Docbeecee Friday Healthwatch
By Dr Brighton Chireka
We all have expectations when we visit a health facility. Most health facilities or systems have a mission statement or a pledge to the users of its services. In most cases what people expect and what they find in reality is not the same. This article is going to look at what we expect or imagine our health system in Zimbabwe to be and the reality of what we experience.
I have had a detailed look at our national health strategy and the quality policy. These two documents clearly articulate the type of health system that we should have in Zimbabwe.
Our health strategy clearly stipulates that there must be quality in our health services and no one should be left out. This national health strategy has been in place from 2016 and will end in 2020. The midterm review of the strategy was carried out this year.
When we talk of quality assessment in health systems a handful of frameworks have been developed but one of the most influential is the framework by the Institute of Medicine (IOM) which has six aims . These six aims are safe, effective , patient centred, timely , efficient and equitable.
Our national health strategy and the quality policy put these six aims as what we should imagine our health system to be able to deliver . This article will look at what is imagined by these aims and what is happening in reality.
Our health system should be safe.
The care that is intended to help patients should not harm them. If one goes to a hospital they expect to be cured and come out better, not dead. The maternal and infant mortality rates are still unacceptably high. I was pained when I saw a video of a man narrating how his wife had died at Mbuya Nehanda Hospital. He had a lot of questions that he was asking but no one could answer him. Post mortem showed that his wife had ruptured uterus and bled to death.
It seems this was not picked up due to lack of close monitoring of his wife. He had no kind words for the staff at Parirenyatwa and ended up calling them “satanists”. I can understand his anger but are the staff to blame for this? I do not condone negligence by our health workers but we must look at the context of our health system.
Evidence shows that we have a high rate of pregnant women who are being attended to by skilled health professionals. Why then are we having high death rate of our pregnant women ?
Our health system should be patient centred.
According to the IOM (Institute of Medicine) patient-centered care is defined as providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions. The attitude of some of our health workers staff is not good. Staff attitude cannot be divorced from staff welfare. Here we have demoralised health workers who are working under stressful conditions.
Most of these nurses are struggling to make ends meet. The few fortunate ones go to private hospitals to work to supplement their meagre salaries they are getting from government. Sadly we cannot expect much from them as they will be tired. Even if they want to work hard they get frustrated when they run out of basic equipment to use .
If you run out of gloves and basic fluids to give to dying patients then you lose the compassion to help people . To make matters worse that person being asked to look after another’s welfare , have they had a balanced meal, can they afford to go back home tomorrow , when they get home do they rest after a night shift ?
Our health system should be efficient.
Our health system should avoid waste, including waste of equipment, supplies, ideas, and energy. The 2010 World Health Organisation report estimated that wastage in health systems is between 20 and 40%. In Zimbabwe, we waste ideas by having policies from our intellects accumulating dust in Kaguvi building without implementing them.
We cannot even mention the cost of engaging these professionals to come up with these policy documents. What do we benefit if we have a good policy document that is accumulating dust . One person told me that Kaguvi building is like an abandoned library because of its many policies that are not implemented.
Drugs are expiring before being used and on the other hand we have shortages of certain drugs. There is over-reliance on high margin profit making drugs and less use of generic medicines . It does not need an economics degree to see that it is not good value for money to pay $60 per month for a drug that you can get as a generic at $5 per month. This shows that our drug procurement system is not efficient.
Our health system should offer a timely service
The health system should reduce waits and sometimes harmful delays . We have a number of people who are dying of cancer due to delays in treatment and also delays in them seeking treatment . Patients are sent home because we do not have theatre time or the equipment to carry out certain procedures. These delays are causing needless loss of lives.
Our health system must be effective
Our health system should provide services based on scientific knowledge to all who can benefit from it and refrain from providing services to those not likely to benefit. As a health system , we do not have home grown guidelines on managing most of the non communicable diseases such as diabetes . To make matters worse we have not even adopted guidelines from other countries. As a country we do not have a policy/strategy on non communicable diseases or drug and substance misuse to just mention a few.
Our health system should offer an equitable service
The health system should provide care that does not vary in quality because of personal characteristics such as gender , ethnicity, geographic location , political party affiliation or socioeconomic status . No one should be left behind or be segregated. My heart bleeds when reality dawns on us . A few days ago we lost a healthy young man in police custody.
I have witnessed the pain and suffering of families still looking for answers, who have encountered not compassion and redress from the authorities, but what they feel as evasiveness and obstruction. Prisoners have a right to healthcare and are allowed to choose a doctor of their choice but this right is denied to certain people in Zimbabwe.
We have top government officials being airlifted to far countries for treatment even if it is terminal illness or when the local facilities can manage their ailments. This allocation of public funds shows that “ all animals are equal but others are more equal than others “
It is sadly my conclusion that the gap is too wide between what a health system should offer and the reality in our country. What makes it more sad is that we have the skilled health professionals and the resources to deliver a quality health system for everyone. It is my humble appeal to our current leaders to reflect on their actions and inactions and stop what they are doing and start to sort out our problems.
How can we close the gap of what we expect our health system to do and what is happening in reality ?
Here are my ten points.
First we need to cut down on the Presidential trips and cut down on his entourage. A two week foreign trip in a private jet is estimated to cost US$125 million . We must not forget that budget allocated to the Ministry of health in 2019 was US$755 million.
So the president is using money equivalent to 17% ‘of the health budget on a 2 week trip that is not benefiting the country. I will leave you to guess the number of foreign trips he has made so far this year. I will not be surprised that the president has used more money than what was allocated to the Ministry of health.
Second we must stop the Medical tourism by our leaders at the expense of the public funds. Divert those funds to the renovation of our tertiary hospitals. At the moment we have the Vice President getting treatment in China for the last 4 months. One would have hoped that he would have returned to Zimbabwe for nursing and rehabilitation care. How much money is being used to finance the treatment of the Vice President?
Third we must introduce health tax on tobacco and alcohol as well as sugar . We also must use all the AIDS levy and the airtime tax efficiently on our health system.
Fourth we must introduce a national health insurance to pool resources so that we do not punish the poor by asking them to pay exorbitant hospital fees.
Fifth we need to stop wastage in our hospitals – no inappropriate investigations or operations .
Six we must stop the use of brandy drugs and stick to the use of generics in all our health system
Seven we must stop the corruption in the procurement of the drugs and hospital equipment . Government must buy directly and stop the middle men who are inflating prices ridiculously.
Eight We must improve the welfare of our health workers and their attitude
Nine We must train our health workers in good customer care and quality improvement and implementation of those policies accumulating dust at Kaguvi. Here professionals in the diaspora can help by sharing their experiences from different healthcare systems.
Ten We must focus on healthcare and not sickcare by promoting health prevention and empowering members of the public to take ownership of their health.
This article is not exhaustive of what needs to be done so feel free to make your suggestions and engage in the discussions . As always when it comes to health issues Iwe neni tine basa .
Asante Sana .