Now Daily Opinion
- Police monitor striking Zimbabwe doctors and nurses.
Health professionals have called for the dissolution of the Health Services Board led by Lovemore Mbengeranwa, accusing them of corruption and incompetence in dealing with their problems.
Health services in Zimbabwe have ground to a halt after doctors went on strike last week. Nurses joined the strike on March 1.
Glen View MP Fani Munengami said he was shocked when he took a sick person to hospital this week only to find the system not functioning.
Former Zimbabwe Hospital Doctors Association (ZHDA) press consultant Francis Rwodzi comments:
“Time to reform our public health system
I have been watching closely developments engulfing our public health system for the past 3 years and I am not at all surprised by the latest crippling strike by Junior Doctors and Registrars against appalling service conditions and lack of impetus of the bureaucracy. I worked for the Zimbabwe Hospital Doctors Association (ZHDA) for two years as a press consultant and I must say that I was shocked to see the rate at which our country’s health system has been sinking and a total collapse is surely in the horizon unless the presidency makes hard decisions. There is no doubt that this situation is catastrophic to say the least and what this only calls for is a total overhaul of our health delivery system. To start with, a doctor to patient ratio of 1:250,000 is unacceptable by any standard and to expect doctors who earn $1.80 per hour on-call to work on such a huge burden is mind boggling. It is even dumbfounding to hear that the government even has the audacity to freeze doctors’ posts when the situation is so critical. To make matters worse, junior doctors who are supposed to undergo further mandatory one year district deployment on top of a 2-year internship suddenly find themselves unable to proceed with their careers because they cannot be issued their Open Practicing Certificates by the same employer. The working conditions for doctors and nurses in public health institutions is horrible considering that the government is not able to provide basic stuff such as gloves which is unacceptable. The rights of patients are violated daily, where they are made to pay but still the health institutions are not able to provide even paracetamol. The most worrying thing is that while hospital pharmacies are empty, at the same health institutions, there are thriving private pharmacies that are making a killing by milking desperate patients.
- Under fire: Health minister David Parirenyatwa.
The biggest problem in our health delivery system is an entity called the Health Services Board (HSB). To many Zimbabweans who are not privy to the politics of the public health system, this may seem an obscure and irrelevant board (of course it is as we shall learn later) but it is the main reason why doctors and nurses strike is a perennial occurrence. The HSB was established by an Act of Parliament in 2005 as a bridge to the establishment of a more effective Health Service Commission, which sadly has not materialised for the past 12 years. The board is chaired by Dr Lovemore Mbengeranwa, who prior to joining, was fired as director of health of the City of Harare by the then Mayor Engineer Elias Mudzuri for gross incompetence. It is no surprise he just transferred the same qualities to the HSB. Former Attorney General Sobuza Gula Ndebele is part of the same board. During my time with the ZHDA that was led by Dr Fortune Nyamande, doctors went on strike for almost the same grievances that the current crop is expressing today except that the issue of availability of posts was not as dire as it is now. To my surprise, the entire ZHDA executive was suspended by the HSB for ‘inciting’ doctors to go on strike. Honestly, how could you expect doctors who were earning less than a dollar an hour to wait to be incited to go on strike? I made my own investigations at the time and only found out that even the Minister of Health Dr David Parirenyatwa advised Dr Mbengeranwa that doctors had genuine grievances and their actions did not warrant any suspension. My sources told me that however, Minister Parirenyatwa was and still is even scared of Dr Mbengeranwa (for reasons I do not know) that he forced the ministry to conduct a wild goose chase by instituting an investigation which was evident would collapse on its head. The investigation team went on to produce a report which exonerated the ZHDA executive from any wrongdoing, much to the rage of Dr Mbengeranwa who demanded that the report be dismissed and a case be found against the four ZHDA executive members which again hit a brick wall. I am told the majority of board members in HSB were against this humiliating drama which cost the country thousands of dollars in form of hotel bookings and allowances for the investigators. I realised that this board was clueless when they summoned me to a meeting at their offices at Net One building and indicated that they may sue me for tarnishing their image! I looked at the public relations officer in amazement, it was unbelievable, they even went on to write to my lawyers indicating the same. Phew! Here are public officials who had been proven guilty for stealing public funds who wanted to sue a victim for their corrupt practices. The kangaroo tribunal finally found me ‘guilty’ of inciting doctors to go on strike and tarnishing their image. Surely this was the height of lunacy. After being forced to eat a humble pie, the same board went on to draft a cynical contract for junior doctors (The same crop that is striking today) which was aimed at stiffing the operations of ZHDA and rights of doctors, further plunging the already strained relations to a new low.
- Doctors demonstrate for more money.
Doctors working conditions are appalling, they are underpaid, their morale is low, same as nurses, but the HSB doesn’t care. In fact, I will not be surprised to hear that this current HSB executive has been suspended because according to Dr Mbengeranwa and his hangers-on, the problem is with doctors who are guilty of their abject poverty and sorry state. The HSB is a very corrupt institution which in 2015 was exposed by the Auditor General for siphoning hundreds of thousands of dollars through a dubious car hire scheme and outrageous fuel allocations. The board had to flee its rented offices at NetOne building after accumulating over $200 000 in unpaid rentals while board members were playing hide and seek with CMED who are also owed hundreds of thousands by this organisation. As I write, the HSB sought refuge at Parirenyatwa Hospital where they were accommodated after being chased away from their rented premises. Dr Mbengeranwa and his board were slammed by the Auditor General for allocating themselves at least $14 000 a month each as fuel allowances and $450 000 in car hire. The HSB is hugely bloated where office secretaries earn in the range of $1 500 while doctors are living from hand to mouth. I honestly do not know what the Anti-Corruption Commission is doing when criminals like Dr Mbengeranwa and company are walking scot-free and still enjoying the privilege of public office. All this is happening right under the nose of Minister Parirenyatwa who himself seems clueless about the problems facing our health system. However, I am not surprised by Dr Parirenyatwa’s incompetence because we have seen him at the helm of this important ministry for several years and for President Mugabe to expect a different result also brings into question his leadership style. Dr Parirenyatwa in 2015 without shame, with our health system on its knees, siphoned $100 000 from the struggling Public Service Medical Aid Association to prop up his private practice. There is no doubt that he is unfit for public office. Even the bureaucracy in the ministry of health is headed by Dr Gerald Gwinji who was in the headlines in 2015 for squandering funds part of 1.5 million dollars that was released by treasury for health workers’ allowances. In short, our country’s health system is under the whims and caprices of a corrupt and inept leadership whose captain is the clueless minister Parirenyatwa, supported by the useless HSB led by Dr Mbengeranwa and a bureaucracy under the leadership of the hopeless Dr Gwinji.
- Walkout: health workers leave their posts.
What needs to be done?
The government must immediately come up with a reasonable offer for doctors so that they earn decent salaries and allowances for on-call shifts, allow doctors to easily import duty free vehicles since the employer has failed to do that so that they can attend to patients swiftly and to guarantee posts for all junior doctors on internship. Our health system is in a mess caused by endemic corruption which the government has no capacity to resolve because even other horizontal institutions of accountability such as the anti-corruption body need a shake-up. There is need to reform the health system starting with the dissolution of the HSB and then a proper investigation be conducted to weed out corrupt elements who continue to feast at the expense of suffering Zimbabweans. The ministry must then come up with a new framework which is embedded within the ministry that is guided by a strategic plan that ensures that Zimbabwe remains on track on the attainment of Sustainable Development Goals. Priority should be given to ensuring the adequate allocation on the national budget to the health ministry in line with recommendations of the Abuja Declaration of 15 percent of the national budget. A funding model that ensures that all citizens especially the poor have health insurance must be put in place so that the loss of lives as is happening now can be avoided in the future.”
- The writer is a former Press Consultant for the Zimbabwe Hospital Doctors Association, a Journalist and Governance and Development scholar at the Institute of Development Studies, University of Sussex, UK. He writes in his personal capacity.