Zimbabwe needs to find sustainable solutions to its perennial health crisis

During the course of the past two weeks, social media has been awash with videos of the Member of the Executive Committee (MEC) of Health for the Limpopo Province of South Africa directly humiliating Zimbabwean patients who had sought elective surgical treatment in her province.

By Dr Grant Murewanhema

There have been mixed reactions from the Zimbabwe, South African and international community at large regarding the conduct of the MEC. Some have described the actions as highly unethical and not expected from somebody of her stature and education. The MEC is a powerful position in a devolved South Africa, representing the equivalent of Provincial Minister of a particular sect. However, some have said she raised important issues which have been ignored for long, and even though she said them on a wrong platform, they were worth of an urgent discourse.

The President of South Africa, Cyril Ramaphosa, issued a statement reiterating that foreign nationals who migrate to other countries must have the ability to pay for services. In a tough economic environment, governments run on tight budgets. For health coverage, it is not unusual for recipient countries to expect an immigration health surcharge or proof of health insurance for the duration of a foreigner’s stay.

It is critical to state that Zimbabwe has been undergoing a socioeconomic crisis spanning over decades, which has been largely blamed on external forces by the responsible authorities. Healthcare provision has largely been hit hard by the ongoing crisis, making it difficult for local people to access quality healthcare. Among the drivers of this trend has been a massive outward migration of skilled healthcare manpower, exacerbated by the COVID-19 pandemic, dilapidated healthcare infrastructure in public hospitals, perennial shortages of consumables including medicine, lack of adequate theatre facilities and theatre time for elective procedures, lack of blood products for medical and surgical emergencies and lack of medical insurance in a country whose employment is largely informal.

As Zimbabweans have turned to neighboring countries for survival, they have also found their way into other countries such as South Africa, Botswana and Zambia to seek quality and cheap medical care. These countries have largely been receptive, offering care especially in times of emergencies. Unfortunately, patients have turned to these countries for non-emergency healthcare, possibly placing a strain on the fiscus in the recipient countries. Hence, the call by other countries for Zimbabwe to fix its public health sector and ensure that patients can be treated in their country.

The COVID-19 pandemic second and third waves in 2020 and 2021 exposed the lack of capacity and resilience of the Zimbabwean public health sector to deal with public health emergencies. As the number of symptomatic COVID-19 cases increased dramatically, the country struggled to cater for the healthcare for both COVID-19 and non COVID-29 patients, leading to patients resorting to home-based care, home remedies and complementary medicines. Excessive morbidity and mortality during the COVID-19 pandemic may have been attributable to this lack of public health sector inadequacy.

Beyond the peak of the COVID-19 pandemic, out of a public health emergency, the country has continued struggling to provide quality healthcare for its people. Blood products, medicines, sundries and human resources are now in gross shortage, forcing people to seek help in remote mission hospitals and straining them at the expense of local communities.

It is clear that the country has serious healthcare sector challenges, but these are not occurring in isolation. Dealing with the crisis requires acknowledgement from the responsible authorities that it indeed exists, and its occurring within the context of a broader political and socioeconomic crisis, hence cannot be dealt with through piecemeal solutions.

The performance of the economy, currently at its lowest in the past 12 years, is the major driving force behind the current health care crisis. Inadequate budget allocations and lack of adequate remuneration are the biggest challenges faced by the sector. Unfortunately, in most instances the responsible authorities have played deaf to cries by healthcare workers, and sometimes opted for tough legislation against workers raising genuine concerns. In the end, the workers are left with no option except to find other ways to look after their families. Until remuneration issues are adequately addressed through appropriate means in a country that constantly boasts of budget surpluses, the quagmire is likely to remain.

Financing healthcare is the responsibility of a central government in any country, and access to quality healthcare is a basic human right. Denying a laboring woman a chance for a decent delivery of the newborn is gross violation of human rights. Denying children with acute diarrhea and acute respiratory tract infections access to quality treatment is equivalent to denying the country of a healthy future. There is therefore need to appreciate that provision of quality healthcare is central to the socioeconomic development of any progressive nation.

Against the background, the responsible authorities in the country must prioritize political and socioeconomic reforms that foster national development and allow provision of quality healthcare for the population. Genuine and expedited discourse by all concerned is needed to deal with the situation decisively and sustainably and avoid further embarrassment of our people as they seek services elsewhere. As a country, we urgently need to find permanent solutions to the challenges bedeviling our public health sector.

About the Author: Dr Grant Murewanhema is an Independent Public Health Specialist and 
Epidemiologist; who has main interests in Maternal, Sexual and Reproductive Health and
Control of Infectious Diseases)

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