Community Working Group on Health

… as fears of politicisation of health products grows
The Community Working Group on Health (CWGH) has commended government for
making blood and blood products free in public health institutions beginning next month, but expressed concern over the unclear funding mechanism for the drive.
By Michael Gwarisa

CWGH executive director Itai Rusike said the high cost of blood has been one of the major barriers that prevented ordinary Zimbabweans from accessing and enjoying their health entitlements and rights as enshrined in the country’s Constitution which stipulates that health is a right.

He however said government should come clear as to how they intend to fund the free blood subsidy.

“However, notwithstanding the good intentions, the public would however like to know how the government – already saddled by external debt and a collapsing national economy – will fund the subsidy on blood? Where is the money coming from?

“Will the money come from national fiscus, AIDS Levy, Health Levy or Health Development Fund? Is
the subsidy funded by external partners? For how long? And how sustainable is the free blood
initiative?” said
He added that without answers to the above queries, CWGH remains concerned about the feasibility and
sustainability of this very nobble initiative because such a pronouncement has to be backed with a
strong financial purse.

“What measures has the government put in place to make sure blood will always be available given that it has been always in short supply even when being sold? Making a pronouncement without explaining the modalities is not enough.”

He added it was critical for the Ministry of Health and Child Care (MoHCC) to come out clean and explain the source of funding and the sustainability of this noble initiative for the sake of transparency, accountability and good governance.

“We fear that free blood initiative will go down the “user fee policy” of pregnant mothers under 5s and those aged 65 years and above which remained in most areas a political pronouncement.

“In 1980 free health care was introduced for those on low incomes (below $Z$150, then worth US$220). The policy position on user fees has been that those who can afford to pay for services should do so but implementation of the principle has been mixed.”

Meanwhile, the policy of free public sector care at rural clinics is still in force, although most mission and local authority clinics do not follow it hence this has been mainly funded by development partners through the Results-Based Financing (RBF) funded by the World Bank and the Health Development Fund (HDF) a basket fund by multiple donors such as DFID, EU, Swedish Government and the Norwegian Government.

However, in some health institutions mothers continue to be detained after delivery and Child Birth Records being withheld at public health institutions after failing to pay fees.

“It is against this background that CWGH demands that government explains fully the source of funding and the modalities to avoid the pitfalls of the “user fee policy” which has not been fully embraced and implemented for the benefit of the vulnerable groups it is supposed to serve.

“We need a separate budget line allocation from the national health budget to fund the free blood
policy to public health institutions!!!”

He however said the move to make blood free would lessen financial strain on patients and preventing avoidable deaths that have been occurring in the country as patients failed to access blood because of its high cost.

“The government’s subsidy on blood therefore comes as relief considering the high number of people that are dying in public hospitals after failing to buy blood while families have been disposing priced possessions for a song to save the lives of their loved ones.

“It is commendable that government has since last year been gradually reducing the cost of blood to
ensure that it is within the reach of the ordinary person from $150 a pint in 2016 to the current $50
a pint, with the ultimate aim of making it totally free by next month.”

He added that the free blood initiative was a welcome move as it shows the government’s political will and total
commitment to Universal Health Coverage (UHC), which entails all people and communities accessing health care without financial hardships.

KAROI — Ratidzai Moyo (33) of Chikangwe high density suburb is five months-pregnant and has suffered from the life threatening disease malaria twice within the last six months.

Moyo told NewsDay that she was a victim of a recurrence of the malaria scourge that gripped Chiedza suburb in the farming town three years ago.
She said there was a recurrence of malaria outbreak in Ward 10 while responsible authorities took long to curb it.

“As you can see, we have many water bodies around Chikangwe. We are victims of mosquitos around here,” she said.

Moyo is not the only one facing the malaria predicament here as many residents have complained of the disease.

Positive rate

When provincial Epidemiology Disease Control officer, Gift Masocha, visited Chiedza suburb during a testing campaign, out of 390 people tested, 190 were found positive to malaria infection.

The figure translated to a 48% positive rate that saw the establishment of health clubs to scale up awareness campaigns, as a critical intervention measure.

Ironically, health campaign have not yielded any positive results for many residents in Chikangwe and other suburbs in the farming town.

Population Services International partnered with Ministry of Health and Child Care for a 10-year advocacy campaigns in mainly malaria prone rural outskirts including Hurungwe district where mosquito nets were distributed freely.

In Chiedza the malaria control unit is religiously spraying anti-malaria pesticide where residents are “safe” from malaria.

Divide and rule

Zimbabweans commemorated World Malaria Day on April 25. Ward 3 councillor, Stewart Jena, complained of the “divide and rule” methods he said were used in dealing with malaria in Karoi by health officials.

This is the case around other places around Zimbabwe.

“We informed the council’s Environmental Health department and got assurances it will be solved but to no avail,” Jena said.

Sources revealed that mosquito nets distribution was done with the supervision of the environment health office.

Fatal

A malarial attack can turn fatal if there is no early intervention.

“We do not know why they are not acting, as nearly every rural clinic has mosquito nets outnumbering affected communities,” said a source who declined to be named.
A local doctor confirmed that uncomplicated malaria can turn fatal.

“It is not advisable that patients get the same medication after a few days or months of the same disease,” he said.

“There is need to react urgently on this medical crisis in Karoi town.”

But Masocha, the provincial Epidemiology Disease Control officer, begged to differ. He said Hurungwe was no longer badly affected after the rate significantly declined since 2016.

“We had 21 people per 1 000 affected by malaria in 2016, and 5 per 1 000 in 2017 while only 2 where affected this year,” Masocha said.

Hurungwe has four doctors and 88 nurses, 30 outlying clinics and three outlying hospitals with a catchment population of 410 181.

“We are ready if resources are timely availed and adequate consultations on the chemical of choice for IRS are done,” Masocha said.

Community Working Group on Health officer, Esther Sharara, said they were implementing health literacy programmes in Manicaland’s 35 districts where Nyanga, Chimanimani, Chipinge, Mutasa and Mutare are high burden districts.

“Malaria affects pregnant women as being pregnant lowers immunity resulting in many women passing on due to the disease,” she said.

“Stakeholders like Global Fund, USAID among others have mobilised funds to fight TB, Malaria and Aids as interventions in the communities in the country.”

Malaria is the third leading cause of illness and mortality in Zimbabwe, with 45 of the country’s 62 districts are malarial, with 33 categorised as high burden malaria areas. The 2002 malaria stratification estimates that about half the population is living in high-risk areas.

In its weekly surveillance report last week, the Ministry of Health and Child Welfare reported a total of 5 997 malaria cases and five deaths for the week ending March 5.
“This comes as deaths from malaria in Zimbabwe last year outstripped the 2016 figures amid indications that the number of people succumbing to the old age disease is still high. Zimbabwe recorded 518 deaths from malaria in 2017, compared with 231 for the whole of 2016 and 462 the previous year,” reads the report in part.

According to World Health Organisation 2018 theme ‘Ready to Beat Malaria’ but for many residents in Karoi, there is no winning for divided communities.

Key facts according to World Health Organisation WHO

• Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable.
• In 2016, there were an estimated 216 million cases of malaria in 91 countries, an increase of 5 million cases over 2015.
• Malaria deaths reached 445 000 in 2016, a similar number (446 000) to 2015.
• The WHO African region carries a disproportionately high share of the global malaria burden. In 2016, the region was home to 90% of malaria cases and 91% of malaria deaths.
• Total funding for malaria control and elimination reached an estimated $2,7 billion in 2016.
• Contributions from governments of endemic countries amounted to $800 million, representing 31% of funding.

The Community Working Group on Health (CWGH), a health delivery services pressure group, has expressed dismay over the continued failure to operationalise the renal unit at Masvingo General Hospital, saying the situation was making life difficult for kidney patients in the province.

Efforts to open the unit have stalled several times in the past few months amid allegations of red tape and bureaucratic bungling by officials at the provincial health referral centre.

CWGH provincial chairperson Mrs Entrance Takaidza last week called on the Ministry of Health and Child Care to ensure the unit is opened as a matter of urgency.

“As an organisation which stands for patients’ rights, we are perturbed by the delays in installing a renal unit at Masvingo General Hospital.

“This is happening at a time when the number of patients with kidney disease is increasing,” said Mrs Takaidza.
She said it was worrying that the Ministry of Health and Child Care has made several promises in the past over the opening of the renal unit at Masvingo General Hospital.

“We were told the machine (dialysis) was supposed to start working by end of last month, with some personnel having already been trained to operate it. However, a month down the line, nothing has happened and this is making life hard for patients in need of dialysis services.’’

Mrs Takaidza said kidney patients continue to fork out their hard-earned money to travel either to Harare or Bulawayo for dialysis services, yet the renal unit was lying idle at Masvingo General Hospital.

At Makurira Memorial Hospital, which is privately-owned, a dialysis session costs more than $150, while the average cost at Government-owned hospitals is about $60.

Masvingo provincial medical director Dr Amadeoas Shamu said opening of the renal unit was being hindered by outstanding minor works.

He admitted that its operationalisation was taking too long.

“The machine has been installed and personnel trained. However, we cannot start operating the machine now because there are minor works that need to be done before dialysis sessions begin,” said Dr Shamu.

The dialysis machine at Masvingo General Hospital was acquired from China under a government-to-government agreement in 2016, which benefited all major health referral institutions in the country’s 10 provinces.

Walter Mswazie Masvingo Correspondent

HARARE – The health sector’s $520 million 2018 budget allocation remains too low, despite Finance minister Patrick Chinamasa having increased it from $454 million, Health minister David Parirenyatwa said.
He said there was a lot of damage, wear and tear at the hospitals that needs to be fixed.
“Our target was $1,1 billion, it’s still not sufficient if you look at the number of repairs that are needed in our hospitals, just as an example.
“Before I touch medicines, if you look at how many laundry machines countrywide have broken down, the X-Ray machines that need to be replaced, the laboratory equipment that need to be addressed. Parirenyatwa said.
“We cannot replace all the laundry machines in all the hospitals in one year; we need to phase it and all that needs a big budget, so that budget to me is insufficient.”
Zimbabwe’s hospitals have been crippled by lack of medicines and equipment, which has in the past resulted in the suspension of some surgical operations at some major hospitals.
In trying to solve the situation, government introduced a health tax on airtime to boost revenue collection for drugs and equipment procurement, which according to Parirenyatwa has so far fetched $22 million.
Community Working Group on Health executive director Itai Rusike said the revised budget allocations were not adequate to meet a lot of challenges and that it still fell below “the Abuja Target of 15 percent of national budget that should be allocated to the health ministry.
“Access to allocated funds has also remained an issue in previous years as a result of limited flows of funds into the fiscus and other issues to do with absorption of funds.
“However, the need to prioritise the health sector when funds are disbursed from the fiscus has to be emphasised with the ministry of Finance,” he said.
“Civil society organisations have advocated for a pro-poor budget and a budget that promotes the principles of primary health care while moving towards the realisation of universal health coverage. We have also advocated for budget policies that reflects the country’s commitments to the international laws, norms and commitments such as the Right to Health, the Abuja Target and the Sustainable Development Goals.”