COMMUNITIES say the newly gazetted Public Health Bill (PHB) is a noble document but still needs to be worked on to address public health issues at community level.
By Michael Gwarisa
The development comes in the midst of ongoing Public feedback meetings on the PBH which kicked off this week in Mutare.
The Community Working Group on Health (CWGH), a Non Governmental Organizations which represents and drives health issues on behalf of communities says the new bill is silent to a number factors which directly impact health at community level especially the aspects of Health Center Committees and Village Health workers.
“Although Health Centre Committees (HCCs) have been legally recognized in Section 17 they are not represented in the District Health Team in Section 16 for feedback to and from the communities. Therefore we strongly recommend that community involvement mechanisms need a representation mechanism in the district health team as the district government council in addition to the hospital management board which oversees functionality of the district hospital.
“HCCs were fully captured. However the role of Village Health Workers (VHWs) and other community based workers is not satisfactorily and explicitly stated in the act except for Section 137 sub-section 1(b) in a general statement that says “The Minister may make regulations
providing for: Recognizing and providing for the roles of non- state actors and communities. Thus provisions for the VHWs could be detailed soon after Section 17 of HCCs,” said CWGH Executive Director, Itai Rusike.
He added that including VHWs at length in the bill was important since they do not have an association or representation like other health cadres and yet they are the backbone of all community health programmes, hence the need for legal backing in order to be given priority.
“Include specific inclusion of the broad roles and functions of VHWs including how they relate to other community based workers (home based carers, family planning distributors, OI/ART/Dots coordinators, school health coordinators, malaria spray perators etc.
“The Bill is silent on the Health Centre staff establishment. It is therefore crucial to have a specific clause in the Bill that speaks to issues of the ideal healthcare establishment that looks realistically to the country attaining universal health coverage and the SDGs given that the
current staff establishment was determined using the 1982 population statistics and when the disease burden was very low.”
He also said although the issue of health centre staff establishment is covered in the Health Services Act it should still reflect in the Public Health Act Amendment Bill so that the two are harmonized and be in tandem with the Constitutional provisions of leaving no one behind.
The Public feedback meeting on the PHB being spearheaded by the Portfolio Committee on Health and Child Care and the Thematic Committee on HIV and AIDS commenced March , 5 2018 and will end Marc, 10h 2018. The Committees will be split into two (2) groups and will cover all the provinces.
“Furthermore all management of health services should have the requisite public health training in addition to the basic medical/health training required.
“Local authority management must also have public health competencies and have a sound appreciation of the social, commercial, proximal and broad determinants of health so they know why they have to act in the public health interest and provide the services as mandated,” said Rusike
He also said they should be adequately supervised by the MOH as well as the respective parent Ministries (Environment – for water/sewerage/solid wastes); local government for regulated and healthy urbanization; and Secretary for Health for the health directorates of local authorities in order to avoid the current pitfall where health disasters have resulted due to limited capacity and public
health understanding by office bearers.
Meanhwile, Section 103: The Public Health Infrastructure nationwide should conform to Constitutional provisions and those standards that the country has committed to in the various international declarations on environment, water provision, solid waste and sewerage management; the SDGs 2030, The Shanghai Declaration on healthy Cities, the International Health Regulations, etc.
“It should be explicitly stated that; No Communal Toilets and Shallow unprotected wells in Urban Areas – All new housing areas should be serviced first before occupation. Every communal household should have a provision for rubbish bin, ventilated toilet before the construction of a kitchen.”
He also noted that the local health sector needed to prioritise communal areas and ensure every province should has a Provincial Hospital
“The case of Matabeleland North operating without a Provincial Hospital should be addressed as a matter of urgency. Harare and Bulawayo Metropolitan Provinces should have District Hospitals to avoid suffocating the Central Hospitals and there is need to have functional adequate Emergency Services (Ambulances) in all the districts instead of shifting the burden to the communities to look for alternative transport.
“Compulsory immunization, we need to make immunization and all other proven effective public health interventions such as deworming, Vitamin A Supplementation etc as deemed necessary at national scale especially for children compulsory despite the person’s religious affiliation o Reconstitute the Public Health Advisory Board by having CSO representation and make it functional supported with resources from the national health budget.”