chance,” CWGH executive director Itai Rusike told NewsDay yesterday.
Doctors last week snubbed disciplinary hearings by government over their refusal to go back to work after being ordered by the court to do so.
The refusal, accompanied by Information deputy minister Energy Mutodi’s threat to fire and blacklist all the striking doctors, has complicated the negotiation process.
CWGH initially met with the ZDHA executive committee last week as well as the HSB.
A meeting was then convened on Wednesday for a joint discussion and meetings are continuing even though progress is said to be slow.
This is due to mistrust and suspicion between the two parties, who have had a standoff for more than two months, with government instituting disciplinary hearings.
“Both parties should bear in mind that more than 90% of the Zimbabwe population depends on the underfunded and understaffed public health system,” Rusike said.He added that there was need to prioritise patients and the vulnerable populations in their dialogue to resolve the crisis.“We also would like to see the leadership from the HSB to ensure speedy resolution of this crisis. The general public would like to be furnished with concrete steps, including timelines the government is committing to address the current dispute,” Rusike said.
Rusike also said sadly, the issue of brain drain as a result of push factors was very worrying. “Experienced doctors are leaving and this compromises the quality of health care,” he said.
The HSB has maintained that they are sticking to the laid-down procedure and would go ahead with the hearings with or without the doctors.
The doctors, who have not been reporting for work for over 60 days, on the other hand, have said that they would not attend the hearings.
“We do not care about the hearings, all we are concerned about are the issues of incapacitation, which have not been addressed,” ZHDA acting secretary-general Tawanda Zvakada said yesterday.
Heads should roll at Parirenyatwa
Health watchdogs have called for thorough investigations into the recent death of a woman during labour at Parirenyatwa Hospital amid allegations that she was left unattended for too long.
Sharon Munyonho’s body was found in a grisly state with the baby stuck between her legs.
“There is need for thorough investigations. It is sad and painful that she died while giving birth unattended at Parirenyatwa Hospital, one of the country’s largest referral institutions, which is supposed to be the shining beacon of professionalism in the health sector,” said Itai Rusike, the director for Community Working Group on Health (CWGH).
Rusike said what made the death more disturbing were reports that nurses on duty ignored her pleas for help.
Unconfirmed reports allege that the woman was in distress from around midnight, but nurses dismissed her pleas assuming she was clamouring for undue attention. She reportedly passed on together with her baby.
“This is unacceptable. No woman should die while giving life. The Community Working Group on Health would like to call upon the responsible authorities to urgently institute thorough investigations into this disturbing case, which could have been avoided,” Rusike said.
The health watchdog also challenged the Health Ministry to publicise the findings and take appropriate action against anyone found to have been negligent.
“The nursing profession is a calling and we cannot allow that noble profession to be tainted by rogue and mercenary individuals who vent their frustrations on innocent patients. Nurses and doctors are known to have hearts; hearts to love, to be patient and to save lives,” Rusike added.
Zimbabwe is still battling a high maternal mortality rate of over 500 deaths per 100 000 live births.
“CWGH is worried by the high number of maternal deaths in the country. It is disturbing that over 200 women have died while giving birth since the beginning of this year. This number is unacceptably high. In other countries, a single maternal death will result into a major inquiry and the outcomes will be made public,” Rusike said.
Statistics indicate that most of the maternal deaths are occurring at health facilities (92%), with 5% occurring at home and 3% elsewhere. Parirenyatwa Hospital spokesperson, Lenos Dhire said they were finalising a report on the findings.
BY Phyllis Mbanje
Health sector mourns Mugabe
AS the country and the world continues to mourn the passing on of former president Robert Mugabe, players in the health sector have chosen to celebrate his life by sharing some of his successes and vision.
Mugabe died on Friday at around 4am at Gleneagles Hospital in Singapore.
He was 95.
Mugabe was Zimbabwe’s first democratic leader after gaining independence from the colonial bondage of Britain in 1980 and he is credited with some of the policies which saw Zimbabwe scoring successes on many health fronts.
Zimbabwe managed to eradicate the usually known “six killer diseases” and also built hospitals and clinics around its territory under his stewardship.
Former Permanent Secretary in the Ministry of Health and Child Care, Dr Gerald Gwinji said the former president had a vision of providing health services to all.
“He had a vision of providing health services for all and this vision had to be achieved by 2020.
“He also aimed at decentralising the health services so that people from the rural area can also access the services.
“Mugabe made sure that there were more trained health workers locally which saw an increase in the services provided,” he said.
He added:
“In essence his vision had been achieved partially though there were challenges here and there.
“For example, the issues of sanctions were a hindrance because if the economy does not perform well naturally social sectors suffer.”
Community Working Group on Health Executive Director Itai Rusike said Mugabe made a lot of achievements in the early years of Independence.
“After adopting the Primary Health Care Strategy at Independence in 1980, huge gains with excellent health outcome indicators in maternal and child health, family planning and immunisation were achieved in the early years of Independence.
“Great investments were also realised in the construction of new health facilities from about 500 health facilities at Independence to more than 1 600 public health facilities that we now have across the country after adopting a policy of having a health facility within ever eight kilometer radius.
“Major gains were also achieved in the training of human resources for health (nurses and doctors) that made Zimbabwe the envy of the region on highly skilled health workers hence today our doctors and nurses are sought after worldwide.
“Unfortunately most of the gains achieved in the first ten years of Independence have now been reversed after the country adopted the ruinous Economic Structural Adjustment Program (ESAP) in the late 1990s, and with the advent of HIV/AIDS, brain drain and corruption scourge,” he said.
A senior health expert who served in the Government in the 90s said the late Mugabe was the reason the country boast of professional doctors we pride ourselves with today because of his continued vision for learning.
“Cde Mugabe made sure doctors and other health professionals were sent for further training to countries like Cuba and Russia and today we have highly qualified professionals,” said the expert who preferred anonymity.
Fiona Ruzha, H-Metro Reporter
Scale up 2020 health budget, govt urged
GOVERNMENT has been urged to craft innovative and sustainable healthcare financing policies and protect the poor and vulnerable groups through implementing a comprehensive national health financial strategy.
Community Working Group on Health (CWGH) executive director Itai Rusike said this in his 2020 CWGH national health strategy budget paper.
Rusike noted that Zimbabwe’s health sector was grossly underfunded compared to neighbouring countries in the Sadc region to the extent that government in 2019 spent US$41 per capita (per person) on health, which is grossly inadequate.
“Government spends a relatively small share of its gross domestic product (GDP) on health care and the lower levels of per capita health expenditure indicate that health expenditure in the country is insufficient to guarantee adequate access and quality of healthcare,” Rusike said.
“Per capita health allocation stands at about US$41 in 2019 up from US$31 in 2018, while per capita health spending is US$650 in South Africa, US$90 in Zambia and US$200 in Angola, and the inadequate public financing of health has resulted in an overreliance on out-of-pocket and external financing, which is highly unsustainable,” he said.
With the prolonged strike of medical doctors at Zimbabwe’s health institutions, poor people are the worst affected because they can not access medical treatment from private institutions.
Rusike said what made the country’s health situation worse was the fact that most of the health financing was donor sourced, which is unsustainable.
“Development partners are expected to complement the 2019 budget appropriations. The Global Fund, for instance, is expected to provide US$75 million. The high dependency on external financing is unreliable, unpredictable, unsustainable and highly dependent on the political environment, raising concerns on the sustainability of health financing and the vulnerability of government’s budget should external funding be withdrawn,” CWGH director said.
Rusike said the main sources of health financing in Zimbabwe are employers (28,4%), followed by households (25%), external financing (24,9%) and government at the lowest at (21,4%).
“There is an over-reliance on out-of-pocket and external financing. Out-of-pocket payments by households have driven many households deeper into poverty. The high dependency on external financing is unreliable, unpredictable, unsustainable and highly dependent on the political environment, raising concerns on the sustainability of health financing institutions and the vulnerability of government’s budget should external funding be withdrawn,” he said.
Rusike said donor funding was dwindling owing to global economic constraints, and, therefore, government must respect the Abuja Treaty requirements that health should get at least 15% of the National Budget.
He said high out-of-pocket spending in health has turned many households poor.“The free user-fee policy for pregnant women, under-fives and those aged 65 years and above has not been backed by resources and has resulted in over-crowding at the tertiary institutions. Moreover, the blanket cover does not look at ability to pay,” he said.
Rusike adjudged the health situation in the country as currently in a critical situation due to macroeconomic instability.“Public health sector allocation stood at 8,9% in 2019. Employment costs, however, constitute 66% of the total health budget. The Abuja 15% target remains an elusive target for the country. The sub-Saharan African average is 13%. As of 2015, Rwanda was spending at least 23% of its budget on health care,” he said.
On shortages of health personnel, Rusike said high drop-out rates in public sector health care posts have resulted in vacancy rates of over 50% for doctors, midwives, laboratory and environmental health staff, exacerbated by the fact that Zimbabwe’s nurses’ establishment was last reviewed in 1983 yet the population has increased significantly.
Meanwhile, acting general treasurer of Zimbabwe Hospitals Doctors’ Association Peter Mungofa said most doctors were now considering job opportunities in other countries as government has failed to meet their demands.
“Nothing has changed despite President (Emmerson) Mnangagwa’s chilling threats. What has changed is that doctors are enquiring about going to work outside the country and our fear is that very few doctors will remain in the country,” Mungofa said.
Mungofa said they were shocked by Mnangagwa’s threats when they thought he was going to resolve the issue of salaries and doctors’ conditions of service.
2019-10-21 newsday BY VENERANDA LANGA/NUNURAI JENA
Victoria Falls Hospital has no ICU, drugs
HWANGE district’s biggest referral health institution, Victoria Falls Hospital, is running without emergency facilities and basic medication, a development which is compromising service delivery in the event of a disaster in the country’s prime tourist resort.
Doctors at the institution said there was no functional intensive care unit (ICU) and related supplies such as oxygen synthesisers.
A government medical officer, Michael Jeans, recently told United States ambassador to Zimbabwe, Brian Nichols that in cases of emergency, it takes about six hours for patients to be evacuated to the nearest health facility in South Africa.
He said the hospital needed facilities for trauma and life support, including oxygen synthesisers in the ICU.
“We also don’t have medication to stabilise patients affected by heat stroke nor injection for blood thinning and blood in emergency situations,” Jeans said.
“As a result, we alternate to anti-clotting pills like aspirin which is also not always available.
These injections are always in stock even in rural areas of South Africa, yet the prime tourism destination does not have.”
He added that due to electricity shortages, emergencies were difficult to attend to as the generator at times would not have adequate fuel to run.
Nichols said 60 000 Americans visited the country annually and safe healthcare was a necessity.
Acting district medical officer Fungai Musinami said they were working with US-based organisation, Matter, which recently donated maternity equipment.
Victoria Falls Hospitality Association of Zimbabwe chapter chairperson Farai Chimba said there was need for collaborative efforts to capacitate hospitals in order to promote smooth running of tourism.
“We had to take an injured tourist to hospital, but he died upon admission in South Africa, otherwise many prefer private hospitals,” he said.
Matabeleland North provincial medical director Purgie Chimbengwa said the Victoria Falls Hospital “is ideally not at a level of a provincial hospital, where one expects to find services such as ICU”.
In a bid to improve service delivery, he said they had deployed an obstetrician and gynaecologist to complement the government medical officers.
Community Working Group on Health executive director Itai Rusike said the deplorable state of the country’s health system required urgent attention, giving priority focus to revitalising the primary healthcare system and addressing the social determinants of health to achieve universal health coverage, thus enabling every Zimbabwean equitable access to essential quality health without facing financial hardships.
newsday October 12, 2019 -BY Nokuthaba Dlamini
Health funding still poor: CWGH
THE Community Working Group on Health (CWGH) yesterday said the supplementary budget for the health sector, which Finance minister Mthuli Ncube announced on Thursday last week is still inadequate in the face of rising disease and mortality levels in the country.
BY VENERANDA LANGA
CWGH executive director Itai Rusike told NewsDay in an interview that despite Ncube’s strong expressions, during the budget presentation, placed on social priorities including health, the supplementary budget for health only had a nominal increase which did not match priorities in the sector.
Zimbabwe’s per capita health spending in 2019 is a measly $41 per person after Ncube allocated only $755 million towards health in the 2019 Budget, which has also been increased by a small margin in the July supplementary budget.
“We would like to know whether the Ministry of Finance has any guide in its allocations of a level of per capita funding of health services that constitutes the ‘bottom line’ in terms of the rights or needs of citizens,” Rusike said.
“The supplementary budget allocation for the health sector is inadequate in the face of rising disease and mortality levels,” he said.
Rusike said there has been a massive increase in the cost of essential drugs in the country as well as a drop in the ability to purchase drugs by low income people resulting in barriers to access to healthcare due to the high costs.
“These trends are exacerbated by government failing to sufficiently look into the cost of health services. The state of the health services — near collapse — is directly related to government misplacing its priorities in not allocating adequate resources to the health sector,” he said.
The CWGH said government should start making health delivery a top priority if it is to save its health institutions from imminent collapse.
“We only hope that the Ministry of Health and Child Care will manage the additional funds allocated to them as efficiently and effectively as possible in order to maintain good health standards in the face of collapsing health services,” he said.
During his 2019 supplementary budget statement, Ncube said among some of the things that government will do for the health sector is to acquire 100 fully equipped ambulances.
“The Ministry of Health and Child Care has completed the tendering process for procurement of ambulances, and in this regard an amount of $68 million in additional funding is proposed to complete the procurement process that targets acquisition of 100 fully equipped ambulances,” Ncube said.
He also said to strengthen the referral health system, government was rehabilitating and upgrading health infrastructure as well as constructing rural health posts.
“With regards to central hospitals, refurbishment works for the medical gas reticulation system, theatres and incinerators at Mpilo and United Bulawayo Hospitals, have been completed. Following a fire outbreak which affected Mbuya Nehanda Maternity Hospital at Parirenyatwa Group of Hospitals in February 2019, refurbishment of wards and installation of new theatre equipment has been completed and the hospital is now fully operational,” Ncube said.