Below is the opinion of a Zimbabwean serving on the frontline in the country’s public health systems. It’s published here in full:
To make impactful change that improves the deteriorating status quo we must at least be honest about the narrative of a collapsing health system. For decades the public healthcare system has experienced the putrid stenches like rewards for CEOs for no work or improvement done.
To be honest as health workers we are also contributing to the inevitable system failure in our healthcare facilities by maintaining the same systems. This opinion piece is based on brewed frustrations of over fifteen years of personal experience and observations of the public healthcare system, mainly focusing on the hospital level.
Some of the challenges in the health system in Zimbabwe are as a direct or indirect result of the failure of weak systems, leadership crisis, poor healthcare policies and on the part of the government, the staffing of key health positions and the failure to have policies and procedures to have those running health institutions accountable. What we have in the health system is an endemic failure to follow good corporate governance principles for us as a country to achieve vision 2030 and SDGs.
The failure by patients, members of the public to take active interest and oversight role in public healthcare matters has reduced the struggle for the improvement of the healthcare system in the hands of the health workers. Yet the patients and the members of the public are the ones who suffer most because of a failed health system. Currently, many lives are lost due to system failure than the disease itself, which sometimes could have been prevented if there was even a minimal intervention.
Yearly we continue to see a rise in maternal mortality something which could have been prevented if there was a well functional public healthcare system. At the least, Zimbabweans must understand that a well-functioning public health care system will drive away unjustifiable healthcare billing in the private sector.
As we stand, globally, Zimbabwe is among some of the countries where the costs of major medical surgical interventions are astronomically high to an extent that it is cheaper to book a return ticket to a country like India, pay for a hotel stay and get treatment there instead of getting it in Zimbabwe. It is not that Zimbabwe does not have the specialists, they are there, and our medical schools continue to produce some of the brightest minds in the medical field. One of the brightest eye surgeons in Africa is our own Dr. Guramatunhu, and we have internationally acclaimed achievers such as Professor C. Chetsanga in our history books, so why is it so expensive to get proper medical treatment in Zimbabwe?
Here I delve into some grassroots level factors that are contributing to the comatose public health care system.
- Are the current healthcare leaders (CEOs/Cinical Directors) the right candidates to improve the public health system of Zimbabwe or stewards of the public health system?
- Does Health Service Board (HSB) currently have any policy to ensure that there is full commitment put by these cadres towards public institutes or is HSB the conduit to the collapsing system?
Unwarranted remunerations sanitized as ‘benefits’
Have you ever wondered why clinical directors and heads of public healthcare institutions always give statements alluding to the fact that the situation at health institutions is normal or services are being rendered in times of healthcare worker industrial action? Is it because they are out of touch and they don’t know the extent of the devastation or they choose to ignore or it’s a case of intentionally misleading the communities they cater for, or maybe they are singing for their supper? Have you ever wondered why these individuals stick to ‘poorly remunerated’ posts? Are there covert benefits?
The truth is that some of the big wigs in health ministries and health boards are beneficiaries of unwarranted remunerations that they try and sanitize as ‘benefits.’ In addition, some of the people who run most of the public hospitals are fully aware of the going on but have conflicting interests of either committing to public service or profitably running their parallel private practices.
Conflict of interest
How is it possible to serve two masters at once? That is, concurrently run a private healthcare facility and a public one? Why has HSB allowed this? Do we have medical cartels which are benefiting from the collapsing public healthcare system? It is public knowledge that some of the public health institutions, if not most, are run by doctors who also own private healthcare practices. A collapsing public health care system creates clients for their private enterprises. As such it is not in their interest to have a functional public health system in Zimbabwe. They spend (Stealing labour hours from government) most of their working hours at their private practices and locums.
It is a public secret in Zimbabwe that more often than not some doctors and specialists who operate in public health facilities refer or inform patients to be consulted in their private practice or that certain procedures can only be performed on patients in their capacity as a private practitioners. Desperate folk end up selling almost all they own and have to borrow in oder to pay for the procedures, or die in their quest for health.
Rewards for ‘zero’ performance
The Zimbabwe public health system is a system that rewards most hospital managers and leadership for almost zero performance. They are rewarded for a lot of ‘empty’ press statements and public appearances with nothing to show on the side of improving the actual healthcare system in the country.
Members of the HSB and other senior health officials are rewarded with latest, state of the art vehicles and other pecks while, clinics and hospitals are littered with antiquated and dysfunctional CT Scans, MRIs, and X-ray equipment, among others. Hospital pharmacies are poorly stocked and health professional operate without even basic Personal Protective Equipment (PPE) such as surgical gloves and masks?
How is it that multimillion USD hospital equipment in government facilities is declared to be dysfunctional with no follow up investigations, or accountability and the next thing you hear are private health institutions with similar equipment and charging exorbitant prices for their services.
Why do we have leaders that are being paid to innovate the health care system in Zimbabwe while the healthcare education system has been stagnant for over two decades. Is it not worrying the curriculum taught in some nursing modules is from textbooks or content from the 80s, 90s, early 2000s, yet the nursing profession has drastically modernised and digitalised? Trainers and healthcare leaders are being rewarded for stifling skills growth. Do we have a public healthcare system which does not allow growth in skills or adaptation of evolving evidence-based practices because it renders its leaders and their practices obsolete?
We have so many excellent Zimbabwean healthcare professionals doing amazingly well in other countries and are leaders in their specialities, but you hardly hear anyone asking for their expertise unless there is a huge chunk of funding attached. Are the current leaders creating an environment which allows growth and innovation in the public sector or it remains a case of entitlement or ‘no one should do it better’ than them?
To sum up
Some health institutions are run like tuckshops and village bottle stores with little or no transparency or accountability. There should be room for inquests into some patient deaths and malpractice, malfunctioning and defunct equipment. This way, individuals who have capitalised on the collapse of the public healthcare can be held accountable. Who truly benefits from a collapsed public health system? Are healthcare workers really united in the fight for a better public healthcare system?