23 January 2013

Zimbabwe: Public Hospitals in Dire Straits

PLANS by government to establish management working boards at all provincial and district hospitals have been put on ice due to lack of funding.

The plan had been mooted after the successful establishment of such boards at all central hospitals since 2005 in accordance with the Health Services Act to enhance accountability in the handling of health funds and improve the health delivery system, said to be in the intensive care.

Health and Child Welfare Minister Henry Madzorera said nothing looks likely to materialise this month as had been expected.

"I do not see the plan materialising this month as planned and cannot say when it will happen," he said.

Five major referral hospitals in the country have management boards. These are the United Bulawayo Hospitals and Mpilo Central in Bula-wayo, Parirenyatwa and Harare Central in the capital and Chitungwiza Hospital.

A seven-member management board is expected for Gweru provincial hospital.

The rest are still to have management boards.

Madzorera blamed financial constraints as having contributed to the delay although critics point to mismanagement, a shortage of health professionals and deteriorating infrastructure.

Current funding from government is far below what the hospitals require.

Government spending on health care takes up less than half of total health expenditure even though the public health delivery system serves more than 65 percent of the population.

Four years after Zimbabwe's economy was dollarised, most of the country's public hospitals still do not inspire confidence.

On the outside, the hospitals are characterised by shabby exteriors, dotted with broken windows and leaking pipes.

The wards themselves are no better, epitomising the decline of what was once a top-notch health delivery system.

The beds in the country's main referral hospitals are also not comfortable for the sick; the wards are over-crowed; medical equipment and vehicles often in a state of disrepair and the food is not appetising.

Some of the major hospitals have inadequate water, sanitation and waste disposal facilities and are therefore hazardous to health workers and patients.

There are also concerns regarding the pricing of drugs and specialist/general doctors' consultation fees as well as hospital and maternity fees at city health clinics.

Government has been mulling regulating maternity fees but nothing has come out of this.

Most hospitals have underdeveloped information systems and research activities are erratic.

"A report has since been compiled on how best hospitals could be turned around," said an official at Harare Hospital who declined to be named for professional reasons.

"I have seen many instances of patients in the public health delivery system dying when hospitals cannot keep them longer. If you have money, you might live," he said.

Most doctors, especially specialist surgeons work in the private sector, with a few serving the public sector.

Private hospitals are still in a better state although they are beyond the reach of many.

Jessie Majome, the Deputy Minister of Woman's Affairs, Gender and Community Development, said failure by central and local government health institutions to guarantee access to maternal healthcare was tragic.

"With the absence of free maternal healthcare for those who need it, Zimbabwe seems poised to remain with the dubious distinction of having the third highest maternal mortality rates on the continent," she said.

Majome said a comprehensive and sustainable effort was required to ensure local authorities and other institutions were resourced to be able to provide such services.

"It is also time to attend more vigorously to the other causes of high maternal mortality, such as skilled birth attendant availability and medical equipment and facilities. The other big question we should pose and answer as a nation, given the difficulty of financing free maternal care is -- where are the men involved in those pregnancies?" she asked.

"Any correctly functioning society should not leave women, who have generally less money than men, literally holding the baby when the men responsible are allowed to sneak out of the picture completely. Let us bring men into this conversation -- they must stand up and be counted and not leave women to die giving birth to their babies," Majome said.

Madzorera said while the perception is that public hospitals do not inspire confidence, his ministry was working hard to improve the situation.

While admitting that it will take long for the hospitals to recover to levels they were 10 years ago, he said government would do everything possible to refurbish every hospital.

"We already have a blue print on what needs to be done to revive our health system. I can promise you that as more funds become available this will continue changing for the better," he said.

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