Higher budget still falls short on health care goals
SET against the context of acute shortage of materials, medicine and manpower, a health budget of $486 million may not be enough to put the country’s health services in a position to deliver quality service to most of its patients.
Even though, this allocation announced in the 2017-2018 estimates of expenditure, still represents a significant amount compared to what other line ministries got.
Health care lobbyists say it may not result in substantial improvement to what is now being described as a dire health-care service unable to cope with the daily demands of the population.
Hopes were high that the shift into a new political dispensation would channel more resources into the health sector to firmly put the country on a pro-poor, inclusive and sustainable development path.
Minister of Finance and Economic Development Patrick Chinamasa unveiled the 2017-2018 budget on December 7, this year.
Health lobbyists have raised concerns on whether the amount allocated will be adequate to revive and develop the sector from service provisions and availability of drugs.
Community Working Group on Health (CWGH) executive director Itai Rusike, said the budget allocation made to the health delivery system will not address the critical areas in the sector.
“While there has been a slight improvement in the health budget in 2018, it however still remains inadequate to fund the critical needs in the health sector,” he said.
“Lower levels of per capita health expenditure indicate that health expenditure in the country is insufficient to guarantee adequate access and quality of healthcare.”
“The inadequate public financing of health”, he said, “has resulted in an over-reliance on ‘out-of-pocket and external financing which is highly unsustainable. Moreover, the bulk of the resources will be channelled towards financing employment costs leaving very little for capital expenditures,” the health lobbyist said.
Mr Rusike felt the effectiveness of the budget may be hindered by the 2018 elections.
“The performance of the healthcare sector is likely to be affected by elections both in terms of funding requirements and in terms of increasing uncertainties,” he said.
“The national budget may therefore fail to meet some of its targets. The financial conditions of state-owned companies and public entities represents another significant risk over the medium term,” said Mr Rusike.
He suggested that future budget allocations should prioritise key areas for the development of the sector.
“Future budgets must contain a matrix articulating key initiatives in the preceding budget, progress made in this context and a plan and time-line for key milestones to be achieved during the budget period,” Mr Rusike said.
Tendayi Westerhof, a Pan-African Positive Women’s Coalition activist echoed similar concerns.
“I am not sure if the amount allocated to the health sector will be sufficient considering the deplorable state of some of the public healthcare facilities,” she said.
“There is lack of essential medicines and other challenges that include lack of specialised manpower due to brain-drain.”
Westerhof said there was a lot that needed to be done to improve healthcare in the country.
“For as long as the health budget does not address treatment of certain ailments that force those who can afford to seek medical services outside Zimbabwe, we still have a long way to go as this gives the impression that the rich have no confidence in our health delivery system,” she said.
Westerhof also highlighted the great need to improve HIV and Aids treatment.
“The supply chain management of HIV treatment continues to be erratic,” the outspoken health critic said.
“There are still no adequate healthcare services to the most vulnerable in rural areas and I hope part of the budget will be used to fill this gap.
“There is need for more investment in diagnostic health equipment such as viral load machines,” she said.
The difficult economic situation prevailing in the country has made it difficult for the majority of the poor to access health care services from various institutions, countrywide.
Most people still travel long distances to access health care services while the well-heeled go abroad in search of medical treatment.
The economic hardships have also resulted in various challenges in health institutions, including a critical shortage of drugs and specialised manpower.
Many have died from curable diseases due to lack of drugs.
Clinics, especially in rural areas have inadequate medical facilities including transport. Some even complain that only painkillers are dispensed to patients to ameliorate pain.
In 1985, the World Health Organisation (WHO) declared that the Zimbabwe healthcare system was among the best in the developing world.
However, indications are that most of the gains made after Independence have been reversed by lack of manpower, poor management and lack of resources.
According to WHO statistics, there are 1,6 physicians and 7,2 nurses for every 10 000 people (Zimbabwe Ministry of Health and Child Welfare, Human Resources for Health information sheet, 2010).
Skills flight and a public sector job freeze has compounded the problems resulting in a vacancy rate of over 50 percent for doctors, midwives, laboratory, and environmental health staff (National Health Strategy for Zimbabwe 2009-2013).
Recent data suggests a slight decrease for some of these categories (Human Resources for Health Profile, 2009), which may be a positive result of an Emergency Retention Scheme created in 2008.
The WHO has identified the failure to contain and manage the loss of health sector personnel due to unattractive retention incentives, poor and unequal distribution of health workers within the sector, low outputs from training of health workers, and an absence of bilateral/international agreements relating to HRH recruitment as some of the major problems affecting the sector in Zimbabwe.
However, there is a ray of hope since the 2018 national budget came after the shift into a new political dispensation, which brought confidence and optimism for an economic turnaround to the general populace.
The majority of the poor are pinning their hopes on President Emmerson Mnangagwa, who has already demonstrated his commitment to cut unnecessary expenditure and to revamp critical public institutions.
Expectations are high and the majority of the poor are looking to his administration for better healthcare delivery.