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We can improve health service delivery in 2023: Here is how

Johannes Marisa

THE year 2022 has ended with different memories as people share their experiences of the year.

Some lost their dear friends and relatives, while others had their companions migrating to the United Kingdom, Australia, New Zealand and the United States, to mention but a few.

It is the same year that saw an unprecedented outflux of nurse aids, with lawyers, accountants, engineers queuing to train as nurse assistants in order to gain entry to countries like the United Kingdom.

Both the private and public health systems stood tall for containing the diabolical COVID-19 which has so far killed at least 5 635 Zimbabweans.

Lockdowns were lifted as the pandemic showed signs of regression as evidenced by incidence rate, prevalence, morbidity, case fatality rate and mortality.

As we enter 2023, the tribulations of 2022 should not continue to haunt us if we take action as a country, especially if central government takes corrective action on the ills bedevilling the health sector in Zimbabwe.

In 2007, the World Health Organisation came up with a framework that describes health systems in terms of six core components, namely service delivery, health workforce, health information systems, access to essential medicines, financing and governance.

These pillars are of great importance and the absence of one of them may mean a shaky health system that may not be able to sustain itself.

A quick look at what transpired in 2022 shows that the following problems were dominant in the year and they should be clamped if we are to achieve universal health coverage:

lInadequate budgetary allocation The allocation to the health sector has never been enough in Zimbabwe for a long time.

The Abuja Declaration of 2001 stipulates that the minimum budgetary allocation to the health sector should be 15% of the national fiscus.

In 2022, the Health ministry was given 10,6% of the total budget, which is expected to rise by 0,6% to 11,2% in 2023.

Donor support is expected to hover around US$200 million for 2023, but it is difficult to rely on donors who may decide to withdraw their funds anytime they wish to.

lLate and suboptimal disbursement of the budgeted funds — Given the current inflation, it is not advisable to delay the disbursement of funds to relevant ministries.

It is thus prudent that the Finance and Economic Development ministry acts with speed to disburse the funds to avoid inconveniencing ministries.

lInefficient procurement systems — The suppliers, who bid to supply public health systems, charge high premiums and many of them are briefcase companies that get tenders through favouritism.

On many occasions, tender procedures are flouted, much to the detriment of sound health service delivery.

Maladministration — Poor administration at some public health institutions is hampering health service delivery.

Clinics and hospitals are allowed to disintegrate, while the few available resources are converted to things that do not benefit patients.

Demotivated health personnel — Brain drain is now a national disaster and government should do everything possible to retain staff.

Solutions have been proffered from many corners, but the implementation stage remains stagnant.

Both monetary and non-monetary incentives have been suggested such as residential stands, land, vehicle loans, housing loans, better working conditions, recognition, self-development, which constitute both intrinsic and extrinsic motivation.

Zimbabwe continues to lose millions of dollars through training of health personnel, who unfortunately, get snatched away by other countries. We are the training ground for other countries, but  we gain nothing from our sweat as a country.

The last 12 months saw at least 4 000 healthcare workers leaving the country for greener pastures and if this continues unabated, many healthcare facilities will be unsustainably understaffed sooner than later.

Unavailability of tools at healthcare facilities — It is embarrassing to hear that there are many public healthcare facilities that are operating with no or limited supplies of simple drugs like drips (Normal Saline, Ringers Lactate, Dextrose 5%, Gelafundin), antibiotics, painkillers, anti-convulsants et cetera.

I heard a harrowing story about the shortage of syringes at one peri-urban hospital to the extent that patients needing injections had to buy their own syringes and needles.

Further inquiry showed that the National Pharmaceuticals (NatPharm) was overwhelmed as government facilities are all supposed to put their orders at the central pharmacy.

What type of management is this that puts the whole nation in danger because one has to wait for NatPharm to stock first yet patients are suffering.

Ambulances are scarce and in times of need, patients wait for long hours without being assisted.

Theatres in our central hospitals had to cancel elective cases because of unavailability of theatre drugs, only leaving space for emergency cases.

The 2022 ills should not be allowed to spill into 2023 if we are to archive a better health status as a country.

Government should make sure that clinics and hospitals are running smoothly. All impediments should be eliminated.

Johannes Marisa is president of the Medical and Dental Private Practitioners Association of Zimbabwe. He writes here in his personal capacity.

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