Time For Citizens To Demand Accountability To Ensure Attainment of Universal Health Coverage

THE 12 of December is the Universal Health Coverage (UHC) Day which is celebrated worldwide. Combined with the closing of another year, this is a time to take stock of how far we have gone in reaching the UHC goals in Zimbabwe.

By Edinah Masiyiwa

According to the World Health Organisation UHC means that everyone who requires health care should get it and that people should afford the health care. This year’s UCH theme is “Health For All: Protect everyone.” We have a long way to go until we reach that goal in Zimbabwe.

Zimbabwe has experienced many challenges that are affecting progress towards UHC despite the fact that its health delivery system is built on the constitutional right to health care in Section 76, sub-section 1-4, of the Zimbabwe Constitution, which states that; “Every citizen and permanent resident of Zimbabwe has the right to have access to basic health care services, including reproductive health, Every person living with a chronic illness has the right to have access to basic healthcare services for the illness, No person may be refused emergency medical treatment in any healthcare institution.

The National Health Strategy (2016 -2020) also implies the idea of universal access to health care as it emphasizes “Equity and quality in health: Leaving no one behind.”

The reality on the ground is however the opposite of what is spelt out in the constitution and other policy documents as citizens are failing to access health care because of several reasons. These include direct payment for health services, distances they must travel to reach to the health centers and continued strikes by health workers. It is unbelievable that in the city of Harare some women are delivering under the care of untrained birth attendants because of the a lack of trained health service providers in our institutions, among other reasons.

A report produced last year by UNICEF highlighted that the Zimbabwe health sector was still recovering from decades of significant challenges which included inadequate financing, shortages of qualified staff and obsolete equipment. This was evidenced by the findings from the Multiple Indicator Survey (2019) where maternal mortality rate went down from 614 to 462 deaths per 100000 live births. Delivery under the supervision of a skilled attendant also went up from 80% to 86%.

The situation has been made worse with the COVID-19 and the strikes by nurses and doctors. Health care remains beyond the reach of many in Zimbabwe as some people have to walk or catch a bus to get to the nearest health center.

In July the Harare city council closed some of its polyclinics citing that human resources were being put to the COVID 19 response. This is a move that makes it difficult for people to access health care thereby pushing the country away from the goal of UHC. Polyclinics are the first point of care for patients who need health care. Women are the most affected by the closure of clinics as they are the most users given their reproductive health needs. Women are largely delivering under the care of traditional midwives, a practice which is unacceptable in the 21st century. Delivering without the supervision of a skilled health worker may increase maternal deaths.

Hopefully once the COVID-19 pandemic is behind us as the already weak health delivery system is being affected more by the epidemic.

It is however encouraging to note that the government through the National Development Strategy 1 (2020-2030) has put strategies to address the barriers to UHC. The national strategy acknowledges the fact that staff are demotivated and the dilapidated hospital infra structure as well as lack of medicines and commodities. The strategy further acknowledges the high out of pocket expenditure for medical health care.

My observation therefore is that our government is aware of the challenges facing the health care and the fact that something needs to be done to ensure universal access to health care. Zimbabwe is well known for having good policies and plans but challenge is on implementation. It is important that as citizens we should monitor how the plans that have been put into place will be rolled out.

The first step that was put in the plan is increasing domestic funding for health. I would like to applaud government for allocating the health budget for 2021 to 13% from the previous 10.1% in 2020.Government has also planned to increase the public health expenditure per capita from USD30.29 to USD86 by 2025. This is positive.

Now, we as citizens need to continuously monitor these plans and demand accountability. In the past we have learnt that budgets are allocated annually but not all the budgeted amounts are disbursed to the ministry. I therefore call upon the government to honor their promises. Health care is a basic human right which everyone should enjoy. As we commemorate the UHC Day, let us reaffirm our commitment to health for all as an investment in humanity, wellbeing and prosperity for everyone.

Edinah Masiyiwa is a Women’s rights activist and Executive Director Women’s Action Group

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