Govt hospitals face collapse

By Andrew Kunambura

Major referral hospitals across the country are on the brink of collapse owing to rising debts, outdated equipment, poor funding and maladministration, among other pressing issues conspiring to put the lives of ordinary Zimbabweans at risk.

Investigations by the Financial Gazette have revealed that government is racing against time to avert the total collapse of public hospitals, which cater for the majority of Zimbabwe’s 13 million people.

Fears among health experts are that, at the rate the situation is deteriorating, the country’s public hospitals could be rendered impotent and unable to attend to even minor ailments. This would force patients, including the majority poor, to flock to pricey private hospitals whose charges are beyond the reach of many.

As it is, complex surgeries are being referred to private hospitals and abroad, where not many people can afford. What has triggered the desperate situation at public health institutions is lack of reasonable funding from Treasury over many years now.

The Ministry of Health and Child Care, along with other stakeholders in the health sector, has bemoaned government’s failure to fulfill the Abuja declaration which mandates governments to allocate at least 15 percent of the annual budgets to healthcare.

In April 2001, African Union countries meeting in Abuja, Nigeria, pledged to increase government funding for health to at least 15 percent of their annual budgets but, instead, government has significantly cut spending on healthcare over the past few years.

In the 2015 National Budget, the Ministry of Health and Child Care was allocated US$301 million which translates to a paltry 6,3 percent of the country’s National Budget of US$4,1 billion. This was a 2,2 percent decline from the 2014 allocation, which was US$337 million.

The highest allocation to the health ministry so far during the past three years was 9,87 percent in the 2013 National Budget. The allocation, however, fell short of the 15 percent Abuja threshold.

Government has previously depended heavily on international donor funding to keep the sector in good health but international support has since dried up.

With donors turning switching off their taps, government is now struggling to boost staff morale which has been dampened by to poor remuneration and working conditions. Similarly, it has been difficult for it to equip the hospitals and replenish stocks of drugs.

A series of strikes involving doctors, nurses and supporting staff, leading to unnecessary deaths, bears testimony to the crisis gripping the sector, which has not been spared by incessant power cuts and water shortages.

Parirenyatwa Group of Hospitals, the country’s largest referral medical centre, tops the list of State hospitals that are in serious crisis, with its clinical and financial stability precarious due to spiralling operational costs and shortage of medicines.

Once the country’s beacon in medical excellence which used to offer heart surgery and advanced kidney treatment during its hay days, Parirenyatwa is chocking due to poor funding and the inflexibility on the part of government to approve cost-recovery prices for its services.

The hospital is also being weighed down by debts as the tenuous economic situation has impaired patients’ capacity to pay for the services they would have accessed. Parirenyatwa has since applied to write-off US$2 million in outstanding bills by patients as the institution totters on the brink.

In Zimbabwe’s second city of Bulawayo, the United Bulawayo Hospital (UBH), which is the principal referral centre for the entire Matabeleland region, is in such a dire state that it may soon be unable to function unless immediate corrective measures are taken to save the institution. The same situation applies to Inguthseni, a mental health care institution also in Bulawayo.

The dire situation at the country’s major hospitals in Harare and Bulawayo is a mere prelude to the desperation at provincial, district and mission hospitals were drug, equipment and personnel challenges can only be worse.

Comptroller and Auditor-General, Mildred Chiri, has written a damning indictment of the country’s state public health system, and describes how, due a combination of ineptitude, corruption and neglect, these State hospitals have been brought close to collapse.

The recently released audit report for 2014, which has been tabled in Parliament by Finance and Economic Development Minister, Patrick Chinamasa, warns of a total collapse of Zimbabwe’s health care system.

“I draw your attention to these issues that describe circumstances that are casting significant doubt on the ability of the (Parirenyatwa) hospital as a going concern,” wrote Chiri as she raised issues to do with misstated financial statements for Parirenyatwa Group of Hospitals which has highly compromised the institution’s incoherent inventory system.

“The inventory management system did not generate drug expiry and aged analysis reports. The generation of expiry reports would help the hospital to monitor the expiry of drugs and slow moving items more effectively and in order to come up with correct valuation of inventory. This means expired drugs may be dispensed to patients,” said Chiri in her 220-page report that cuts across all State departments.

The government audit report also “cast significant doubt over the ability of Bulawayo’s UBH to continue as a going concern). The hospital, which provides highly specialised health care, is on the verge of collapse, with its operating net deficit having ballooned to US$5,5 million. Its current liabilities exceed its assets by almost US$1 million.

Chiri’s audit unearthed a myriad of malpractices that could have helped prejudice the critical health care institution of thousands of dollars. Chiri said UBH’s financial statements do not present a fair fiscal position of the institution; its financial performance and cash inflows fell far short of internationally accepted financial reporting standards.

Raising concerns over the functionality of the institution’s property, plant and equipment in the absence of a valid valuation analysis, the report raises fears that most of UBH’s medical equipment could be outdated or outlived its lifespan.

“I noted that the surgical stores department did not perform periodic physical inventory counts. The risk is that fraud and error within the inventory cycle will be undetected while theoretical inventory levels could be misstated as they are not reconciled to the physical inventory,” she said in the report.

UBH is also operating without an audit committee, thereby falling foul of the Public Finances Act (section 84). The committee would ensure protection of assets by exercising utmost care.

The audit also found out that UBH had flouted tendering regulations by breaching the US$10 000 informal tender threshold for the provision of the same goods and services that cumulatively exceed threshold, creating a high risk of fraud within the procurement cycle.

In this case, tenders can be intentionally set below the informal tender threshold or awarded to unsuitable suppliers leading to financial losses. Chiri predicted the collapse of Ingutsheni, whose net operating deficit has hit US$1,5 million while its current liabilities exceeded its assets by US$700 000.

The institution was not audited in 2012 and 2013 and no asset inventory was done for the same period, further raising fraud and pilferage fears. It is also operating without an audit committee against the legal provisions.

To make matters worse government has hardly managed to implement any of the recommendations that the Comptroller and Auditor-General’s office over the years. Health and Child Care Minister, David Parirenyatwa, said government has no money to bail out the hospitals at the moment.

“Hospitals like Ingutsheni and Ngomahuru are special hospitals that do not generate money from patients. The patients are treated for free and therefore they need funding. As a ministry, we need to get those hospitals funded but you know the situation in the country now. There is no money,” he said when contacted via telephone this week.

The minister, who survived President Robert Mugabe’s Monday Cabinet reshuffle, however skirted questions on Chiri’s report on the situation obtaining at Parirenyatwa and UBH saying, “Let’s write things that help the nation. I cannot answer those questions now, come and see me later”.

The public health system is the largest provider of health-care services in Zimbabwe, complemented by mission hospitals and health care delivered by non-governmental organizations.

In recent years, economic decline and political instability have led to a reduction in health-care budgets, affecting provision at all levels.

In the past five years, the country’s poorest have suffered the most, with a 40 percent drop in health-care coverage.

Zimbabweans continue to experience a heavy burden of disease dominated by preventable diseases such as HIV infection and Aids, malaria, tuberculosis and other vaccine-preventable diseases, diarrhoeal diseases and health issues affecting pregnant women and neonates.

Every year, one in every 11 children in Zimbabwe dies before his or her fifth birthday. In other words, 35 500 Zimbabwean children under the age of five die every year. Financial Gazette