New book offers framework for health system reforms

THE Covid-19 pandemic, which ravaged the world over the last three years, killing millions of people along the way, could probably pass as the greatest ever litmus test for global health systems, many of which were shaken to their very foundations.

People that are wise will learn from their experiences. And what we experienced at the height of the Covid-19 pandemic provided new insights into our health systems — many of which, particularly in Africa, would have been decimated had the pandemic not eased off before pattering out after a few years.

These are some of the issues Dr Paulinus Sikosana — a veteran public health specialist — sought to unravel in his new book, ‘Doing the Right Thing’, in which he addresses the critical matters of leadership and governance, health information systems, service delivery, medicines and vaccines technologies, human resources and health financing.

In many ways, all these facets were put to the test as Covid-19 swept through the land like a veld fire. With Zimbabwe having been commended by the World Health Organisation for its robust response to Covid-19, there are, however, a lot of loopholes in the public health delivery system that still need to be plugged if the industry, currently in a fragile state due to massive brain drain and a struggling economy, is to be restored to optimum level.

This book can be a landmark publication, providing as it does a bird’s eye view of the entire health system for stakeholders to take a look and start strengthening the system to minimise the shocks should another virulent pandemic knock on our doors. In fact, researchers have pointed out that we may be in an age where we are likely to see more pandemics of a similar nature to Covid-19, if not worse.

Thankfully, in his book, Dr Sikhosana shares recommendations he believes if adopted, could put Zimbabwe in a better position to fight off the next pandemic without losing too many lives.

We cannot afford to be caught off-guard again. Covid-19 caught us napping, and we paid a very high price for our lack of adequate preparation. Even a few lives are just one too many.

In 14 comprehensive chapters, we are taken on a tour of Zimbabwe’s health sector as the author explores in depth how the country’s health policy framework has evolved over the years, the performance of the health system, how it can be strengthened, health financing and workforce, epidemic preparedness and response, access to medicines, health information systems and challenges as well as rebuilding the local health delivery system. These are key issues that any government should grapple with.

In any industry where statistics speak volumes about the nature of a system and its modus operandi, Dr Sikhosana does well to furnish us with critical statistics that serve the key purpose of helping us understand his message better. These statistics are like microcosms of the macrocosm. They serve as indicators of what has been done, where we failed, and what needs to be done going forward.

While Covid-19 came — and is going, thankfully — Dr Sikhosana also traces how, even following the reduction of HIV and Aids into a manageable condition particularly with the advent of antiretroviral therapy, diseases such as tuberculosis remain a stubborn problem that needs to be contained.

Although non-governmental organisations in the health field have done a lot to help the government carry the burden of disease, which has also be a significant strain on an economy on life support system, the government has an obligation to ensure health coverage for all citizens. But the reality on the ground is that many are still dying from treatable disease because access to health for all, which is guaranteed in Zimbabwe’s constitution, is still a pipe dream for the majority. All these are issues that Dr Sikhosana wrestles with in his new publication.

In simpler terms, health sector reforms are an urgent and pressing need if health services are to become accessible and affordable to the entire population regardless of their backgrounds or social and economic status.

Dr Sikhosana identifies the gaps and weaknesses in the health delivery system and proffers solutions on how best they can be addressed.

So beyond just identifying the structural weaknesses in the system, he bends over backwards to ensure that he proffers possible solutions that policy makers can consider for drafting and implementation.

The author also brings in a historical context to provide a framework through which the current challenges afflicting the health sector can be understood. The Bretton Woods’ prescription of the economic adjustment of the early 1990s played a critical role in that regard. In essence, the health sector is still paying a price for those prescriptions, which also caused major upheavals in other segments of the economy.

This means while there is a lot of talk and campaigns in the political and economic sectors around the issue of reforms, the health sector is not an exception, and Dr Sikhosana spells out how the positive impact such reforms should be experienced through positive outcomes whose benefits will trickle down to the ordinary man in the street.

In summation, ‘Doing the Right Thing’ can be called a book of the moment, because this is exactly what the doctor ordered. If stakeholders are to adopt the suggested policy recommendations spelt out here, then there is hope that our health sector can bounce back and become the pride of the nation.

This book is certainly poised to become a vital resource for policy makers and stakeholders in the health delivery system. It is such a wellspring of information and knowledge, broken down and systematically arranged in such a way that it gives the reader an oversight of the country’s health delivery system, its challenges, weaknesses as well as the positive aspects that need to be strengthened through the relevant interventions.