Sundaymail Editor
Leroy Dzenga
Senior Reporter
At Warren Park Polyclinic, a handful of nurses walk around the facility.
They straddle around with papers in hand, looking dejected.
Less than five people occupy the usually crowded benches; the animated chatter which usually punctuates these benches is absent.
This clinic was built to cater for the 89 000 Warren Park residents and thousands more from neighbouring suburbs.
Only a few years ago, the facility was a beacon of service.
It was renowned for providing world-class maternal healthcare comparable with services provided by reputable private hospitals.
All that has changed today.
There are a few nurses on duty today, all trying their best to provide a service albeit under the strain of a punishing workload.
The situation at Warren Park Polyclinic mirrors what is obtaining at most Harare City Council-owned primary healthcare facilities across the capital.
Council clinics have been operating at subdued capacity as a result of massive human capital flight, which has witnessed hundreds of nurses leaving the country for assumed greener pastures.
Nurses are leaving the country in droves, primarily destined for the United Kingdom where the National Health Service is offering employment opportunities to trained healthcare professionals from developing countries.
Harare’s health department currently has 350 vacancies, with nursing posts accounting for most of the openings.
This development has prompted the city to close down several smaller facilities indefinitely owing to staff shortages.
Harare has closed the Highlands, Matapi and Southerton polyclinics because of nurse shortages.
In addition, satellite clinics in Avondale, Belvedere, Braeside, Glen Norah and the Family Health Services clinic in Highlands have also been shut down.
The city’s acting spokesperson Mr Innocent Ruwende told The Sunday Mail that Harare’s health department is operating with half of its required staff complement.
“We have lost quite a number of nurses,” said Mr Ruwende.
“We have lost 50 percent of our staff, especially in the nursing section.
“In terms of the number of staff we have lost to the United Kingdom, it is hard to tell exactly, but we have 350 vacancies in our health department.
“As a result, we have had some clinics that have been closed, these clinics have been closed for over a year now.
“These are the smaller clinics.
“The decision was taken to maintain service at the bigger clinics than in smaller clinics.”
Experts contend that one polyclinic should provide primary health services to a population of about 50 000.
The closure of three polyclinics in Harare may have resulted in 150 000 city residents being deprived of primary health care.
To counter the staff haemorrhage Harare says it has reviewed its locum rates to attract temporary nursing staff to fill in for those who have left.
A locum is a term used in the medical field to describe a person who temporarily fulfils the duties of another.
“We are making an effort to reopen these clinics, we have adopted a new recruitment approach, where nurses can be recruited at clinic level for locum purposes,” added Mr Ruwende.
“Council has approved an upward review for the locum rates and hopefully this will attract and retain locum nurses.”
Greener pastures?
Wealthier nations including the United States and the United Kingdom are aggressively recruiting medical professionals from the developing world to replenish a health care workforce drastically depleted by the Covid-19.
The Sunday Mail reached out to one Zimbabwean nurse, who recently migrated. She outlined the perks that await expatriate nurses in the UK.
“Starting pay for a recently qualified nurse (Band 4) is £22 500 annually the first three years and goes up to £24 500 annually after that period.
“Working hours are shift-based and nurses do 12-hour shifts a day, amounting to 37,5 hours a week,” said the nurse, who requested anonymity.
Shifts usually run from 7am to 7pm or 7pm to 7 am.
“There is also overtime on bank (holidays) and agency shifts on off days so you can make extra,” said the nurse.
Agency shifts are side-gigs done by nurses outside the ambit of the NHS.
She said many Zimbabwean nurses fail to resist the allure of working in England and other Western countries on account of the conditions of service offered in the developed world. Many are plotting their exits, she added.
Reeling
Harare is not the only city affected by the brain drain, Bulawayo is also reeling.
Last week it advertised 50 vacant nursing posts at several council-owned clinics.
In 2021, Bulawayo lost 161 nurses, many of whom were understood to have migrated to the UK.
The city now only has 50 percent of its required complement of nurses.
Burdened
As a result of the shortage of nurses at primary health facilities referral hospitals are now shouldering much of the burden.
Most major health centres have over the last year witnessed increasing patient traffic.
This is despite the fact that these facilities are also grappling with staff exodus.
Last week, this publication witnessed low-risk maternity cases and injuries, which are generally handled at primary health centres, being referred to major hospitals like Parirenyatwa Group of Hospitals.
Incentives
Government-owned health centres have not been spared the massive staff turnover, after losing 898 nurses to other countries in 2021 alone.
In response to the staff exodus, the Government has set up a high-level committee to quell the malaise through improving conditions of service in the public health sector.
Health Services Board (HSB) spokesperson Ms Tryphine Dzvukutu said authorities were instituting measures to curb the brain drain.
“Government set up an inter-ministerial committee which proposed a plan to improve the lives and conditions of service for health workers through the provision of monetary and non-monetary incentives for health workers.
“This relates to competitive remuneration, adequate tools of the trade, decent accommodation and reliable transport,” said Ms Dzvukutu.
Zimbabwe is also seeking to refuge in international treaties crafted to minimise predatory recruitment of health professionals by better-resourced countries.
Said Ms Dzvukutu:
“The board has also brought to the fore the World Health Organisation’s Global Code of Practice on the international recruitment of health personnel, which seeks to strengthen ethical management of international health recruitment through improved data, information and international cooperation.
“The code should be used as a guide in the formation and implementation of bilateral agreements and other international legal instruments for recruitment of staff,” said Dzvukutu.
She said the HSB was confident that the code would guide discussions with the aggressor nations to ensure that there is orderly recruitment of health professionals from Zimbabwe.
No need to panic
She insisted, however, the situation in public hospitals did not necessitate panic.
Government institutions, she said, were absorbing hundreds of graduates from its nursing schools annually.
“Most of the qualified nurses in Zimbabwe are employed as soon as they graduate.
“These are employed in both private and public sectors. As a result of staff attrition, there will be gaps in employment levels.
“As of December 31, 2021, 96 percent of all nursing positions were filled in the public sector,” said Ms Dzvukutu.
Predatory
The mass recruitment of nurses from developing countries by the NHS has raised questions about the morality of the approach in medical circles.
A report tabled in the British parliament last September revealed that there are 4 780 Zimbabweans under the employ of the NHS.
Between March and September 2021, 1 334 Nigerian-trained nurses joined the NHS while Kenya is set to lose 20 000 nurses to the UK’s public healthcare system over the next three years. A prime destination for health professionals, the NHS has a shortage of about 39 000 nurses, a situation that has been compounded by staff absence occasioned by Covid-19 infections.
As a consequence, the UK has adopted a predatory recruitment approach to entice foreign health professionals, especially nurses.
The new policy thrust involves fast-tracking visa applications and exempting visa applicants by nurses from Immigration Health Surcharge, which is paid at the time of making a visa application.
In addition, the Health and Care Visa for nurses is now being processed within three weeks.
A letter written by NHS chief executive Amanda Pritchard in November last year to NHS trusts, published in British media recommended enhanced recruitment of foreign labour.
“Trusts should seek to accelerate recruitment plans where possible, including for healthcare support workers, and where possible bringing forward the arrival of internationally recruited nurses, ensuring they are well supported as they start work in the NHS,” reads the letter.
Responding to questions from The Sunday Mail, a British Embassy spokesperson defended the European nation’s predatory recruitment practices arguing that it is in line with international best practice.
The embassy said donations made to Zimbabwe’s health sector by the UK are evidence that they are acting in good faith.
“The NHS’s hiring policy aligns with principles set out by the World Health Organisation,” said the spokesperson.
“The UK is a leading partner for Zimbabwe’s health sector. Between 2017 and 2022 the UK will have spent £130 million through the pooled Health Development Fund (HDF).”
Compensation
Association of Nurses and Midwives in Government chairperson Dr Pisirayi Ndarukwa said the country must come up with a plan to immediately replace the expertise it is losing.
Dr Ndarukwa said the receiving countries have a moral obligation to compensate the source country.
“These countries should remit back to Zimbabwe part of the taxes paid by the nurses as they work in their countries.”
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