health talk:with Dr Johannes Marisa
The year 2020 would go down memory lane in the history of medical service in the entire world. The end of 2019 saw the emergence of a notorious infectious agent, coronavirus [Covid-19], a novel creature that went on to claim close to 1,9 million lives with more than 83 million people being infected. The World Health Organisation declared the coronavirus infections a global pandemic on March 11, 2020. Everyone was affected by the coronavirus in one way or another with the political, economic and social environments being some of the worst hit. The economic giants of the world were hit left, right and centre with the United States being the worst hit country in world. So far, at least 354 000 people have died from Covid-19 in the US alone.
Africa has fared well and as of December 31, 2020, confirmed cases of Covid-19 reached 2 728 817 with at least 64 771 deaths. So many theories have been put forward pertaining to the low prevalence and incidence rates in Africa. Underreporting has been one of the factors for low numbers in Africa coupled with inadequate testing and general lack of seriousness by many. Zimbabwe has fought its wars against the pandemic with pitfalls and some strengths that brought hope to the nation long slandered for paying poor attention to the health sector. So far, there have been about 13 867 cases with around 363 deaths.
We applaud the government for drastic action taken on enforcing public health measures like the wearing of masks and social distancing. Lockdowns helped in slowing the spread of the virus. Many medical developments occurred in Zimbabwe in the year 2020 and chief among them were:
The strike by health workforce: Doctors went on strike from October 2019 to May 2020 demanding better working conditions, which included both intrinsic and extrinsic rewards. The nurses followed with an industrial action from June to September 2020. Hospitals became white elephants as wards were deserted. The outpatient departments of central hospitals locked doors as only emergency cases were attended to via casualty.
The sacking of Obadiah Moyo: The acquisition of personal protective equipment (PPE) came with allegations of corruption against the then Health minister Obadiah Moyo, over a US$60 million Covid-19 scandal. Moyo was replaced by Vice-President Constantino Chiwenga who took over as the Health minister in August 2020. Chiwenga went on to negotiate with the striking nurses who then returned to work.
Restructuring of the health sector: It was applauded and many people felt that the restructuring was long overdue. The central hospital bosses were fired and many directors at Kaguvi building were sacked. This was done in a bid to improve operational efficiency, effectiveness and accountability, according to Health Services Board chairperson Paulinus Sikhosana.
The allocation of $54,7 billion which translated to 13% of the total budget to the health sector: The Abuja Declaration of 2000 recommends that 15% of the budget should be to the health sector if health financing is to be adequate.
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The continuing feud between medical aid societies and practitioners: The mistrust between medical aid societies and service providers continued unabated with some medical aid societies still wanting to be bullies and dictators on the ground. Service providers still cried about non-honouring of their claim forms. The patients should understand that payment of their monthly premiums is to the medical aid societies and not to the service providers. If service providers are not paid their dues, where can they get funds to run clinics, surgeries, laboratories, pharmacies especially in this Covid-19 era?
For development of any nature to occur, health should be a priority: A healthy nation has great potential to develop through many facets. Staff absenteeism is reduced when there is good health. Zimbabwe needs to make sure that health is accessible to many and primary health care should be uplifted according to the Alma Ata Declaration of 1978 where there was a general call for action by governments, health and development workers and the world community to protect and promote the health of all people. In view of that, it is thus imperative that the following be looked at if health service delivery is to be satisfactory:
Stakeholder engagements: Involvement of all stakeholders in national health planning as sidelining others may be impediments to the full recovery of the health sector. Government should engage non-governmental organisations, churches, councils, private practitioners and sincerely consider their relevant input for the betterment of the nation. It is unfortunate that some non-governmental organisations are seen as driving the interests of so-called opposition parties which might just be unfounded. Private practitioners should never be sidelined on strategic planning issues.
Improved relations between government and its employees: The lack of trust between the two major protagonists of the public health system has been a thorny issue for a long time. Doctors and nurses have been fighting running battles with government with a lot of finger-pointing. The employees have lamented the shortage of PPE in hospitals, poor salaries and ridiculous benefits which have incapacitated many of them. Government, as the custodian of means of production like land, can avail affordable stands to its employees. Car loans can be given to workers to incentivise them. Motivation is key in health service delivery.
Cultivation of good working measures: Many people often rush to blame government on poor service delivery in public health institutions. Lately, bad attitudes have been blamed for lack of seriousness in public medical facilities coupled with mere negligence. One good example was in December 2020 when some victims of road traffic accident could not be attended to at Chegutu District Hospital because there were no gloves at the hospital. Upon investigation, it was found that the pharmacist had locked them in the pharmacy and left for his home, leaving the whole hospital without the necessary items to use. That shows lack of seriousness and a high level of egotism.
Coordinated efforts on Covid-19 control: The ravaging effects of Covid-19 were heavily felt mid-year around June and towards the end of 2020. With minimal testing and surveillance, many people were caught unaware after the borders were reopened to the public on December 1. High-density suburbs like Kuwadzana and Dzivarasekwa, among others, are under siege with numerous clinical Covid-19 patients and PCR-positive ones. Data collection should be enhanced, information should be generated if planning is to be done properly.
Both medical aid societies and service providers should find each other: The bully mentality that has been lingering in many medical aid societies should stop forthwith. So many rules have been put in place by some medical aid societies and some of these rules have only worked to infuriate the service providers. Action should be taken against defiant medical aid societies to safeguard the interests of the subscribers.
Enhanced donor funding: Donor funding is vital for many processes in the health sector considering the inadequacy of the budgets. Immunisations, maternity services, reproductive health and research can develop well if there are enough resources to fund them. It is thus important for government to befriend the available non-governmental organisations if we are to win health wars.
Protect yourself in 2021. Prevention is always better than cure. Covid-19 is a reality that cannot be ignored. Be wary of the common symptoms of Covid-19 infection: Fever, tiredness, cough, sweating, diarrhoea, loss of appetite.
l Dr Johannes Marisa is a medical practitioner and public health practitioner who writes in his personal capacity. He can be contacted on: [email protected].
