Urgent Need To Build Public Health Sector Capacity & Resilience Ahead Of Further Waves Of COVID-19

THE month of January was a clear testimony of healthcare workers’ lamentations over the years. Public health sectors doctors and nurses have gone on industrial action several times over the past years, crying not only over poor remuneration but poor conditions of service.

By Dr Grant Murewanhema

They have often cited poor equipment, lack of essential medicines and gross shortage of sundries as barriers to provision of quality healthcare. This has seen an exodus of highly qualified healthcare personnel from the public health sector into countries countries and regions.

Our public health sector is supposed to be well-organised, with an efficient referral system from community facilities up to the tertiary level facilities. Proper use of the referral system would result in efficient resource utilisation and quality service delivery at every level from the clinic or polyclinic, to the district hospital, provincial hospital up to the tertiary level facility. The current problems have seen major hospitals such as Parirenyatwa and Sally Mugabe Hospital being flooded with patients who must be handled at lower facilities.

With adequate support and capacity, our healthcare workers can offer world class medical services. Separation of siamese twins, excision of a 12-kg angiomyolipoma and many other examples come into mind. Despite very poor returns, specialist doctors have committed themselves to providing quality services. Though their services would be much appreciated elsewhere, many have remained behind serving our population, exhibiting an amazing and unappreciated level of patriotism. Indeed these are the war veterans of our times.

The COVID-19 pandemic which we have been battling since March 2020 in Zimbabwe has exposed the gross deficiencies in our public health sector. A harsher second wave ravaged our country just after the festive season, and resulted in an accelerated rate of infections, and an over 50% increase in fatalities over a short period of time. Despite several prior warnings to adequately prepare the public health sector, it was still found inadequate. Shortages of hospital space around the country, isolation facilities and facilities for higher care (intensive care units and high dependency units), as well as critical shortages of skilled manpower became apparent.

A scramble for home oxygen concentrators, home remedies and pharmaceutical medicines as people failed to get treatment in hospitals provided enough evidence for our health sector incapacitation.

Community deaths in large numbers tell a story, and people have resorted to home visits by doctors, a clear testimony of lack of confidence in the public health sector. Hospital is the place to be for sick people, and when people prefer otherwise, it serves as clear testimony that all is not well.

The current wave seems to be steadying gradually, with reduced numbers of confirmed daily cases, but daily reported deaths are still over 10. The worst is not yet over, but its now more important to look ahead. We are anticipating that our population will be vaccinated at some point (close to a 100 million people have already been vaccinated elsewhere), and this will bring some level of control to the COVID-19 pandemic.

However, epidemiologists anticipate further waves of COVID-19 in the next few months. It would be a pity after a year of experience to be found wanting again. We have to prepare for further waves, but we have to build capacity to deal with essential health services in general. Our population might also have suffered a great deal from the indirect effects of the COVID-19 pandemic on provision of essential healthcare, possibly losing people to preventable causes of death.

 

Consultative forums with technical experts in healthcare provision and management are needed to build capacity and resilience, to protect our population. To improve the response moving forward, there is a need to shift from political approaches to a pandemic to a more science oriented approach. Our population deserves better, and with the right financial and other resource allocations our healthcare sector can rise again and become first class.

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