Zimbabwe’s health system is still on crutches despite the best efforts of foreign donors, who have poured in millions of dollars to prop it up.
Now, activists are demanding that government devotes 15 percent of the budget to health care as envisioned in the so-called Abuja Declaration of 2001, which Zimbabwe signed but has totally ignored.
With a cholera outbreak that killed 4 000 in 2008-9 (the largest cholera death toll in the world for decades) having abated, the face of pain once so common on international TV screens has vanished.
Consequently, donor funding to the health sector has been dwindling steadily over the past year. An international appeal by the UNDP yielded very little. The statistics are daunting. According to the Unicef country representative, Peter Salama, 100 children are dying in the country daily. A 2009 survey shows a rise in infant and under five mortality rates to 67 per thousand and 94 per thousand respectively.
“That these deaths were mainly due to preventable diseases and illnesses such as HIV and AIDS, pneumonia, diarrhoea and measles, reflects the urgent need to improve the provision of health care,” Salama told The Zimbabwean.
AIDS is killing at least 2 000 a week, even as the country battles other chronic diseases such as tuberculosis, childbirth complications, heart and blood problems, which have always given health specialists nightmares.
Animal Farm luxury
Government’s commitment to financing the country’s crumbling health system has come under renewed scrutiny after leaders were found enjoying Animal Farm-type pleasures while the poor can not even afford pain killers.
Luxurygate, a scandal in which cabinet ministers and top officials were pampered with expensive vehicles, has blown into the open the avarice of public officials on both sides of the deeply divided inclusive government.
Other examples, including massive salary increases for Ministers, MPs, soldiers, war veterans and the CIO, have infuriated the public, which is continuously being asked to be patient with the slow pace of reforms.
“In the 1980s, Mugabe’s motorcade used to consist of Peugeot 504s. Today it is made up of luxury Mercedes. Can a poor country like Zimbabwe afford this waste while the people are dying because they cannot afford medicines?” said Webster Rufaro, an unemployed youth whose pregnant wife miscarried recently at Chitungwiza hospital. The unemployed graduate now faces a hospital bill of $500, more than a teacher’s salary.
Begging in Rolexes
Former US ambassador to Zimbabwe James McGee said last year that he was shocked by local politicians’ penchant for luxury vehicles, especially Mercedes Benzes. McGee warned that rich nations were really put off by Zimbabwe’s “beggars in Rolexes” and that made them averse to spending their taxes on a country represented by avaricious politicians.
Last week, Zimbabwe Lawyers for Human Rights released a shock report showing that less than 10 percent of the population has adequate access to private health care as they have to pay cash for it.
The lawyers say government must live up to the expectations of the people by devoting at least 15 percent of the national budget to health, according to guidelines set out in the Abuja Declaration.
“The call for more money for health is made against a history of neglect. When health services are mainly out of pocket, low-income families and communities will be hard hit as they are unable to access basic health care. Government should then come in to address the situation and deliver health care to its people,” says the report.
Budget consultations under way across the country are seen as just another waste of funds by the government as the findings are not expected to have much impact on Finance Minister Tendai Biti’s final presentation in November.
The budget is traditionally skewed in favour of the defence forces, the President’s expenses and government salaries at the expense of public health.
Quoted in the report, the Programme Manager of ZLHR HIV/AIDS, Human Rights and Law Project, Tinashe Mundawarara said ill health and inequality were closely related. He said while the government waffled about indigenisation and empowerment, those programmes would be a failure if they did not address the health care needs of “poor communities that continue to be ravaged by the burden of disease”.
Keeping us alive
“By empowering poor communities in health care we do not mean token gestures of building unresourced clinics by mining firms, we mean sustainable provision of health care that includes annual monetary provisions towards essential medicines, diagnostic equipment, human resources and support towards determinants of health like clean water and sanitation,” Mundawarara said.
Unicef’s Salama says women and children have borne the brunt of a shortage of drugs and facilities that has dogged Zimbabwe since the economy went into a tailspin in 2007. He said for Zimbabwe to stay on the path to full recovery of the health sector, it was essential to ensure “that the poor and vulnerable members of society also have access to quality health services”.
While Mugabe rubbishes the West and clings to China for military support, it is the countries that he often rails against that are keeping Zimbabweans alive through their generous donations. Since the inception of the Essential Medicines Support Programme in 2008, the European Union, which Mugabe hates with a passion, has contributed $25.5 million of the total $52 million from donors. Other contributions have come from Canada and Australia, countries which Mugabe says are sworn enemies of Zimbabwe after they imposed targeted sanctions against him and his coterie.
Now the country depends on donors for 80 percent of essential medicines to stock 1 400 public health facilities across the country.
“There is no doubt that the Essential Medicines Support Programme has led to dramatic improvements in people’s health through the availability of essential medicines. Since the commencement of the programme in 2009, there was only eight percent availability of eighty percent of the drugs. Today, 82.5 percent of health facilities have 80 percent availability of drugs,” Salama said.
Puppets of West
“In particular, this programme has helped reduce the disparity in availability of essential medicines between rural and urban health facilities. This has improved access to health services by the entire Zimbabwean population.” Health Minister Henry Madzorera acknowledged that the contribution of Western donors had done a lot to improve health delivery at a time of severe funding problems for the government.
“There was a loss of qualified staff within the Ministry to effectively manage programmes, deterioration of institutional capacity for the management of programmes, deterioration of infrastructural capacity for the management of medicines and a decline in the real value of the budget allocated for the procurement of essential medicines,” Madzorera told The Zimbabwean.
According to the EU’s Vital Health Service Support Programme survey, in 2008 there was what in medical parlance is called a stock-out. The survey reported that only 28 percent of essential medicines were available in public health institutions.
So, while Mugabe is calling for disengagement with the West, Prime Minister Morgan Tsvangirai is demanding better ties.
“I hope that this fruitful co-operation will be maintained and strengthened,” said Madzorera, a key member of the MDC-T.
But for daring to do the practical thing and work with Mugabe’s sworn enemies, Tsvangirai and his cabinet associates have already paid the price, being labelled puppets of the West.Post published in: Africa News