Dr Parirenyatwa’s tall order

Health Reporter

A LOT is expected from Ministry of Health and Childcare Minister, Dr David Parirenyatwa who has been tasked to get the sector that has been badly affected by sanctions and brain drain out of the woods.

To address the current challenges, there is need to pin point where the downward trend in health delivery began.

It must be noted that the health system has been operating under a legal and policy framework that in essence does not recognise the right of citizens to health, a fact emphasised by President Robert Mugabe when he officially opened the Eighth Parliament of Zimbabwe recently.

“The constitution imposes on the State the obligation to take concrete and reasonable measures to prevent the spread of diseases and to treat health care as an inalienable right for every Zimbabwean citizen,” said President Mugabe.

“The health services act, the medical services act, the public health act and other pieces of legislation, will therefore be urgently amended to reflect this perspective.”

Historically, health care in Zimbabwe was provided primarily to cater to colonial powers with separate care or second-provision made for Africans.

After 1980, Zimbabwe adopted the concept of Equity in Health and Primary Health Care and this resulted in the narrowing of the gap between health provision in rural areas and urban areas.

However, by the mid-90s there were growing inequities in health provision and health care due to the adoption of the Economic Structural Adjustment Programme (ESAP), 1991–1995, and health policy changes.

ESAP caused public expenditure decline on health care to 39 percent in 1994-95.

This meant reduced spending on common drugs, extension and preventative health services, specialist facilities and treatment, and other components of quality health care delivery.

At the same time, the Government’s stricter enforcement of a user fees system erected barriers to health care in the way of poorer social groups who were, typically, those most in need of health services.

Due to the user fee system, there was high prenatal mortality incidences and decreased access to prenatal consultancies, equipment, necessary facilities and drugs.

For example, life expectancy at birth was 56 in the 1980s, increased to 60 in 1990, but is now down to 43.

The then Minister of Health, Dr Timothy Stamps acknowledged that only one in 10 Zimbabweans could afford to pay for their own health care.

However, fees remained in place, largely at the insistence of ESAP policy makers.

By 1992, doctors and nurses began referring to ‘ESAP deaths,’ noted death of patients due to the inability of patients to pay for the minimal length of time in the hospital, or for prescription medicine.

By 2000, rural clinics and hospitals noted the near collapse of health care services under the weight of service cutbacks and imposed self-reliance.

Professional morale and service delivery within the public health system went down.

The deterioration of the Zimbabwean health services sector has also partially been due to increasing shortages of qualified personnel.

The public sector has been operating with only 19 percent staff since 2000.

According to Zimbabwe’s Ministry of Health and Child Welfare, 69 percent of doctor positions, 80 percent of midwife posts and 62 percent of nursing tutor positions were vacant in 2011.

Many doctors, nurses and technicians have joined the higher-paying, better equipped local private sector, or have gone abroad.

However, President Mugabe reassured Zimbabweans that the new Government would improve conditions in the health sector.

“Over and above, Government will continue to work on the improvement of the conditions of employment of our health sector,” he said.

A lot of unemployed graduate nurses are also hoping that the newly appointed Minister and Government will address this issue

Morbidity (diseases) and mortality (death rates) trends in Zimbabwe show that the population is still affected by the traditional preventable diseases and conditions that include nutritional deficiencies, communicable diseases, pregnancy and childbirth conditions and the conditions of the new born.

Over the years, chronic under-investment in the health sector made a bad situation even worse with local drug manufacturers like CAPS closing down.