Social pact only cure for perennial health service...

Social pact only cure for perennial health service ailments

Sustainable solutions are needed for the public health delivery system

Audrey Galawu

According to his daughter, Dzehonye had suspected kidney problems which led to a swelling of his legs and hands. On the morning of June 26, 2022, he was taken to Chitungwiza Central Hospital, only to be dismissed because they had no money.

Listen to her story:

https://youtu.be/CSfh3nXdyDY

“There were no doctors and for those who were at work, they also wanted to be paid for their immediate services. Initially we paid USD$12 for his card, and I was told to pay USD$610, USD$300 for admission, USD$300 for the physician and USD$10 for the antigen whatever it is,” she said.

An antigen is a toxin or other foreign substance which induces an immune response in the body, especially the production of antibodies. So probably this was some test to be run on the patient.

Dzehonye’s daughter he tried to negotiate with the doctors to treat her father whose health was deteriorating by the hour.

She was told to take him outside immediately if she had no money and she decided to go to CITIMED private hospital where she again paid US$15 but was referred back to Chitungwiza Hospital.

She returned to Chitungiwza Hospital where she found another doctor who upon hearing that she had no money removed his gloves and disappeared.

“The doctor told me that he is risking his life by attending to us because his colleagues were outside protesting, so it had to be worth that risk. At this time my father could not help himself to the toilet so we could not leave him by himself without care. One of the nurses advised me to buy some sanitary items for him while she looked out for him.

“At around 5pm I received a phone call from the hospital informing me of my father’s passing on,” she said.

Striking off the poor

Zimbabwe has faced several strikes in the health sector with public health workers demanding a salary increase and better working conditions. Hundreds of public workers went on strike in June 2022 demanding to be paid in US dollars.

The impacts of these prevalent strikes have been notable through the experiences of people like the late Jeminas Dzehonye who lost his life after being refused treatment during a strike.

Union strikes affect mostly the less privileged who cannot afford to pay for alternative medical care particularly from private clinics whose fees are exorbitant.

While strikes are experienced all over the world, some effects can be more fatal in certain countries than others due to resource and infrastructural challenges as well as unaffordable alternative options for the poor.

The better off can access reasonable service in the private sector, but the poor are left to die as they cannot finance alternatives.

A Hippocratic Or Hypocritical Oath?

“Everyone knows that the health service workers are not being paid enough. But I really wonder why they bother pretend to be working if they are just watching people die.

“After all, those of us going to the public institutions are not rich. We are also struggling. So what do the doctors and nurses get out of condemning us to die?” asked a Harare teacher who declined to be identified.

She also did not want to name the hospital in question, except that it is one of the big ones in Harare.

She said she felt that her seven-year old’s son died because of the nurses and doctors who did not care.

“If they cannot work for this money, they should just stop going to work. Then we will know that there is no hospital service. We will just die in our homes instead of wasting our little resources going for medical attention when there is none,” she said.

The woman said she had to spend money on a taxi to take her son to hospital, pay consultation fees, then spend a whole day waiting for someone to attend to her son.

“A kind nurse who came om duty in the afternoon examined him. She said he was very ill and he would have to be seen by the doctor. By 8pm the doctor had not yet come. And my poor little boy died there in hospital without getting even a painkiller,” the woman said.

The Hippocratic Oath to which doctors are required to adhere carries injunction: “the health of my patient will be my first consideration” (Stuart 2010:20).

Zimbabwe Nurses Association (ZINA) president Enock Dongo says their work is important but they cannot work if they are incapacitated.

“Strikes are unfortunate, but we cannot continue working with low pay and unfavourable conditions. It is not only the issue of salaries that pushes us to strike but also the lack of equipment,” he says.

He adds government should invest more in the health sector and equip hospitals as a long-term solution to avoid future strikes.

“Government should devote at least 15% from the national budget that goes towards equipping hospitals as well as health workers’ remuneration,” he noted.

Joint responsibility for sustainable solution

A senior official at a hospital said that Zimbabweans need to come up with a social pact if the country is to create a viable health service delivery system.

He did not want to be named as he felt that the health service workers under him would say that he is not fully sympathetic to their plight.

“The blame game has been going on for years and it serves no one. The health service workers need to be paid reasonably. In fact, that is true for all public service workers, really.

“But it is not enough to just say Government must increase salaries. From where? In countries where such services like health and education are free, almost 100 percent of the citizens and businesses pay taxes.

The majority of people in Zimbabwe are in self-employment and do not pay taxes. There is also an estimation that the informal sector accounts for a USD7 billion economy which contributes little or nothing to the national treasury.

“There is need to government, private corporates, civil society and the whole population as individuals to take joint responsibility, to come together and create a sustainable health funding model,” he said.

He gave an example of the Aids Levy as something that can be extended and refined.

“But if you look at that, you see the gap where only the formally employed contribute but everyone who is infected needs to access free ARVs. It only works because there is lots of donor funding and private companies also have employee benefit schemes. But if the whole infected population had only that, we would not be distributing free ARVs in this country and many poor people would die.

Whereas if all 15 million of us put aside a dollar a month into a common fund, we could pay our public health workers well and access efficient service as needed.”