Friday, February 01, 2019

Zimbabwe's Health Crisis

In January, almost 2000 doctors working in Zimbabwe's public hospitals lost the fight to have their salaries paid in US dollars. The Herald, a daily newspaper published in Zimbabwe, said in February last year that the use of plastic money over cash transaction was highest in 2017. However, because there were hard currency shortages and the value of electronic money continued to drop, businesses and civil servants, including doctors, have been demanding their salary be paid in US dollars.
 3 days after a 40-day strike calling for the government's improvement of their working conditions and drugs in hospitals, a massive fuel hike further dampened the doctors' morale. The government's midnight fuel hike on Jan 13 raised petrol from US$1·24 to $3·31 per litre and diesel from $1·36 to $3·11 per litre, making fuel in Zimbabwe the most expensive in the world.
“As doctors, we work outside normal shifts; we were hit hard by the fuel increase”, said Mthabisi Anele Bhebhe, the secretary-general of Zimbabwe Hospitals Association, which represents all doctors in the public sector.
“It's not just about the fuel hike alone, the fuel is not there”, said Bhebhe. “It's a severe blow now as even ambulances are struggling to get fuel, compromising emergency services.”
“Now, a doctor who uses public transport must pay about $8 per day, which sums up to close to $300 per month. This is against a basic salary of $329 per month”, explained Bhebhe. “Doctors are working for transport money to put it simply”, he said.
“We have had 12 strikes in the past 10 years”, Bhebhe told The Lancet. “It's always the same grievances and demands. In some cases, unfulfilled and broken agreements are the triggers…the government has a habit of not following and honouring agreements made with its employees.”
Doctors blame the health service board for failing to provide a sustainable stock of essential medicines and supplies in state hospitals. As a result, unpleasant stories of doctors performing bare-handed surgeries, use of plastic bread bags to collect patients' urine, and broken-down machines are common. Shortages of gloves, disinfectants, and face masks have exposed doctors to biohazardous working conditions says Bhebhe, who is also a medical doctor at Mpilo Central Hospital in the second largest city, Bulawayo.
Understaffing, long working hours, and old and poor-quality basic equipment in hospitals compound the problem. Whereas WHO recommends 1 doctor for 1000 patients, “In Zimbabwe, the ratio is 1 doctor to 12 000 patients”, said Bhebhe.

At the heart of the doctors' bubbling stew of grievances is funding. Financial problems mean it is difficult to meet key obligations of the ministry of health, including building enough reserves to invest in human resources for health, Vuyelwa Sidile-Chitimbire, the executive director of Zimbabwe Association of Church Related Hospitals, told The Lancet.
Zimbabwe is a signatory to several global health declarations, notably the Abuja Declaration of 2001, in which member states agreed to allocate 15% of the national budget to health.
“18 years down the line, we have always fallen far short from this target. The closest we ever got near was 8·9%”, Bhebhe says.
According to Star FM, a Zimbabwe-based radio station, ahead of the 2019 budget announcement on Nov 22 in which Mthuli Ncube, Zimbabe's finance minister, allocated $694·5 million for the 2019 health budget, or 9% of the national budget, Gerald Gwinji, the health and child care permanent secretary, told the parliamentary committee on health that the health sector needs almost $1·4 billion in 2019 to meet its health demands.
The country has constantly failed to meet the minimum WHO per-capita expenditure on health, which should be $86 per person per year.
Doctors in Zimbabwe are now waiting to see whether the government will act to fulfil the promises it agreed on in January, to prevent yet another strike. If the fundamental challenges are not addressed, then the chances that another strike could happen again in 2019 are very high”, said Nyamande.

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