Community Working Group on Health

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on the sustainability of health financing and the vulnerability of government’s budget should external funding be withdrawn,” CWGH director said.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

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.

 

newsday - August 5, 2019

Government is expected to appoint a board of directors for the National Aids Council (NAC) within the next month, Health and Child Care Minister Dr Obadiah Moyo has said.
The previous board was dissolved in March this year.
Once a new one has been appointed, it will then appoint a substantive chief executive to replace the long serving Dr Tapuwa Magure who left in December last year.
Responding to questions from stakeholders who felt the NAC board was taking long to be reconstituted, Dr Moyo said Government was following due procedure in the appointment of board members.
“We are working flat out to ensure that the board is well represented through following stipulated procedures,” he said.
“We anticipate that the board would be fully constituted for appointment within the next month.”
Since the departure of Dr Magure, NAC has so far seen two directors taking up the CEO role in acting capacities.
Pressure groups continue to advocate for the quick appointment of both the board and the CEO, arguing that lack of leadership at such levels impedes efficiency and effectiveness in resource allocation and usage.
The Community Working Group on Health (CWGH) is the latest organisation to call for a speedy reconstitution of the NAC board.
A number of other organisations, including those representing people living with HIV and Aids, petitioned Parliament earlier this month with the same concern.
CWGH executive director Mr Itai Rusike said NAC appeared to be failing to execute its mandate of late, as evidenced by a number of allegations, including misuse of public funds, maladministration, corruption and nepotism.
People on treatment are also reportedly battling to access enough drugs.
“The minister needs to urgently appoint board members and a substantive CEO for this organisation to make sure that it functions normally and makes important policy decisions that address the current burden of disease, integration of care and enable the country to attain developmental and universal health coverage goals,” said Mr   Rusike.
He said apart from reconstitution of the board, NAC must also provide a comprehensive review of its work, 20 years on.
Mr Rusike said the Aids Levy was a public purse, which must always be accounted for.
NAC is an organisation that came into being through an Act of Parliament in 1999 to coordinate and facilitate the national multi-sectoral response to HIV and Aids.

Paidamoyo Chipunza Senior Health Reporter

STAKEHOLDERS have scaled up calls on the Health minister Obadiah Moyo and Health Services Board (HSB) to urgently reconstitute the National Aids Council (NAC) board and appoint a substantive chief executive officer (CEO) to ensure smooth running of the organisation which has been dogged by allegations of maladministration, abuse of office and corruption.
The previous board was dissolved almost four months ago and at the time the Health minister in a letter said the board had been improperly appointed and that President Emmerson Mnangagwa had concurred to its dissolution.
However, no substantive appointments have been made, with Moyo recently saying they were following due process and that within a month, these appointments would have been made.
Agitated HIV activists are disgruntled and dissatisfied at the dragging process. The ZNNP+ Harare province advocacy chairperson Charles Kautare said the board was needed to make sound and coherent decisions. “The delay impacts negatively upon its service delivery mandates, bearing in mind that almost 100 000 people living with HIV and Aids are on second line treatment and are facing severe shortages of drugs,” he said.

Kautare also said given the prevailing situation, it would be difficult to meet the targeted 2030 mark of ending the devastating effects of the disease.
Community Working Group on Health (CWGH) director Itai Rusike also weighed in, saying the reconstitution of the board was critical since NAC, as an organisation, manages public funds (Aids Levy) and plays a pivotal role in the country’s HIV and Aids response. “The Honourable Minister needs to urgently appoint board members and a substantive chief executive officer for this organisation to make sure that NAC functions normally and makes important policy decisions that address the current burden of disease, integration of care and enable the country to attain developmental and Universal Health Coverage (UHC) goals,” he said.
Rusike said they felt strongly that the appointment of the CEO had taken too long considering the critical role that NAC plays in providing measures to combat the spread of HIV as well as management, co-ordination and implementation programmes that reduce the impact of HIV and Aids in the country.
“We disapprove the current ad-hoc and reactive appointments being done at NAC, an important organisation that holds keys to millions of lives that cannot do without its services,” he said.
“This points to serious management and governance shortcomings, and we strongly feel this runs contrary to the new dispensation’s thrust of health for development. We cannot allow such an important institution to operate on auto-pilot.”
The CWGH also made an urgent appeal for the reconstitution of other strategic and key governance institutions such as the Public Health Advisory Board, the National Cancer Forum and in addition set up a forum that looks at UHC.

 

©newsday - July 23, 2019  PHYLLIS MBANJE

ZIMBABWE should draw serious lessons from other countries who have successfully implemented national health insurance schemes that cater comprehensively for every citizen to ensure the attainment of universal health coverage (UHC), stakeholders have said.
High cost of medicines compounded by persistent industrial action by health workers has made it virtually impossible for ordinary citizens to access basic health care.
The call came as most health insurance providers have indicated that they will, from July 1, hike their fees by between 40% and 80% to cushion their businesses against inflation.
“In the absence of a national safety net coupled with the current prohibitive cost of health care services, it is imperative that Zimbabwe sets up a UHC, where
all people receive quality and essential health services when they need them including services designed to promote better health, prevent illness, and to provide treatment, rehabilitation and palliative care of sufficient quality, while at the same time ensuring that the use of these services does not expose the user to financial hardship,” Community Working Group on Health executive director Itai Rusike said.
Last month, Health minister Obadiah Moyo told the Parliamentary Thematic Committee on HIV and Aids that government was in the process of crafting a National Health Insurance Bill.
“This law will also control medical aid societies so that they do not just do what they want, so this Bill will ensure that they do not become service
providers,” Moyo said.
The health policy, which is expected to be operational by January next year, has been on the drawing board for the past 15 years.
The cost of health care in Zimbabwe remains one of the highest in the region and over the years, has denied many people access to quality medical care.
Most private health institutions are now demanding payment in hard currency or the parallel market equivalent in bond notes or RTGS dollar payments.
Meanwhile, medical aid providers have also been challenged to come up with schemes for the lower income bracket as many low-income earners are battling with
shortfalls and co-payments, which can be prohibitive given the current economic situation.

June 22, 2019 By Phyllis Mbanje

THE Community Working Group on Health (CWGH) has implored Government to prioritise the capacitation of pharmaceutical companies to ease obtaining shortages of drugs in the country.
Speaking to The Herald, CWGH executive director Mr Itai Rusike said while Government policies on drugs were very robust, there was an urgent need for it to avail foreign currency to capacitate local drug manufacturers.
“CWGH appreciates Government policies on essential drugs and equity in health which have over the years widened access to treatment,” he said.
“However, it is evidently clear that hospitals and clinics are facing critical shortage of drugs. It is our view that Government needs to inject foreign currency into local pharmaceutical companies which include; Caps, Datlabs and Varichem, among others to enhance their drug production capacity.
“At the same time we are saying there is need for a deliberate intervention to control drug prices, which continue sky-rocketing and are currently burdening consumers countrywide.
“For instance as an organisation, we have been monitoring issues to do with leakages, thefts, improper use of drugs in the health sector and submitting reports to Government for further action.”
Mr Rusike said his organisation was rolling out a number of community health literacy programmes on the use of drugs.
He encouraged Government to promote whistle-blowing in the health sector to curb artificial shortages of drugs in health institutions.
“Further, it is also our humble view that essential drugs must be ranked with energy and fuel as priority claimants of foreign currency,” said Mr Rusike.

Masvingo Correspondent