By Takura Zhangazha*
Medical doctors at government hospitals last week announced that they would embark on an indefinite strike on Monday 27 October. This, after their demands for a review of their salaries and working conditions have not received what they consider an appropriate response from the Ministry of Health and Child Welfare.
This is however not the only immediate challenge facing our health delivery system. Medical Aid Societies under the umbrella Association of Health Funders of Zimbabwe (AHFOZ) are also having their own differences with the same ministry and private hospitals over payment rates that they remit for their clients.
The main reason this latter development has raised a lot of dust is because it is the private hospitals that have the best treatment facilities and therefore attract the most patients who are willing or will eventually pay their hospital bills. They are also at the heart of our booming medical industrial complex whose primary motive is profit before all else.
Both developments point to a health services provision system that is in its own intensive care unit. Except perhaps that the experts and policy makers attending to it may be ill equipped to deal with it. Or their intentions may not be as ethical as one would expect.
In the first instance, the responsible ministry has tended to have an approach of seeking to sweep things under the carpet. This is largely due to its inept responses to the state medical doctors demands through to its lack of a long term sustainable reform of the public health sector to make it affordable and accessible to the majority poor.
Instead government has sought largely to inconsistently commercialise public health while at the same time relying on donor funding to keep it afloat.
This has meant strenuous conditions for medical personnel in state hospitals and in the long run, compromised health service delivery for low income earning patients. As with the private hospitals, personal money is the key to full treatment of the sick. One may get admitted but there is no guarantee of proper treatment unless you or your family have money to pay for drugs or specialist services.
This is why the state doctors strike must be taken seriously and resolved with urgency. It is symptomatic of the ‘it will fix itself’ approach government has to health services provision.
And this is an attitude that has perhaps been learnt more from the private hospitals and AFHOZ. As with state hospitals but with much more evident disdain for human life, it is the money that matters. Hence the private clinics are the loudest in condemning the medical aid companies for not fulfilling payments of their clients.
The bigger question that emerges is that of the extent to which it is a profit matrix that appears to be falling apart. Where the issue at hand is not so much the negative impact this has on the provision of health services even to those on medical aid, but keeping the profit margins high. This is particularly so for the medical aid societies (companies) who have been reported in the media as giving their executives ridiculously high and disproportionate salaries. All of which is done with alarming impunity and arrogance.
Because private health services provision has a literally permanent market due to the dilapidated nature of state hospitals, these disputes between the medical aid societies and the private hospitals can only be deemed as one of fighting over larger pieces of the cake. As opposed to seeking to work to improve the quality of service, its affordability (even for profit) and accessibility to many.
So we have a dangerous cyclical health crisis characterised by doctors/nurses strikes, state inefficiency and disregard of citizens’ right to health and the profit motive of competitive but without innovation private health players.
What is therefore urgent is an overhaul of the health service provision system in the country to put the patient at the heart of the process as opposed to just profit. This would include structural changes to public health administration such as ensuring an integrated local health delivery system with a central one, departing from hotchpotch commercialisation of state hospitals and ensuring a broader engagement framework with medical professionals in the employ of the state on their working conditions.
Furthermore there is need to place a cap on the profit motive of private health services players and introduce a broader ethical regime that values human life more than it does the business aspects. This is particularly so for medical aid societies and their relationship with both state and private hospitals.
Above all else, government must tackle its complicity in the existent medical industrial complex with greater fortitude.
The standards of service at state hospitals is what has led to flourishing of private services that rely on the ineptitude of the former to make a profit and have the arrogance to turn poor patients away. And even further arrogance to be involved in a public spat about medial aid society remittances to private hospitals and doctors.
The state is therefore the primary reason why there are problems in health service delivery. Its scant attention to the structural challenges of the health delivery sector only to emerge in pretence at putting out fires that were not only foreseen but evidently cyclical are compromising the Zimbabweans’ right to health and therefore life.
*Takura Zhangazha writes in his personal capacity (takura-zhangazha.blogspot.com)