Online Reporter
THE decision by President Mnangagwa to just turn up unannounced at Parirenyatwa Group of Hospitals and Sally Mugabe Hospital on Monday, with no warning, no sirens and just a handful of senior officials from his office, shows he has the people of Zimbabwe at heart.
The surprise visit allowed him the opportunity to see first hand, the dire state of the health delivery system in the country’s public hospitals, warts and all.
It is clear that more such visits are required if the President is to see for himself, without filters, what is going on in Zimbabwe, allowing him to ask the right people the right questions, get behind the statistics and to initiate more effective action.
This is not to decry the more official planned visits. The advance preparations at a State institution getting ready for a Presidential visit, that special effort of cleaning up and getting critical stores released, serve a purpose as every place can always use a bit of spring cleaning.
But they also hide quite a lot of what might well be the normal state of affairs and practices, hence the President’s decision to just turn up at the two hospitals without prior warning and using a private motorcade without sirens and outriders, so no one would guess he might be on his way.
Much has been said and written about the significant improvements in Zimbabwe’s public health system under the Second Republic.
These have been both important and considerable and whatever the President found and did not find at the two hospitals this week were dwarfed by the problems at the start of his term of office.
But it is equally clear that the dramatic expansion in budgets and the re-organisation of the public health sector, which averted a total meltdown and disaster, clearly have to be reinforced, and that simply looking at the statistics and reading the reports does not give any indication of what actually must still be done. We are only halfway up the steep slope we still have to climb.
It was the distress and determination of some of those who had seen what was going on, starting with First Lady Dr Auxillia Mnangagwa, that was disturbing the President and driving his decision to go and see for himself without any bureaucratic interference and without warning.
The President was also able to meet and talk to ordinary staff at the two hospitals, and since these would be well-educated health professionals, they would be able to give precise details and figures of what was actually happening on the ground. Some equipment was overage, irreparable and needed replacement.
Other equipment, while working, needed to be augmented so all patients who needed it could have it.
There were still missing basic and cheap items, like bed screens, and a curiosity in drug supplies, with decent stocks in the NatPharm warehouse but zero stocks of even simple and exceptionally cheap painkillers not available in the wards.
There are complications between ownership of some stocks, with donors trusting NatPharm to store the drugs but retaining their own rights when it comes to allocation.
Medical professionals in the State sector obviously want their conditions of service improved, but they are also professionals who want to do their job properly, and that means they want to have the equipment and supplies that allow them to do so. Again we have moved from the meltdown of seven years ago, but the statistics do not tell the full story, and that story is that we still need a lot more.
Zimbabwe is about to meet the African target of allocating 15 percent of the total national budget to the public health sector, and yet this sort of advanced funding is likely to continue to prove to be inadequate and more money, admittedly efficiently administered, needs to be found.
One particular problem in Zimbabwe is the gap between the public and private health sectors. This produces a serious imbalance between levels of funding.
Most people in formal employment, including the civil service and others in State service, have at least basic health insurance through medical aid schemes.
In the old days, patients covered by medical aid usually went to Government hospitals, and this source of funding was important, giving the public hospitals a reasonable percentage of full-fee patients and so allowing their allocations from the national budget to be concentrated on capital development and helping the seriously poor.
These days anyone with their own money, or some sort of medical aid, will try and go private, leaving the Government hospitals relying almost totally on their budget allocations.
Fees are charged, but often are not collectable and in any case are well below the cost of the services.
The national health budget must be increased to cope with the withdrawal of significant sources of external assistance, regardless of whether this is done through allocations from the Consolidated Revenue Fund or through ties to special taxes and levies. But there are limits.
For some years there has been discussion about a national health insurance scheme, and the need for this appears to be ever more urgent as it is obvious that more sources of finance are required and that relying on what ordinary people can afford in fees and the growing sums allocated by the national budget are simply not going to provide the services at the minimum acceptable level.
Even rich countries with universal health services that are free for patients rely on extensive insurance schemes, usually public, and even then professionals and hospital administrators complain, as do patients.
Even in a country moving fast towards upper middle income status, like Zimbabwe is, public health services cannot manage on even a large percentage of the taxes paid and so we need to seek more sources of money.
Meanwhile, President Mnangagwa has found a new way of turning those statistics and reports reaching his office into what people actually face every day, and we would hope that these surprise informal visits will continue.
