A perennial problem for many developing countries is how to retain highly-trained medical staff within the public sector without breaking the national budget, thus causing an economic collapse, or without having to ration medical services by ability to pay by allowing the private health sector to dominate.
Zimbabwe faces this problem. A lot of effort and money is spent on training doctors, nurses and other health professionals and the numbers that go through university and nursing schools is more than adequate to meet national requirements.
But then two problems arise. The first is the strong flow from the public sector into private practice and private health facilities. These are continually expanding, with the expansion driven in a large part, at least in the past, by a decline in the public sector. In many ways that flow of skilled professional staff accelerated the public sector decline.
Private hospitals and clinics could pay better, and could ensure that their staff had access to the necessary equipment, medications and medical supplies
Normally such a flow would be limited, as even when fees are charged the amount a patient or a patient's family has to find in the public sector is a small fraction of what purely private professionals, hospitals and health centres will charge. But families, faced with serious illness, will find the money, even if they have to borrow.
But generally the top 10 percent of the population in terms of family income use a substantial percentage of available health resources. Yet the other 90 percent, who cannot afford the private sector, are not measurably healthier.
The second problem, and this accelerated in the economic meltdown in the days of hyperinflation, is the emigration drift. Zimbabwean training is considered excellent and the professional certifying bodies are considered very good gatekeepers in setting international standards. Zimbabwean doctors and nurses are seen as desirable immigrants into countries with money but a shortage of professional health staff.
Even in the growing international anti-immigrant cultures, medical professionals can find openings denied to many others, although they might well have to spend some years at the beginning filling posts that local people are reluctant to fill. But emigration has been an option and is still an option, especially for younger professionals who can go through the mill of working in areas that are considered less desirable for a few years.
Some serious work has been done in the Second Republic on fixing the public health sector. Within the last two years a lot of hospitals have had at least the worst of neglected maintenance work done and in the general drive for improvement the shortages of equipment and drugs has been seriously addressed. This is continuous of course, and the budget has to cope with catching up as well as the routine maintenance that still needs to take place. But the work is now being done.
A lot of bad staff relations are now being fixed. The near continuous labour disputes have been tackled, partly through the general progress being made by the Government for the whole State sector as part of economic and budgetary reform. Progress is obviously not as fast as staff would desire but at least there is a plus sign on the directions.
One important aspect comes with economic growth. In the end, pushing Zimbabwe into a middle income economy will automatically ensure that the level of tax gathered will, with the health budget taking the same percentage, be enough to equip the public hospitals and clinics and pay the staff properly.
But part of that growth is dependent on having a fully functioning public health system in place now. It is not something that can be neglected and added later when there is enough money.
The Government has been tackling this problem since it came into office, and the advent of Covid-19 helped to accelerate the progress as well as exposing gaps that needed urgent ad hoc action. One of these major gaps was the discovery that the urban local authorities in general, and those in Chitungwiza and Harare in particular, had as part of their general poor administration been skimping seriously on health.
Government has decided to take over the municipal health staff, to ensure that they are at least paid, paid on time and that the hundreds of vacancies that have arisen are filled so that the basic clinic system can function. When some remote rural district council manages its basic primary health system better than Harare we know there are troubles.
Now the Cabinet wants to go further and this week started looking at how to convert the rhetoric on perks into action. Basically the idea is to start capitalising some of the staff requirements. Already a fair number of professionals have access to inexpensive State housing, with rural health centres totally reliant on providing this if they want even a nurse. It is not new but obviously the State housing schemes now in progress have to include a significant element for health staff.
This must include both institutional houses and flats near hospitals and health centres for those assigned to these and a way of helping staff buy or build their own homes.
Getting transport sorted out seems essential. Many medical professionals work shifts and relying on public transport does not seem possible, let alone ideal. Again the Government has been allocating a decent share of the new buses and other public transport services to the health sector and now want to do more.
Car loan schemes have been on the books in the past with the general intent damaged by inflation and other economic problems now being sorted out. Ideally there should be a block of capital that health staff can tap into to buy their private vehicles with the repayments being used to lend to the next batch of applicants. Lowish inflation seems essential for this work, again linking the system to economic reforms.
But the general concept could be extended, the Cabinet believes. It seems that with this desire, coupled with the significant improvements in labour relations, some detailed and creative discussions should be possible that tie together the budgets available with the priorities that staff have. Again the important point is continual improvement since sudden jumps are difficult.