The Sunday Mail
Dr Edwin Muguti
Most of our state hospitals are facing challenges in terms of resources, that is drugs, equipment and other manpower.
In terms of manpower they are still relying on staff establishments that were put in place decades ago which are no longer sustainable for our growing population.
And this is one of the many reasons that has caused poor service delivery in our hospitals.
However, when you have an institution running out of drug stock like what happened at Harare Central Hospital last week many people ask how and why is this happening.
In Zimbabwe we have what we call the essential drugs list which was established years ago and is reviewed regularly. It shows what drugs are essential, necessary and desirable in every hospital.
However, for any hospital to provide effective services there is need for the availability of resources.
And who is supposed to provide funding for the procurement of drugs and payment of services provided by health personnel in State hospitals?
It is the State, and that is why we have a health budget in the national budget.
According to the Abuja Declaration, 15 percent of the budget must be allocated to the health sector.
To my knowledge Zimbabwe has never attained this figure, the highest we ever attained is nine or 10 percent and that figure has been dropping for some time now.
The procurement process of drugs in State hospitals has also left a lot to be desired.
These institutions are supposed to be supplied through National Pharmaceutical Company, Natpharm, but there are moments when the pharmaceutical company is not adequately supplied and this affects State hospitals as well as they cannot access drugs.
I believe at the moment 80 percent of the drugs at NatPharm are from donors and that is not sustainable, it is actually a security risk to the country.
Yes we can have donors, but they must be a support mechanism and not the mainstay of our health services.
So if NatPharm is not adequately stocked, the question that arises is why? Are they adequately funded? Who should fund them?
The issue goes back to budgetary allocations. Yes the country is going through economic crisis, industries are closing and the economy in general is not performing well, but we need to know what to prioritize.
We have been very unwise at times as a country in terms of what we need to know.
Because if you do not fund the health sector, you cannot have an efficient health system and if you do not have an efficient health system, it causes unnecessary deaths and human suffering.
Once you start having unnecessary deaths then the population will not be amused because people can accept a death that was inevitable but one cannot accept a death that could have been avoided.
Efficient health services can only be achieved were Governments have invested in resources as well in manpower.
Zimbabwe has done well in terms of manpower development. We increased the number of nurses and doctors but we have not been remunerated competitively so that they do not go looking for greener pastures.
It is a litany of a very sad scenario which requires the Government to change the way they look at the health sector and the economy in general.
However, most hospitals are suffering because of the management styles.
In the past we used to have medical superintendent heading hospitals.
These would medical doctors who had good understanding of the needs of the hospitals.
Now we have a situation where hospitals are headed by Chief Executive Officers (CEOs) who are none medical people, who might not have a clear understanding of the running of the hospitals or needs of the patients on day to day basis.
They might not also have the same priorities that medical practitioners such as doctors and nurses might have.
If a hospital is confronted by shortages of drugs it will have a major impact on medical personnel because they know what it means.
Whereas non-medical people may just look at this as statistics because when people die it can be reduced to statistics but when you have a clear understanding and in-depth of how the problem could have been solved, I think you are more likely to solve the problem.
There are questions around that issue and also the issue of prioritisation.
If a CEO has these requirements that they must have a 4×4 which costs $100 000 and then your paediatric ward does not have a certain antibiotic, what would you buy first.
We have situations of non-core or non-essential issues being prioritised and when you do that you do not present a good picture to the nation.
You present yourself as non-caring. There will always be shortages of money everywhere but it is how you prioritise that makes a difference.
Prioritisation has suffered because of the change in the management structures because we have taken people who are non-medical who do not understand the emotional and emotive side of medical environmental in the way doctors and nurses understand them.
If someone dies they might just look at as statistics, but that statistic has far reaching consequences in families or communities.
If people lose a breadwinner or a child, it is a irreparable damage.
The management of resources can be contrasted between Chitungwiza and Harare Central Hospital.
Chitungwiza which was built recently is over taking Harare hospital.
If you go there they have drastically changed and improved over the years. I do not know how they have done it, but I suspect that the difference between the two must be the management systems.
We need to review our management systems.
There is also a lot of corruption going in the country at the moment and the health sector and hospitals have not been spared.
If you go to Parirenyatwa right now, there is a private pharmacy inside the institution. Whose interest is that pharmacy serving?
Why should we allow a private pharmacy to be established inside a hospital? There should be a hospital pharmacy which will serve the interests and need of patients.
The case might be that whoever owns that pharmacy might be instigating or creating artificial shortages in the hospital so that a drug needed in the hospital will be found in the private pharmacy at a higher price.
A drug which would cost $2 in the hospital pharmacy would cost $10 or $15 in the private pharmacy at the hospital grounds.
There is also the issue of unnecessary outsourcing of services where services such as cleaning or catering are outsourced.
Why cannot a hospital have its own staff? At the end of the day you will find the company providing services might have a direct or indirect link to the hospital administration.
This level of corruption is suicidal to the nation. It might benefit a few individuals at the short term individual basis, but in the long run it disadvantages the nation.
The next question that rises is do we audit our health systems and sectors?
Because I believe that any organisation worth its salt should appraise itself and see how it is performing.
An audit is not a witch-hunt but it is a scientific way of self-appraisal. To see where to improve and how to improve.
Regular audits are necessary. They might be unpleasant to those with skeletons in the closet but are necessary and progressive part of an institution.
Because if do not have an efficient management, even if you improve your budget allocation your money will still be wasted.
There might be other criminal activities taking place within the institution such as drugs being taken out on the black market.
Thus besides availing more funding to the sector, there is need to plug these holes which leak revenue.
At the moment a lot of people are seeking medical attention outside that country and whenever they leave they take money out of the country.
And some of the medical services they are seeking outside the country can actually be done in the country and at state hospitals.
We have state laboratories at Parirenyatwa, they are supposed to do all the tests under the sun, but the test are not being done even some of the x-rays, blood tests, microbiology all the tests.
The public health is there but the specimens are collected for Parirenyatwa to private lab.
If we had maintained the labs, the state would be collecting and keeping revenue rather than that revenue going to private hospitals and other countries.
All this is money that is leaking outside the system and at the end of the day we say we do not have funding.
So the whole system just need a complete overhaul from top to bottom. Because it is not as if people don’t know what to, people know what to do.
People are simply exploiting loopholes of inadequate supervision.
And another key thing is that we need a well-functioning Information Technology system.
The state hospitals should be linked so that at the press of a button, the person in charge should be able to tell how many stocks of a particular drug is at Gwanda Hospital.
How much vaccine is available at Masvingo, Tsholotsho, Chakohwa at a press of a button.
This will eliminate the expiry of drugs whilst in stock because we have of institutions which overstock drugs which they do not use.
So if we manage our drugs well, we will be able to monitor shelf life of a drug. We will have a policy of first in first out, which means a drug which was procured first is the one to be first used before it expires.
You may find that Masvingo has a shortage of a drug which is actually expiring in Mutoko.
So you should then be able to say, Mutoko, send to Masvingo then you have and internal system of crediting each other for the products.
You can also easily monitor you laboratories, your pharmacies all this at a touch of a button.
Computers are not new. We should use them in procurement. I also think they are too many middle men in the supply chain.
Hospitals should be able to approach the manufacturers and procure their supplies directly and pay their debts.
Some of the middlemen even go to South Africa to source drugs using public transport.
Drugs are sensitive. They need to be kept under strict conditions.
But I suspect that there is some resistance in terms of employing IT systems because it will eliminate opportunities for corruption.
Our fee structure also comes into play. How much are we charging? I think some of our charges are too high. So if you price your services too high, it means your services are not going to be utilized.
So the institutions should be given some level of autonomy as far as the budget is concerned because they do collect revenue.
So instead of the revenue all being sent to the ministry of finance consolidated revenue fund I think the institution should be allowed to retain a functional proportional of the revenue they collect so that can continue to run the services.
Our managers should be taught and supervised to understand that these resources are national resources for the nation.
They should be faithful to the mandate which is given. There is a lot of selfishness going on out there.
In the short term, we should be able to prioritise. Even if we are having problems they should be some minimum acceptable standards.
I think we need an urgent rescue of the health system. I think we should improve management systems.
