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ZIMBABWE, like others in Africa, is already taking steps to cope with suspensions and possible ceasing of health support from the United States with measures already being implemented to create more efficient health systems as well as make sure there are no gaps.
Last week, Health and Child Care Minister Dr Douglas Mombeshora made it clear that there were two essential areas that had to be kept going without pause or disruption regardless of what decisions were made in the US.
The first was keeping the medical staff doing a first-class job, continuing to do so, by bringing them onto the State payroll. The second was to start ordering shipments of critical drugs that had been paid for by the US so that there would never be a shortage.
Moves were already being made last year to bring the almost 20 000 health workers paid through foreign aid channelled through non-governmental organisations (NGOs) into the public health system and formalising the ties that the more sensible had already established.
There was also a need to ensure that all health initiatives at least fitted in with Zimbabwe’s professionally-guided system that followed best international practice.
Frosty ties between Zimbabwe and the US since the Land Reform Programme at the beginning of the century meant that US aid for Zimbabwe was almost entirely concentrated in the health sector and was largely channelled through NGOs, a preference of the US, rather than as direct support through the Ministry of Health and Child Care.
This worked reasonably well, if not perfectly, since a large majority of the actual health workers paid via NGOs were sensible people who kept in close contact with the ministry’s administrative system, built around provincial medical directors and district health officers, but extending right down to the sisters in charge of clinics.
But there were problems with people who might or might not be at work, with no way of finding out why they might be missing. And there were always dangers that some of the curiosities of non-scientific health practices common in America, such as the anti-vaccination movements, could hit chunks of Zimbabwe’s health programmes under the direction of a similarly orientated NGO.
So the Health Ministry had already started working with the Ministry of Finance, Economic Development and Investment Promotion to work out how to bring almost 20 000 health workers employed by the NGOs, and largely funded through USAID, into the regular Government-employed health workforce.
Most of these, around 19 000, are classified as community health workers, who have become the backbone of many health programmes, being in the frontline of the highly successful anti-malarial battle.
They have also been helping to ensure that all those who should be tested for HIV actually get tested, and making sure that the anti-retroviral medication gets to those who are on the programme, almost 100 percent of those who have tested positive for HIV these days.
This is besides having someone sensible in every village who can give good advice on general hygiene and preventative medicine and help make sure that those who need to go the nearest clinic can go.
They have also performed magnificently in such areas as the vaccination drives, and came in for particular praise from district medical officers fighting the last measles outbreak for their ability and hard work in getting the vaccination message through to mothers in communities where there was resistance to vaccination.
The idea that they should be dumped has obviously horrified the medical staff who have come to admire, respect and rely-on these community health workers as an essential part of the chain of health services.
They have more than justified their movement into the Ministry.
There are also a little under 1 000 more specialist doctors and nurses who have been providing services whom the Health Ministry wants to bring into the formal structure, again most of them already cooperating with the Ministry so this should not present any problems.
The use of NGOs as employers and channels of aid did create higher administrative costs, as there was that belt of administrators and NGO heads who added little value that could not be done by the Ministry administrative staff, which is kept very tight as Ministers of Health like to see their staff budget going to health professionals providing health services rather than to administration.
Dr Mombeshora wants the health professionals and community health workers, but is unlikely to want a pile of extra bureaucrats.
So, while Zimbabwe will have to find a significant chunk of the money that might be lost if the US decides to withdraw all or most of its health aid, the higher levels of efficiency and simpler reporting structures and better use of medical staff will mean that not every dollar has to be replaced.
Dr Mombeshora was also anxious to reassure those who have been receiving medication with significant levels of US aid funding, including quite large chunks of the anti-retrovirals and tuberculosis medication for example, that steps were already being taken to buy the next shipments required with the present respectable stocks able to last to June.
The Health Ministry and the Government in general does not expect any disruptions, regardless of what final decisions are made in the United States.
As we have commented before, the Second Republic has been able to cope with budgetary emergencies remarkably smoothly since it reformed the whole fiscal system in 2018.
The Covid-19 emergency and the need to feed several millions of Zimbabweans for almost a year after the last harvest was so badly hit by severe drought were both largely funded by some rapid and sensible rebudgeting.
The probable need for a higher health budget has already been addressed by the Ministry of Finance, Economic Development and Investment Promotion, which is looking at ring-fencing more taxes for health, as well as intensifying efforts to make sure that those who are supposed to pay taxes establish their relationship with Zimra so they do pay.
Online Reporter