BY PHYLLIS MBANJE
ZIMBABWE’S healthcare delivery system is tottering on the brink of collapse with perennial shortages of medicines and strike by the medical personnel the key challenges.
The decay has not happened overnight, but it has been a prolonged malaise that has not been addressed.
In the early 1980s, the Robert Mugabe government was eager to maintain a robust healthcare system for its people and of note was the setting up of a vibrant primary healthcare to provide a buffer for the majority of the population.
Primary health care is a strategy that seeks to respond equitably, appropriately, and effectively to basic health needs and to address the underlying socio-economic, and political causes of poor health, to provide accessible essential health services and to involve the participation of communities.
For years, it thrived with enough funding and a motivated workforce that was key in guaranteeing quality health for all. Even the rural facilities served their communities.
However, misrule, debt mismanagement and human rights abuses, among other ills, all started to take a toll on the economy, which crumbled along with social services. The health sector was one of the hardest hit.
The infrastructure at most hospitals lay in ruins and the most qualified health personnel initiated what would become a mass exodus of employees.
Nurses migrated to the United Kingdom, where they were offered better working conditions and salaries.
Doctors, too, trekked across the continent and the globe in search of more lucrative perks.
As years went by, the situation deteriorated to levels that were unimaginable and one of the greatest mishap was the 2008 cholera outbreak, which killed over 5 000 people.
The Government of Zimbabwe was taken to task for not taking prompt action.
This was one of the big signs that all was not well and that the country was ill-equipped to handle a disaster of that magnitude.
Cholera patients were carted in wheelbarrows to the few facilities that were offering services, while many died in their homes.
The international media was harsh, and rightly so. They challenged the government to protect its people, but clearly, the government was not in a position to do so and it took foreign donors to rescue the situation.
Then there was the 2018 cholera outbreak, which affected more than 10 000 Zimbabweans, with at least 55 deaths.
Had there been a mitigation taskforce in place, the viral intensity of the outbreak would have been lessened. But as always, the government waited for donations to come.
This dependency syndrome has become a plague and the health sector’s reliance on donors has not helped much in terms of local resourcing and crowd funding.
Of note is the repeated industrial action by the health personnel, nurses, doctors as well as non-medical staff.
The year 2019 opened with a crippling strike, which had spilled over from the previous year.
Throughout 2019, doctors went on strike twice protesting against poor remuneration, on-call allowances and unsatisfactory working conditions.
This led to the closure of almost all central hospitals, children’s units, provincial hospitals and the cessation of emergency lifesaving procedures throughout the country.
The perennial industrial actions have become a common feature every year, but no plausible solutions have been proffered despite repeated calls by stakeholders to reconsider the health budget (10,1%), which still falls short of the Abuja Declaration which stipulates that governments should apportion at least 15% of the national cake to health.
The junior doctors’ job action was most probably one of the longest, clocking over three months and to date has not been resolved.
The doctors were hauled before the courts which ruled in the favour of the employer, who wasted no time in instituting disciplinary action. Four-hundred and forty-eight doctors were fired.
State of hospitals
In March this year, head of paediatric unit at Parirenyatwa Hospital, Azza Mashumba, broke down and wept uncontrollably as she explained how hospitals were under-resourced, and how doctors were being forced to watch their patients die from avoidable ailments because there wasn’t enough medication and equipment.
More doctors weighed in on Mashumba’s words, exposing the dire state of the facilities.
Health minister Obadiah Moyo and his officials were given graphic accounts of how babies were dying, while post-surgical patients were having to go without pain relievers.
Even bandages, latex gloves, betadine and needles, the most basic things of primary healthcare, were said to be out of stock.
Throughout the year there was a massive drug outage. A tour of the of the National Pharmaceuticals (NatPham) by a team of senior doctors to see the supplies made shocking revelations.
The doctors had been invited by Moyo to go and see for themselves after they challenged him saying there were no drugs.
The doctors, however, claimed that the drug levels were appalling. The representatives said they had only found a few samples. Most of the drugs available were those donated by international partners.
The government, nonetheless, through Moyo insisted that they had purchased drugs from India.
In July, Mashonaland West province reported an alarming shortage of anti-retroviral drugs.
The National Aids Council (NAC) is mandated with purchasing ARV drugs, using the Aids Levy Fund and hands them over to NatPharm for distribution.
At the time, NAC spokesperson Madeline Dube said her organisation was faced with an acute challenge of foreign currency to acquire the drugs, hence the shortages.
The shortages in public health facilities forced patients to go to private pharmacies, where they were charged in forex, while other forms of payments such as swipe or mobile money transfers were not accepted.
Unable to contain the forex challenges, pharmacists resorted to charging in currencies that would allow them to remain in business.
Prices to the equivalent of local currencies became astronomical and beyond the reach of many. This crisis further impoverished the patients, who are stuck between a rock and a hard place.
The public facilities are under-equipped and the alternative of private hospitals is now a preserve for just a few.
Seeking foreign medical treatment has become a trend for senior government officials and those who can afford it.
Vice-President Constantino Chiwenga spent four months in China, while President Emmerson Mnangagwa was carted off to South Africa after allegedly eating poisoned ice cream.
The late MDC leader Morgan Tsvangirai spent a long time receiving treatment at a private South African hospital.
Vice-President Kembo Mohadi, who was injured in a bomb blast at White City Stadium in Bulawayo last year in June, received physiotherapy treatment at a South African hospital.
The late former President Robert Mugabe was also a serial medical tourist, whose yearly check-ups were done in Singapore, gobbling taxpayers’ money in the process. This was made worse by his wife, former First Lady Grace’s penchant for shopping.
So, as the curtains come down on 2019, a quick flashback on a few shockers, boobs, that made the headlines.
Prophetic Healing and Deliverance Ministries (PHD) founder and leader Walter Magaya was convicted for contravening sections of the Medicines and Allied Substances Control Act after manufacturing and marketing an anti-HIV drug without clearance.
His dramatic court case followed his announcement in November 2018 that he had found a cure to HIV and Aids.
Dubbed Aguma, the herbal drug according to Magaya, would destroy the HIV virus within 14 days, he claimed.
Magaya was let off with a $700 fine for his misdemeanour.
One story that drew mixed feelings was that of the Mbare midwife, who assisted over 100 women to deliver at her home after nurses at council clinics downed tools over salaries.
While Esther Zinyoro’s role cannot go without merit, there were, however, concerns on the dangers of giving birth outside health facilities and in the absence of skilled personnel
Family health director in the Health and Child Care ministry, Bernard Madzima, explained that although they recognised traditional midwives, the country conformed to international standards and guidelines which discourage home births by traditional birth attendants.
But the story that hogged the limelight for the longest time was the abduction, torture and subsequent return of the leader of the Zimbabwe Hospital Doctors Association, Peter Magombeyi, in September.
According to a message he managed to send before his abduction, three unidentified men abducted him from his home in Budiriro high-density suburb, Harare.
But it was dismissed as “a characteristic propaganda stunt by the opposition and its supporters”.
However, this exposed the government’s desperation and repressive tendency which has received international backlash.
In solidarity with their mate, doctors protested, demanding that Magombeyi be released.
He was later found in Nyabira disoriented and in great pain. He claimed that he had been held captive by unknown people who tortured him.
Magombeyi was briefly admitted at a local hospital, but later had to seek further medical treatment in South Africa.