Farai Muchemwa: A public health specialist’s perspective on Mnangagwa’s 100 days

By Farai Muchemwa

The fall of Mugabe was welcomed with a lot of celebration and an expectation of better things to come despite an uncertain political future. His replacement by his long-time lieutenant Emmerson Mnangagwa brought a glimmer of hope of improvements in public health delivery.

The president gave his minsters a task to set targets to achieve within 100 days which were supposed to shake up the delivery of government services. The First Lady went on a whirlwind tour of public health institutions, orphanages and prisons, giving the impression that a new era had indeed dawned, one in which the sick, the disadvantaged and vulnerable had finally found an ally who has the ear of the man who occupies the highest office in the land. Any scepticism of what this new dispensation stood for regarding public health care was surely washed away, right?

Not so. The announcement of what Zimbabweans call a deadwood recycled cabinet was a betrayal of people’s hopes and aspirations and brought great disappointment. The ineffectual David Parirenyatwa was retained as Minister of Health.

There is something special and unique about Dr Parirenyatwa. The country’s flagship hospital, Parirenyatwa, formerly Andrew Flaming Hospital, is named after the minister’s father, Dr Samuel Tichafa Parirenyatwa. Dr Samuel Parirenyatwa was the country’s first medical doctor and a prominent nationalist. He was an illustrious medical practitioner and an icon of Zimbabwe’s liberation. It is a deserving honour for him to be named after the country’s premier teaching hospital. In its heyday, in the Rhodesian era, Andrew Flaming was a prestigious hospital.

Granted the government has a responsibility to look after all its public health institutions, and all ministers should work hard in their various ministries. It is however unthinkable that the son of such a great doctor, the first black physician in the country and a champion of African rights would preside over the rot and decay of a hospital bearing his family name, named after his own father…. No more needs to be said. Suffice to say David Parirenyatwa’s failure as a minister is in a class of its own.

If the choice of minister of health fell short of expectation, the budget left little doubt that President  Mnangagwa’s government was not serious about improving the country’s health service. The ministry asked for a little over a billion dollars for its annual budget but got about 40%. This was far below the 15% of annual government expenditure agreed by African governments in Abuja in 2000.

To show what is the Mngangagwa administration’s top priority, the military was given a billion dollars.

The government was presented with another opportunity to show its commitment to the nation’s heath when a cholera outbreak hit Chegutu within two months of President Mnangangwa’s inauguration. Four people succumbed to the disease. There were 65 suspected cases. The Minister of Health explained that cholera was caused by raw sewage contaminating drinking water due to broken pipes.

The government did not show any urgency in dealing with this matter or outline and implement a programme to replace broken pipes and purify urban water to ensure that no Zimbabwean ever dies of a disease Dr Parirenyatwa said is of the dark ages. Ensuring clean, safe, sewage free water and proper sewage disposal are basic functions of a government. The government is duty bound and has a constitutional obligation to deliver these services to all citizens.

While government incompetence and neglect led to cholera deaths, the ministry of health was showing its callous disregard for the health and safety of its own workers. A ministry of health lorry packed with workers was involved in an accident, resulting in tens of deaths. Given the state of the country’s roads and lack of basic passenger safety features in a lorry, it is unbelievable that someone at the ministry had authorised its use to transport health workers.

When news of the accident hit the headlines, instead of apologising unreservedly, Dr Parirenyatwa blamed a drunk and speeding driver. This was irresponsible and insensitive.

The person responsible for authorising the use of the lorry should have been relieved of his job, or, at the very least, demoted. A public enquiry should have been undertaken to establish why a lorry was used to ferry workers and why a drunken driver was allowed at the wheel. A review of public sector personnel transport would have been done without delay to ensure that such incidences will not happen again.

The government should have gone further to look at how people are transported across the board. Are lorries really designed to ferry people? This was an opportunity for the administration to come up with clear guidelines for all to keep the population safe on the roads.

A broader enquiry and review of health and safety at work legislation and practices would have shown a government committed to departing from a culture of ‘business as usual.’   

Interestingly, while public health workers perished in an avoidable accident due to use of an unsuitable vehicle, chiefs received luxury SUVs priced at over $30 000 apiece. The cars were purchased during the tenure of former President Robert Mugabe, but it must be borne in mind that most of the members of the current cabinet were also members of Mugabe’s cabinet. They must bear some level of responsibility for the misplaced priorities of the Mugabe era.

Within 100 days of Mnangagwa’s presidency, two government ministers made decisions and pronouncements that showed that the government was a serious threat to public health, order and safety. While President Mnangagwa was at Davos telling the world that Zimbabwe ‘was open for business,’ Water and Environment Minister Oppah Muchinguri shocked the nation when she announced a ‘shoot to kill’ policy on poachers. This showed a serious disregard for life and was at odds with Mnangagwa’s reformist thrust. It demonstrated a lack of policy cohesion and defeated the purpose of Mnangagwa’s visit. He might as well have stayed at home.

As Muchinguri threatened to shoot suspected poachers on sight, Minister of Local Government July Moyo declared that he will use soldiers and police to remove vendors from Harare’s central business district.

The use of armed forces was uncalled for. Government created fear and despondency and mistrust and showed lack of careful planning and regard for human rights and public safety. They should have consulted widely and involved affected citizens to come up with practical and effective solutions that do not involve the use of threats of or actual force.

Within a short time after that July Moyo came up with another idea to restore Harare to its Sunshine City status. This time by barring mini-buses and kombis from entering the city centre. He used just the police, armed with real guns. The inevitable happened. The police shot and killed innocent people and injured many more.

Shamelessly, the new Commissioner of Police issued a statement saying that the police were defending themselves from violent members of the public. This was reckless and insensitive. He should have apologised and promised to bring the culprits to book. The policy of arming the police should have been revoked with a provision that special clearance would be required when confronting armed gangs.

Government decision- making and policy implementation need a complete overhaul. ZANU (PF) is still in war mode. They created the country’s problems and they have only one solution-force. Even as people are willing to let ‘bygones be bygones,’ how can they forget the past when for the government it is brutality as usual?

Police brutality targets the working age population, entrenching poverty. Breadwinners are killed or injured, leaving families helpless. Survivors live in chronic fear.

Dr Dixon Chibanda, a psychiatrist in Zimbabwe, wrote in the British Guardian about the mental health burden caused by chronic fear under a brutal regime. Due to poverty, repression and despair Zimbabwe has the highest suicide rate in southern Africa. It is ranked number 20 in the world. The ZANU (PF) government needs to shake off its tag of viciousness and begin to offer real solutions to the problems they presided over under Mugabe’s dictatorship.

Cleaning the city should have been done in phases using thoughtful and considerate approaches not by show of force. The rot took years. It cannot be undone in one day.

Arming the police is a licence to kill. It is as good as an order to hurt and maim law abiding citizens. It is not a decision that is made by local police commanders. It is done by politicians. Rightfully they should take the blame and fall when such incidences happen. Unfortunately for Zimbabwe, it is business as usual.

People injured by police could not get a doctor’s attention in public hospitals. At the time of writing public sector doctors were on strike demanding increased on-call allowances and better working conditions. They wanted to see an end to drug shortages and lack of equipment.

Junior doctors earn a paltry $329 a month. Their on-call allowances are pegged at $1.50 per hour. They want a rise of on-call allowance to $10.00 an hour. They had not received their allowances since November 2017.

Their demands are reasonable. Staff welfare is essential for an effective health care delivery system. It is surprising that just after the expiry of the 100-day target President Mnangagwa set for himself and his ministers, a doctors’ strike should cripple the public health care sector. One wonders what it is exactly President Mnangagwa expected Dr Parirenyatwa to achieve in that time if not to attend to the issues raised by striking doctors.

Apologists of the government might argue that lack of money is hindering health delivery. But, as the doctors pointed out, while government says there is no money for healthcare, there is a lot available for the president and government officials to travel. As the cholera outbreak raged and the doctors’ strike was going on, the president was flying around the region and beyond. He flew to all the southern African countries ostensibly to inform them of the developments in the country. I wonder if he mentioned the cholera outbreak or the doctor’s strike or police slayings of innocent civilians.

Ministers and other government officials are also doing their own share of travelling within and outside the country. Manicaland Provincial Minister Monica Mutsvangwa went to New York to attend a Women’s Solidarity Conference. Back home 3 000 women die during childbirth every year. They need solidarity and practical action to ensure that pregnancy and childbirth are safe. Mrs Mutsvangwa and other women in positions of power and influence could use their time and connections to raise money to complement the government’s poor efforts.

If the government cuts its travel budget and allocate money to health, the improvements that have so far eluded the sector will materialise. Given the parlous state of the health delivery system, government should ban all non-essential travel.

It is sad that while junior doctors earn poverty wages, the government is doing politics as usual as characterised Mugabe’s ruinous rein. During the time of the cholera outbreak, President Mnangagwa went about his business as if all was normal. He has adopted the same stance during the doctors’ strike. He uttered no comment and took no action to deal with the issues that are testing his leadership capabilities. Beyond that, he has shown a propensity to put politics above everything. He is rewarding politicians obscenely at the expense of the entire nation.

The outrageous pensions of former president Robert Mugabe and the late ex-prime minister Morgan Tsvangirai are a case in point and run into several hundred thousand dollars a year. Mugabe gets the same benefits as a sitting head of state in addition to four trips annually to Singapore for medical attention at state expense.

The benefits are said to be the highest in the whole southern African region. The government argues that these are provided for in the constitution. Yet the same government is not providing basic services for the rest of the population as guaranteed by the same constitution.

Health care is a human right and is guaranteed in the constitution, but government does not see it fit to make it available to all. The same constitution does not provide for provincial ministers, but Mnangagwa appointed ten of them. Money for their pay, office expenses and benefits should have been used to provide maternity services or give reasonable on-call allowances to junior doctors, for example.  

It is grossly unfair that the former president and late ex-prime minister got huge pensions in a country with unprecedented levels of poverty. Their benefits should be slashed to reflect the country’s economic crisis. These two gentlemen were co-authors of Zimbabwe’s misery of the past 30 or so years, for which they are rewarded with massive benefits, further impoverishing the country. Zimbabwe’s major health problems are due to poverty.

Mugabe’s disastrous economic policies and political decisions brought the country where it is today. He clung to power at all costs. His main rival, the late former prime minister Morgan Tsvangirai wanted the same power and was prepared to get it by whatever means necessary. Callously he invited and encouraged tough economic sanctions against the country. Even when sanctions made the poor and not the political elites suffer, he did not look back or review his policy or ask his Western handlers to do the same. Instead he urged ever tighter screws on the economy.

Doctors should not have to resort to downing their stethoscope to demand their well-earned allowances while politicians get massive pensions. The news that Mugabe was getting monthly cash payments of $13 000 is distressing. He deserves that amount in bond notes only.

Some have said the jury is still out on President Mnangagwa’s first 100 days. Regarding his handling of the public health sector so far, he has massively let the country down. Zimbabwe expects and deserves better.