The Citizens’ Cabinet is calling for urgent action to address the dire health and social protection crisis in the country. The situation has particularly become critical in the wake of policies adopted by the government as part of the recently announced Transitional Stabilization Program (TSP).
As citizens’ we are alarmed that our public health delivery system is facing total breakdown across all the core pillars defined by the World Health Organization (WHO) as prerequisites for a functional health delivery system, especially with regards to Health service delivery;Health workforce; and Access to essential medicines.
Whereas a good functioning health service delivery should be characterized by a comprehensive range of services including preventive, curative, palliative, rehabilitative, and health promotion activities – our own public health system is falling far short leaving ordinary citizens’ in a death trap.
Furthermore, accessibility has become a major issue especially since the TSP. In particular the exorbitant cost of medicines, sanitary wear, consultation fees and charges for medical procedures have become a barrier to ordinary citizens. Most pharmacies are selling medicines in US dollars only, thus denying access to the majority of citizens who have no access to forex.
Additionally, public health service delivery is severely compromised on quality. Most public health facilities are in a deplorable state suffering from neglect and lack of investment;the workforce is strained and demoralized due to poor salaries and unfavorable working conditions;and generally service is not patient friendly. The impact is most severe on women as seen in the increasing numbers of maternal mortality due to poor maternal health care.
It is an outrage that the political elite is able to avoid the consequences of their criminally
negligent mismanagement of the public health sector by going abroad for medical care and resorting exclusive private healthcare solutions. What about the poor? What about those who can’t fly to South Africa, India or Singapore?
As the Citizens’ Cabinet we seek to remind the government, as the duty bearer, that access to health is a constitutional right guaranteed in our Constitution which places an obligation on the State to take reasonable legislative and other measures to achieve the realization of the right to healthcare.
The unraveling of the health care sector cannot be ignored as the right to health is the pivot upon which we build and sustain a nation. Failure to take corrective measures to the already dire situation risks plunging Zimbabwe into a humanitarian crisis of unprecedented proportions.
ACCORDINGLY, WE ARE CALLING ON THE GOVERNMENT TO:
1) Declare State of Emergency Over the Health Crisis – We are calling on the government to publicly acknowledge the depth of the crisis that has emerged in the health sector, especially post-TSP, and declare a state of emergency to bring about the necessary unrelenting focus, national dialogue and mobilization as well as international support needed to find solutions that work for all.
2) Prioritize Allocation of Foreign Currency to Health Sector – Health services must be prioritized in the allocation of foreign currency because the health sector directly addresses issues of life and death. Service providers must be given predictable access to foreign currency to ensure uninterrupted supplies of medicines and other essential procurement. However, as proposed previously in the Citizens’ Cabinet Statement on the Erosion of Wages, Savings and Pensions and the General Impact of the Economy on Citizens’ Lives, all forex allocations by the reserve bank must be done transparently and properly accounted for. We must avoid a situation where some service providers are receiving forex allocations from the reserve bank at 1:1 and yet they refuse to accept RTGS payments from citizens.
3) Prioritize Health Sector in Budget Allocation – We are calling on the government to fulfill the Abuja Declaration which commits African countries to allocate at least 15% of the national budget towards the health sector. Such a commitment is essential to the resourcing of the National Health Strategy which speaks of “Equity and Quality in Health: Leaving No One Behind”. Public health institutions currently receive 55% of their income from individuals paying for health care directly out of pocket. Further, the funds that the government receives through statutory collections such as the 10% Health Levy on airtime must be strictly utilized to improve health delivery.
4) Subsidize Basic Health Care and Attend to General Erosion of Social Protection– We are calling on government to recognize the limitations of Public Private Partnership approach to healthcare and other essential social services. The poor end up marginalized when essential social services are availed on strict market terms to those who can afford to pay. As such we call on the government to prioritize state investment in public services and to particularly subsidize basic health care through the national budget.
Further, we are calling on the government to immediately take action to address the complete erosion of social protection measures in health care and assist all vulnerable groups and prevent loss of life. Health care and social protection are intrinsically related and as such measures undertaken in the health sector must be extended across the whole social services sector in particular with regards to care and support to the elderly, orphans, vulnerable children, disabled persons and prisoners
Additionally, as part of the social safety nets to mitigate the effects of medical staff shortages we are calling on the government to invest in community health workers who provide home based care to vulnerable members of the community including the chronically ill and also champion best health practices such as malaria and cholera prevention.
5) Address Water & Urban Sanitation Infrastructure Problems and Emergency Response Preparedness – Lastly, the Cholera and typhoid crisis that affected mostly Harare’s townships over the last few months is primarily a result of inadequate and dilapidated high density sewer and water reticulation infrastructure and lack of emergency response preparedness. As the rainy season approaches the Citizens’ Cabinet would like to bring attention to the imminent resurgence of water borne disease and accordingly calls for the following:
Water Supply
In the short-term government and the local authorities must urgently work on refurbishing water distribution networks including restoring all burst pipes, valves and appurtenant fittings and repair service connections. We further call for local authorities to deploy mobile browsers with clean drinking water for those areas in which running water does not reach.
In the long term, priority in term of government infrastructure spending must be placed on the construction of dams that feed water into our urban settlements. In particular we call upon government and ZINWA to urgently re-mobilize the Kunzvi Dam project and the subsequent water transmission infrastructure and the resumption of the Zambezi water project.
Sewer reticulation
We are calling on urban Councils, in particular, City of Harare to replace all damaged and leaking sewer pipes and ensure raw sewerage does not spill into natural water sources and cause yet another cholera epidemic.
We strongly call on the government to resuscitate and strengthen disease outbreak surveillance and early warning systems in order to contain recurrent epidemics of communicable diseases like Cholera; and we further call on the government to reactivate the country’s emergency preparedness and response systems on disease outbreak so that funds will be readily available in cases of emergency and we avoid senseless loss of lives.
Ultimately, the government needs to prioritize the full spectrum of pillars of a functioning health system with a focus on improving health service delivery; improving the numbers and motivation of the health workforce, harnessing IT for improved health information management systems; guaranteeing access to essential medicines, fostering innovating health financing and above all improving the leadership and governance of the health sector in the country.
As the Citizens’ Cabinet, we shall continue to draw on the expertise of Zimbabweans at home and the diaspora and sustain consultations on the most pressing challenges confronting citizens and we will be boldly advancing people centered solutions without fear or favour.