ZIMBABWE is currently going through a new political dispensation following the resignation of former President Robert Mugabe who had ruled the country for 37 years, paving way for former Vice President Emmerson Mnangagwa.
By Michael Gwarisa
Through out Mugabe’s 37 year rule, Mnanagwa has been his wing man and unarguably his most trusted lieutenant. In the process, he (Mnangagwa) also attracted a bad name tag as a result of the atrocities that were committed by the Mugabe regime.
It takes more than just a miracle to correct an image which had gone so long on the bad side. However, all hope is not lost for ED as some might want to call him as he can learn one or two things from Rwandan President Paul Kagame whom despite being labelled a despot and the ancestor of tyranny, has emerged a darling of the masses.
In one international Magazine, The Politico Magazine, Kagame is labelled a “Darling Tyrant” as most Rwandan people just cant have enough of him despite his terrible human rights record. Kagame is hailed even at an international level where former great leaders like Bill Clinton call him the greatest leader of our time while Tony Blair calls him a visionary.
Kagame has one secret and it is through that secret that Rwanda has emerged to be one of Africa’s fastest growing economies. Kagame’s secret is simple, ” He Prioritizes Health Care.” As long as people have access to basic drugs and healthcare, there is no reason for them to hate you, no wonder why Kagame always wins Presidential elections.
Zimbabwe is a signatory to the Abuja declaration which states that governments should avail at least 15% of the national budget to the health sector. Empirical evidence has shown that a 1% increase in public spending on health care reduces child and maternal mortality rates while improving life expectancy.
In Zimbabwe however total health allocation has remained lower than the 15% Abuja target and the Sub Saharan African average of 11.3%. According to the World Health Organisation (WHO), countries such as Malawi, Rwanda, Madagascar, Togo and Zambia have managed to reach the Abuja target. As of 2015, Rwanda was spending at least 23% of its budget on health care.
On this side of the equator however, Zimbabwe allocated a paltry 8% to the health sector from the national budget which is a far cry from the 15% Abuja and the 11% African average target.
The health sector is a cross cutting sector and by prioritizing it, governments tend to benefit immensely economically and growth is inevitable under such circumstances. Adequately funding the health sector would ensure that even some of the most expensive essential drugs we purchase from various country’s can be manufactured locally hence cutting the import bill by a huge margin.
The Air time health levy this year availed an amount to the tune of $18 million to the ministry of health and the money according to health minister Dr David Parirenyatwa will go towards beefing up drug stocks among other critical areas that need urgent attention in the health sector.
This is a commendable move but still needs government support through allocating meaningful financing for the sector at a domestic level through the national budget.
The human resource aspect is also a critical aspect in the health sector. Zimbabwe over the years has seen a freeze obtaining in most government institutions including the health sector. This move has not spared the health sector as most health institutions are poorly manned despite the growing burden in diseases.
Below are some of the take homes and lessons the Mnangangwa led government can take from the Rwandan experience.
Health Care lessons From Rwanda
Health insurance system
Rwanda follows a universal health care model, which provides health insurance through a system called Mutuelles de Santé. The system is a community-based health insurance scheme, in which residents of a particular area pay premiums into a local health fund, and can draw from it when in need of medical care. Premiums are paid according to a sliding scale, with the poorest members of society entitled to use the service for free, while the wealthiest pay the highest premiums and are charged copays for treatment. In 2012, about 45% of the system was funded by premium payments, with the rest coming from government funding and international donors.
Rwanda’s healthcare system operates roughly 440 health centers, 34 health posts which are mainly involved with the outpatient programmes such as immunizations and family planning services, a number of dispensaries, and 48 district hospitals. The country’s villages are served by a network of thousands of community health workers. There are four national referral hospitals which are Centre Hospitalier Universitaire de Kigali (CHUK), Centre Hospitalier Universitaire de Butare (CHUB), King Faisal Hospital (KFH) and the Kanombe Military Hospital. The most advanced of them is King Faisal Hospital, which, although a private facility, participates in the national health insurance system, and therefore accepts patients referred to it by other hospitals and clinics. It is the most advanced hospital in Rwanda, equipped with a CT and MRI machine, two dialysis machines, and a wide range of surgical capabilities.
Rwanda’s clinics are equipped with basic medical equipment and a cupboard of essential medications. The district hospitals offer basic surgical services, and all have a minimum of 15 doctors. Those in need of more advanced and specialized care are referred to one of the four national referral hospitals. There is one cancer treatment center in the country which offers an almost full spectrum of cancer treatment, providing services such as screening, diagnosis, surgery, chemotherapy, palliative care, and a pathology laboratory, with those in need of radiology services referred to Mulago Hospital in Uganda. A new university teaching hospital which will be equipped with the country’s second cancer treatment center is scheduled to be completed by 2018, with a second campus ultimately planned. It will be run by Partners in Health.
Rwanda is also currently participating in a seven-year program begun in 2013 that sees hundreds of medical educators and clinicians from 25 American medical institutions, including Harvard Medical School, Yale Medical School, and Duke Medical School, training Rwandan medical personnel and establish training and residency programs, which, after seven years, will be run by the Rwandan government with its own budget, teachers, and clinicians.
Maternal and child health
Rwanda is one of the countries which is on track in fulfilling the 4th and 5th Millennium Development Goals. In terms of the maternal mortality ratio, it reduced from 1,400 deaths per 100,000 live births in 1990 to 320 deaths per 100,000 live births in 2013. This was with an average annual rate of reduction to 8.6 from 2000 to 2013. Due to a variety of reasons such as poverty, poor roads due to the hilly terrain in the rural areas, misleading traditional beliefs and inadequate knowledge on pregnancy related issues, 31 percent of the women end up delivering at home despite having a public health insurance scheme. Some of the solutions which have been sought to the challenges include the training of more community health workers (village health teams) to sensitize the community,on top of providing them with mobile phones to contact the health facilities in emergency situations such as heamorrhage. The number of ambulances to some of the rural health centres have also been increased. According to a recent report by WHO most of the pregnant women die from hemorrhage (25%), hypertension (16%), abortion and sepsis (10% each) and a small number die from embolism (2%).
The demand for family planning was satisfied for 71% by 2010; the number of women who went for antenatal visits four or more times went up to 35% in 2010, which may have led to the observed increase in the number of pregnant women seeking a skilled attendant at delivery from 26% in 1992 to 69% in 2010. In terms of prevention of mother-to-child transmission of HIV, in 2010 the percentage of HIV and pregnant women receiving anti-retroviral drugs rose from 67% to 87% in 2012. 45 percent of women between the ages of 15 and 49 use family planning methods. Rwandan women on average, give birth to 4.6 children throughout their lifetime (RDHS 2010).
Water and sanitation
From 1990 to 2012, an improvement in the drinking water coverage was registered from 59% to 67% and the use of surface water reduced from 25% to 11%. There was also an improvement in the sanitation coverage from 1990 to 2012. This was from 30% to 64%. The unimproved sanitary facilities reduced further from 59% to 23%, while open defecation reduced from 7% to 3%