IRIN Focus report on a growing health sector crisis

As doctors in Zimbabwe’s public health sector vowed on Thursday to remain on strike over salaries, working conditions and outdated equipment, the country’s Community Health Working Group (CWGH) has said that the national budget for the year 2000 has not allocated sufficient funds to meet the country’s basic needs. In a detailed analysis of the health budget published this week by the CWGH, Dr Rene Loewenson, said there “is little to give confidence” in a health budget which allocated approximately US $13 per capita against defence spending of US $19 per capita. Defence gets the bigger chunk of government spending “It indicates that while the 2000 budget has improved the real per capital allocation for health by about 40 percent from US $9 to US $13 per capital, it still falls short of the estimated US $18 per capita needed for health services,” she said. The CWGH was particularly concerned that preventive health services had only been allocated a total of 10.6 percent of the 6.2 billion Zimbabwe dollars (US $155 million) health budget for next year. That figure compared with 15.8 percent in 1993 and the allocation has dropped steadily in the years since. “It is inconceivable that in a country which has faced a cholera epidemic, severe malaria outbreaks, among other serious and fatal environmental diseases, that we continue to give so little priority to preventive health services. An allocation of about 14 percent of the health budget would have been closer to appropriate levels, reducing the share allocated to administration,” she said. The report said that funds could have been taken from other sources to make up the difference in a country where ill health and mortality had increased fourfold due to the HIV/AIDS. Grim HIV/AIDS figures According to estimates by UNAIDS and local health authorities, about 1,200 people are dying weekly in Zimbabwe of HIV/AIDS-related causes, while the number of people getting infected is calculated at 2,000 per week. For a country of 12 million people, there is now a population of approximately 300,000 so-called AIDS orphans. AIDS, said ‘The Daily News’ in an editorial this week, should be declared a national disaster. The government’s reaction to the epidemic, this week, has been to announce a new 3 percent “AIDS levy”. But its critics in the health service, besides the media and opposition politicians, view the move as simply passing the burden onto the taxpayer without transparent, democratic accounting. Loewenson said in her report there was no doubt the epidemic demanded public sector intervention and leadership: “But translating this into the much hated, non-transparent ‘levy’ approach with no clear plan for AIDS prevention and management that identifies how the funds would be used, no mechanism for public monitoring of the funds, nor for channelling them into scaling up successful local and community based approaches has led to suspicions that AIDS is simply the next way of raising money for the fiscus.” It was a decision which would weaken, rather than strengthen response to the epidemic by allocating the funds to the country’s many successful local authority, private sector, non-government and community AIDS programmes, she said. The priorities and the doctors’ strike Referring to Zimbabwe’s most controversial issue, at home and with the international donor community, she added: “The problem is with our priorities. We could surely afford to do without the expenditure on the war in the Democratic Republic of Congo (DRC).” Simeon Mwanza, of Zimrights, who has been trying to help resolve the doctors’ strike, said in exasperation after an afternoon of talks on the issue: “Why do I need US $19 for my defence next year? This is a country at peace, we don’t have a quarrel with anyone and I don’t need any defence. But if someone outside here gets hit by a car, will there be someone at the clinic to treat that person? Will the necessary drugs and equipment be available?” Since 21 September, 400 of the country’s junior and middle level doctors - there are 800 doctors in Zimbabwe altogether - have been on strike. A government spokesman reiterated to IRIN this week the government pledge that their salaries, some as low as the equivalent of US $200 month, would be increased. President Robert Mugabe, he added, was “deeply concerned” about the health crisis. But the spokesman insisted that doctors would not be paid for the period they are on strike. Some doctors have complained bitterly that their bank accounts have been frozen in recent days. “All we want,” said a representative of the Hospital Doctors’ Association, “is for the pledge to be in writing. We are demanding that our salaries be doubled. Give us that pledge in writing, and we’ll return to work immediately.” However, the devil in the small print of the budget, as pointed out to IRIN by Leowenson and Mwanza, is that salaries, wages and allowances in Zimbabwe’s health sector for the year 2000 have only been allocated a 14 percent increase in the national budget. Given that inflation in September reached 70 percent, the increase is considered paltry. It makes the demand for a 100 percent increase seem reasonable. What Loewenson and Mwanza fear is that doctors would move into the private sector, leaving clinics staffed by nurses who cannot move as easily into the private sector, and thus deprive the country’s most needy patients of medical services they are needing more and more. Who will take on the liabilities? The CWGH report said it would appear that this small increase in salaries signalled an intention to reduce the central government’s direct employment in the health service. Local authorities, NGOs and contracted service providers could be possible employing authorities. But the report said reduced funding in this sector indicated a failure to recognise the “vital link” between these organisations and service delivery in key areas such as disability, the elderly, youth and emergency services. Although their role might increase, where, it asked, would the funding be found? “The major disappointment is thus the failure to use the Health Review Commission as a springboard for organising what its a widespread national concern for health into a national recovery plan, with public funding at its core,” Loewenson said. Why such a crisis? In a scathing editorial on Thursday, ‘The Financial Gazette’ said: “Clearly the solution to tackling the AIDS epidemic was to dramatically slash the budgets of government ministries such as defence and foreign affairs, whose financial votes leapt 50 and 200 percent respectively, and to give that money to the health sector. No, the government would not have any of this because such action would spoil the party for the boys and the sacred cows, whose lavish lifestyles must be maintained at any cost.”