Online Reporter
ZIMBABWE is clear about what needs to be done within the public health sector to raise it to standards expected in an upper middle income country, our Vision 2030, with the improvements seen soon after independence in primary care being coupled with the improvements we are already seeing under the Second Republic.
But we still have some way to go over the next five years with a doubling in professional staff, the doctors and nurses, and a corresponding improvement in the infrastructure, the hospitals, clinics and equipment these professionals need.
We also need to get the financing right, which means some more money and use of that money to make sure every dollar we assign to health counts as fully as possible, with not only zero waste but making sure that what is spent produces the best results.
There are already a number of achievements, especially in the last few years that can be added to the major immunisation and child health efforts of the 1980s that did so much to prevent the killer diseases that used to ravage our children.
We have shown, for example, that it is possible for an African country hit hard by HIV to pull through, and we are among the first to have achieved the 95-95-95 targets, that is 95 percent of the estimated HIV positive people have been tested and know their status.
Of this group, 95 percent are taking every day the anti-retroviral drugs that will bring their condition under control and allow them to live a near normal life. And as a final bonus 95 percent of those on the anti-retrovirals have seen their viral load so suppressed that they are no longer infectious so long as they keep taking their medication.
We still, of course, have to tackle the almost 15 percent who do not know their status or are not taking medicines or have not been taking them for long enough to get to the zero new transmissions, but this is now seen as a realistic target to add it our other preventative care programmes.
We still need eternal vigilance and effort in all these programmes and cannot “take a breather”, but so long as we keep up the effort we will continue slashing the number of Zimbabweans who need detailed medical care.
This means that as we find more money, more resources, more staff, more equipment, we can dig into our deficiencies and bring the quality of health care through significant improvements, rather than just trying to prevent disaster.
Almost a quarter century ago, African countries pledged at a major meeting in Abuja, Nigeria, to work to spend at least 15 percent of their total budget on health.
Zimbabwe is not quite there yet, although it is very close and the special extra budgeting we are having to work through at the moment to fill gaps left by some of our development partners may well have pushed us over the line.
But that is just the starting point. Health finance should not be the result of special emergency efforts. It should be one of those regular and guaranteed streams of cash that come through month after month and year after year so that the health professionals know exactly where they are and are able to plan and act accordingly.
So the Government reforms to the health system are going beyond the urgent need for improvement and expansion and are taking into account the need to ensure that this effort is sustainable and then is sustained, so that every year we see another round of improvements and upgrades.
Among the measures being adopted is the ring-fencing of certain taxes, generally newer taxes designed to improve the amount of taxpayer money that goes to health. No one is ever desperate to pay a tax, but when they know, for example, that the sugar tax imposed a couple of years ago is now buying modern equipment for cancer treatment they feel a lot less resentful.
This year should finally see the submission to Parliament of the National Health Insurance Bill, the start of the programme of making sure Zimbabweans are covered by a decent health package funded through monthly payments, a sort of super medical aid.
Parliament and Government will need to work tightly together on this, making sure that at the very least the doors to bringing in the informal sector are open, so that the scheme goes beyond the formally employed.
The future law will need to combine what we can do right now with clear targets as we move towards universal health care.
In any case this new money seems to be additional funding, at least until we have managed to encompass the whole population under a new model, and we will need to maintain and improve the percentages of tax income that go on health while we add in the new funds.
The gaps are too large for any relaxation.
Zimbabwe is getting support for its health upgrades. While some foreign support has declined or been withdrawn as a result of the general American retreat on aid, others are at least maintaining the support they have been giving with new funds becoming available. But we stress that a lot of this support is because we are pushing our own shares, and we have partners keen to reinforcing successes.
Zimbabwe under the Second Republic wins here since we smashed the corruption that had emerged in the health system, showed we were ready to spend our own money on health, and then upgraded administration.
President Mnangagwa himself, with surprise visits to hospitals, identified some practices and bureaucratic procedures that were hampering the proper expansion of health services and ordered action to be taken.
What we have been showing is that decent health care is not a matter for some specific group, but is part of our total and general responsibility. This is why communities help build new clinics; this is why mines and companies sponsor local hospitals, this is why Zimbabwean taxpayers are willing to see more spent, properly, on health.
Between us we can do it and have a public health system that does fit an upper middle income country, and then continue improving it.
Peter Tanyanyiwa