#TalkingCOVID-19WithDrGrant: Demanding Immediate Resuscitation Of The Public Health Sector In Zimbabwe: Whose Responsibility?

Dr Grant Marewanhema

THE past four weeks have been particularly difficult for Zimbabwe. We have seen the number of confirmed cases of COVID-19 rise from 2 digits to over 1400, and the deaths from the same going up to 25. There have been multiple but unverified reports of sudden deaths in communities, which could be due to COVID-19. Of course, people are still dying from other causes, but with a totally crippled health system and a grounded economy, there is no proper surveillance and auditing. Thus, the reasons why people are dying in the community may go unchecked for a while.

By Dr Grant Murewanhema

The number of mothers dying to pregnancy-related causes is reportedly increasing, so are stillborn babies and those who are suffering hypoxic brain damage due to delayed access to quality maternity interventions. There have been numerous reports of children dying to pneumonia and diarrhoea. Elsewhere in the country, outbreaks of typhoid and other diarrhoeal diseases have been reported. The conditions killing people, especially mothers and their babies, are a tremendous reflection of an ailing public health sector requiring immediate and drastic resuscitation.

Nurses have been on strike over the past 3-4 weeks over earnings which are less than the equivalent of USD$50. Highly-trained professionals are living in extreme poverty, failing to meet the daily needs of life, and even failing to report for duty.

Professionals have over the past years failed to send their kids to decent schools, or to acquire properties for themselves. Doctors and ancillary support staff for healthcare delivery have been tried enough, are physically and emotionally draned and tortured, and are also threatening to down their tools. The leadership of the country, that in the past labelled doctors unpatriotic, heartless skilled labourers is nowhere to be found, and its apparent that the threats issued to doctors and nurses during the past industrial actions will not deter them from going on strike again. It is often said a hungry man is an angry man.

Systematic corruption by high-ranking government officials, flouting of tender regulations and misappropriation of budget allocations are commonly reported. Some cases have been reported to the local anti-corruption commission, but no decisive measures have been taken against those responsible.

Purchases of sub-standard commodities, inflating prices and untraceable supply chains have been discussed. Government officials drive expensive vehicles, while their constituents have no ambulances. Programmes that are not donor-funded are grounded.

Many hospitals have become nothing other than huge empty buildings which house human capital and sick people, but not offering any meaningful treatment. For years, the biggest hospitals in the country have been operating sub-optimally, with intermittent supplies of basic consumables and medicines, and patients have had to source these from outside pharmacies. In some hospitals, private support services such as laboratories, radiology and pharmacy were established under the disguise of public-private partnerships, but in reality these being money-milking shenanigans set up by influential members of the society.

Equipment is dilapidated or obsolete, and the beginning of the COVID-19 pandemic badly exposed how deprived we are in terms of ventilators and other life-saving equipment. Consultants and specialists-in-training have often over the years, lamented the lack of critical equipment in the hospitals, but their cries have fallen on deaf ears. Revamping healthcare delivery in the country has not been a priority for decades, as the elite and politically-connected have promoted a look-east policy for healthcare. Presiding over such a broken system must be such a shame for those with face.

The majority of Zimbabweans have no access to medical insurance. With an unemployment rate in excess of 90% its not surprising; being on medical insurance is expensive. Even those who treat people daily will not be able to access quality treatment when in need. These people must access healthcare from the public sector, which is essentially dead. A working system must prioritise the health needs of those in the lower socioeconomic indices of multiple deprivation classes, as proposed by Sir Marmot in his 2010 report, ‘Fair society, healthy lives’, a principle termed proportionate universalism.  The burden of disease in society is heavily skewed towards those who lack the most, therefore it must be obvious that preventive and curative services must be channeled towards these.

Unfortunately for Zimbabwe even the private sector is collapsing too. Those with access to financial resources or some of the best medical insurance schemes are failing to find places for admission in private hospitals, as they are either overwhelmed, or also operating sub-optimally due to the prevailing hyper-inflationary economic environment. With borders currently closed for travel it seems our convergence is quickly approaching, thanks to the COVID-19 pandemic. At some point, both the rich and the poor will have nowhere to run to, and regrets of not having fixed the situation when time permitted will come, but to no help.

The first case to succumb to COVID-19 in the country opened a Pandora’s box. Even with the right financial resources and political connections one may fail to access appropriate interventions when needed.

The doctors and nurses have called for resuscitation of the system multiple times. They have been abused, threatened and violated time and again, and many are frustrated. Many have questioned why they should expose themselves to hazardous working environments for meagre earnings, and are choosing to concentrate on their lives, or leave for some other colored pastures.

Unfortunately, this leaves the citizens as the only segment of society to raise their voices. Quality and timely healthcare is a basic human need, which must be demanded, but citizens have to assume the responsibility. The current approach of waiting for the professionals to do it will not work. As the burden of COVID-19 in the country escalates, and we anticipate a serious upsurge of cases requiring hospitalisation and specialist attention in the following weeks, citizens must stand up and demand what is rightfully theirs.

Martin Luther King told us that what we want cannot be given freely; some sort of sacrifices have to be made. Therefore the citizens of the land must rise above their usual fears and complacency, and fight for whats rightfully theirs. Otherwise we risk losing generations to COVID-19 directly and indirectly. If the situation is not fixed now, many may kiss the face of the earth goodbye prematurely!

(Written by Dr Grant Murewanhema, an Independent Public Health Specialist with a particular interest in tackling the social determinants of health.)

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