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THE major push on upgrading and expanding the public health system is being turned into fact with 47 new health facilities built already since the Second Republic came into office in 2018 and a lot more under construction with local councils, especially in rural areas, working out where they will build next as the devolution money flows in.
Local communities are involved in almost all rural areas, not just putting in the bids for council support as the capital; funds become available, but getting on with it themselves, making bricks, finding and moving the sand and stone and generally getting on with it themselves, so the council cash and other support goes a lot further.
Yesterday we looked at Beitbridge district which has its own special needs, the population densities meaning that there must be a lot of small clinics within walking distance of just about everyone rather than a handful of clinics based on one for so many hundred or thousand people, as central planners tend to calculate.
The rural district council has finished one clinic and is building another, with work in progress, using the funds it has available. But communities in another three wards are also not sitting back and waiting, but getting on with it themselves.
They all require help, but when people see the sort of effort being made then they reckon that help is justified. In Ward 10, the local MP for Beitbridge West helped build the new clinic by using a chunk of the Constituency Development Fund to buy the 200 bags of cement to mould bricks.
With the volunteer labour and free sand, a modest sum went a long way. The local branch of a major national company saw the work being done, and has chipped in with cash for the windows, doors and the plumbing.
We have been reporting on the local initiatives for some time. Even rural district councils like to see a mobilised community when they choose the next devolution-funded clinic, since work can start sooner and the money can go further.
It also tends to stress the need for the new clinic when people start doing work and raising funds themselves. It is useful to remember that a rural clinic is not just a clinic. There have to be cottages for the staff, water and power.
And often that means a borehole and solar panels. So the fact that already more than 200 boreholes have been drilled at health institutions and solar panels fitted to more than 1 000 is also vital.
The Government’s major borehole drilling programme, with 40 new rigs now in the country or in a ship on their way here, will speed this up. The new borehole drilling programme has a lot of targets, but the fact that a clinic is not just stuck in the middle of nowhere, but is usually near a school and has a significant community in the area means that these sort of centres are likely to have priority.
A clinic does need exclusive use of a decent borehole, in fact just a small fraction of the water, so the other requirements can also be met.
Of course the usual backlog of maintenance building up before the Second Republic caused its own problems. But that is being tackled vigorously and often this requires more than just a coat of paint but some serious renovation work.
And everyone has been invited to chip in to get this done, including the army and air force and the churches and others. It is not just Government and local authorities.
Covid-19 clearly helped concentrate minds, with even major hospitals in urban centres needing some rapid work. We should not forget that the Chinese business community in Harare took the lead in converting one of the city council’s infectious diseases hospitals into a useful centre and that even major referral hospitals across the country benefited from needed upgrades, with budgeted Government money going a lot further as individuals, groups and companies added their shares.
A lot of district hospitals and major clinics acquired intensive care facilities as Covid-19 struck, again because of that immediate need but now they are for all the other sorts of illnesses and accidents that require these facilities.
The general upgrade in supplies, with a lot more local manufacturing, meant that the new facilities had what they needed.
The medical oxygen plant built through the Government was part of the reaction to Covid-19, but tanks of oxygen can now be placed in a lot more remote centres for the medical needs of people who have other illnesses.
And even as Covid-19 continues retreating, although with winter coming we need to be ready for a surge, the work continues at a high level. What we have been seeing is that the fixing up of what we had in public medical services, with so much backing from business and others, has created the climate where everyone feels that they no longer have to accept second best in something as important as health and so a lot of communities have decided to take the programme to new heights.
Big cities, and especially Harare, have tended to fall behind in public primary health. Harare City Council, for example, has hardly been expanding its clinic network despite the rapid growth in housing and new suburbs and in some cases was even cutting back on services.
Admittedly the private medical sector, largely non-existent in most rural areas and tiny in smaller towns, has filled some of the gap, but a decent health system needs both public and private facilities if coverage is to be universal.
Most people will find it hard to imagine, but there was once a time when city councils were proud of their health coverage and actually provided such a good ambulance system that no one bothered trying to supplement it, let alone basically take over, with private services. But these can be expensive.
We do not have to sit back even in cities. Beitbridge, to return to that district, has been active here as well. Committed residents in the town have set up a trust and five ambulances sitting immobile are going to be fixed and put back on the road along with three service vehicles.
Once again we have a community that wants action and wants a functioning public health system, so is taking the action.
What we are seeing is that we can have something a lot better than what we have if we all stop complaining and start doing something about it. The Government is doing a major share, and with its devolution programme has discovered that a lot of rural communities put a better clinic network high on the priority list, but as some very poor communities have shown, they are prepared to be mobilised so what can be done can be done sooner.
Online Reporter