IRIN Focus on public health service crisis

A fresh puddle of human blood on the floor, the sick old man lying unattended on a wooden bench, and the old wheel chairs carelessly dumped on the other side of the casualty unit of Harare Central Hospital reflect a sense of total neglect and decay. Peasant farmer Solomon Kamombe, who had travelled more than 200 km from his rural home to see a sick nephew admitted at the state-run hospital, paced anxiously up and down the passageway. “This?” he shouted, brandishing a small piece of paper on which the doctors had written the prescription he had to buy for his nephew. “Why then come to hospital if all they have are ordinary pain killers?” he fumed to no one in particular, before resuming his pacing. Zimbabwe’s crumbling health sector, with its under-funded and overcrowded hospitals and crammed mortuaries, is an eloquent testimony to the more far-reaching decline of a nation that a decade ago was a showcase of social service provision. At independence in 1980, along with promises of education and housing for all, the then avowedly socialist government of President Robert Mugabe made universal health by the year 2000 its pledge to its people. In the early days startling successes were achieved, especially set against the neglect of the majority of the population by the white minority Rhodesian regime. In education, for example, the number of primary schools was increased by about 90 percent in the first decade of independence, from 2,401 in 1980 to 4,549 primary schools in 1990. Enrolment shot up by nearly 200 percent from 820,000 to 2.4 million pupils in the same period. But it was perhaps in the health sector where Mugabe and his government achieved their most remarkable success, and demonstrated how much a developing nation could, with the right commitment, achieve. “What inspired our policy on health was a desire to ensure that every Zimbabwean at least had access to some form of health facility or care,” Health and Child Welfare Minister Timothy Stamps told IRIN. The statistics, said Stamps, a trained medical doctor, were enough evidence of the correctness of that policy. From only 14 percent of Zimbabweanswith access to modern health facilities in 1980, that number shot up to 87 percent thanks to a national programme to build hundreds of clinics and hospitals across the country. An aggressive vaccination campaign by the government with the aid of non-governmental organisations saw polio eradicated in 1992, neo-natal tetanus in 1998, while measles was brought firmly under control with only one death from the disease recorded in 1998. Three out of every four children in Zimbabwe have been vaccinated against the six major child killer diseases, according to a health study carried out last year by the government’s Central Statistics Office and a US firm. While fertility was reduced by about 60 percent from seven children per woman per year in 1980 to 4.3 children per woman per year now, infant mortality was also slashed to about 102 deaths per 1,000 births. But 20 years down the line, ask any ordinary Zimbabwean what they think about the collapsing public health system - the only access to health services for more than 80 percent of the 12 million population - and the answer is far from complimentary. “It is like a test of endurance,” said Mary Simomo. She was visibly angry and disappointed after being told by staff at Harare hospital to buy drip-feed for her sick sister because it was out of stock at the hospital. “It makes no sense for the government to boast that it has built more hospitals than the former colonial authorities when the hospitals have become merely places where people come to die,” she told IRIN. Writing in the private ‘Daily News’ this week, Zimbabwe Catholic Bishops Conference spokesman, Father Oscar Wermter, summed up the modest wish list of many Zimbabweans. “We need drugs and medicines put back on the empty shelves of our dilapidated hospitals,” lamented Wermter. But it is not only essential drugs that are in short supply in Zimbabwe’s hospitals. Morale and commitment among nurses, doctors and even floor cleaners has hit rock bottom with industrial action by staff now almost an annual ritual. A strike for better pay by nurses and doctors at Harare and Parirenyatwa hospitals - the two largest referral hospitals in the country - entered the fourth week this week with no solution in sight. Stamps said the devastating effect of the HIV/AIDS virus and inadequate funding had combined to erode what was once one of Africa’s best public health systems. According to the minister, government spending on health had dropped from US $35 per head per year in the 1980s to only US $11 last year, at a time when HIV/AIDS is placing an extra burden on public health institutions. “When you do not provide the money you also do not get a good health service,” Stamps reluctantly admitted. But others argue the rot started setting in the public health system during the first decade of independence, at the same time when some of the greatest strides were being made in the sector. “The level of expenditure initiated by the government in the early 1980s was unsustainable,” University of Zimbabwe business studies professor Tony Hawkins said. Together with free education, the government provided free health to millions of poor Zimbabweans between 1980 and 1991. But this drove up debt as the state had to borrow the money to cover the expenditure. With more than 50 percent of government revenue now going to service a Z $194 billion (US $3.5 billion) domestic debt and the US $4.5 billion owed to multi-lateral institutions and other foreign creditors, it was inevitable the government would be unable to maintain public health spending levels. “A shortage of foreign currency has only helped worsen the situation with prices of mostly drugs going up by about 145 percent this month to place them beyond the reach of most people,” Hawkins added. The way forward, said Stamps, was for the government to now concentrate its limited resources on prevention of disease rather than on costly treatments. “We have to focus more on prevention as we have already successfully done with diseases such as cholera because it is cheaper to do that,” Stamps said. But for the many poor Zimbabweans with nothing but the collapsing government hospitals and their equally poorly paid staff to depend on for treatment, seeking care for almost any ailment no matter how minor has become a test of endurance.