'Cheaper to die than to get treated' as health system fails

When Jasper Simalie suffered from severe respiratory complications two years ago, his family had no reason to fear for the worst. They had their hopes pinned on Zimbabwe's affordable health care service, which enjoyed the reputation of being one of the best in Southern Africa. And it delivered. After two months' recuperation, Simalie returned to his job with one of Zimbabwe's leading cement manufacturers. The condition returned to haunt him last year, and this time the family made frantic but futile efforts to find affordable treatment. Simalie's illness forced him to stay at home for three months. He was retrenched, and left with only enough money to pay his way back to his rural home in the northwestern province of Binga. He has been bedridden for the past eight months. "For the pain I feel, I wish I had died two years ago. Eight months of suffering is worse than all the pains of a lifetime. If I had the money, I would seek private medical service and buy myself the necessary drugs. But I don't," he told IRIN. Hospitals, according to Simalie, "are now a place to die - they refer everyone to a filthy deathbed under a hardworking but underfunded home-based care system." Simalie's predicament mirrors that of many other Zimbabweans, suffering as a result of public health sector inefficiencies. The astronomical increase in the cost of private and public services has aggravated the situation. Plagued by a scarcity of drugs, dilapidated medical equipment and persistent strikes over poor remuneration by health sector professionals, the public health care system is on the verge of collapse. Over the past two years, people have been forced to turn to private medical practitioners for services no longer offered by government clinics and hospitals. The last straw came this month when private medical doctors increased their consultation fees. General practioners hiked their rates from an average of US $5 to US $13 per consultation, while specialists began charging up to US $32. Doctors cited an official inflation rate of around 600 percent as the reason for the increased fees, and stopped accepting medical aid schemes, demanding cash upfront. State hospitals also raised their consultation fees this month, while public sector clinics in Bulawayo, the country's second city, now charge US $2 per consultation - last year they were charging only 28 cents. Drug suppliers, feeling the pinch of the high inflation rate, increased the cost of drugs by 1,000 percent in October last year - 500 ml of children's cough mixture rose from 12 cents to US $1.80, while a full course of common antibiotics now costs around US $11. A month's supply of antiretrovirals to control HIV cost more than many people earn in a year. Pharmacy managers and health consultants say inflation cannot be ignored in a sector that relies heavily on imports, and foreign exchange is hard to find. "At this rate, no ordinary Zimbabwean worker can afford to buy drugs at these prices. But, as drug retailers, we have no choice but to pass the increases on to the patients," said a manager with one of the city's major pharmacy chains. Isaiah Shoniwa, the secretary-general of the Zimbabwe Medical Wholesalers Association (ZIMWA), said price increases in the drug sector were unavoidable because importation costs had risen by the same margin of 1,000 percent. "We find the cost of importing drugs highly prohibitive. In fact, most of us are not sure if we will remain in business because of the costs involved," Shoniwa said, adding that another hike was imminent this year. Bulawayo residents who spoke to IRIN said health care was now well beyond their reach. "There is no way - one cannot afford health care services in Zimbabwe. The government hospitals have no drugs. In the rare instances when deliveries are made, there are no nurses or doctors to attend to patients. The poor can only die silently at home," said Patience Mpofu. Private doctors interviewed by IRIN defended their rates. "Inflation has not stabilised - so why should I charge less? If there is no business I can simply close the surgery and relocate to other countries, rather than try to beat government in offering expensive services at subsidised rates," said one gynaecologist. He confirmed that several private doctors with surgeries in the low-income, high-density suburbs of Bulawayo had either closed down or relocated because there was no business, and medical aid societies were out of the picture because of the impasse over consultation fees between doctors in the Zimbabwe Medical Association (ZIMA) and the National Association of Medical Aid Societies (NAMAS). Doctors had rejected as "meagre" a 200 percent increase in consultation fees, pegged at US $7, proposed by the medical aid societies, he pointed out. "Medical aid cards will remain irrelevant as long as NAMAS does not want to accept the 400 percent increase we have already effected." Government attempts to bring order to the country's health sector have been characterised by threats to invoke sections of the Public Health Act. When drug retailers increased the cost of medication, the government threatened to introduce price controls. The government resorted to similar measures when a strike by doctors and nurses paralysed the public health sector last year. The doctors were demanding a monthly salary of US $8,305, which Minister of Health Dr David Parirenyatwa described as "black market inspired". In response, the minister threatened to invoke the Health Services Act, and proposed a health services commission that would define health care professionals as providers of an essential service who could not go on strike. Phibion Manyanga, president of the Hospital Doctors Association, scoffed at suggestions that the commission could prevent future strikes. "The fate of the patients in this country will depend on whether the government will understand the need for reasonable remuneration for employees in the public health sector. Whether it is set up or not, that commission will not stop inflation, so industrial action will be embarked upon whenever it becomes necessary. Besides, the professionals still have the choice of resigning if the conditions of service violate their right to reasonable remuneration," said Manyanga. Julia Mpofu, a 45-year-old bedridden tuberculosis patient at Bulawayo's Thorngrove isolation hospital gave her assessment of the health care system: "It has become cheaper to die than to get treated."