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Funding critical to health delivery

Lack of a proper health financing policy and a framework to pool resources together has largely contributed to the poor state of the health delivery system in Zimbabwe and turning patients into “medical tourists”.

By Phyllis Mbanje

Most major referral hospitals in the country have been reduced to death traps, run by a skeletal staff, demoralised by poor salaries and deplorable working conditions characterised by lack of equipment and drugs.

Recently the public health facilities were crippled by a 21-day strike by doctors who were demanding better salaries and working conditions.

Lives, especially of the poor and vulnerable people like women and children, have been lost needlessly as the health sector battles to bring normalcy to the chaos that has worsened in the face of debilitating challenges.

“We used to have open heart surgeries right here in this country but now people are being flown all the way to places such as India and South Africa to seek treatment that was once available here,” said Rutendo Bonde from the Zimbabwe Association of Doctors for Human Rights (ZADHR).

“I once benefited from the quality surgeries that used to be performed in this country and had my club feet separated successfully,” she said.

The accomplished medical doctor was born with congenital talipes equinovarus, a condition where feet are deformed and twisted.
But several people have come face-to-face with the limitations of a health delivery system that falls short of its mandate of healing and restoring.

Bernadette Sobuthana’s mother was pregnant with twins when she suddenly vomited and died. The problem was hypertension, which could have been easily treated with drugs, but there wasn’t enough time. The closest clinic was 25 km away and the only form of transportation was an ox-drawn cart.

Teclar Gohori had heard plenty of horror stories about women dying of post-partum bleeding while giving birth at home. But when she became pregnant with her first child, she discovered that hospital delivery was simply out of reach.

In addition to a US$10 registration fee, the local clinic required that she brought her own sanitary pads, bed sheets, a bucket of water, a razor blade to cut the baby’s umbilical cord, gloves for the nurses, candles for lighting, and new clothes for the newborn. All that would add up to US$20. If she was transferred to a higher-level hospital in case of an emergency, she would have needed to pay at least US$70 or more. A blood transfusion, if needed, would cost her US$120 per unit.

These two women are part of a larger group that has been failed by an underfunded health sector which is desperately in need of a revamped infrastructure and skilled personnel who are well-remunerated.

“Funding is critical in the health sector, especially considering that 70% of the population live in the rural areas where access to medical care is very limited,” said Bonde.

She said attention was only given to the sector when there were disease outbreak threats like Ebola or cholera.

Last week the chief executive officer for Harare hospital Peggy Zvavamwe said the institution had become so dilapidated it was now an eyesore, deeply demoralising to both the staff and the patients.

“How is someone supposed to recover when they are in a ward with peeling paint and sagging roofs. And who wants to work in such a depressing environment,” she said.

Harare Hospital is among the other institutions like Parirenyatwa which are grappling with severe water challenges.

“Water is critical and a priority at a health facility because it minimises further spread of infection,” said Zvavamwe.

Faced with such a dilemma, key players from various sectors who gathered in the capital last week agreed that a health financing policy was now critical.

Currently the health ministry is in the process of developing the first National Health Financing Policy (NHFP) which will ensure the provision of universal health coverage.

Health and Child care minister, David Parirenyatwa said his ministry and partners were compelled to adopt an approach to health financing reform that looked at opportunities to improve efficiency at a time when the industry was not doing well.

“Health financing for universal health coverage has been central to the planning of government since independence,” he said.
Parirenyatwa said the ministry was also bound by the Alma declaration on primary health care of 1978.

The declaration urges member states to implement strategic health financing policies and plans that protect the poor and vulnerable, in particular women and children.

“We should also implement the Abuja declaration which directs governments to allocate 15% of the overall national budget to health,” he said.

Although Zimbabwe is a signatory to the declaration, in the 2014 national budget, health was allocated US$337 million, which is just 8,2% of the total vote. This was even lower than the 2013 one of 9,87%.

“We are cognisant of the fiscal challenges our country is going through but the ministry is committed to embrace innovative ways of financing health services,” said the minister.

Among the several strategies that will be used in health financing, pooling of resources is one such function that was discussed.

This approach will involve the accumulation of prepaid health care revenues on behalf of the population to eventually pay for the provision of health services for a defined population.

Pooling of resources will also serve to reduce fragmentation in financing of health care by combining resources into one joint fund.

The public health sector largely receives most of its funding from the donor community under the Health Transition Fund (HTF), a US$435 million multi-donor pooled fund established in 2011 and set to expire in 2015.

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