When President Emmerson Mnangagwa’s government came to power in November 2017 following a military takeover, he quickly established a government and made numerous promises regarding government programmes within the first 100 days in power.
By Dewa Mavhinga & Fortune Nyamande
The government had, “hit the ground running” and had adopted 100-day plans, as their framework to monitor and evaluate their performance across government departments.
Among the fans of the new government, there was cautious optimism that a new era had dawned, and many pressed for Mnangagwa to be given a chance to deliver on his promises.
After more than 100 days in office, it is time to evaluate the government’s achievements or failures within the health sector.
Health-care financing
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The new government did not outline any new policy propositions with regards to the health-care funding model in Zimbabwe.
Globally, there are four models of health-care funding and most countries can be described to fall into one of the four categories.
The first is the Beveridge model in which the government provides for and finances health-care through tax payments, just as it does for the police, the army, and other public services.
Second is the Bismarck model, which utilises an insurance system financed by both employees and employers, while health-care service provision is delegated to private providers.
The government in this case tightly regulates the health insurance funds, hence, keeping the health sector costs at a minimum.
The third model, which the Zimbabwe government could have adopted, is the national health insurance model, which utilises private health-care providers with finance from a government run insurance programmes, which all citizens subscribe into.
Sadly, Zimbabwe has remained fixated with the fourth model, the out-of-pocket model, where citizens pay for their health-care as and when the need arises.
In this model, the rich get access to treatment and the poor are left vulnerable and without access to basic health services.
Contrary to claims by government authorities that certain services, including neo-natal services, are now provided free of charge, the harsh reality is that vulnerable groups have in the past 100 days been required to pay for services in government-run hospitals.
Neo-natal care facilities are not being provided for free, the elderly are paying for their medication and surgical bills and mental health patients are being given prescriptions to buy medications on their own.
The pronouncement regarding free health services in certain categories was not backed by a clear and proper provision of financial resources by the government, reducing the entire affair to media grand-standing far removed from reality.
Human resources for health
In Mnangagwa’s first 100 days in office, the government failed to provide positive signals on the urgent need to improve the availability, retention, motivation and capacity development of health workers in Zimbabwe.
In the context of the government’s failure to honour promises to health-sector workers, some of which date back to 2015 under the previous government under Mugabe, threats of industrial action from nurses and doctors continue to make national headlines.
In fact, most government employed doctors now earn less than what they used to earn during Mugabe’s last days in office, following the downsizing of the retention funds provided by the Health Development Fund.
Poor salaries and working conditions for doctors and nurses continue to be a major morale-dampener, causing many to leave in frustration.
The new government has not announced any plans to empower the Health Services Board (a board established by an Act of Parliament to improve working conditions of health workers in 2005) through establishing an independent fiscal allocation, reinvigorating the board, or specific support to decentralise its secretariat.
The national budget announcement by Finance minister Patrick Chinamasa missed a key opportunity to lift the blanket recruitment freeze in the health sector.
Shockingly, Zimbabwe currently uses a 1983 staff establishment that was designed to cater for a population of seven million when the current population has doubled.
The pathetic doctor to people ratio in Zimbabwe is one to 250 000 against the recommended World Health Organisation (WHO) standard of one to 600.
Instead of a clear focus on policy priorities in the health sector, it seems much of the attention is on First Lady Auxillia Mnangagwa, who has been at the forefront of window dressing visits to hospitals ridiculing the few, underpaid staff and possibly usurping the role of the Health minister.
Drug situation, health infrastructure and determinants of health
Major pharmaceutical companies continue to operate at below maximum capacity utilisation, with most drugs still being imported from abroad.
Since November 2017, there has been no meaningful change in the availability of drugs, fluids or other sundry materials in hospitals.
At Karoi Hospital recently a ceiling collapsed on top of hospital beds, an example of the poor infrastructure in the health sector.
The first 100 days of Mnangwagwa’s government have also been plagued by a cholera outbreak in Chegutu and Norton.
The new government has not developed and announced any new policy positions with regards to providing clean, safe water and no propositions have also been made for much needed infrastructure overhaul to replace old, broken sewer pipes that are contaminating water sources.
Looking back at the Mnangagwa government’s first 100 days in the office, it is clear that there has been more talk than the actual drafting of new policy frameworks to revitalise the health sector in Zimbabwe.
Admittedly, the budget allocation to the health sector has marginally improved, but still falls short from allocations made by comparable countries in terms of economic status.
The decline in doctors’ income in the last 100 days and the persistent threats of work stoppages by health workers continue to pose threats on Zimbabweans’ ability to enjoy the right to health as provided for in section 65 of the constitution.
Mnangagwa’s first 100 days in office have been about shooting in the dark and missed opportunities, including failure to adopt new policy priorities in health sector financing, human resources for health, diarrhoeal disease control, non-communicable diseases, pharmaceutical industry revitalisation and health sector infrastructure overhaul.
Dewa Mavhinga is the Southern Africa director at Human Rights Watch, he is reachable on Twitter @dewamavhinga.
Fortune Nyamande is the spokesperson of the Zimbabwe Association of Doctors for Human Rights and can be contacted on fortunyamande@gmail.com. They write in their personal capacities.