14 May 2014

Zimbabwe: Hospitals - Bridging the Service Gap


Government hospitals are underfunded, overused, under-equipped, under-staffed and cheated by some the people whose lives they save.

Yet, with a few modest changes in policy and a little bit of money from the Treasury or aid donors, quite a lot could be done.For a start, the freeze on recruitment of health professionals and the essential support and administrative staff must be lifted.

The Health and Child Care Ministry cannot be treated the same as many other Government departments.

The staff establishment is inadequate for the present population, and not filling all posts simply makes an inadequate service very bad.

Secondly, as minister Dr David Parirenyatwa has noted, the big referral hospitals should not, and cannot, do everything.

When Harare and Parirenyatwa hospitals were built, the population of Harare was 10 to 20 percent of present levels.

The growth in private medical facilities has absorbed some of the increase in population, but the State hospitals are still having to cope with at least three times as many people as they were designed for.

So Dr Parirenyatwa wants to see as many medical functions as possible moved to clinics.

Here he is on solid ground. The private sector has long used pricing and ease of access to move many functions traditionally done in hospitals to doctors rooms and the 24-hour emergency rooms.

In the developed world, minor operations, treatment of most wounds and much of the diagnostic work are not done in hospitals, but in private clinics, and done at less than half the price they would cost in a major hospital with all the trimmings.

In fact this vital step, missing in much of the State system locally, is what makes private care affordable for so many.

So with a little extra money, from the Harare City Council and from the Treasury, many of the more modern suburban clinics could be upgraded and could be given a resident doctor.

Most people would still see the nurses, but having a doctor in the background and having more equipment would bridge that required step between clinic and major hospital.

We also need a cultural change.

Those with nothing need free health, but most of us have something, so we should pay something.

Harare's State hospitals are owed US$50 million by patients who don't or can't honour their debts.

Perhaps we need more subsidies for the very poor, but clearly some people who could pay at least part of their bill are not paying.

Dr Parirenyatwa's decentralisation plans and upgraded clinics would also help make care more affordable.

Faced with a bill of US$100 many might despair and never pay; faced with one of US$25 they might start planning how they would pay.

The fact that some people pay bribes, or least say that they do, suggests first that some using State facilities should be in the private sector instead of clogging the wards at Parirenyatwa.

Secondly it suggests that people are prepared to pay for better services. We need to build on that.

Those running the State health sector have been remarkably candid. They need extra money, but not as much as laymen might imagine.

They want to make better use of money, by upgrading intermediate facilities to take the burden off the hospitals. And they need adequate staff, in a country which is exporting doctors and nurses.

The solutions are not difficult to define, and all seem possible. Let us start working out how we will at least ameliorate the mess.


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