How do we deliver Health Services to People?

I really do think the Covid pandemic has been overplayed across the globe, but the one thing it has shown us, is how flawed our medical delivery systems are, everywhere.

It was President Obama in 2015 who said that the world must prepare itself to fight disease on a global scale. He was referring to the outbreak of a disease in central Africa that killed 90 per cent of those it infected and was massively contagious. It was called Ebola.

But he might have used as an example, any one of the major disease problems in our past history. The Spanish Flu (another form of Covid) killed up to 30 million people in 1919. When I was a child I remember the panic over polio that left millions crippled or on iron ventilators in hospitals. Tuberculosis – remember the hospitals built just for this pandemic? Measles, malaria, yellow fever, all were, in their time, regarded as universal threats. Science has enabled us to control and even eliminate these problems.

There are several issues that concern me about the global Covid response. Firstly, despite the existence of the World Health Organisation, the global response has been uncoordinated and based mainly on wealthy international pharmaceutical firms and the rich countries. I guess this is inevitable, but it entrenches the haves and have-not’s syndrome which has emerged in the past 100 years. The result is that we have emerged from the first year of response with a dozen or more vaccines of varying types and effectiveness and at a cost of US$70 a shot to US$3 a shot and two injections required for protection at about 70 per cent. The first and most effective vaccine requires freezing down to minus 75 Celsius – an impossible target for 90 per cent of the globe.

To compound this problem, nationalism has raised its head and most countries are demanding a policy of “Me first”. I well remember the example of the Polio epidemic and its resolution – a small group of scientists working sacrificially found the solution, offered it free to any firm who wanted to manufacture it for distribution and it was made available virtually free to the whole world. I can remember lining up at school and taking the drops into my mouth.

It costs anything up to US$300 to get a Covid test. Here in Zimbabwe, we seem to have settled at about US$70 a test – a bit better but still totally unaffordable to the great majority of our people. This has been compounded by Governments who have made it compulsory to get on a plane or cross a border, even though the test is not accurate. What is involved? Go to a tent, a person comes up to you in what looks like a spacesuit, sticks a tiny swab of cotton wool on a stick worth about 5 cents up your nose and then charges you a month’s income with instructions to collect the result from a laboratory somewhere. What is the cost? Maybe US$3 to US$5 a test? Good money to me. In the UK it costs nearly US$300 for a test if you are not in the system for free health care. Are they charging the NHS these ridiculous rates?

Chaos across the world and in the process we have destroyed the livelihood of hundreds of millions of people and made some very wealthy people even more wealthy than before. As for the poor, they are left to cope both with the disease and the aftermath of panic in Government circles and among the elite. Herd immunity has already been established in most poor countries, simply because the majority of us have had the disease and survived. The vaccines are not going to help in any significant way.

It comes back to how do we, who live in the forgotten world, deliver health services to our majority? Our resources are tiny and our infrastructures totally inadequate?

It requires some very tough decisions. First, we have to recognise that we live in an unequal world. Every country has to have a private medical system that can deliver a first world standard of care when required and if you can pay for it. Tick that box; we have a small but very sophisticated medical system that serves about 1,2 million people or about 8 per cent of our population. Countries have no choice, if you want people with international skills and capacity to live in your country and make their living here, then you have to have such facilities.

This case moves to our Universities. There is no point in producing doctors without first world skills. This takes a long time and requires Universities and medical Schools at the international level. The problem then is that you have to be prepared for the majority of your graduates to leave the country and work elsewhere if you cannot match their demands. We have long depended on skills from abroad, some have started to come home from the Diaspora with skills and experience and even capital, but they all go into the private sector.

This then leaves us with responsibility for the State-funded system that must operate on a very limited budget and yet try to meet the needs of over 90 per cent of our population.

We need to recognise the hard fact we are never going to be able to provide anything like the standard of health care that you can get in the private system. We simply cannot afford this level of care. Curative institutions are at the top end of the cost structure for health care, public health and home-based health care, at the other end – low-cost systems that can deliver a better quality of life and longer life, for the majority.

Our problem is that we spend 80 per cent of our budget on curative care of a low standard and some on community based health care and virtually nothing on public health. Somehow we have to reverse this priority of expenditure within our national budget.

I have been told that 85 per cent of all health problems can be dealt with at community level clinics. For me, our focus as a country should be on providing a basic health centre within walking distance of all our people. We already have 1600 of these, perhaps we need to expand this network to 2500. We need to train an intermediate level of staff for these centres, people who are more than Nurses or Orderlies and who can deliver a baby, diagnose the majority of common ailments and dispense the majority of medicines. Each centre should be managed by a Committee elected by the Community and have all the facilities required. They should also have staff who can pay home visits and monitor public health issues.

We should tap into modern technology and provide a consultation service to all these clinics via the internet. This system should be serviced by experienced and well-trained doctors and be accompanied by a video link and a system for dispensing the drugs required.

All our Hospitals should be handed over to the private sector and run as businesses. The one thing that stands out for me is the very low quality of care and attention that clients get from all State-controlled and managed health institutions. The reports of corruption and waste are legion. Faith institutions manage their hospitals much better and even if they are not as well equipped, clients prefer them for treatment because they are clean, the staff treat them as human beings and the doctors dedicated and professional.

Public health issues such as clean water, waste management and control of communicable diseases where solutions are available – should receive a much higher priority. At present, the failure of local governments in this field of service should be of concern to every Zimbabwean.

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