Under the Second Republic a great deal of effort has been made to upgrade and expand public-sector health facilities and ensure that all Zimbabweans can access, as a practical right, adequate health treatment.
So we have seen more clinics and intermediate facilities built and opened, often by local authorities committing central Government devolution funds to add to the efforts being made by local communities. Government hospitals have seen renovations and new equipment and major efforts have been made to ensure that public-sector hospitals and clinics have access to the consumables and medicines they need.
This upgrade was already in progress when Covid-19 struck the country, but that pandemic concentrated attention and saw the acceleration of the public-sector revamp, often with private companies and others willing to help out with some of the capital equipment. The result is that Zimbabwe now does have a properly functioning public-sector health system, which is undergoing continual improvement.
This is allowing, in turn, an ability to meet some of the health rights listed in our Constitution, rights that were perhaps more theoretical than practical until the work that has now been done, and is continuing to be done.
So the time has come to amend the Medical Services Act, the legislation that outlines the health services system in Zimbabwe.
This is the Act that, as it states in its long title, ensures the provision and maintenance of comprehensive hospital services in Zimbabwe; provides for admissions to Government hospitals and the fixing of fees; provides for consultants and access of other non-Government medical staff; outlines what medical aid societies have to do to be registered and maintain registration; and sets the conditions for the registration of private hospitals. In other words, it outlines the hospital system, with detailed regulations backing it up where necessary.
The amendment Bill gazetted last week and shortly to come before Parliament and go through the normal process of committee analysis and debate in the National Assembly and Senate, now wants to expand the original legislation to start taking in the Constitutional rights and the sort of special attention to vulnerable groups that the Constitution lays out.
Some of the amendments are minor, reflecting changes in how medical services are organised, or tie the law closer to the Constitution. For example, a section that carefully bans discrimination in admission to a private hospital on a long list, now simply states that discrimination banned in the Constitution, where there are lists, is also banned in health services.
The Government has sensibly divided the Constitutional provisions into two groups, those that can right now be set out explicitly in statute law, in the sort of final form that lasts, and those that are still work in progress where the approach has been to give the Health Minister authority to make regulations that can be continually upgraded and improved.
Among the changes that the Government wants to lock in are legal rights of patients and children. Patients will, when the amendment becomes law, have to be legally treated as sensible rational adults who have a complete right to know their medical condition, the diagnosis and prognosis, and be consulted over treatment and treatment options.
If they might wish to refuse treatment, that will be allowed, although the medical staff have the duty to explain what that could mean. If experimental treatment is likely to be the best, and this can happen since in some cases the cutting edge of medicine is the best hope for the patient, this must again be explained, and the patient's informed consent obtained.
But there are also hierarchies of rights. A parent or guardian will explicitly under the proposed legal changes lose any right to refuse treatment for a minor child. This has been a grey area, that can involve legal action, but the proposed change makes it clear that a child's rights trumps the parental rights, and the Constitution did upgrade children's rights.
One area where treatment will have to be given is for life-threatening emergencies, which are carefully defined. We are basically talking about serious injuries from an accident, or something like a person collapsing in the street from a heart attack. Basically a hospital has to take such a patient and save the life while paperwork or other procedures are sorted out. Sometimes treatment is time-urgent.
Sign up for free AllAfrica Newsletters
Get the latest in African news delivered straight to your inbox
While the amendment lists those who can give permission for treatment to an unconscious person, mainly relatives with again an order established so some relatives can overrule others, a hospital faced with a badly smashed-up but unknown and unconscious accident victim must save the life first and then follow permission procedures. Emergency life-saving treatment in serious circumstances will become an absolute right. Enough resources are available now for this right.
The Constitution lays down a lot of other medical rights, such as the special attention needed for the elderly, the disabled, war veterans and others. Here the Government has been making efforts, but these are usually steps towards what is seen as ideal once more resources are in place. So here the amendment sensibly proposes allowing the Health Minister to make regulations on these issues.
Statutory instruments can be easily amended so this method allows continual upgrading of the stated services, as resources, equipment and staffing make that possible. This fits in with the Second Republic's policy of continually making all services better, including hospital services, building our future one brick at a time.
